Test Bank Essentials of Psychiatric Nursing 2nd Edition Boyd Luebbert

Test Bank Essentials of Psychiatric Nursing 2nd Edition Boyd Luebbert Table of Contents Chapter 1 Mental Health and Mental Disorders ........................................................................... 2 Chapter 2 Cultural and Spiritual Issues Related to Mental ........................................................ 10 Chapter 3 Patient Rights and Legal Issues ............................................................................... 18 Chapter 4 Ethics, Standards, and Nursing Frameworks ............................................................ 26 Chapter 6 Biologic Foundations of Psychiatric .......................................................................... 34 Chapter 7 Recovery Framework for Mental Health ................................................................... 42 Chapter 8 Therapeutic Communication ..................................................................................... 50 Chapter 9 The Nurse–Patient Relationship ............................................................................... 59 Chapter 10 The Psychiatric–Mental Health Nursing .................................................................. 68 Chapter 11 Psychopharmacology, Dietary Supplements, and Biologic Interventions ................. 77 Chapter 12 Group Interventions ................................................................................................ 87 Chapter 13 Stress and Mental Health ....................................................................................... 96 Chapter 14 Management of Anger, Aggression, and Violence ................................................ 105 Chapter 15 Crisis, Loss, Grief, Response, Bereavement, and DisasterManagement ............. 113 Chapter 16 Suicide Prevention ................................................................................................ 122 Chapter 17 Mental Health Care for Survivors of Violence ....................................................... 130 Chapter 18 Anxiety Disorders ................................................................................................. 139 Chapter 19 Trauma- and Stressor-Related Disorders ............................................................. 150 Chapter 20 Obsessive–Compulsive and Related Disorders .................................................... 159 Chapter 21 Depression ........................................................................................................... 172 Chapter 22 Bipolar Disorders .................................................................................................. 181 Chapter 23 Schizophrenia and Related Disorders .................................................................. 188 Chapter 24 Personality and Impulse-Control Disorders .......................................................... 199 Chapter 25 Addiction and Substance-Related Disorders ........................................................ 206 Chapter 26 Eating Disorders ................................................................................................... 215 Chapter 27 Somatic Symptom and Dissociative Disorders...................................................... 222 Chapter 28 Sleep–Wake Disorders ......................................................................................... 230 Chapter 29 Sexual Disorders .................................................................................................. 238 Chapter 30 Mental Health Disorders of Childhood and Adolescence ...................................... 245 Chapter 31 Mental Health Disorders of Older Adults ............................................................... 253 1 | P a g eChapter 1 Mental Health and Mental Disorders 1 . A nursing instructor is describing the DSM-IV-TR to a group of nursing students. Which of the following would the instructor include as the primary purpose of this classification? A) B) C) D) Provide a commonly understood diagnostic category for clinical practice. Describe treatment modalities for psychiatric disorders and mental illnesses. Identify various etiologies for mental disorders based on family histories. Provide optimal outcomes for treatment for individuals with mental illnesses. 2. A nurse is providing care to a patient with a mental disorder classified by the DSM-IV-TR. The nurse understands that although the first three axes appear to contain all the diagnostic information about a patient, a truly accurate picture of the client is incomplete without considering other factors such as an estimate of current functioning and: A) B) C) D) 3. Life stressors Cultural background Marital status Genetic history A patients global assessment functioning reveals that he has minimal symptoms with good functioning in all areas. Which score would the nurse correlate with these findings? 2 | P a g eA) B) C) D) 4. 94 82 75 63 A female patient was admitted to the hospital with pneumonia, and in the course of her treatment, it was determined that she was experiencing alcohol dependence because she began experiencing alcohol withdrawal while she was in the hospital. When the psychiatrist who was called in as a consultant documented the patients mental disorder, he identified her alcohol dependence on which axis? A) B) C) D) 5. Axis I Axis II Axis III Axis IV A 25-year-old woman who recently had abdominal surgery was admitted to the psychiatric unit, where it was determined that she had a borderline personality disorder. During the first week on the unit, it was determined that she also has diabetes. Her diabetes mellitus would be listed in which axis of her DSM-IV-TR diagnosis? A) B) Axis I Axis II 3 | P a g eC) D) 6. Axis III Axis IV As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders. B) C) D) Epidemiology helps explain research findings about the neurophysiology that causes mental disorders. Epidemiology provides a thorough theoretical explanation of why specific mental disorders occur. Epidemiology predicts when a specific psychiatric client will recover from a specific mental disorder. 7. A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address? A) B) C) D) Public stigma Self-stigma Label avoidance Negative life events 4 | P a g e8. A group of students are reviewing the multiaxial diagnostic system of the DSM-IV-TR. The students demonstrate understanding of the axes when they identify that each axis represents which of the following? A) B) C) D) 9. An evidence-based research finding An experimental design to guide care A domain of information A laboratory test finding A nursing student is assigned to care for a patient diagnosed with schizophrenia. When talking about this patient in a clinical postconference, the student would use which terminology when referring to the patient? A) B) C) D) 1 0. Committed patient Schizophrenic Schizophrenic patient Person with schizophrenia Mrs. Green is a patient on a psychiatric unit. At the time of her admission, her dog was killed when a car accidentally ran over it; in addition to that, she just found out that her mother has been diagnosed with colon cancer. This information would be addressed in which DSM-IV axis? A) B) C) D) Axis I Axis II Axis III Axis IV 5 | P a g e1 1. A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The student interprets this as which of the following? A) B) C) D) 1 2. Rate Prevalence Point prevalence Incidence While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the patients is really psycho. Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) B) C) D) 1 3. Lack of knowledge Public stigma Label avoidance Self-stigma After teaching a group of students about mental health and mental illness, the instructor determines that the teaching was successful when the group identifies which of the following as reflecting mental disorders? A) B) C) D) Capacity to interact with others Ability to deal with ordinary stress Alteration in mood or thinking Lack of impaired functioning 6 | P a g e1 4. A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) B) C) D) Mental disorders are defined by an underlying biological pathology. Numerous laboratory tests are used to aid in the diagnosis of mental disorders. Cluster of behaviors, thoughts, and feelings characterize mental disorders. Manifestations of mental disorders are within normal, expected parameters. 1 5. A) B) C) D) E) F) 1 6. Which of the following would a nurse identify as being categorized as Axis I in the DSM-IV-TR? Select all that apply. Paranoid personality disorder Posttraumatic stress disorder Anorexia nervosa Mental retardation Unemployment Coronary artery disease A psychiatricmental health nurse is providing care for a patient with a mental disorder. The patient is participating in the decision- making process. The nurse interprets this as which component of recovery? A) B) 7 | P a g e Self-direction EmpowermentC) D) 1 7. Person-centered Holistic A nurse is explaining recovery to the family of a patient diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this process? A) B) C) D) It is a step-by-step process from being ill to being well. The patient focuses mainly on the emotional aspects of his condition. The patient is helped to live a meaningful life to his fullest potential. Although peer support is important, the self-acceptance is essential. 1 8. A psychiatricmental health nurse is preparing a presentation about recovery for a group of newly hired nurses for the mental health facility. Which of the following would the nurse identify as one of the most important concepts? A) B) C) D) 1 9. A) B) 8 | P a g e Self-direction Peer support Respect Hope The nurse is reviewing the medical record of a patient and notes the information below. Which of the following would be found on Axis III? Select all that apply. Cocaine dependence Bipolar I disorderC) D) E) F) 2 0. Chronic obstructive pulmonary disorder Cellulitis Homelessness Arrest for cocaine possession with intent to sell A college-aged student and his friend arrive at the student health center. The friend reports that the patient has been having difficulties concentrating, remembering, and thinking. Hes had quite a few research papers due this past week. After ruling out other problems, the nurse determines that the patient is experiencing a culture- bound syndrome. Which of the following would the nurse most likely suspect? A) B) C) D) Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 9 | P a g e Ataque de nervios Brain fog Mal de ojo Shenjing shuairo A A B A C A C C D1 0. 1 1. 1 2. 1 3. 1 4. 1 5. 1 6. 1 7. 1 8. 1 9. 2 0. D D B C C B, C B C D C, D B Chapter 2 Cultural and Spiritual Issues Related to Mental 10 | P a g e1 . When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the nurse identify as a reason for this belief about many mental health facilities? A) B) C) D) Require periods of hospitalization Do not provide 24-hour emergency services Are not reimbursed by third party payers Do not accommodate their cultural needs 2. A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Asian Americans, Polynesians, and Pacific Islanders, the nurse would address high rates of which of the following? A) B) C) D) 3. Schizophrenia Manic disorders Dementia Suicide The nurse is doing an assessment interview of a patient. During the interview, the patient comments, Our people are connected with nature. Our world, our seasons, and our weatherthey all have many lessons to teach us. The nurse interprets the patients statement as an expression of which of the following? A) B) Religiousness Tribal law 11 | P a g eC) D) Spirituality Ecological values 4. A psychiatricmental health nurse is providing care to a patient who has recently emigrated to the United States from Eastern Europe. Which of the following would be least effective in providing culturally competent care? A) B) C) D) 5. Demonstrating a genuine interest in the patient Avoiding assumptions about the patients culture Speaking to the patient in his native language. Acquiring information about the patients country. A psychiatricmental health nurse working in a Veterans Administration Medical Center is meeting with a military wife who is an Asian American. The woman is to be joining a support group for wives of veterans who have posttraumatic stress syndrome. When asking her to describe her husbands mental health problems, which response would the nurse most likely expect? A) B) C) D) Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his family. I know the war messed his mind up. Hell never be the same. Sometimes he hallucinates that he is back in Vietnam. He just stays to himself; he never talks to me about what is bothering him. 6. A psychiatricmental health nurse is working with a patient who is being treated for depression. Which patient statement would indicate that her spirituality is intact? 12 | P a g eA) B) C) D) 7. My church friends came to visit me this past Sunday afternoon. Nothing will ever be the same again; my life is not worth living. I know I am as well off as I can be under the circumstances. I know God must be punishing me for all my sins. A patient is being treated for prostate cancer; his prognosis is very poor. The patient has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for the patient? A) B) C) D) 8. Ill take you to visit my church if you can get a pass. You have to belong to the same church I do if youre going to go to heaven. Would you like me to bring you a guided imagery audiotape? We can pray together if youd like. A psychiatricmental health nurse is teaching a class about social factors associated with mental illness at a community health center. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk? A) B) C) 13 | P a g e Older adults Individuals with physical disabilities Single-parent familiesD) 9. Homeless individuals During an assessment, the patient states, We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of him. The nurse interprets this as indicating which of the following? A) B) C) D) 1 0. Acculturation Cultural identity Cultural competence Linguistic competence Within the context of the culture of poverty, which of the following most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral? A) Unemployment causes poverty; a lack of willpower and motivation can, in turn, cause unemployment in people who do not have a strong work ethic. B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications. C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self- esteem) that sustain poverty. D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty. 14 | P a g e1 1. A group of nursing students are reviewing information about spirituality and religiousness. The group demonstrates understanding of these concepts when they identify religiousness as which of the following? A) B) C) D) 1 2. Feeling of connectedness Way of interpreting life events Relationship with a unifying force Community participation in common worship A nursing instructor is preparing a class about rural cultures and the influence on mental health problems. Which of the following would the instructor include as impacting the use of mental health services for this group? Select all that apply. A) B) C) D) E) 1 3. A) B) C) Limited access to care Lack of available resources Geographical similarities Diverse cultural groups Consistency in treatment approaches A psychiatricmental health nurse is working on developing cultural competence. Which of the following would be most appropriate for the nurse to do? Research information about the cultures of the population being served after assessing the patients. Recognize that ones own culture is the predominant way of addressing a patients health care needs. Assume that any individual of a racial or ethnic group is the same as another individual in that group. 15 | P a g eD) Demonstrate an appreciation of and a genuine interest in the individual and his or her cultural beliefs. 1 4. During assessment, a patient tells the nurse that he follows Buddhist beliefs. The nurse would integrate understanding of which of the following when developing the patients plan of care? A) B) C) D) 1 5. Desire is the cause of all human suffering and misery. Self-indulgence is necessary to reach nirvana. Present behavior is based on current unhappiness. Salvation is achieved through faith and humility. After teaching a group of students about the beliefs associated with the major religions, the instructor determines that additional teaching is needed when the students identify which belief as associated with Confucianism? A) B) C) D) 1 6. A) B) C) D) 16 | P a g e People are born good. People are assigned to castes. Authority figures are respected. Self-responsibility leads to improvement. During an interview, a patient states, God does not exist for me. The nurse interprets this statement as reflecting which of the following? Animism Agnosticism Atheism Polytheism1 7. After reviewing the major beliefs of Hinduism, a nursing student identifies the following castes. The student demonstrates understanding by identifying which of the following as the highest caste? A) B) C) D) 1 8. A) B) C) D) Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 17 | P a g e Kshatriyas Vaisyas Brahmans Untouchables The nurse is assessing an Asian American patient. During the interview, the nurse determines that the patient likely follows Taoism based on which statement? Purity and balance guide all of my actions. I strive to be in happy harmony with nature. Natures powers must be respected in life. God is worshipped out of love, not fear. D D C C A C D D B1 0. 1 1. 1 1 3. 1 4. 1 5. 1 6. 1 7. 1 8. C D A, B, D 2. D A B C C B Chapter 3 Patient Rights and Legal Issues 1 . A) A nurse is explaining advance care directives, or living wills, to a patient and the patients spouse. Which of the following would the nurse include in the description? The document tells what treatment is to be omitted if the patient is unable to make the decision. B) It requires that the patient sign the living will document while an attorney is present. 18 | P a g eC) The patients physician must act as a witness when the patient signs the document. D) An attorney draws up the papers to be given to the patient and his or her family. 2. A psychiatricmental health nurse determines that a patient is competent when he is able to do which of the following? A) B) C) D) 3. Speak coherent English. Communicate his or her choices. Write a living will. Comply with the medical regimen. A patient receives a court order for commitment. Which of the following best exemplifies the concept of least restrictive environment? A) B) C) D) Involuntary commitment to an outpatient community mental health center Medication administration for sedation so the patient cannot get out of bed Placing the patient in a locked padded room in response to threats of self-harm Allowing the patient to make the decision about whether treatment is necessary 4. A nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patients confidentiality if the patient states which of the following? A) 19 | P a g e I think that the federal government is spying on me.B) C) D) 5. A) B) C) D) 6. I get really turned on by your appearance. That doctor I had today really made me angry. When I get out of here, Im going to kill my neighbor. Which patient would the nurse determine to be the most likely a candidate for involuntary commitment? The client who refuses to take the prescribed medication The client who is screaming in the street disturbing neighbors The client who refuses to participate in the planned therapy The client with a mental disorder who is homeless The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in the patients medical record? A) B) C) D) Patient states that he had a good night with no complaints. Complained of being unable to sleep because he heard voices throughout the night. Had a typical night without incidence of insomnia or nightmares. Acted crazily throughout the night; kept hearing voices and noises. 20 | P a g e7. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murrays latest laboratory work and psychological testing results so Mr. Murrays medical records in employee health can be kept up to date. Based on the nurses knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? A) B) C) D) Im sorry; were not allowed to give out that information about our patient. Ill have to get the patients signed consent before we can send that information to you. I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit. Sure, give me your address, and I will see that the information is sent to you. 8. A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be seeing on an outpatient basis. Which response by the nurse would be most appropriate? A) B) C) D) Sure, well have that information sent out in todays mail. You will need to sign written authorization for us before we can do this. I think it would just be best if you just told your psychologist everything he needs to know. How are you feeling about being discharged this afternoon? 21 | P a g e9. A patients psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect the patients right to request a second opinion before agreeing to this suggestion? A) B) C) D) 1 0. A) Self-determinism Least restrictive environment Confidentiality Mandates to inform A nurse is preparing to administer an as-needed (PRN) medication. Which of the following would the nurse need to keep in mind when documenting administration? It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a patient. B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient. C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a patient. D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a patient. 1 1. A) B) 22 | P a g e A nursing instructor is preparing a class discussion on the topic of self-determinism. Which of the following would the instructor expect to include? Select all that apply. Personal autonomy as a key value Choices based on pleasing othersC) D) E) 1 2. Activities reflect personal goals Right to refuse treatment Lack of empowerment A group of nursing students are reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify which of the following as an example? A) B) C) D) 1 3. American Hospital Association American Public Health Association State mental health provider The Joint Commission After teaching a class about competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated? A) B) C) D) 1 4. A) B) C) D) 23 | P a g e Communication of choices Understanding of relevant information Appreciation for situation and consequences Discussion of what is right and wrong A patient is involuntarily committed without a court order. The nurse understands that the emergency short- term hospitalization can occur for which time frame? A maximum of 24 hours 48 to 92 hours 3 to 5 days One week1 5. A) B) C) D) 1 6. A nurse is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? Part of personal life not governed by societys laws Ethical duty for nondisclosure Involvement of two individuals Knowledge of treatment costs and benefits A psychiatricmental health patient has an advance care directive on his medical record. A clinician provides treatment that disregards the patients directive. The clinician would be liable for which of the following? A) B) C) D) 1 7. Assault Battery Medical battery False imprisonment A group of students are preparing a class presentation about negligence. Which of the following would the group include as an element required for proving negligence? Select all that apply. A) B) C) D) E) F) Duty to provide care Proximate cause Resultant damages Breach of duty Cause in fact Evidence of mistake 24 | P a g e1 8. A psychiatricmental health nurse is documenting information in a patients medical record. Which of the following would be least likely to increase the nurses legal liability? A) B) C) D) 1 9. Patient reported that he was feeling better today than yesterday. Administered haloperidol 10 mg IM stat as ordered for agitation. Patient was talking with another staff member and started screaming. Applied restraints to all four patient extremities. After teaching a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which of the following as a right? A) B) C) D) Answer Key 1. 2. 3. 4. 5. 6. A B A D B B Freedom from restraints or seclusion Access to ones own mental health records on request An individualized written treatment plan Refuse treatment during an emergency situation 25 | P a g e7. 8. 9. 1 0. 1 1 2. 1 3. 1 4. 1 5. 1 6. 1 1 8. 1 9. C B A B A, C, D 1. C D B A C A, B, C, D, E 7. B D Chapter 4 Ethics, Standards, and Nursing Frameworks 26 | P a g e1 . A) B) C) D) 2. When applying the biopsychosocial model to client care, the nurse integrates the psychological domain when involved with which of the following? Behavior therapy Family support Nutritional therapy Sleep hygiene measures A nursing instructor is describing the impact of technology and electronic health records on psychiatricmental health care. Which of the following would the instructor identify as a major challenge associated with it? A) B) C) D) 3. Maintaining confidentiality Establishing educational models Decreasing fragmented care Defining professional standards more clearly A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurses opinion most closely reflects which ethical principle? A) B) C) D) Nonmaleficence Paternalism Veracity Justice 27 | P a g e4. A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The students decision reflects which ethical principle? A) B) C) D) 5. Autonomy Beneficence Fidelity Veracity In a postclinical conference, a group of students are engaged in a discussion with their instructor. The instructor repeatedly has the students analyze and evaluate the nursing interventions implemented throughout the clinical experience. The students are engaged in which of the following? A) B) C) D) 6. Therapeutic use of self Critical thinking Interdisciplinary care Planning care A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following as an advanced practice level function? 28 | P a g eA) B) C) D) 7. Milieu therapy Promotion of self-care Psychopharmacology interventions Health promotion activities A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level practice? A) B) C) D) Case management Program development Clinical supervision Community interventions 8. A nurse is working on developing ways to meet the challenge of knowledge development. Which of the following would be most appropriate? A) B) C) D) Access new information through continuing education programs. Improve access to community psychiatric care for all populations. Reduce the burden of mental illness by fighting