Nursing 2230 Mental Health Final Exam- Regular with Questions and Answers- Keiser University

Nursing 2230 Mental Health Final Exam- Regular with Questions and Answers- Keiser University Chapter 01. The Concept of Stress Adaptation 1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data? A. The client is experiencing severe distress and is at risk for physical and psychological illness. B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness. C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D. The client may view these losses as challenges and perceive them as opportunities. 2. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: Perhaps this was the best thing to happen. Maybe Ill look into pursuing an art degree. How should the nurse characterize the clients appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging 3. Which client statement should alert a nurse that a client may be responding maladaptively to stress? A. Ive found that avoiding contact with others helps me cope. B. I really enjoy journaling; its my private time. C. I signed up for a yoga class this week. D. I made an appointment to meet with a therapist. 4. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight-or-flight stage 5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The clients mother states, Thats not something to be stressed about! Which is the most appropriate nursing response? A. Teenagers! They dont know a thing about real stress. B. Stress occurs only when there is a loss. C. When you are in poor physical condition, you cant experience psychological well-being. D. Stress can be psychological. A threat to self-esteem may result in high stress levels. 6. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time? A. Meditation B. Problem-solving training C. Relaxation D. Journaling 7. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention? A. Encourage the student to use the alternative coping mechanism of relaxation exercises. B. Complete the problem-solving process for the client. C. Work through the problem-solving process with the client. D. Encourage the client to keep a journal. 8. A school nurse is assessing a distraught female high school student who is overly concerned because her parents cant afford horseback riding lessons. How should the nurse interpret the students reaction to her perceived problem? A. The problem is endangering her well-being. B. The problem is personally relevant to her. C. The problem is based on immaturity. D. The problem is exceeding her capacity to cope. 9. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into ones feelings C. A demonstration of appropriate role behaviors D. An enhanced ability to problem-solve 10. A distraught, single, first-time mother cries and asks a nurse, How can I go to work if I cant afford childcare? What is the nurses initial action in assisting the client with the problem-solving process? A. Determine the risks and benefits for each alternative. B. Formulate goals for resolution of the problem. C. Evaluate the outcome of the implemented alternative. D. Assess the facts of the situation. 11. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. Which student response indicates that learning has occurred? A. When an individual has limited experience dealing with stress B. When an individual inherits maladaptive genes C. When an individual experiences existing conditions that exacerbate stress D. When an individuals physiological and psychological resources have become depleted 12. When an individuals stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response 13. Which symptom should a nurse identify as typical of the fight-or-flight response? A. Pupil constriction B. Increased heart rate C. Increased salivation D. Increased peristalsis 14. A nurse is evaluating a clients response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event? A. When the individual judges the event to be benign B. When the individual judges the event to be irrelevant C. When the individual judges the resources and skills needed to deal with the event D. When the individual judges the event to be pleasurable 15. Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool? A. Specific illnesses are not identified. B. The numerical values associated with specific life events are randomly assigned C. Stress is viewed as only a physiological response. D. Personal perception of the event is excluded. 16. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response? A. Genetics have nothing to do with your temperament. B. How you reacted to past experiences influences how you feel now. C. If youre in good physical health, your stress level will be low. D. Stress can always be avoided if appropriate coping mechanisms are employed. 17. A nurse is interviewing a distressed client, who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the clients appraisal of the situation? Select all that apply. A. What resources have you used previously in stressful situations? B. Have you ever experienced a similar stressful situation? C. Who do you think is to blame for this situation? D. Why do you think you were fired from your job? E. What skills do you possess that might lead to gainful employment? 18. A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? Select all that apply. A. Enjoy a pet. B. Spend time with a loved one. C. Listen to music. D. Focus on the stressors. E. Journal your feelings. 19. A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress C. Relaxation exercises D. Identifying support systems 20. A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient are common initial biological responses to stress? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations Chapter 02. Mental Health/Mental Illness: Historical and Theoretical Concepts 1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the clients behaviors? A. The clients behaviors demonstrate mental illness in the form of depression. B. The clients behaviors are extensive, which indicates the presence of mental illness. C. The clients behaviors are not congruent with cultural norms. D. The clients behaviors demonstrate no functional impairment, indicating no mental illness. 2. At what point should the nurse determine that a client is at risk for developing a mental disorder? A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates significant distress D. When the client uses defense mechanisms as ego protection 3. A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents? A. Reactions to stress are relative rather than absolute; individual responses to stress vary. B. It is abnormal for identical twins to react differently to similar stressors. C. Identical twins should share the same temperament and respond similarly to stress. D. Environmental influences weigh more heavily than genetic influences on reactions to stress. 4. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, I work hard to provide for my family. I dont see why I cant drink to relax. The nurse recognizes the use of which defense mechanism? A. Projection B. Rationalization C. Regression D. Sublimation 5. Which client should the nurse anticipate to be most receptive to psychiatric treatment? A. A Jewish, female journalist B. A Baptist, homeless male C. A Catholic, black male D. A Protestant, Swedish business executive 6. A new psychiatric nurse states, This clients use of defense mechanisms should be eliminated. Which is a correct evaluation of this nurses statement? A. Defense mechanisms can be self-protective responses to stress and need not be eliminated. B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged. 7. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, Im here for my heart, not my head problems. Which is the nurses best response? A. Its just a routine part of our assessment. All clients are asked these same questions. B. Why are you concerned about these types of questions? C. Psychological factors, like excessive stress, have been found to affect medical conditions. D. We can skip these questions, if you like. It isnt imperative that we complete this section. 8. Which statement reflects a student nurses accurate understanding of the concepts of mental health and mental illness? A. The concepts are rigid and religiously based. B. The concepts are multidimensional and culturally defined. C. The concepts are universal and unchanging. D. The concepts are unidimensional and fixed. 9. A mental health technician asks the nurse, How do psychiatrists determine which diagnosis to give a patient? Which of these responses by the nurse would be most accurate? A. Psychiatrists use pre-established criteria from the APAs Diagnostic and Statistical Manual of Mental Disorders (DSM-5). B. Hospital policy dictates how psychiatrists diagnose mental disorders. C. Psychiatrists assess the patient and identify diagnoses based on the patients unhealthy responses and contributing factors. D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from. 10. The nurse is preparing to provide medication instruction for a patient. Which of the following understandings about anxiety will be essential to effective instruction? A. Learning is best when anxiety is moderate to severe. B. Learning is enhanced when anxiety is mild. C. Panic level anxiety helps the nurse teach better. D. Severe anxiety is characterized by intense concentration and enhances the attention span. 11. Which of the following are identified as psychoneurotic responses to severe anxiety as they appear in the DSM-5? A. Somatic symptom disorders B. Grief responses C. Psychosis D. Bipolar disorder Somatic symptom disorder is characterized by preoccupation with physical symptoms for which there is no demonstrable organic pathology. One of the diagnostic criteria is a high level of anxiety about health concerns or illness. 12. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? A. The employee assertively confronts the boss B. The employee leaves the staff meeting to work out in the gym C. The employee criticizes a coworker D. The employee takes the boss out to lunch 13. A teenage boy is attracted to a female teacher. Without objective evidence, a school nurse overhears the boy state, I know she wants me. This statement reflects which defense mechanism? A. Displacement B. Projection C. Rationalization D. Sublimation 14. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation 15. Which nursing statement about the concept of neuroses is most accurate? A. An individual experiencing neurosis is unaware that he or she is experiencing distress. B. An individual experiencing neurosis feels helpless to change his or her situation. C. An individual experiencing neurosis is aware of psychological causes of his or her behavior. D. An individual experiencing neurosis has a loss of contact with reality. 16. Which nursing statement about the concept of psychoses is most accurate? A. Individuals experiencing psychoses are aware that their behaviors are maladaptive. B. Individuals experiencing psychoses experience little distress. C. Individuals experiencing psychoses are aware of experiencing psychological problems. D. Individuals experiencing psychoses are based in reality. 17. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial? A. Hiding liquor bottles in a closet B. Yelling at their son for slouching in his chair C. Burning dinner on purpose D. Saying to the spouse, I dont drink too much! 18. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? A. If only we could have tried again, things might have worked out. B. I am so mad that the children and I had to put up with him as long as we did. C. Yes, it was a difficult relationship, but I think I have learned from the experience. D. I still dont have any appetite and continue to lose weight. 19. A nurse is performing a mental health assessment on an adult client. According to Maslows hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? A. Maintaining a long-term, faithful, intimate relationship B. Achieving a sense of self-confidence C. Possessing a feeling of self-fulfillment and realizing full potential D. Developing a sense of purpose and the ability to direct activities 20. According to Maslows hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? A. A client rudely complaining about limited visiting hours B. A client exhibiting aggressive behavior toward another client C. A client stating that no one cares D. A client verbalizing feelings of failure 21. Which is an example of the ego defense mechanism of regression? A. A mother blames the teacher for her childs failure in school. B. A teenager becomes hysterical after seeing a friend killed in a car accident. C. A woman wants to marry a man exactly like her beloved father. D. An adult throws a temper tantrum when he does not get his own way. 22. Which is the most significant consequence of the excessive use of defense mechanisms? A. The superego will be suppressed. B. Emotions will be experienced intensely. C. Learning and the ability to grow will be enhanced. D. Problem-solving will be limited. 23. A husband accuses his wife of infidelity. Which situation would indicate to the nurse the husbands use of the ego defense mechanism of projection? A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows. B. The husband ignores the wifes continued absence from the home. C. The husband has already admitted to having an affair with a coworker. D. The husband takes out his marital frustrations through employee abuse. 24. Which should the nurse recognize as a DSM-5 disorder? A. Obesity B. Generalized anxiety disorder C. Hypertension D. Grief 25. A nurse is educating a patient about the difference between mental health and mental illness. Which statement by the patient reflects an accurate understanding of mental health? A. Mental health is the absence of any stressors. B. Mental health is successful adaptation to stressors in the internal and external environment. C. Mental health is incongruence between thoughts, feelings, and behavior D. Mental health is a diagnostic category in the DSM-5. 26. Most cultures label behavior as mental illness on the basis of which of the following criteria? A. Incomprehensibility and cultural relativity B. Strength of character and ethics C. Goal directedness and high energy D. Creativity and good coping skills 27. Which should the nurse recognize as an example of the defense mechanism of repression? A. A student aware of the need to study for tomorrows test goes to a movie instead. B. A woman whose son was killed in Iraq does not believe the military report. C. A man who is unhappily married goes to school to become a marriage counselor. D. A woman was raped when she was 12 and no longer remembers the incident. 28. Which of the following statements should a nurse recognize as true about defense mechanisms? Select all that apply. A. They are employed when there is a threat to biological or psychological integrity. B. They are controlled by the id and deal with primal urges. C. They are used in an effort to relieve mild to moderate anxiety. D. They are protective devices for the superego. E. They are mechanisms that are characteristically self-deceptive. 29. A nurse is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptoms might the client demonstrate? Select all that apply. A. Fidgeting B. Laughing inappropriately C. Palpitations D. Nail biting E. Extremely limited attention span 30. Which of the following are cultural aspects of mental illness? Select all that apply. A. Local or cultural norms define pathological behavior. B. The higher the social class the greater the recognition of mental illness behaviors. C. Psychiatrists typically see patients when the family can no longer deny the illness. D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion. 31. How is the DSM-5 useful in the practice of psychiatric nursing? Select all that apply. A. It informs the nurse of accurate and reliable medical diagnosis. B. It represents progress toward a more holistic view of mindbody. C. It provides a framework for interdisciplinary communication. D. It provides a template for nursing care plans. E. It provides a framework for communication with the client. Chapter 03. Psychopharmacology 1. The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics: A. Remain in the system longer B. Act more quickly to reduce delusions C. Produce fewer extrapyramidal effects D. Are risk free for neuroleptic malignant syndrome (NMS) 2. The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a: A. 30 mm Hg decrease in blood pressure reading B. Respiratory rate of 24 respirations per minute C. Temperature reading of 104° F D. Pulse rate of 70 beats per minute 3. A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would the nurse assess as the likely cause of these symptoms? A. Decreased dopamine at receptor sites B. Blockade of histamine C. Cholinergic blockade D. Adrenergic blocking 4. Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)? A. Grimacing and lip smacking B. Falling asleep in the chair and refusing to eat lunch C. Experiencing muscle rigidity and tremors D. Having excessive salivation and drooling 5. A nurse administers a medication that potentiates the action of GABA. Which finding would be expected? A. Reduced anxiety B. Improved memory C. More organized thinking D. Fewer sensory perceptual alterations 6. On the basis of current knowledge of neurotransmitter effects, a nurse could anticipate that the treatment plan for a patient with memory difficulties might include medications designed to: A. inhibit GABA. B. increase dopamine at receptor sites. C. decrease dopamine at receptor sites. D. prevent destruction of acetylcholine. 7. A patient has disorganized thinking associated with schizophrenia. A PET scan would most likely show dysfunction in which part of the brain? A. Temporal lobe B. Cerebellum C. Brainstem D. Frontal lobe 8. A nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the: A. parasympathetic nervous system. B. sympathetic nervous system. C. reticular activating system. D. medulla oblongata. 9. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing: A. increased concentration of neurotransmitter in the synaptic gap. B. decreased concentration of neurotransmitter in the synaptic gap. C. destruction of receptor sites. D. limbic system stimulation. 10. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? A. Dopamine-blocking effects B. Anticholinergic effects C. Endocrine-stimulating effects D. Ability to stimulate spinal nerves 11. A nurse assesses that a patient demonstrates anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter? A. GABA B. Histamine C. Acetylcholine D. Norepinephrine 12. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours ago. The patient will need teaching about a drug from which group? A. Tricyclic antidepressants B. Antimanic drugs C. Benzodiazepines D. Antipsychotic drugs 13. A patient is hospitalized for severe depression. Of the medications listed below, a nurse can expect to provide the patient with teaching about: A. clozapine (Clozaril) B. chlordiazepoxide (Librium) C. tacrine (Cognex) D. fluoxetine (Prozac) 14. A patient hospitalized with a mood disorder has an elevated unstable mood, aggressiveness, agitation, talkativeness, and irritability. A nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): A. anticholinergic. B. mood stabilizer C. psychostimulant D. antidepressant 15. A drug causes muscarinic receptor blockade. A nurse will assess the patient for: A. gynecomastia B. pseudoparkinsonism C. orthostatic hypotension D. dry mouth 16. A patient tells a nurse, "My doctor prescribed Paxil [paroxetine] for my depression. I suppose 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(n): A. tricyclic antidepressant B. MAOI C. selective serotonin reuptake inhibitor D. selective norepinephrine reuptake inhibitor 17. A nurse can anticipate anticholinergic side effects are likely when a patient is taking: A. lithium (Lithobid). B. isperidone (Risperdal). C. buspirone (BuSpar). D. fluphenazine (Prolixin). 18. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: A. hypotensive shock. B. hypertensive crisis. C. cardiac dysrhythmia. D. cardiogenic shock 19. A patient has taken many conventional antipsychotic drugs over years. The health care provider, concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics: A. are less costly. B. have higher potency. C. are more readily available. D. produce fewer motor side effects. 20. A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha-1 receptors because the patient may experience: A. increased psychotic symptoms. B. a hypertensive crisis. C. orthostatic hypotension. D. severe appetite disturbance. 21. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. For which patient should the nurse be most alert for alterations in cardiac or cerebral electrical conductivity as well as fluid and electrolyte imbalance? The patient receiving: A. lithium (Lithobid) B. clozapine (Clozaril) C. fluoxetine (Prozac) D. venlafaxine (Effexor) Chapter 04. Concepts of Psychobiology 1. A depressed client states, I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again. Which nursing response is appropriate? A. Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors. B. Because biological factors are the sole cause of depression, medications will improve your mood. C. Environmental factors have been shown to exert the most influence in the development of depression. D. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment). 2. A client diagnosed with major depressive disorder asks, What part of my brain controls my emotions? Which nursing response is appropriate? A. The occipital lobe governs perceptions, judging them as positive or negative. B. The parietal lobe has been linked to depression. C. The medulla regulates key biological and psychological activities. D. The limbic system is largely responsible for ones emotional state. *3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations? A. Peripheral nervous system B. Somatic nervous system C. Sympathetic nervous system D. Parasympathetic nervous system 4. Which client statement reflects an understanding of the effect of circadian rhythms on a persons ability to function? A. When I dream about my mothers horrible train accident, I become hysterical. B. I get really irritable during my menstrual cycle. C. Im a morning person. I get my best work done in the a.m. D. Every February, I tend to experience periods of sadness. 5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? A. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy B. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill C. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents D. Studies in which monozygotic twins were raised together by mentally ill biological parents E. All of the above 6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? A. The study of neuroendocrinology B. The study of psychoimmunology C. The study of diagnostic technology D. The study of neurophysiology 7. A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being implicated in this behavior? A. Dendrites B. Axons C. Neurotransmitters D. Synapses 8. An instructor is teaching nursing students about neurotransmitters. Which term best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? A. Regeneration B. Reuptake C. Recycling D. Retransmission 9. A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter? A. Acetylcholine B. Dopamine C. Serotonin D. Norepinephrine 10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the clients neurotransmitters should a nurse expect to be elevated? A. Serotonin B. Dopamine C. Gamma-aminobutyric acid (GABA) D. Histamine 11. A clients wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The clients therapist stresses the importance of proper sleep, nutrition, and exercise. What is the best rationale for the therapists advice? A. The therapist is using an interpersonal approach. B. The client has an alteration in neurotransmitters. C. It is routine practice to remind clients about nutrition, exercise, and rest. D. The client is susceptible to illness due to effects of stress on the immune system. 12. Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? A. Major depression B. Schizophrenia C. Anorexia nervosa D. Alzheimers disease 13. Which cerebral structure should a nursing instructor describe to students as the emotional brain? A. The cerebellum B. The limbic system C. The cortex D. The left temporal lobe 14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? A. Acute mania B. Schizophrenia C. Anorexia nervosa D. Alzheimers disease 15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the presentation of these symptoms? A. Abnormal levels of serotonin B. Decreased levels of dopamine C. Increased levels of norepinephrine D. Decreased levels of acetylcholine 16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? A. Mania B. Schizophrenia C. Anxiety D. Depression 17. Which client diagnosis should a nurse associate with a decrease in gamma-aminobutyric acid (GABA)? A. Alzheimers disease B. Schizophrenia C. Panic disorder D. Depression 18. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? A. Schizophrenia B. Depression C. Body dysmorphic disorder D. Parkinsons disease 19. A nursing instructor is teaching about the monoamine category of neurotransmitters. Which student statement indicates that learning about the function of norepinephrine has occurred? A. Norepinephrine functions to regulate movement, coordination, and emotions. B. Norepinephrine functions to regulate mood, cognition, and perception. C. Norepinephrine functions to regulate arousal, libido, and appetite. D. Norepinephrine functions to regulate pain, inflammatory response, and wakefulness. 20. A student nurse is studying the effect of the drug isocarboxazid (Marplan) on neurobiology. The student should recognize that the neurotransmitter serotonin is catabolized by which enzyme? A. Glycosyltransferase B. Peptidase C. Polymerase D. Monoamine oxidase 21. During a sleep study, a delta rhythm has been recorded for a client experiencing sleep apnea. The nurse recognizes that which characteristic is associated with this rhythm, and what stage of sleep activity would be documented? A. Delta rhythm is a period of dozing, occurring in stage 1 of sleep activity. B. Delta rhythm is a period of deep and restful sleep, occurring in stage 3 of sleep activity. C. Delta rhythm is a period of relaxed waking, occurring in stage 0 of sleep activity. D. Delta rhythm is a period of dreaming, occurring in stage 2 of sleep activity. 22. Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? Select all that apply. A. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. B. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. C. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. D. There is a possible correlation between increased levels of prolactin and anorexia nervosa. E. There is a possible correlation between altered levels of oxytocin and anorexia nervosa. 23. Which of the following symptoms should a nurse associate with increased levels of thyroidstimulating hormone (TSH) in a newly admitted client? Select all that apply. A. Depression B. Fatigue C. Increased libido D. Mania E. Hyperexcitability 24. Which of the following symptoms should a nurse expect to assess in a client experiencing elevated levels of thyroid hormone? Select all that apply. A. Emotional lability B. Depression C. Insomnia D. Restlessness E. Apathy Chapter 07. Relationship Development 1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A. To clarify personal attitudes, values, and beliefs B. To obtain thorough assessment data C. To determine the clients length of stay D. To establish personal goals for the interaction 2. A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation 3. Which is the best nursing action when a client demonstrates transference toward a nurse? A. Promoting safety and immediately terminating the relationship with the client B. Encouraging the client to ignore these thoughts and feelings C. Immediately reassigning the client to another staff member D. Helping the client to clarify the meaning of the current nurseclient relationship 4. What is the priority nursing action during the orientation (introductory) phase of the nurse client relationship? A. Acknowledge the clients actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care. 5. Which client response should a nurse expect during the working phase of the nurse client relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors. 6. What should be the nurses primary goal during the preinteraction phase of the nurseclient relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change 7. Which phase of the nurseclient relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination 8. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurseclient relationship? A. I cant bear the thought of leaving here and failing. B. I might have a hard time working with you. You remind me of my mother. C. I cant tell my husband how I feel; he wouldnt listen anyway. D. Im not sure that I can count on you to protect my confidentiality. 9. A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. You are feeling very depressed. I felt the same way when I decided to leave my husband. B. I can understand you are feeling depressed. It was a difficult decision. Ill sit with you. C. You seem depressed. It was a difficult decision to make. Would you like to talk about it? D. I know this is a difficult time for you. Would you like a prn medication for anxiety? 10. A mother who has learned that her child was killed in a tragic car accident states, I cant bear to go on with my life. Which nursing statement conveys empathy? A. This situation is very sad, but time is a great healer. B. You are sad, but you must be strong for your other children. C. Once you cry it all out, things will seem so much better. D. It must be horrible to lose a child; Ill stay with you until your husband arrives. 11. If an individual is two-faced, which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect B. Genuineness C. Sympathy D. Rapport 12. On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the clients insight and perception of reality 13. A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, Do you want to be my girlfriend? Which nursing response is most appropriate? A. You are upset now. It would be best if you go to your room until you feel better. B. Remember, we have a professional relationship. Are you feeling uncomfortable? C. We have discussed this before. I am not allowed to date clients. D. I think you should discuss your fantasies with your therapist. 14. A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, Im not well enough to switch to a different nurse. What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using splitting as a way to remain dependent on the nurse. 15. According to Peplau, which nursing action demonstrates the nurses role as a resource person? A. The nurse balances a safe therapeutic environment to increase the clients sense of belonging. B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness. C. The nurse monitors the administration of medications and watches for signs of cheeking. D. The nurse explains, in language the client can understand, information related to the clients health care. 16. According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate? A. The nurse functions as a nurturing parent in order to build a trusting relationship. B. The nurse plays cards with a small group of clients. C. The nurse discusses childhood events that may affect personality development. D. The nurse provides a safe social environment. 17. As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurses most therapeutic statement? A. I want to assure you that I will maintain your confidentiality. B. A long-term goal for someone your age would be to develop better job skills. C. Which identified problems would you like for us to initially address? D. I think first we need to focus on your relationship issues. 18. What is the main goal of the working phase of the nurseclient therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the clients problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment 19. Which client statement may indicate a transference reaction? A. I need a real nurse. You are young enough to be my daughter and I dont want to tell you about my personal life. B. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor. C. I dont seem to be able to relate to people. I would rather stay in my room and be by myself. D. My mother is the source of my problems. She has always told me what to do and what to say. 20. Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit. 21. Which client statement indicates that termination of the therapeutic nurseclient relationship has been handled successfully? A. I know I can count on you for continued support. B. I am looking forward to discharge, but I am surprised that we will no longer work together. C. Reviewing the changes that have happened during our time together has helped me put things in perspective. D. I dont know how comfortable I will feel when talking to someone else. 22. When is self-disclosure by the nurse appropriate in a therapeutic nurseclient relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client 23. The nurse client therapeutic relationship includes which of the following characteristics? Select all that apply. A. Meeting the psychological needs of the nurse and the client B. Ensuring therapeutic termination C. Promoting client insight into problematic behavior D. Collaborating to set appropriate goals E. Meeting both the physical and psychological needs of the client Chapter 08. Therapeutic Communication 1. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I get angry, I get into a fistfight with my wife or I take it out on the kids. Nurse: I notice that you are smiling as you talk about this physical violence. A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations 2. Which therapeutic communication technique is being used in this nurseclient interaction? Client: My father spanked me often. Nurse: Your father was a harsh disciplinarian. A. Restatement B. Offering general leads C. Focusing D. Accepting 3. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I am anxious, the only thing that calms me down is alcohol. Nurse: Other than drinking, what alternatives have you explored to decrease anxiety? A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition 4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? A. Do you know why you are here? B. Are you feeling depressed or anxious? C. Yes, I see. Go on. D. Can you chronologically order the events that led to your admission? 5. A nurse states to a client, Things will look better tomorrow after a good nights sleep. This is an example of which communication technique? A. The therapeutic technique of giving advice B. The therapeutic technique of defending C. The nontherapeutic technique of presenting reality D. The nontherapeutic technique of giving false reassurance 6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. What occurred prior to the rape, and when did you go to the emergency department? B. What would you like to talk about? C. I notice you seem uncomfortable discussing this. D. How can we help you feel safe during your stay here? 7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. You appear to be talking to someone I do not see. B. Please describe what you are seeing. C. Why do you continually look in the corner of this room? D. If you hum a tune, the voices may not be so distracting. 8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R 9. An instructor is correcting a nursing students clinical worksheet. Which instructor statement is the best example of effective feedback? A. Why did you use the clients name on your clinical worksheet? B. You were very careless to refer to your client by name on your clinical worksheet. C. I noticed that you used the clients name in your written process recording. That is a breach of confidentiality. D. It is disappointing that after being told, youre still using client names on your worksheet. 10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, Im so proud of you for being assertive. You are so good! Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations 11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the clients behavior D. To give the client critical information 12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. Why do you continue to alienate your peers by your angry outbursts? B. You accomplish nothing when you lose your temper like that. C. Showing your anger in that manner is very childish and insensitive. D. During group, you raised your voice, yelled at a peer, and slammed the door. 13. A client diagnosed with dependent personality disorder states, Do you think I should move from my parents house and get a job? Which nursing response is most appropriate? A. It would be best to do that in order to increase independence. B. Why would you want to leave a secure home? C. Lets discuss and explore all of your options. D. Im afraid you would feel very guilty leaving your parents. 14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed 15. A mother rescues two of her four children from a house fire. In an emergency department, she cries, I should have gone back in to get them. I should have died, not them. Which of the following responses by the nurse is an example of reflection? A. The smoke was too thick. You couldnt have gone back in. B. Youre feeling guilty because you werent able to save your children. C. Focus on the fact that you could have lost all four of your children. D. Its best if you try not to think about what happened. Try to move on. 16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. Everyone diagnosed with OCD needs to control their ritualistic behaviors. B. It is important for you to discontinue these ritualistic behaviors. C. Why are you asking for help if you wont participate in unit therapy? D. Lets figure out a way for you to attend unit activities and still wash your hands. 17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. Weve discussed past coping skills. Lets see if these coping skills can be effective now. B. Please tell me in your own words what brought you to the hospital. C. This new approach worked for you. Keep it up. D. I notice that you seem to be responding to voices that I do not hear. 18. A client tells the nurse, I feel bad because my mother does not want me to return home after I leave the hospital. Which nursing response is therapeutic? A. Its quite common for clients to feel that way after a lengthy hospitalization. B. Why dont you talk to your mother? You may find out she doesnt feel that way. C. Your mother seems like an understanding person. Ill help you approach her. D. You feel that your mother does not want you to come back home? 19. A clients younger daughter is ignoring curfew. The client states, Im afraid she will get pregnant. The nurse responds, Hang in there. Dont you think she has a lot to learn about life? This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing 20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. You did not attend group today. Can we talk about that? B. Ill sit with you until it is time for your family session. C. I notice you are wearing a new dress and you have washed your hair. D. Im happy that you are now taking your medications. They will really help. 21. A client is trying to explore and solve a problem. Which nursing statement would be an example of verbalizing the implied? A. You seem to be motivated to change your behavior. B. How will these changes affect your family relationships? C. Why dont you make a list of the behaviors you need to change. D. The team recommends that you make only one behavioral change at a time. 22. The nurse says to a newly admitted client, Tell me more about what led up to your hospitalization. What is the purpose of this therapeutic communication technique? A. To reframe the clients thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation 23. A student nurse tells the instructor, Im concerned that when a client asks me for advice I wont have a good solution. Which should be the nursing instructors best response? A. Its scary to feel put on the spot by a client. Nurses dont always have the answer. B. Remember, clients, not nurses, are responsible for their own choices and decisions. C. Just keep the clients best interests in mind and do the best that you can. D. Set a goal to continue to work on this aspect of your practice. 24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. Touch carries a different meaning for different individuals. B. Touch is often used when deescalating volatile client situations. C. Touch is used to convey interest and warmth. D. Touch is best combined with empathy when dealing with anxious clients. 25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. Describe one of the best things that happened to you this week. B. Im having a difficult time understanding what you mean. C. Your counseling session is in 30 minutes. Ill stay with you until then. D. You mentioned your relationship with your father. Lets discuss that further. 26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, You are incompetent! Which is the nurses best response? A. Do you believe that I was the cause of your blood test being canceled? B. I see that you are upset, but I feel uncomfortable when you swear at me. C. Have you ever thought about ways to express anger appropriately? D. Ill give you some space. Let me know if you need anything. 27. During a nurseclient interaction, which nursing statement may belittle the clients feelings and concerns? A. Dont worry. Everything will be alright. B. You appear uptight. C. I notice you have bitten your nails to the quick. D. You are jumping to conclusions. 28. A client on an inpatient psychiatric unit tells the nurse, I should have died, because I am totally worthless. In order to encourage the client to continue talking about feelings, which should be the nursing initial response? A. How would your family feel if you died? B. You feel worthless now, but that can change with time. C. Youve been feeling sad and alone for some time now? D. It is great that you have come in for help. 29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. Can you tell me why you said that? B. Keep your chin up. Ill explain the procedure to you. C. There is always an explanation for both good and bad behaviors. D. Are you not understanding the explanation I provided? 30. A client states, You wont believe what my husband said to me during visiting hours. He has no right treating me that way. Which nursing response would best assess the situation that occurred? A. Does your husband treat you like this very often? B. What do you think is your role in this relationship? C. Why do you think he behaved like that? D. Describe what happened during your time with your husband. 31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. My sister has the same diagnosis as you and she also hears voices. B. I understand that the voices seem real to you, but I do not hear any voices. C. Why not turn up the radio so that the voices are muted. D. I wouldnt worry about these voices. The medication will make them disappear. 32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. I think it would be great if you talked about that problem during our next group session. B. Would you like me to accompany you to your electroconvulsive therapy treatment? C. I notice that you are offering help to other peers in the milieu. D. After discharge, would you like to meet me for lunch to review your outpatient progress? 33. A client slammed a door on the unit several times. The nurse responds, You seem angry. The client states, Im not angry. What therapeutic communication technique has the nurse employed, and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement 34. Which of the following individuals are communicating a message? Select all that apply. A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, No one understands me E. A father checking for new e-mail on a regular basis Chapter 09. The Nursing Process in Psychiatric/Mental Health Nursing 1. Which data-gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful 2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client, including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations. 3. Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations 4. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days. 5. Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment teams goals. B. Nursing interventions are directed solely by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures. 6. Within the nurses scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services 7. A nurse charts Verbalizes understanding of the side effects of Prozac. This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response 8. The nurse should recognize which acronym as representing problem-oriented charting? A. SOAPIE B. SOLER C. DAR D. PQRST 9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale 10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect 11. What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis. 12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? A. Health teacher B. Case manager C. Milieu manager D. Psychotherapist 13. The following outcome was developed for a client: Client will list five personal strengths by the end of day 1. Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt 14. How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physicians priority of care D. By the clients preference 15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this clients problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The clients sleep habits will improve during hospitalization. 16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking. 17. A student nurse asks an instructor which resource is best to use when developing nursing outcomes for clients. Which reply by the instructor most accurately answers the students question? A. Use the Nursing Interventions Classification (NIC), as a reference for nursing outcomes. B. Use the NANDA resource to identify appropriate outcomes. C. Use the Nursing Outcomes Classification (NOC), as a reference for nursing outcomes. D. Copy your standard outcomes from a nursing care plan textbook. 18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this clients problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion 19. A nursing instructor is teaching students about the purpose of using the nursing process in the care of psychiatric patients. Which of the following statements by the student indicates that learning has occurred? A. The nursing process is a method for interviewing the patient in a systematic way. B. The nursing process is used to assist patients to adapt successfully to stressors within the environment. C. The nursing process is used to provide support for the psychiatric diagnosis. D. The nursing process is used primarily to minimize allegations of negligence. 20. A client is diagnosed with generalized anxiety disorder. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the clients level of anxiety B. Assessing and documenting the clients vital signs C. Assessing suicide risk D. Assessing availability of support systems 21. During the implementation phase of the nursing process, a nurse is teaching an adult depressed patient with a cochlear implant about medicatio