PHNP - Purple Book 4th Edition 100
Questions and Answers.
The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope
and Standards of Practice is to
a. Define the role and actions for the NP
b. Establish the legal authority for the prescription of psychotropic medications
c. Define the legal statutes of the role of the PMHNP
d. Define the differences between the physician role and the NP role - Correct Answer: A.
The ANA's Psychiatric-Mental Health Nursing: Scope and Standards of Practice defines the role
and actions of the nurse practitioner.
REF: Pg. 16
Primary prevention care practices are an essential aspect of the PMHNP role. Which of the
following is the best example of a primary prevention care strategy for community behavioral
health?
a. Aftercare program for chronically mentally ill clients recently discharged from the hospital
b. Court-ordered counseling for abusive parents
c. 24-hour crisis hotlines
d. Parenting skills classes for pregnant adolescents - Correct Answer: D.
Information reduces incidence of disease.
REF: Pg. 103
The trend in legal rulings on cases involving mental illness over the past 25 years has been to
a. Encourage juries to find defendants not guilty by reason of insanity
b. Protect the person's freedoms or rights when he or she is committed to a mental hospital
c. Place increasing trust in mental health professionals to make good and ethical decisions
d. Decrease the "red tape" associated with commitments so that commitments are faster and
easier - Correct Answer: B.
Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients.
REF: Pg. 20, 21
Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to
take any of his ordered medication because he believes "Jesus Christ told me I am the prophet
and must fast for a year." Your actions should be based on your knowledge of which of the
following?
a. Psychiatric clients cannot refuse treatment
,b. Psychiatric clients do not always know what is good for them
c. Psychiatric clients can refuse treatment
d. Psychiatric clients cannot be trusted to make good healthcare decisions and, therefore, the
nurse's best clinical judgment should guide actions - Correct Answer: C.
As with any client, psychiatric clients can refuse treatment un-less a legal process resulting in
involuntary commitment or mandatory court order for treatment has been obtained.
REF: Pg. 19, 31
Which of the following statements best reflects the difference between the nurse-client (N-C)
relationship and a social relationship?
a. In the N-C relationship, the primary focus is on the client and the client's needs.
b. Goals in the N-C relationship are deliberately left vague and unspoken so that the client can
work on any issue.
c. In the N-C relationship, the nurse is solely responsible for making the relationship work.
d. In the N-C relationship, there is no place for social interaction. - Correct Answer: A.
Social relationships are mutual interpersonal relationships in which the needs of both parties are
addressed. The N-C relationship is most concerned with meeting the needs of the client.
REF: Pg. 38
A community has an unusually high incidence of depression and drug use among the teen-age
population. The public health nurses decide to address this problem, in part, by modifying the
environment and strengthening the capacities of families to prevent the development of new
cases of depression and drug use. What is this is an example of?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Protective factorial prevention - Correct Answer: A.
This action focuses on interventions designed to reduce the incidence of new cases of disease
REF: Pg. 103
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave
because "this place can't help me." The best nursing action that reflects the legal right of this
client is
a. Discharge the client
b. Explain that the client cannot leave until you can complete further assessment
c. Allow the client to leave but have her sign forms stating she is leaving against medical advice
d. Immediately start the paperwork to commit the client and to allow you to treat her against her
wishes - Correct Answer: B.
,Almost every state allows for a brief period of detainment to assess a client for dangerousness to
self or others before allowing the client to leave a hospital setting, even if the admission was
voluntary.
REF: Pg. 21
In forming a therapeutic relationship with clients, the PMHNP must consider developing many
characteristics that are known to be helpful in relationship-building. Which of the following is an
essential part of building a therapeutic relationship?
a. Collecting a family history
b. Like-mindedness
c. Authenticity
d. Accuracy in assessment - Correct Answer: C.
Authenticity. Being genuine, honest, and respectful are essential elements in establishing a
working relationship with any client. Like-mindedness is not a part of the therapeutic
relationship. Although an important aspect of the PMHNP role, collecting a family history and
accuracy in assessment does not in and of itself facilitate relationship-building.
REF: Pg. 38
According to the DSM-5, which of the following is true? (Ch. 3)
a. A mental disorder is equivalent to the need for treatment.
b. Diagnostic criteria are used to inform clinical judgment.
c. Socially deviant behavior is considered a mental disorder.
d. A culturally expected response to a stressor is not a mental disorder. - Correct Answer: D.
All DSM-5 disorders need to be made taking a person's culture into account. A cultural
expression of a response to grief, loss, or stress is not considered a DSM-5 diagnosis.
REF: Pg. 23
Mrs. French has been in individual therapy for 3 months. She has shown much growth and
improvement in her functioning and insight and is to discontinue services within the next few
weeks. In the next session, after you discuss service termination, she suddenly begins to
demonstrate the original symptoms that had brought her to treatment initially. She is now
hesitant to discharge, wants to continue services, and is displaying an increase in regressive
defense mechanisms. What is the best explanation for Ms. French's behavior?
a. An exacerbation of her symptoms related to stress
b. The normal cyclic nature of chronic mental health symptoms
c. A sign of normal resistance to termination seen in the termination phase of therapy
d. A sign of pathological attachment to the therapist that must be addressed - Correct Answer: C.
Clients frequently display resistance and regression at the termination of a meaningful
therapeutic process. The PMHNP is responsible for planning an effective termination and
monitoring clients during the termination period
, REF: Pg. 39
A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of de-
pendency. These behaviors indicate developmental failure of which of the following stages of
development:
a. Infancy
b. Early childhood
c. Late childhood
d. School age - Correct Answer: B.
These signs indicate developmental failure of early childhood.
REF: Pg. 40 - Table 3-2
Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or
what time appointments are scheduled, and he has stated that he thinks these are just random
behaviors that have no particular meaning. Which Freudian-based psychodynamic principle
assumes that all behavior and actions are purposeful?
a. Pleasure principle
b. Psychic determinism principle
c. Reality principle
d. Unconsciousness principle - Correct Answer: B.
The psychic determinism principle states that all behavior has purpose and meaning, often
unconscious in nature, and that no behaviors occur randomly or by coincidence.
REF: Pg. 41
An example of a mature, healthy defense mechanism is
a. Denial
b. Rationalization
c. Repression
d. Suppression - Correct Answer: D.
Suppression is the only defense mechanism listed in which the client channels conflicting
energies into growth-promoting activities.
REF: Pg. 44 - Table 3-5
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While
discussing his current concerns of marital stress, he lies on the floor and assumes the fetal
position. This is most likely an example of
a. Immature regressive defense mechanism
b. Denial of reality
Questions and Answers.
The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope
and Standards of Practice is to
a. Define the role and actions for the NP
b. Establish the legal authority for the prescription of psychotropic medications
c. Define the legal statutes of the role of the PMHNP
d. Define the differences between the physician role and the NP role - Correct Answer: A.
The ANA's Psychiatric-Mental Health Nursing: Scope and Standards of Practice defines the role
and actions of the nurse practitioner.
REF: Pg. 16
Primary prevention care practices are an essential aspect of the PMHNP role. Which of the
following is the best example of a primary prevention care strategy for community behavioral
health?
a. Aftercare program for chronically mentally ill clients recently discharged from the hospital
b. Court-ordered counseling for abusive parents
c. 24-hour crisis hotlines
d. Parenting skills classes for pregnant adolescents - Correct Answer: D.
Information reduces incidence of disease.
REF: Pg. 103
The trend in legal rulings on cases involving mental illness over the past 25 years has been to
a. Encourage juries to find defendants not guilty by reason of insanity
b. Protect the person's freedoms or rights when he or she is committed to a mental hospital
c. Place increasing trust in mental health professionals to make good and ethical decisions
d. Decrease the "red tape" associated with commitments so that commitments are faster and
easier - Correct Answer: B.
Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients.
REF: Pg. 20, 21
Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to
take any of his ordered medication because he believes "Jesus Christ told me I am the prophet
and must fast for a year." Your actions should be based on your knowledge of which of the
following?
a. Psychiatric clients cannot refuse treatment
,b. Psychiatric clients do not always know what is good for them
c. Psychiatric clients can refuse treatment
d. Psychiatric clients cannot be trusted to make good healthcare decisions and, therefore, the
nurse's best clinical judgment should guide actions - Correct Answer: C.
As with any client, psychiatric clients can refuse treatment un-less a legal process resulting in
involuntary commitment or mandatory court order for treatment has been obtained.
REF: Pg. 19, 31
Which of the following statements best reflects the difference between the nurse-client (N-C)
relationship and a social relationship?
a. In the N-C relationship, the primary focus is on the client and the client's needs.
b. Goals in the N-C relationship are deliberately left vague and unspoken so that the client can
work on any issue.
c. In the N-C relationship, the nurse is solely responsible for making the relationship work.
d. In the N-C relationship, there is no place for social interaction. - Correct Answer: A.
Social relationships are mutual interpersonal relationships in which the needs of both parties are
addressed. The N-C relationship is most concerned with meeting the needs of the client.
REF: Pg. 38
A community has an unusually high incidence of depression and drug use among the teen-age
population. The public health nurses decide to address this problem, in part, by modifying the
environment and strengthening the capacities of families to prevent the development of new
cases of depression and drug use. What is this is an example of?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Protective factorial prevention - Correct Answer: A.
This action focuses on interventions designed to reduce the incidence of new cases of disease
REF: Pg. 103
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave
because "this place can't help me." The best nursing action that reflects the legal right of this
client is
a. Discharge the client
b. Explain that the client cannot leave until you can complete further assessment
c. Allow the client to leave but have her sign forms stating she is leaving against medical advice
d. Immediately start the paperwork to commit the client and to allow you to treat her against her
wishes - Correct Answer: B.
,Almost every state allows for a brief period of detainment to assess a client for dangerousness to
self or others before allowing the client to leave a hospital setting, even if the admission was
voluntary.
REF: Pg. 21
In forming a therapeutic relationship with clients, the PMHNP must consider developing many
characteristics that are known to be helpful in relationship-building. Which of the following is an
essential part of building a therapeutic relationship?
a. Collecting a family history
b. Like-mindedness
c. Authenticity
d. Accuracy in assessment - Correct Answer: C.
Authenticity. Being genuine, honest, and respectful are essential elements in establishing a
working relationship with any client. Like-mindedness is not a part of the therapeutic
relationship. Although an important aspect of the PMHNP role, collecting a family history and
accuracy in assessment does not in and of itself facilitate relationship-building.
REF: Pg. 38
According to the DSM-5, which of the following is true? (Ch. 3)
a. A mental disorder is equivalent to the need for treatment.
b. Diagnostic criteria are used to inform clinical judgment.
c. Socially deviant behavior is considered a mental disorder.
d. A culturally expected response to a stressor is not a mental disorder. - Correct Answer: D.
All DSM-5 disorders need to be made taking a person's culture into account. A cultural
expression of a response to grief, loss, or stress is not considered a DSM-5 diagnosis.
REF: Pg. 23
Mrs. French has been in individual therapy for 3 months. She has shown much growth and
improvement in her functioning and insight and is to discontinue services within the next few
weeks. In the next session, after you discuss service termination, she suddenly begins to
demonstrate the original symptoms that had brought her to treatment initially. She is now
hesitant to discharge, wants to continue services, and is displaying an increase in regressive
defense mechanisms. What is the best explanation for Ms. French's behavior?
a. An exacerbation of her symptoms related to stress
b. The normal cyclic nature of chronic mental health symptoms
c. A sign of normal resistance to termination seen in the termination phase of therapy
d. A sign of pathological attachment to the therapist that must be addressed - Correct Answer: C.
Clients frequently display resistance and regression at the termination of a meaningful
therapeutic process. The PMHNP is responsible for planning an effective termination and
monitoring clients during the termination period
, REF: Pg. 39
A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of de-
pendency. These behaviors indicate developmental failure of which of the following stages of
development:
a. Infancy
b. Early childhood
c. Late childhood
d. School age - Correct Answer: B.
These signs indicate developmental failure of early childhood.
REF: Pg. 40 - Table 3-2
Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or
what time appointments are scheduled, and he has stated that he thinks these are just random
behaviors that have no particular meaning. Which Freudian-based psychodynamic principle
assumes that all behavior and actions are purposeful?
a. Pleasure principle
b. Psychic determinism principle
c. Reality principle
d. Unconsciousness principle - Correct Answer: B.
The psychic determinism principle states that all behavior has purpose and meaning, often
unconscious in nature, and that no behaviors occur randomly or by coincidence.
REF: Pg. 41
An example of a mature, healthy defense mechanism is
a. Denial
b. Rationalization
c. Repression
d. Suppression - Correct Answer: D.
Suppression is the only defense mechanism listed in which the client channels conflicting
energies into growth-promoting activities.
REF: Pg. 44 - Table 3-5
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While
discussing his current concerns of marital stress, he lies on the floor and assumes the fetal
position. This is most likely an example of
a. Immature regressive defense mechanism
b. Denial of reality
