TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK LATES

TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK LATEST TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK PsychiatricMentalHealthNursing7thEdition Test Bank Chapter 1 1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having a positive impact on the individual's mental health? A) Not needing othersfor companionship B) The ability to effectively manage stress C) A family history of mental illness D) Strivingfor totalselfrelianceAns: B Feedback: Individual factors influencing mental health include biologic makeup, autonomy, independence,self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness,sense of belonging, reality orientation, and copingor stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness areboth needed for good mentalhealth, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologicmakeup of an individual, which may have a negative impact on anindividual'smental health, aswell as a negative impact on an individual's interpersonal and social ñ cultural factors of health. Total self-reliance is not possible,and a positive social/cultural factor is accessto adequate resources. 2. Which ofthe following statements about mental illness are true? Select all that apply. A) Mentalillness cancausesignificantdistress, impaired functioning, or both. B) Mentalillnessis only due to social/cultural factors. C) Social/culturalfactorsthat relate to mental illnessinclude excessive dependency on or withdrawal from relationships. D) Individualssufferingfrommental illness areusuallyable to cope effectivelywith daily life. E) Individualssuffering frommentalillness mayexperiencedissatisfaction with relationships and self. Ans:A, D, E Feedback: Mental illness can cause significant distress, impaired functioning, or both. Mental illness may be related to individual, interpersonal, orsocial/cultural factors. Excessive dependency on or withdrawal from relationships are interpersonal factorsthat relate to mental illness. Individuals suffering from mental illness can feel overwhelmed with dailylife. Individualssuffering frommental illness may experience dissatisfaction with relationships and self. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 3. Aclient grieving the recent loss of her husband asksifshe is becoming mentally ill because she is so sad. The nurse's best response would be, A) ìYou may have a temporarymental illness because you are experiencing so much pain.î B) ìYouare notmentally ill. This is anexpected reaction to the loss you have experienced.î C) ìWere you generallydissatisfiedwith yourrelationship before your husband's death?î D) ìTrynot to worry about thatright now.You never knowwhatthe future brings.î Ans: B Feedback: Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally the behavior must not be culturally expected. Acute grief reactions are expected and therefore not considered mentalillness.False reassuranceor overanalysis does not accurately addressthe client's concerns. 4. Which ofthe following are true regardingmentalhealth andmental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotionalstability. D) Personswho engagein fantasies are mentally ill. Ans: C Feedback: Whatone societymay view as acceptableand appropriate behavior, anothersocietymay see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasiesmay bementallyhealthy, butthe inability to distinguishreality from fantasyis an individual factor that may contribute to mental illness. 5. ThenurseconsultstheDSM forwhich of the following purposes? A) Todevise a plan of care for a newly admitted client B) Topredictthe client's prognosis of treatment outcomes C) Todocument the appropriate diagnostic code in the client'smedical record D) To serve as a guide for client assessment Ans: D Feedback: The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. Diagnosis of mental illness is not within the generalistRN'sscope of practice,so documentingthe codein the medicalrecordwouldbe inappropriate. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 6. Which would be a reason for a student nurse to use the DSM? A) Identifyingthemedical diagnosis B) Treatclients C) Evaluatetreatments D) Understandthe reasonforthe admissionand the nature of psychiatric illnesses. Ans: D Feedback: Although student nurses do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledgeaboutthe natureof psychiatric illnesses. Identifying the medicaldiagnosis, treating, and evaluating treatments are not a part of the nursing process. 7. The legislationenacted in 1963waslargelyresponsibleforwhich of the following shifts in care for the mentally ill? A) Thewidespreaduseof community-based services B) The advancement in pharmacotherapies C) Increasedaccessto hospitalization D) Improvedrightsforclientsin long-terminstitutional care Ans: A Feedback: TheCommunityMentalHealthCentersConstruction Actof 1963 accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 8. Whichone ofthe following is a resultof federal legislation? A) Making it easier to commitpeople formentalhealthtreatmentagainst their will. B) Makingitmoredifficultto commitpeople formental health treatment against their will. C) Statemental institutions being the primary source of care formentallyill persons. D) Improvedcare formentally ill persons. Ans: B Feedback: Commitment laws changed in the early 1970s, making it more difficult to commit people for mental health treatment against their will. Deinstitutionalization accomplished the release of individuals from long-term stays in state institutions. Deinstitutionalizationalso hadnegative effectsin thatsome mentally ill persons are subjected to the revolving door effect, whichmay limit careformentally ill persons. 9. Thegoal ofthe 1963CommunityMental HealthCenters Act wasto A) ensurepatients'rightsfor the mentally ill. B) deinstitutionalizestate hospitals. C) provide fundsto build hospitalswith psychiatric units. D) treatpeoplewithmentalillnessin a humane fashion. Ans: B Feedback: The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shiftof clientswith mentalillnessfromlarge state institutionsto carebased in the community. Answer choices A, C, and D were not purposes of the 1963 Community Mental Health CentersAct. 10. The creation of asylumsduring the 1800swasmeant to A) improvetreatmentofmental disorders. B) providefoodand shelterfor the mentally ill. C) punishpeoplewithmentalillness who were believed to be possessed. D) removedangerouspeoplewithmentalillnessfromthe community. Ans: B Feedback: The asylum was meant to be a safehaven with food, shelter, and humane treatment for the mentally ill. Asylums were not used to improve treatment of mental disorders or topunish mentally ill people who were believed to be possessed. The asylum was not created to remove the dangerouslymentally ill from the community. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 11. Themajorproblemswith large state institutions are:Select all that apply. A) attendantswere accused ofabusing the residents. B) stigmaassociatedwith residencein an insane asylum. C) clientsweregeographicallyisolated fromfamily and community. D) increasingfinancialcoststo individualresidents. Ans: A, C Feedback: Clients were often far removed from the local community, family, and friends because state institutions were usually in rural or remote settings. Choices B and D were not major problems associated with large state instructions. 12. Asignificant change inthe treatment ofpeoplewith mental illness occurred in the 1950s when A) communitysupportserviceswere established. B) legislationdramaticallychanged civil commitment procedures. C) thePatient'sBillofRightswas enacted. D) psychotropicdrugs became availableforuse. Ans: D Feedback: The development of psychotropic drugs, or drugs used to treatmentalillness, beganiI n the 1950s. Answer choices A, B, and C did not occur in the 1950s. 13. Beforethe period ofthe enlightenment, treatmentofthe mentallyill included A) creatinglarge institutionsto provide custodial care. B) focusingonreligious educationto improve theirsouls. C) placing thementallyillondisplayforthe public's amusement. D) providinga safe refuge or haven offeringprotection. Ans: C Feedback: In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and ridiculing the mentally ill, who were seen as animals, less than human. Custodial care was not often provided as persons who were considered harmless were allowed to wander in the countryside or live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed as evil or possessed. Priests performedexorcismsto rid evilspirits, and in the colonies, witch hunts were conducted with offenders burned at the stake. It was not until the period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 14. The firsttraining of nursesItoIworkIwithIpersons withmental illness was in1882 in which state? A) California B) Illinois C) Massachusetts D) New York Ans: C Feedback: The firsttraining for nursesto workwith persons withmentalillness wasin 1882 at McLean Hospital in Belmont, Massachusetts. 15. What ismeant by the termìrevolving dooreffectîinmentalhealth care? A) Anoverallreduction in incidence ofseveremental illness B) Shorterandmore frequent hospitalstaysfor personswith severeand persistent mental illness C) Flexibletreatmentsettingsformentally ill D) Mosteffectiveandleast expensive treatmentsettings Ans: B Feedback: The revolvingdoor effectrefersto shorter, but more frequent, hospitalstays.Clientsare quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatmentsettings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriatelycouldresult in stabilizationand less need foremergencydepartment visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 16. Whichofthe following statementsistrue oftreatment of people withmental illnessin the United States today? A) Substanceabuse is effectively treated with brief hospitalization. B) Financialresources arereallocated fromstate hospitalsto communityprograms and support. C) Only25%of people needingmental healthservices arereceiving those services. D) Emergencydepartmentvisits by persons who are acutelydisturbed aredeclining. Ans: C Feedback: Only one in four (25%) adults needing mental health care receives the needed services. Substanceabuse issues cannot be dealt with in the3 to 5 daystypicalfor admissionsin the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe andpersistent mental illness have shorter hospitalstays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%. 17. Whichofthe following isthe priorityof theHealthy People 2020 objectivesfor mental health? A) Improvedinpatient care B) Primarypreventionof emotional problems C) Stressreductionand management D) Treatmentof mentalillness Ans: D Feedback: The objectives are to increase the number of people who are identified, diagnosed, treated, andhelped to live healthierlives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Answer choices A, B, and C are not priorities of Healthy People 2020. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 18. Whichisa positive aspect oftreating clients withmental illnessin a communitybased care? A) ìYouwill not be allowed to go outwith yourfriends while in the program.î B) ìYouwill have to have supervisionwhen you want to go anywhere else in the community.î C) ìYou will be able to live in your own home while you stillsee a therapist regularly.î D) ìYou will have someone in your home at all timesto ask questionsif you have any concerns.î Ans: C Feedback: Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs. 19. Oneofthe unforeseeneffects ofthemovementtoward communitymental health services is A) fewerclientssuffering frompersistentmental illnesses. B) an increased number of hospitalbeds available forclientsseeking treatment. C) anincreased numberof admissionsto available hospitalservices. D) Longerhospitalstaysfor people needingmentalhealthservices. Ans: C Feedback: Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The number of individuals with mental illness did not change. 20. Whichisincluded inHealthyPeople2020 objectives? A) Todecrease the incidence of mental illness B) Toincrease the number of peoplewho are identified, diagnosed, treated, and helped to live healthier lives C) Toprovidementalhealth services only in the community D) Todecrease the numbers of peoplewho are being treated for mental illness Ans: B Feedback: Oneofthe HealthyPeople2020objectivesisto increase the number ofpeople who are identified,diagnosed,treated,and helpedto live healthierlives.It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 21. A client diagnosed with amild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes A) medicalmanagementofsymptoms. B) dailypsychotherapy. C) constantstaffsupervision. D) psychological stabilization. Ans: A Feedback: Communitymental health centersfocus on rehabilitation, vocational needs, education,and socialization, as well as on management of symptoms and medication. Daily therapies, constantsupervision, and stabilization require a more acute care inpatient setting. 22. Which of the following is defined as an advanced-levelfunction in the practice area of psychiatric mental health nursing? A) Casemanagement B) Counseling C) Evaluation D) Health teaching Ans: C Feedback: Advanced-levelfunctions arepsychotherapy, prescriptive authority, consultationand liaison,evaluation, andprogramdevelopment andmanagement.Casemanagement, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing. 23. Psychiatricnursingbecame a requirementin nursing education inwhich year? A) 1930 B) 1940 C) 1950 D) 1960 Ans: C Feedback: Itwasnot until 1950 that the NationalLeague forNursing, whichaccredits nursing programs,required schoolsto include an experience in psychiatric nursing. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 24. Anew graduate nurse has accepted a staff position at an inpatient mental health facility. The graduatenurse can expectto be responsible forbasic-levelfunctions, including A) providingclinicalsupervision. B) usingeffectivecommunication skills. C) adjustingclient medications. D) directing program development. Ans: B Feedback: Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologicinterventions, healthteaching, casemanagement, andhealth promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision. 25. Whichone ofthe following isone oftheAmericanNurses Association standardsof practice for psychiatricñmental health nursing? A) Prescriptiveauthorityis granted to psychiatric andmentalhealth registered nurses. B) Allaspectsof Standard 5:Implementationmay be carried out by psychiatric andmental health registered nurses. C) Some aspects ofStandard5:Implementationmayonly be carried out by psychiatricandmental health advanced practice nurses. D) Psychiatric andmental healthadvanced practice nurses are the only ones who may provide milieu therapy. Ans: C Feedback: Prescriptiveauthorityis used bypsychiatricñmental health advancedpracticeregistered nurses in accordance with state and federal laws and regulations. Standards 5DñG are advanced practice interventions and may be performed only by the psychiatricñmental health advanced practice registered nurse. Psychiatricñmental health registered nurses may provide milieu therapy according to Standard 5C. This is not restricted to psychiatricñmental health advanced practice nurses. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 26. Which ofthe following is a standard of professionalperformance? A) Assessment B) Education C) Planning D) Implementation Ans: B Feedback: Educationis a standardofprofessionalperformance.Otherstandards ofprofessional performance include the quality of practice, professional practice evaluation, collegiality,collaboration,ethics,research, resourceutilization, and leadership. Assessment,planning, andimplementationare componentsofthe nursing process, notstandards of professional performance. 27. Whichofthe following is a standard of practice? A) Quality of care B) Outcome identification C) Collegiality D) Performance appraisal Ans: B Feedback: Standards of practice include assessment, diagnosis, outcomes identification, planning, implementation,coordinationof care,healthteaching andhealth promotion, andmilieu therapy. The standards of professional performance include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 28. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions? Select all that apply. A) Tellsthe client aboutpersonaleventsand interests B) Discussesthe anxiousfeelings with the instructor C) Assumesthatthe client's unwillingnessto talk to a studentnurse is a personal insult or failure D) Buildsrapportwith thepatient beforeasking personal questions E) Consultsthe instructorif a shocking situation arises F) Gravitatesto clientsthatthe studentmay know personallyAns: B, D, E Feedback: Listening carefully, showing genuine interest, and caring about the client are extremely importantratherthanspeaking aboutoneself. The studentmustdeal with his or her ownanxiety about approaching a strangerto talk about very sensitive andpersonalissues. Student nursesshould not see the client's unwillingness to talk to a studentnurse as a personalinsult or behavior.Beingavailable and willing to listenareoften all it takesto begin a significant interaction with someone. Questions involving personal matters should not be the firstthing a studentsaysto the client. These issues usually arise after some trust and rapport have been established. The nursing instructor and staff are always available to assist if the client is shocking or distressing to the student. If the student recognizes someone he or she knows, it is usually best for the student to talk with the client and reassure him or her about confidentiality. The client should be reassured that the student will not read the client's record and will not be assigned to work with the client. 29. The appropriate action for a student nurse who saysthe wrong thing isto A) pretendthatthe student nursedid notsay it. B) restate it by saying, ìThat didn't come out right.WhatImeant was...î C) state that it was a joke. D) ignorethe error,since no one is perfect.Ans: B Feedback: No one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremelyimportant. A nursewho possessesthese elements but says something thatsounds outof placecan simply restate it by saying, ìThat didn't come out right. What ImeantwasÖî Pretending that the student nursedid notsay it,stating that it was a joke, and ignoring the error are not likely to help the student nurse build and maintain credibility with the client. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK Chapter 2 1. Thenurse is assessing a patientsuffering a head injury as a result of an altercationwith two other individuals. The patient has difficulty accurately reporting the events of the altercationandappearsveryemotionalduring the assessment.The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala Ans: A Feedback: The frontallobes ofthe cerebrum controlthe organizationofthought, bodymovement, memories, emotions, andmoralbehavior.Thecerebellumislocated below the cerebrum and isthe centerforcoordination ofmovements and posturaladjustments. Themedulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory. 2. Anabnormality of which ofthe following structures ofthe cerebrumwould be associated with schizophrenia? A) Parietallobes B) Frontallobe C) Occipitallobe D) Temporal lobes Ans: B Feedback: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivitydisorder(ADHD), and dementia.The parietallobesinterpretsensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assistsin coordinating language generation andvisualinterpretation,suchas depth perception. Page 1 TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 3. A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't wanttI o be sick.î The nurse would best respond with, A) ìPeoplewhodevelopmentalillnessesoften had very traumatic childhood experiences.î B) ìThereissome evidence thatcontracting a virusduring childhood canlead to mental disorders.î C) ìSometimespeoplewithmentalillness have an overactive immune system.î D) ìWe don'tfullyunderstand the cause, butmental illnesses do seem to run in families.î Ans: D Feedback: Currenttheoriesand studiesindicate thatseveralmental disordersmay be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervoussystemmay contribute to mental illness. 4. Whichofthe followingstatements about the neurobiologic causes ofmentalillness is most accurate? A) Geneticsand hereditycanexplainall causes ofmental illness. B) Viralinfectionhas beenproven to be the cause ofschizophrenia. C) Thereis no evidence thatthe immune systemisrelated to mental illness. D) Severalmentaldisordersmay be linked to geneticand nongenetic factors.Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studiesinvolving viral theories have focused on schizophrenia, butso far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specificstressor with a specific diseasehavebeen unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 5. Whichofthe following is an inhibitoryneurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine,norepinephrine, and epinephrine are excitatoryneurotransmitters. 6. Whichofthe following is aneuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA Ans: A Feedback: Neuropeptidesare neuromodulators.Glutamateand dopamine are excitatory neurotransmitters.GABAis an inhibitory neurotransmitter. 7. A nurse is leading a medication education group for patients with depression. A patient states he hasread that herbal treatments are just as effective as prescription medications. The best response is, A) ìWhenstudiesare published they can be trusted to be accurate.î B) ìWe need to look atthe research very closely to see how reliable the studies are.î C) ìYour prescribedmedication isthe best for your condition,so you should not read those studies.î D) ìSwitchingmedications willalterthe courseof yourillness.It is not advised.î Ans: B Feedback: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their familiesto understand. The nurse must ensure thatclients and familiesarewell informed aboutprogressin these areas and must also help themto distinguish betweenfacts and hypotheses. The nursecan explain if or how new research may affect a client's treatment or prognosis. The nurse is a good resource forproviding information and answering questions. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 8. The nurse is preparing a patientfor anMRIscan ofthe head. The nurse should ask the patient, A) ìHaveyou everhad an allergic reactionto radioactive dye?î B) ìHave youhad anything to eat in the last 24 hours?î C) ìDoesyourinsurance coverthe cost of this scan?î D) ìAre you anxious about being in tight spaces?î Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PETscans require radioactive substancesto be injected into the bloodstream. A patient is notrequired to fastbeforebrain imaging studies. Verifyinginsurancebenefits is not a primary role of the nurse. 9. Howshouldthe nurse respond to a familymemberwho asks how Alzheimer's diseaseis diagnosed? A) It isimpossible to knowfor certain that a personhasAlzheimer's disease untilthe person dies and his or her brain can be examined via autopsy. B) Positronemissiontomography(PET)scans can identifythe amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer'sdiseasecanbediagnosed by using chemicalmarkersthat demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography(PET)scansregularlyfor a long period oftime to know ifthe patient hasAlzheimer's disease. Ans: B Feedback: Positronemissiontomography(PET)scans can identify the amyloidplaques and tanglesof Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 10. A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole(Abilify) B) Risperidone(RisperdalConsta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac) Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they controlsymptomswithoutsomeofthe side effects. Injectable antipsychotics,such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms. 11. Whichone ofthe following types of antipsychoticmedicationsismostlikely to produce extrapyramidal effects? A) Atypicalantipsychotic drugs B) First-generationantipsychotic drugs C) Third-generationantipsychotic drugs D) Dopamine system stabilizers Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makesthem effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical orsecond-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugsarethoughtto stabilize dopamine outputthatresultsin control ofsymptoms withoutsome of the side effects of other antipsychotic medications. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 12. Apatient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asksthe nurse how this medicine works. The nurse explains that themechanismby whichthe olanzapinecontrolsthe patient's psychotic symptomsis believed to be A) increasing the amountofserotonin andnorepinephrine in the brain. B) decreasing the amount of an enzyme thatbreaks down neurotransmitters. C) normalizingthe levelsofserotonin, norepinephrine, and dopamine. D) blockingdopamine receptorsin the brain.Ans: D Feedback: The major action of all antipsychotics in the nervoussystemisto block receptors forthe neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine. 13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) Aheadache after eating wine and cheese B) Adecrease in sexual pleasure during intimacy C) Anintense need to move about D) Persistent runny nose Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause lessweight gainthanother antidepressants. Drymouth and nasal passages arecommon anticholinergic side effects associatedwith all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychoticmedication.Furthermore,sedation is a commonside effectofPaxil. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 14. Whichone ofthe following drugsshould the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac Ans: C Feedback: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. Forclientstaking lithium and the anticonvulsants, monitoring blood levels periodicallyis important. 15. Which ofthe followingdisorders areextrapyramidalsymptomsthatmaybe caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neurolepticmalignantsyndrome D) Dystonia E) Anticholinergiceffects F) Breasttendernessin men and women Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncraticreactionto an antipsychoticdrug,notan extrapyramidalsymptom. Breast tendernessinmen andwomenis also a potentialside effect of antipsychotic drugsthat cause elevated prolactinlevels, but it is not an extrapyramidalsymptom. 16. Whichof the followingantidepressantdrugsis a preferred drug for clients at high risk of suicide? A) Tranylcypromine(Parnate) B) Sertraline(Zoloft) C) Imipramine(Tofranil) D) Phenelzine (Nardil) Ans: B Feedback: SSRIs, venlafaxine, nefazodone, and bupropionareoftenbetter choicesforthosewho are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cycliccompounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 17. The nurseknowsthat the client understandstherationale fordietary restrictions whentaking MAOIwhen the clientmakeswhich of the following statements? A) ìI am now allergic to foodsthat are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate.î B) ìCertainfoodswill causeme to have sexual dysfunctionwhen Itake this medication.î C) ìFoodsthatarehighin tyraminewillreduce the medication's effectiveness.î D) ìIshould avoid foods that are high in the amino acid tyramine such as aged cheese,meats, andchocolatebecause this drug causesthe level of tyramine to go up to dangerous levels.î Ans: D Feedback: Because the enzyme MAO is necessaryto breakdown the tyramine in certainfoods,its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia,tachycardia,diaphoresis,tremulousness, and cardiacdysrhythmias. Taking an MAOIdoesnot confer allergyto tyramine. Sexual dysfunction is a commonside effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness. 18. A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseatedsincebeginning the medication. Which of the following actionsisindicated initially? A) Instruct the client to stop the medication for a few daysto see if the nausea goes away. B) Reassure the client that thisis an expected side effect thatwill improve with time. C) Suggest that the clienttake themedicationwith food. D) Tellthe clientto contactthe physician for a change in medication.Ans: C Feedback: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 19. In planning for a client's discharge, the nursemust know that the mostseriousrisk forthe clienttaking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angleglaucoma C) Seizures D) Suicide by overdose Ans: D Feedback: Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effectssuch as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation,delirium, and ileusmayoccur, particularly in olderadults.Othercommonside effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that clients discontinue drug therapy. The risk of seizures is increased by bupropion, which is a different type of antidepressant. 20. A client with severe and persistent mental illness has been taking antipsychotic medicationfor20 years.The nurseobservesthat the client's behaviorincludesrepetitive movements ofthe mouthandtongue,facialgrimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of A) extrapyramidalside effects B) loss of voluntarymuscle control C) posturing D) tardive dyskinesia Ans: D Feedback: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndromeof permanentinvoluntarymovements, ismost commonlycaused by the longterm use of conventional antipsychotic drugs. Extrapyramidalside effects are reversible movement disordersinduced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 21. Aclient is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following? A) Tardivedyskinesia B) Neurolepticmalignantsyndrome C) Dystonia D) Akathisia Ans: D Feedback: Akathisiaisreported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessiveunnecessary facial movements arecharacteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. 22. Which ofthe following is a termused to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism Ans: B Feedback: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, andtorticollisaremanifestations of acutedystonia. Pseudoparkinsonismis drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 23. Whichofthe following medicationsrarelycauses extrapyramidalsideeffects(EPS)? A) Ziprasidone(Geodon) B) Chlorpromazine(Thorazine) C) Haloperidol(Haldol) D) Fluphenazine (Prolixin) Ans: A Feedback: First-generation antipsychotic drugs cause a greaterincidence of EPS than do atypical antipsychoticdrugs,withziprasidone (Geodon)rarelycausingEPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs. 24. Whichofthe followingincreasesthe risk forneurolepticmalignantsyndrome (NMS)? A) Overhydration B) Intakeof vitamins C) Dehydration D) Vegetarian diet Ans: C Feedback: Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS.Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritionalstatus. Vegetarian dietwould notrelate to NMS. 25. Which ofthe followingwasthe first nonstimulantmedication specifically designed and tested for ADHD? A) Methylphenidate(Ritalin) B) Amphetamine(Adderall) C) Atomoxetine(Strattera) D) Pemoline (Cylert) Ans: C Feedback: Strattera was the first nonstimulant medication specifically designed and tested for ADHD.The primarystimulantdrugsusedto treat ADHD aremethylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert). TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 26. Which ofthe followingisthe primaryconsideration withclientstaking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep Ans: C Feedback: Suicide is always a primary consideration when treating clients with depression. 27. Whichofthe following would not be included as a symptom of druginduced parkinsonism? A) Stoopedposture B) Cogwheelrigidity C) Drooling D) Tachycardia Ans: D Feedback: Bradycardia (nottachycardia), a stoopedposture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest. 28. Whichdrugclassification isthe primarymedication treatmentforschizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics Ans: D Feedback: Antipsychoticdrugsare theprimary medical treatment forclients diagnosedwith schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 29. A client on the unitsuddenly cries out infear. The nurse noticesthat the client's headis twisted to one side, his back is arched, and his eyes have rolled back in their sockets.The client hasrecentlybegundrugtherapywith haloperidol(Haldol).Based on this assessment, the first action of the nurse would be to A) get a stat. orderfor a serumdrug level. B) hold the client'smedication until the symptomssubside. C) place an urgentcallto the client's physician. D) give a PRNdose of benztropine (Cogentin) IM. Ans: D Feedback: The client is having an acute dystonic reaction; the treatment is anticholinergic medication.Dystonia ismostlikely to occurin the firstweek of treatment, in clients younger than 40 years, inmales, and in those receiving high-potency drugs such as Haldol.Immediate treatmentwithanticholinergic drugsusually bringsrapid relief. 30. Oneweek afterbeginning therapywith thiothixene (Navane), the clientdemonstrates muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of A) acutedystonic reaction. B) extrapyramidalside effects. C) neurolepticmalignantsyndrome. D) tardive dyskinesia. Ans: C Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidalsideeffectsare reversiblemovement disordersinduced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements,such as blinking, chewing, and grimacing. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 31. Aclient with bipolar disorder has been taking lithium, and today hisserum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A) Constipationand postural hypotension B) Fever,musclerigidity, and disorientation C) Nausea,diarrhea, and confusion D) None;the serumlevel isin therapeuticrange Ans: C Feedback: Serum lithium levels oflessthan 0.5 mEq/Lare rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination. 32. For a client taking clozapine (Clozaril), which of the following symptomsshould the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivityreaction D) Sorethroatand malaise Ans: D Feedback: Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Thisside effectmay not bemanifested immediatelyand can occurup to 24weeks afterthe initiation of therapy. Any symptoms of infectionmust be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rashand photosensitivity reactionare notserioussideeffects. 33. Apatientwith bipolar disordertakeslithium300 mg three times daily. The nurseevaluatesthat the dose is appropriatewhen the patient reports A) feeling sleepyandless energetic. B) weightgain of 7 poundsinthe last 6 months. C) minimalmood swings. D) increased feelingsofself-worth. Ans: C Feedback: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing orminimizingthehighs and lowsthat characterizebipolarillness, and treating acute episodesofmania.Weight gain is a commonside effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a targetsymptom of bipolar disorder, which should diminish with effective treatment. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 34. When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) Amild side effect of the medication. B) The intendedtherapeutic result. C) Anidiosyncratic reaction D) A severe allergy to the medication. Ans: B Feedback: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcoholin the body.Five to tenminutes after a persontaking disulfiramingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are notmild sideeffectsbecausethese arevery uncomfortable symptoms. These symptomswouldnotbe an idiosyncratic reactionbecause thisisthe expected reaction.Thesesymptomsare not indicative of a severe allergy to the medication. 35. When the client asks the nurse how long it will take before the SSRI antidepressantmedicationwill be effective,whichofthe following repliesis most accurate and therapeutic? A) ìThisis agoodmedication!Itwill be effective within 20 minutes of the first dose.î B) ìYou will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is importantfor you to keep taking the medication.î C) ìIt will probably take monthsfor the medication to work. In the meantime, you should work on improving your attitude.î D) ìIf you believe itwill work, then it will. You have to have faith!î Ans: B Feedback: SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of thesedrugs are an ìinitiating eventî and that eventual therapeutic effectiveness results whenneurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months forthe medication. Attitude and faith will improve with the medication's effectiveness. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 36. Aclient has a lithiumlevel of1.2mEq/L. Whichofthe following interventions by the nurse is indicated? A) Call the physicianfor anincrease in dosage. B) Donot give the nextdose, and call the physician. C) Increase fluid intake forthe next week. D) Nointervention is necessaryat this time. Ans: D Feedback: The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level. 37. A patient is seen for frequent exacerbation ofschizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The patient issymptom-freeand therefore doesnotneed to adhere to the medication regimen. B) Thepatient cannot clearlysee the instructionswritten onthe prescription bottle. C) The patient dislikestheweightgainassociatedwith antipsychotic therapy. D) Thepatientsellsthe antipsychoticsto addictsin the neighborhood. Ans: C Feedback: Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychoticsshould be taken regularly and not omittedwhenfreeofsymptoms. Antipsychotics do not adverselyaffect vision, nor do they have addictive potential. 38. Whichofthe following side effects oflithiumare frequentcauses of noncompliance? Select all that apply. A) Metallictaste in the mouth B) Weightgain C) Acne D) Thirst E) Lethargy Ans: B, E Feedback: Lethargyandweightgain aredifficult to manage orminimizeand frequentlylead to noncompliance. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 39. The nurseis educating a patient and family aboutstrategiesto minimize the side effectsof antipsychotic drugs. Which of the following should be included in the plan? SelectaI ll that apply. A) Drink plenty of fruit juice. B) Developing an exerciseprogramisimportant. C) Increasefoodshigh in fiber. D) Laxativescanbe used as needed. E) Use sunscreenwhen outdoors. F) Formisseddoses,take double the dose at the nextscheduled time.Ans: B, C, E Feedback: Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stoolsofteners are permissible,but the clientshould avoid laxatives. The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily. If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose. 40. The nurse has completed health teaching about dietary restrictions for a client takingaI monoamine oxidase inhibitor. The nurse will know that teaching has been effectiveby which of the following client statements? A) ìI'mglad I can eat pizza since it's my favorite food.î B) ìImust follow this diet or I will have severe vomiting.î C) ìItwill be difficult for me to avoid pepperoni.î D) ìNoneof the foodsthat are restricted are part of a regular daily diet.î Ans: C Feedback: Pepperoniisone of the foodscontaining tyramine, soit mustbe avoided. Particular concernto this clientisthe potentiallife-threatening hypertensive crisisif the client ingestsfood that contains tyramine. Answer choices A, B, and D are inappropriate statementstoward effective teaching for the client receiving a monoamine oxidase inhibitor. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 41. Whenteaching a client aboutrestrictionsfortranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods? A) Broadbeans B) Citrusfruit C) Eggproducts D) Fried foods Ans: A Feedback: Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine- containing foods. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK Chapter 3 1. Thenurse understandsthat crises areself-limiting. Thisimplies thatuponevaluation of crisisintervention, the nurse should assessfor which outcome? A) Thepatientwill identifypossible causesforthe crisis. B) Thepatient willdiscover a new sense ofself-sufficiency incoping. C) The patient will resume theprecrisislevel of functioning. D) Thepatientwill expressangerregarding the crisis event.Ans: C Feedback: Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in one ofthreeways. In the first two, the personeither returns to his or her precrisis level of functioning or begins to function at a higher level; both arepositive outcomes for the individual.The third resolutionisthat the person'sfunctioning stabilizes at a levellower than precrisis functioning, which is a negative outcome for the individual. Assisting the person to use existing supports or helping the individual find new sources of support candecrease the feelings of being alone or overwhelmed. The patient may develop guiltIif he or she examines possible causes for the crisis. Expression of anger at 4 to 6 weeks indicates a lessthan favorable outcome of crisis intervention. 2. A patient who has been working on controlling impulsive behaviorshows a strengthening ego throughwhich of the following behaviors? A) Going to therapy onlywhen there is nothing more desirable to do B) Weighingthe advantagesanddisadvantages beforemaking a decision C) Tellingothersin the group the rightway to act D) Reporting having funat a recentsocial eventAns: B Feedback: The id is the part of one's nature that reflects basic or innate desires such as pleasureseeking behavior, aggression, and sexual impulses. The id seeks instant gratification, causesimpulsive unthinking behavior, and has no regard for rules orsocial convention. The superego is the part of a person's nature that reflects moral and ethical concepts, values, and parentaland socialexpectations;therefore, it isin direct opposition to the id. The thirdcomponent, the ego, isthe balancing ormediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world. Page 1 TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 3. A patient hasjust been told she has cervical cancer. When asked about how this is impacting her, she states, ìIt's just an infection; it will clear up.î The statement indicates that this patient A) needseducationon cervical cancer. B) is unable to expresshertrue emotions. C) should be immediatelyreferred to a cancersupportgroup. D) is usingdenial to protectherselffroman emotionallypainful thought.Ans: D Feedback: Ego defense mechanisms are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at theunconsciouslevel of awareness,so people arenot awareof what they are doing andoftenneed help to seethe reality. Education and referrals are premature at this point in the patient's ability to cope. 4. A teenage patient defiesthe nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, ìYou sound just like my mother at home!î and continues to play the video game. The nurse understands that thisstatement likely indicates A) the need ofstricterdiscipline at home. B) earlysigns ofoppositionaldefiant disorder. C) viewingthe nurse as her mother. D) expressionof developing autonomy. Ans: C Feedback: Transferenceoccurswhen the clientdisplacesonto the therapist attitudesand feelings thatthe clientoriginally experiencedin otherrelationships.Transferencepatterns are automatic and unconscious in the therapeutic relationship. The occurrence of transferencedoes not indicate ineffectiveparenting or disciplinary practices, norisit indicative of a disorder.Autonomy is developedmuch earlierinthe toddler years. 5. A patient reports a pattern of being suspicious and mistrusting of others, causing difficulty in sustaining lasting relationships. Which stage according to Erikson's psychosocialdevelopmentwas notsuccessfully completed? A) Trust B) Autonomy C) Initiative D) Industry Ans: A Feedback: The formationoftrustis essential:mistrust, the negative outcome ofthisstage, willimpair the person'sdevelopment throughout his or her life. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 6. The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelingsopenlywith the nurse.The relationship has entered which phase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution Ans: B Feedback: The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions. The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. In the exploitation phase, the client makes full use of the services offered. In the resolution phase, the client no longer needsprofessionalservicesand gives up dependent behavior and the relationship ends. 7. Anurse ismeeting witha crisissupport group. In effortsto help patientsidentify with one another, the nurse explains which of the following about the crisis experience? A) ìEvenhappyevents can cause a crisisif the stressis overwhelming.î B) ìOnlypeoplewho have unfortunate life events will experience a crisis.î C) ìAperson has no control over how a crisis will affect him or her.î D) ìPeoplecanprevent all crisesif they develop goodcoping skills early.î Ans: A Feedback: Not all events that result in crisis are ìnegativeî in nature. Events like marriage, retirement, and childbirth are often desirable for the individual but may still present overwhelming challenges. All individuals can experience a crisis when they confront some life circumstanceorstressorthat they cannot effectivelymanage through use of their customary coping skills. A number of factors can influence how a person experiences a crisis. TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK TEST BANK FOR PSYCHIATRIC MENTAL HEALTH NURSING 7TH EDITION BY VIDEBECK 8. Whichofthe followingtheories couldbe classified as humanistic theories?Select all that apply. A) Cognitivetherapy B) Maslow'shierarchy of needs C) Gestalttherapy D) Rogers'client-centered therapy E) Rationalemotive therapy F) Piaget's cognitive stages ofdevelopment Ans: B, D Feedback: Humanism represents a significant shift away from the psychoanalytic view of the individual as a neurotic, impulse-driven person with repressed psychic problems and away fromthe focuson andexamination ofthe client's pastexperiences. Humanistic theoriesincludeMaslow's hierarchyof needsandRogers'client-centered therapy. Cognitive therapy is an existential therapy that