Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
TEST BANK
Psychiatric Mental Health Nursing
Katherine M. Fortinash, Patricia A. Holoday Worret
5th Edition
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Table of Contents
1. Psychiatric Nursing: Theory, Principles, and Trends
2. Nursing Practice in the Clinical Setting
3. The Nursing Process and Standards of Care
4. Therapeutic Communication: Interviews and Interventions
5. Adaptation to Stress
6. Neurobiology in Mental Health and Mental Disorder
7. Human Development Across the Life Span
8. Culture, Ethnicity, and Spirituality: A Global Perspective
9. Legal and Ethical Aspects in Clinical Practice
10. Anxiety and Related Disorders
11. Somatoform, Factitious, and Dissociative Disorders
12. Mood Disorders: Depression, Bipolar, and Adjustment Disorders
13. Schizophrenia and Other Psychotic Disorders
14. Personality Disorders
15. Substance Related Disorders and Addictive Behaviors
16. Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders
17. Disorders of Infancy, Childhood, and Adolescence
18. Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
19. Sleep Disorders: Dyssomnias and Parasomnias
20. Sexual Disorders: Sexual Dysfunctions and Paraphilias
21. Crisis: Theory and Intervention
22. Suicide: Prevention and Intervention
23. Violence: Anger, Abuse, and Aggression
24. Forensic Nursing in Clinical Practice
25. Psychopharmacology
26. Therapies: Theory and Clinical Practice
27. Complementary and Alternative Therapies
28. Grief in Loss and Death
29. Emotional and Mental Responses to Medical Illness
30. Community Mental Health Nursing for Patients with Severe and Persistent Mental Illness
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Fo r t i n a s h : P s y c h i a t r i c M e nt al H e a l t h N u r s i n g , 5 t h E d i t i o n
C h a p t e r 0 1 : P s y c h i a t r i c N u r s i n g : T h e o r y, P r i n c i p l e s , a n d Tr e n d s
1. Which u n d er stan d in g is the b a s i s for the n u r si n g actions focu sed on min i mi z i n g
men tal health promotion of families with ch ronically men tally ill me mb e r s?
a. Fa m i l y m e m b e r s a re at a n in crea se d risk for men ta l illness.
b. T h e men tal health c are s y s t e m is not p rep a red to d eal with family crises.
c. Fa m i l y m e m b e r s are seld o m p repa red to cop e with a chronically ill individ u al.
d. T h e chronically men ta lly ill recei ve ca re bes t when delive red in a formal setting.
ANS: A
When families live with a dominant m e m b e r who h a s a persistent a n d se v er e m en tal
disorder the outcomes are often ex p r e s s e d a s f amily m e m b e r s who are at in c rease d risk
for p h y s i c a l a n d men tal illn esses. T h e re m ain i n g options are not n e ce s sa r i ly true.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 3
2. Which nu r sin g activity shows the n u rse activ ely e n g a g e d in the p rimary prevention of
men tal disorders?
a. Providing a patient, whose depres sion is well m a n a g e d , with medication on time
b. Makin g regular follow-up visits to a new mother at risk for post-partum
depression
c. Providing the family of a patient, d ia g n o s ed with depression, information on
su icid e prevention
d. Assisting a patient who h a s ob s es s i v e c o m p u ls i v e ten d e n cie s p repare a n d
practice for a job interview
ANS: B
Primary prevention h el p s to red u ce the occu rrence of m en ta l disorders b y sta y i n g
involved with a patient. Providing medicati on a n d information on existin g illn es se s are
e x a m p l e s of se c on d a ry prevention which h e l p s to red u ce the p re v al e n c e of m en tal
disorders. Assistin g a men tally ill patient with preparation for a job interview is tertiary
prevention si n c e it in volves rehabilitation.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
3. Which intervention reflects attention b e i n g f ocu sed on the patien t’s intentions
rega rd in g h is d ia gn osis of se v e re depression?
a. B e i n g p l a c e d on su ic id e precautions
b. En c ou ra gin g visits b y h is family m e m b e r s
c. Re c e i v i n g a combination of med ication s to a d d re s s h is emotional n e e d s
d. B e i n g a s ke d to d e c i d e where h e will attend his prescrib ed the rapy s e s si on s
ANS: D
A pri mary factor in patient treatment in cl u d es consideration of the patient’s intentions
re ga rd in g h is or her own care. Patients are central to the p roce ss that d ete rmin es their
care a s their abilities allow. Under the g u i d a n c e of PMH n u rs e s a n d other men ta l health
personnel, patients a re en c ou r age d to m a k e d eci sion s a n d to actively e n g a g e in their
own treatment p lan s to m ee t their n e e d s . T h e re mai n i n g options are focused on sp e cif i cs
of the dete rmin ed p lan of care.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 5
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
4. When a patient’s family a s k s why their chro nically men tally ill adult child is b e i n g
d i s c h a rg e d to a co m mu n ity- b a s ed livin g facility, the n u rse resp onds:
a. “It is a way to me e t the n e e d for social support.”
b. “It is too ex p e n s i v e to ke e p stabiliz ed patients in acu te care se ttin gs.”
c. “Th i s ty p e of facility will provide the sp e ci al i zed care that is n ee d e d . ”
d. “B e i n g out in the c o m mu n ity will h elp provide hope a n d purpose for living.”
ANS: D
Hospitalization m a y b e n e c e s s a r y for acu te care, but, when patients are stabilized, th ey
m o v e into c om mu n ity -b ased , patient-centered settin gs or are d i s ch a rg e d h o me with
continued outpatient treatment in the co mmu n i ty. Concentrated efforts are m a d e to
red u ce the patien t’s s i c k role b y providing opportunities for the d evelop men t of a
purposeful life a n d instilling hop e for e a c h patient’s future. Although social support is
important, s u c h a livin g arran ge m en t is not the only way to a c h i e v e it. Although acu t e
care is e x p e n s i v e , it is not the major concern when dete rmin in g long-term care options.
C o m mu n it y -b a s e d facilities are not the only option for sp e ci al iz ed care.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 5
5. What is the be st exp lan ation to offer when the mother of a chronically ill te e n a g e
patient a s k s , “Under what ci rcu m s t an ce s would h e b e considered incompetent?”
a. “ Wh en you c a n provide the court with e n ou g h e v i d e n c e to show that h e is not
ab l e to care for himself safely.”
b. “It is not likely that s ome on e h is a g e would b e dete rmin ed to b e incompeten t
re ga rd les s of h i s men tal condition.”
c. “H e would h a v e to e n g a g e in behavior that would result in h arm to himself or to
some on e else; like you or h is sib lin gs.”
d. “If the illn ess b e c o m e s so s e ve re that h is j u d gm en t is imp aired to the point where
the d ecision s h e m a ke s are harmful to himself or to others.”
ANS: D
When a person is u n a b le to cognitively proce ss information or to m a ke decision s about
h is or her own welfare, the person m a y b e dete rmined to b e men tal ly incompetent.
Providing self-care is not the only criteria considered. Age is not a factor considered. T h e
decision is often b a s e d on the potential for s u c h behavior.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 6
6. Which psychiat ric n ur sin g intervention shows a n un d ers tan d i n g of integrated care?
a. A chronically a b u s e d woman is a s s e s s e d for an xiety.
b. A m a n i c patient is ta ken to the g y m to u s e the exe rcis e eq u ip men t.
c. T h e older adult d i a g n o s e d with depressi on is monitored for su icid al ideations.
d. A teen ager who refu ses to obey the unit’s ru les is not allow to p l a y video g a m e s .
ANS: A
T h e majority of h ealth discip lin es now rec ogn ize that men tal disorders a n d p h y s i c a l
illn e ss es are closely linked . T h e p re s e n c e of a men tal disorder in c rea se s the risk for the
dev el op men t of p h y s i c a l illn ess e s a n d v i ce v e r sa . A s s e s s i n g a chronically a b u s e d
individ u al for a n xi e ty call should attention to the psych ia tric disorder that could d evelop
from the a b u s e . T h e re ma in i n g options show interventions that are appropriate for the
men t al disorder.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 6
7. What reason d oes the n u rse g i v e the patient for the e m p h a s i s a n d attention b e i n g
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
p aid to the recovery p h a s e of their treatment plan?
a. Rec o v e ry care, e v e n when inten sive, is l e s s ex p e n s i v e than acu te p sych ia tric
care.
b. Effective recovery care is likely to result in fewer re lap s e s a n d su b s e q u e n t
hospitalizations.
c. Plann in g for recovery care is time c o n s u m i n g a n d in volves d e a l i n g with m a n y
comp lica ted details.
d. Re cov e ry care is u su ally done on a n outpatient b a s i s a n d so is gen e r ally better
acc e p te d b y patients.
ANS: B
Much attention is paid to recovery care s i n c e effective recovery care h e lp s improve
patient outcomes a n d thus mi n i mi z e su b se q u e n t hospitalizations. Re c o ve ry care is not
n e ce s sa ri l y le s s ex p e n s i v e than acu te care. Although effective recovery ca re p la n n i n g
m a y b e time c o n s u m i n g a n d detail oriented, that is not the reason for i mp l e me n ti n g it.
Re co v e r y care is not n e c e s sa r i ly well a cc e p t e d b y patients.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 7
8. T h e nu rse is attendin g a neighborhood me e t i n g where a half-way h ou se is b e i n g
proposed for the neighborhood when a m e m b e r of the co m mu n ity state s, “We don’t
want the facility; we e sp eci ally don’t want violent people livin g near u s.” T h e
resp on se b y the n u rse that best a d d re s s e s the p u b lic’s concern is:
a. “In truth, most in d ivid uals with psych ia tric disorder are p a s s i v e a n d withdrawn
a n d pose little threat to those around th em .”
b. “ T h e m en tally ill sel d om b e h a v e in the m a n n e r th ey are portrayed b y movie s;
th ey are people just like the rest of u s. ”
c. “Patients with psych ia tric disorder are so well m e d i ca t e d that th ey do not d i sp la y
violent behaviors.”
d. “ T h e m en tally ill d e s e r v e a safe, comfortable p l a c e to live a m o n g people who
truly care for th e m.”
ANS: A
A major reason for the e xi s te n c e of the s t i g m a p l a c e d on persons with m en ta l illn ess is
l a c k of knowledge. T h e m a i n fear is of violen ce, although only a s m a l l pe rc en tag e of
patients with men tal illness d is p l ay this behavior. Providing the p u b lic with accu rate
information c a n h elp re d u ce s ti g m a . T h e re ma i n in g options do not directly ad d r e s s the
con ce rns stated.
DIF: Cognit ive Le v e l : Application R E F: Pa g e s 13 - 1 4
9. Which activity shows that a therapeutic allian ce h a s b e e n estab lish e d between the
n u rse a n d patient?
a. T h e n u rse resp ects the patient’s right to p r i v a c y when visitors are s p e n d i n g time
with the patient.
b. T h e patient is e a g e rl y attending all group se s si on s a n d working in d ep en d en tly on
identifying their personal stressors.
c. T h e patient is freely d esc r ib i n g their feelin gs related to the p h y s ic al a n d
emotional trau ma th ey exp e r i e n c e d a s a child with the nu rse.
d. T h e nu rse dutifully ad ministers the patient’s med ication s on time a n d with
appropriate kn owled ge of the potential s id e effects.
ANS: C
A pri mary as p e ct of working with patients in a n y setting a n d particularly in the
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
psychiat ric setting is the d evel op m en t of a therapeutic allian ce with the patient. S u c h a n
allian ce is estab lish ed on trust. It is a professional bond between the n u rse a n d the
patient that s e r v e s a s a ve h i cl e for patients to freely d i s c u s s their n e e d s a n d problems in
the a b s e n c e of the n u rs e’s criticism or j u d gment. Any n u rse h a s a n obligation to respect
the patient’s rights a n d administe r care effectively. T h e patient’s willin gness to
participate in the p lan of care reflects self motivation.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 9
1 0 . Mental health care reform h a s call ed for parity between psych ia tric a n d m e d i c al
d i agn o s e s . Which is a n e x a m p l e of s u c h parity?
a. Dep ression treatment is not p aid for a s readily a s is treatment for a s t h m a .
b. T h e men tally ill patient will b e protected b y law aga in s t social st ig m a.
c. Medical practitioners are trained to b e proficient at treating m en tal disorders.
d. Psychiatric s e r vice reimb u rs emen t will b e eq u ival en t to that of m e d i c a l se r vic es.
ANS: D
T h e term parity a s u s e d here refers to p a y m e n t s for men tal health se r vi ce s that e q u a l
p a y m e n t s c h e d u l e s for m e d i c a l or su rgical conditions. T h e re mai n i n g options(B a n d C ) do
not relate to fin an cial re imb u rsem en t or fu nd s allocated for m en tal health care b e i n g
eq u a l to those of m e d i c a l di agn o se s.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 5
1. Which a s s e s s m e n t fin d in gs s u g g e s t to the n u rse that this patient h a s characteristics
s e e n in a n individual who h a s reac h e d self-actualization? Se lec t all that ap p ly.
a. Reports to h a v e , “found p e a c e a n d security in m y religious faith”
b. Effectively “ c h a n g e d occu pations” when a chronic vision problem worsened
c. H a s consistently ea rn e d a six-figure sala ry a s a n architect for the last 1 0 y e a rs
d. H a s b e e n in a supportive, lovin g relationship with the s a m e individ u al for 1 5
years
e. Provides free literacy tutoring h elp at the local h o m e le s s shelter 3 e v e n i n g s a
week
ANS: A, B , D , E
Characte ristics of self actualization would in clude: spiritual well-being, o pen a n d flexible,
relationally fulfilled, a n d generosity toward others. S a l a r y doesn’t n e ce s sa r i ly reflect self-
actualization.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
2. Which nu r sin g activities represen t the tertiary level of m en tal health care? S ele ct all
that ap p ly.
a. Providing a depressi on s c ree n i n g at a local college
b. He lp in g a men tal -ch allen g ed patient learn to m a ke correct c h a n g e
c. Reporting a n in cid en ce of po ssible elder a b u s e to the appropriate le gal a g e n c y
d. Re gu la r ly a s s e s s i n g a patient’s u n d e rs tan d i n g of their prescribed an tid ep ressan ts
e. Providing a 6-week paren tin g c l a s s to t e e n a g e paren ts through a local h i g h school
ANS: B , D
Tertiary prevention red u ce s the resid ual effects of the disorder s u c h a s depres sion a n d
men t al retardation. Th ere is no quaternary le ve l of prevention. Primary prevention
red u ce s occu rren ces of men tal disorders s u c h a s sc re e n i n g s a n d paren tin g c l a s s e s , a n d
sec on d a ry prevention red u ce s the p re val e n c e of disorders a s e v i d e n c e d b y a s s e s s i n g
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
knowledge.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
3. Which nu r sin g actions indicate a n u n d er sta n d in g of the priority i s s u e s currently
facin g psychiatric men t al health n u r sin g today? Selec t all that ap p ly.
a. Working on the facility’s ‘Sa fe Use of Restraints Policy’ revision com mittee
b. Advocating for in c re as ed salaries for all le ve ls of psych ia tric m en t al health nu rs e s
c. Attending a political rally for in crea s ed state fu nd in g for m en ta l health se r vice
providers
d. Offering a n in-service to facility staff reg a rd in g the cultural implications of car in g
for the H is p an i c patient
e. Joining the state n u r sin g committee working on the role a n d scop e of practice of
the a d v a n c e d practice psychiatric n u rse
ANS: A, C , D , E
Priority i s s u e s in clu d e fun din g, safety i s s u e s in psych ia tric treatment centers—
particularly the u s e of patient restraints, quality-of-care i s s u e s, a c c e s s to heal th care for
minority populations, a n d standardization of a d v a n c e d p ractice n u rse roles.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 9
4. Which a s s e s s m e n t fin d in gs d esc rib e risk factors that in c rea se the potential risk for
men tal illness? S el ec t all that ap p l y.
a. Po sse ss es h i g h tolerance for stress
b. Is ve r y curious about ‘how th in gs work’
c. Admits to b e i n g a m e m b e r of a n ethnic g a n g
d. Only practicing Jew a m o n g school c l a s s m a t e s
e. H a s a y ou nger sib li n g who is men tally c h a l l e n g e d
ANS: C , D , E
R i s k factors are internal pred isp osin g characteristics a n d external in flu en ces that
in crea s e a person’s vulnerability a n d potential for d evelo p in g m en ta l disorders. Ty p e s of
risk factors a n d ex a m p l e s in clu de the following: h a v i n g a men tal ly- ch a l l en g ed family
m e m b e r in the h ome; b elon gin g to a punitive g a n g ; a n d b e i n g the object of reject or
b ullyin g. T h e re ma i n i n g options are protective factors.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 1
5. Which nu r sin g actions show a focus on the f u n da men tal goals that g u i d e psychiat ric
men tal health n u rse s in providing patient care? Sel e ct all that ap p l y.
a. Offering a n informational s es sion of identifying s i g n s of dep ression at a local
senior cen ter
b. Attending a workshop on e v i d e n c e p ractice interventions for the chronically
d e p re s s e d patient
c. Ke e p i n g strict but appropriate boun darie s with a patient d ia gn o s e d with a
personality disorder
d. Askin g a parent who h a s just exp e r i e n ce d the d eath of a child if th ey could
consider talkin g with a grief counselor
e. Identifying what h el p a patient d ia gn o s e d with Alzheimer’s d i s e a s e will n e e d with
instrumental activi ties of daily livin g (IADLs)
ANS: A, B , D , E
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Stan d a rd objectives g u i d e PMH n u r s e s a n d m e m b e r s of related d iscip lin es in the care of
patients (ind ividu als, familie s, commu n ities, a n d organizations). T h e ob jectives a n d
criteria are a s follows: the promotion a n d protection of men tal health, the prevention of
men t al disorders, the treatment of m en tal disorders, a n d recovery a n d rehabilitation.
Ke e p i n g appropriate b o un daries is a ge n e ra li z e d n u rsin g responsibility.
DIF: Cognit ive Le v e l : Analy sis R E F: Pa g e 3
C h a p t e r 02 : N u r s in g Pr actice in t he Clinical S e t t in g
1. Which nu r sin g action is a reflection of Hild ega rd Pep lau’s theoretic framework
rega rd in g psych ia tric m en tal health nursing?
a. B a s i n g patient outcomes on ex p e c t e d instinctual resp on s es
b. D i s c u s s i n g a patient’s feelin gs rega rd in g parents a n d sib lin gs
c. Providing the patient with c l e a n clothes a n d wholesome food
d. Cen terin g professional practice in a state run psychiat ric facility
ANS: B
Pep lau’s pioneering en d eav o r s a n d contributions were la rgely in flu en ced b y
interpersonal p sy ch otherap y. S h e b elie ve d that disorders e v olv ed in the social context of
interpersonal interactions. (i.e., what went on between people). Instinctual resp on ses are
more related to intrapersonal interactions. Florence Nightin gale was instrumental in the
holistic ap p roach to n u rsin g care, whe reas L i n d a Rich ard s’ practice was centered on
institutional care of the men tal ill.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 8
2. T h e nu rse is atte mp tin g to provide a safe en vi ron ment for a patien t at great risk for
self-harm. Which intervention shows a n u n d erst an d in g of e v i d e n c e - b a s e d practice
(EBP)?
a. Usin g p h y s i c a l restraints only after all other options h a v e b e e n proven ineffective
b. Referring to the facility’s policies m a n u a l for gu id e l i n e s for a p p l y i n g p h y s i c a l
restraints
c. Collecting d ata rega rdi n g the short-term effects of u s i n g p h y s ic al restraints on a n
a g g re s s i v e patient
d. Req u irin g constant monitoring of a patient whose inability to self-regulate an g e r
h a s required the u s e of p h y s i ca l restraints
ANS: B
Health ca re s y s t e m s are participating in the shift in n u rsin g practice b y en cou ra gin g
re sea rch in their facilities a n d b y imp l eme n ti n g interventions that in cre a se n u rs es’
knowled ge about EBP. Nurses are participating to m a k e e vi d e n c e - b a s e d n u rsin g
practices av a ilab l e for their u s e , a n d th ey are he l p in g to dete rmine the outcomes that
will benefit patients. T h e re ma in i n g options are e x a m p l e s of long- stan ding practice
related to the u s e of p h y si ca l restraints.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 9
3. Which state men t b y the patient reflects patient education that was b a s e d on the
concept of integrated patient care?
a. “I know I’m an xio u s when I get a tension h e a d a c h e . ”
b. “My an xie ty is a result of stressors I don’t cope well with.”
c. “Medication h a s h e l p e d m e tremen d ously with an x ie ty control.”
TEST BANK
Psychiatric Mental Health Nursing
Katherine M. Fortinash, Patricia A. Holoday Worret
5th Edition
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Table of Contents
1. Psychiatric Nursing: Theory, Principles, and Trends
2. Nursing Practice in the Clinical Setting
3. The Nursing Process and Standards of Care
4. Therapeutic Communication: Interviews and Interventions
5. Adaptation to Stress
6. Neurobiology in Mental Health and Mental Disorder
7. Human Development Across the Life Span
8. Culture, Ethnicity, and Spirituality: A Global Perspective
9. Legal and Ethical Aspects in Clinical Practice
10. Anxiety and Related Disorders
11. Somatoform, Factitious, and Dissociative Disorders
12. Mood Disorders: Depression, Bipolar, and Adjustment Disorders
13. Schizophrenia and Other Psychotic Disorders
14. Personality Disorders
15. Substance Related Disorders and Addictive Behaviors
16. Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders
17. Disorders of Infancy, Childhood, and Adolescence
18. Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
19. Sleep Disorders: Dyssomnias and Parasomnias
20. Sexual Disorders: Sexual Dysfunctions and Paraphilias
21. Crisis: Theory and Intervention
22. Suicide: Prevention and Intervention
23. Violence: Anger, Abuse, and Aggression
24. Forensic Nursing in Clinical Practice
25. Psychopharmacology
26. Therapies: Theory and Clinical Practice
27. Complementary and Alternative Therapies
28. Grief in Loss and Death
29. Emotional and Mental Responses to Medical Illness
30. Community Mental Health Nursing for Patients with Severe and Persistent Mental Illness
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Fo r t i n a s h : P s y c h i a t r i c M e nt al H e a l t h N u r s i n g , 5 t h E d i t i o n
C h a p t e r 0 1 : P s y c h i a t r i c N u r s i n g : T h e o r y, P r i n c i p l e s , a n d Tr e n d s
1. Which u n d er stan d in g is the b a s i s for the n u r si n g actions focu sed on min i mi z i n g
men tal health promotion of families with ch ronically men tally ill me mb e r s?
a. Fa m i l y m e m b e r s a re at a n in crea se d risk for men ta l illness.
b. T h e men tal health c are s y s t e m is not p rep a red to d eal with family crises.
c. Fa m i l y m e m b e r s are seld o m p repa red to cop e with a chronically ill individ u al.
d. T h e chronically men ta lly ill recei ve ca re bes t when delive red in a formal setting.
ANS: A
When families live with a dominant m e m b e r who h a s a persistent a n d se v er e m en tal
disorder the outcomes are often ex p r e s s e d a s f amily m e m b e r s who are at in c rease d risk
for p h y s i c a l a n d men tal illn esses. T h e re m ain i n g options are not n e ce s sa r i ly true.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 3
2. Which nu r sin g activity shows the n u rse activ ely e n g a g e d in the p rimary prevention of
men tal disorders?
a. Providing a patient, whose depres sion is well m a n a g e d , with medication on time
b. Makin g regular follow-up visits to a new mother at risk for post-partum
depression
c. Providing the family of a patient, d ia g n o s ed with depression, information on
su icid e prevention
d. Assisting a patient who h a s ob s es s i v e c o m p u ls i v e ten d e n cie s p repare a n d
practice for a job interview
ANS: B
Primary prevention h el p s to red u ce the occu rrence of m en ta l disorders b y sta y i n g
involved with a patient. Providing medicati on a n d information on existin g illn es se s are
e x a m p l e s of se c on d a ry prevention which h e l p s to red u ce the p re v al e n c e of m en tal
disorders. Assistin g a men tally ill patient with preparation for a job interview is tertiary
prevention si n c e it in volves rehabilitation.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
3. Which intervention reflects attention b e i n g f ocu sed on the patien t’s intentions
rega rd in g h is d ia gn osis of se v e re depression?
a. B e i n g p l a c e d on su ic id e precautions
b. En c ou ra gin g visits b y h is family m e m b e r s
c. Re c e i v i n g a combination of med ication s to a d d re s s h is emotional n e e d s
d. B e i n g a s ke d to d e c i d e where h e will attend his prescrib ed the rapy s e s si on s
ANS: D
A pri mary factor in patient treatment in cl u d es consideration of the patient’s intentions
re ga rd in g h is or her own care. Patients are central to the p roce ss that d ete rmin es their
care a s their abilities allow. Under the g u i d a n c e of PMH n u rs e s a n d other men ta l health
personnel, patients a re en c ou r age d to m a k e d eci sion s a n d to actively e n g a g e in their
own treatment p lan s to m ee t their n e e d s . T h e re mai n i n g options are focused on sp e cif i cs
of the dete rmin ed p lan of care.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 5
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
4. When a patient’s family a s k s why their chro nically men tally ill adult child is b e i n g
d i s c h a rg e d to a co m mu n ity- b a s ed livin g facility, the n u rse resp onds:
a. “It is a way to me e t the n e e d for social support.”
b. “It is too ex p e n s i v e to ke e p stabiliz ed patients in acu te care se ttin gs.”
c. “Th i s ty p e of facility will provide the sp e ci al i zed care that is n ee d e d . ”
d. “B e i n g out in the c o m mu n ity will h elp provide hope a n d purpose for living.”
ANS: D
Hospitalization m a y b e n e c e s s a r y for acu te care, but, when patients are stabilized, th ey
m o v e into c om mu n ity -b ased , patient-centered settin gs or are d i s ch a rg e d h o me with
continued outpatient treatment in the co mmu n i ty. Concentrated efforts are m a d e to
red u ce the patien t’s s i c k role b y providing opportunities for the d evelop men t of a
purposeful life a n d instilling hop e for e a c h patient’s future. Although social support is
important, s u c h a livin g arran ge m en t is not the only way to a c h i e v e it. Although acu t e
care is e x p e n s i v e , it is not the major concern when dete rmin in g long-term care options.
C o m mu n it y -b a s e d facilities are not the only option for sp e ci al iz ed care.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 5
5. What is the be st exp lan ation to offer when the mother of a chronically ill te e n a g e
patient a s k s , “Under what ci rcu m s t an ce s would h e b e considered incompetent?”
a. “ Wh en you c a n provide the court with e n ou g h e v i d e n c e to show that h e is not
ab l e to care for himself safely.”
b. “It is not likely that s ome on e h is a g e would b e dete rmin ed to b e incompeten t
re ga rd les s of h i s men tal condition.”
c. “H e would h a v e to e n g a g e in behavior that would result in h arm to himself or to
some on e else; like you or h is sib lin gs.”
d. “If the illn ess b e c o m e s so s e ve re that h is j u d gm en t is imp aired to the point where
the d ecision s h e m a ke s are harmful to himself or to others.”
ANS: D
When a person is u n a b le to cognitively proce ss information or to m a ke decision s about
h is or her own welfare, the person m a y b e dete rmined to b e men tal ly incompetent.
Providing self-care is not the only criteria considered. Age is not a factor considered. T h e
decision is often b a s e d on the potential for s u c h behavior.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 6
6. Which psychiat ric n ur sin g intervention shows a n un d ers tan d i n g of integrated care?
a. A chronically a b u s e d woman is a s s e s s e d for an xiety.
b. A m a n i c patient is ta ken to the g y m to u s e the exe rcis e eq u ip men t.
c. T h e older adult d i a g n o s e d with depressi on is monitored for su icid al ideations.
d. A teen ager who refu ses to obey the unit’s ru les is not allow to p l a y video g a m e s .
ANS: A
T h e majority of h ealth discip lin es now rec ogn ize that men tal disorders a n d p h y s i c a l
illn e ss es are closely linked . T h e p re s e n c e of a men tal disorder in c rea se s the risk for the
dev el op men t of p h y s i c a l illn ess e s a n d v i ce v e r sa . A s s e s s i n g a chronically a b u s e d
individ u al for a n xi e ty call should attention to the psych ia tric disorder that could d evelop
from the a b u s e . T h e re ma in i n g options show interventions that are appropriate for the
men t al disorder.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 6
7. What reason d oes the n u rse g i v e the patient for the e m p h a s i s a n d attention b e i n g
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
p aid to the recovery p h a s e of their treatment plan?
a. Rec o v e ry care, e v e n when inten sive, is l e s s ex p e n s i v e than acu te p sych ia tric
care.
b. Effective recovery care is likely to result in fewer re lap s e s a n d su b s e q u e n t
hospitalizations.
c. Plann in g for recovery care is time c o n s u m i n g a n d in volves d e a l i n g with m a n y
comp lica ted details.
d. Re cov e ry care is u su ally done on a n outpatient b a s i s a n d so is gen e r ally better
acc e p te d b y patients.
ANS: B
Much attention is paid to recovery care s i n c e effective recovery care h e lp s improve
patient outcomes a n d thus mi n i mi z e su b se q u e n t hospitalizations. Re c o ve ry care is not
n e ce s sa ri l y le s s ex p e n s i v e than acu te care. Although effective recovery ca re p la n n i n g
m a y b e time c o n s u m i n g a n d detail oriented, that is not the reason for i mp l e me n ti n g it.
Re co v e r y care is not n e c e s sa r i ly well a cc e p t e d b y patients.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 7
8. T h e nu rse is attendin g a neighborhood me e t i n g where a half-way h ou se is b e i n g
proposed for the neighborhood when a m e m b e r of the co m mu n ity state s, “We don’t
want the facility; we e sp eci ally don’t want violent people livin g near u s.” T h e
resp on se b y the n u rse that best a d d re s s e s the p u b lic’s concern is:
a. “In truth, most in d ivid uals with psych ia tric disorder are p a s s i v e a n d withdrawn
a n d pose little threat to those around th em .”
b. “ T h e m en tally ill sel d om b e h a v e in the m a n n e r th ey are portrayed b y movie s;
th ey are people just like the rest of u s. ”
c. “Patients with psych ia tric disorder are so well m e d i ca t e d that th ey do not d i sp la y
violent behaviors.”
d. “ T h e m en tally ill d e s e r v e a safe, comfortable p l a c e to live a m o n g people who
truly care for th e m.”
ANS: A
A major reason for the e xi s te n c e of the s t i g m a p l a c e d on persons with m en ta l illn ess is
l a c k of knowledge. T h e m a i n fear is of violen ce, although only a s m a l l pe rc en tag e of
patients with men tal illness d is p l ay this behavior. Providing the p u b lic with accu rate
information c a n h elp re d u ce s ti g m a . T h e re ma i n in g options do not directly ad d r e s s the
con ce rns stated.
DIF: Cognit ive Le v e l : Application R E F: Pa g e s 13 - 1 4
9. Which activity shows that a therapeutic allian ce h a s b e e n estab lish e d between the
n u rse a n d patient?
a. T h e n u rse resp ects the patient’s right to p r i v a c y when visitors are s p e n d i n g time
with the patient.
b. T h e patient is e a g e rl y attending all group se s si on s a n d working in d ep en d en tly on
identifying their personal stressors.
c. T h e patient is freely d esc r ib i n g their feelin gs related to the p h y s ic al a n d
emotional trau ma th ey exp e r i e n c e d a s a child with the nu rse.
d. T h e nu rse dutifully ad ministers the patient’s med ication s on time a n d with
appropriate kn owled ge of the potential s id e effects.
ANS: C
A pri mary as p e ct of working with patients in a n y setting a n d particularly in the
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
psychiat ric setting is the d evel op m en t of a therapeutic allian ce with the patient. S u c h a n
allian ce is estab lish ed on trust. It is a professional bond between the n u rse a n d the
patient that s e r v e s a s a ve h i cl e for patients to freely d i s c u s s their n e e d s a n d problems in
the a b s e n c e of the n u rs e’s criticism or j u d gment. Any n u rse h a s a n obligation to respect
the patient’s rights a n d administe r care effectively. T h e patient’s willin gness to
participate in the p lan of care reflects self motivation.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 9
1 0 . Mental health care reform h a s call ed for parity between psych ia tric a n d m e d i c al
d i agn o s e s . Which is a n e x a m p l e of s u c h parity?
a. Dep ression treatment is not p aid for a s readily a s is treatment for a s t h m a .
b. T h e men tally ill patient will b e protected b y law aga in s t social st ig m a.
c. Medical practitioners are trained to b e proficient at treating m en tal disorders.
d. Psychiatric s e r vice reimb u rs emen t will b e eq u ival en t to that of m e d i c a l se r vic es.
ANS: D
T h e term parity a s u s e d here refers to p a y m e n t s for men tal health se r vi ce s that e q u a l
p a y m e n t s c h e d u l e s for m e d i c a l or su rgical conditions. T h e re mai n i n g options(B a n d C ) do
not relate to fin an cial re imb u rsem en t or fu nd s allocated for m en tal health care b e i n g
eq u a l to those of m e d i c a l di agn o se s.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 5
1. Which a s s e s s m e n t fin d in gs s u g g e s t to the n u rse that this patient h a s characteristics
s e e n in a n individual who h a s reac h e d self-actualization? Se lec t all that ap p ly.
a. Reports to h a v e , “found p e a c e a n d security in m y religious faith”
b. Effectively “ c h a n g e d occu pations” when a chronic vision problem worsened
c. H a s consistently ea rn e d a six-figure sala ry a s a n architect for the last 1 0 y e a rs
d. H a s b e e n in a supportive, lovin g relationship with the s a m e individ u al for 1 5
years
e. Provides free literacy tutoring h elp at the local h o m e le s s shelter 3 e v e n i n g s a
week
ANS: A, B , D , E
Characte ristics of self actualization would in clude: spiritual well-being, o pen a n d flexible,
relationally fulfilled, a n d generosity toward others. S a l a r y doesn’t n e ce s sa r i ly reflect self-
actualization.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
2. Which nu r sin g activities represen t the tertiary level of m en tal health care? S ele ct all
that ap p ly.
a. Providing a depressi on s c ree n i n g at a local college
b. He lp in g a men tal -ch allen g ed patient learn to m a ke correct c h a n g e
c. Reporting a n in cid en ce of po ssible elder a b u s e to the appropriate le gal a g e n c y
d. Re gu la r ly a s s e s s i n g a patient’s u n d e rs tan d i n g of their prescribed an tid ep ressan ts
e. Providing a 6-week paren tin g c l a s s to t e e n a g e paren ts through a local h i g h school
ANS: B , D
Tertiary prevention red u ce s the resid ual effects of the disorder s u c h a s depres sion a n d
men t al retardation. Th ere is no quaternary le ve l of prevention. Primary prevention
red u ce s occu rren ces of men tal disorders s u c h a s sc re e n i n g s a n d paren tin g c l a s s e s , a n d
sec on d a ry prevention red u ce s the p re val e n c e of disorders a s e v i d e n c e d b y a s s e s s i n g
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
knowledge.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 4
3. Which nu r sin g actions indicate a n u n d er sta n d in g of the priority i s s u e s currently
facin g psychiatric men t al health n u r sin g today? Selec t all that ap p ly.
a. Working on the facility’s ‘Sa fe Use of Restraints Policy’ revision com mittee
b. Advocating for in c re as ed salaries for all le ve ls of psych ia tric m en t al health nu rs e s
c. Attending a political rally for in crea s ed state fu nd in g for m en ta l health se r vice
providers
d. Offering a n in-service to facility staff reg a rd in g the cultural implications of car in g
for the H is p an i c patient
e. Joining the state n u r sin g committee working on the role a n d scop e of practice of
the a d v a n c e d practice psychiatric n u rse
ANS: A, C , D , E
Priority i s s u e s in clu d e fun din g, safety i s s u e s in psych ia tric treatment centers—
particularly the u s e of patient restraints, quality-of-care i s s u e s, a c c e s s to heal th care for
minority populations, a n d standardization of a d v a n c e d p ractice n u rse roles.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 9
4. Which a s s e s s m e n t fin d in gs d esc rib e risk factors that in c rea se the potential risk for
men tal illness? S el ec t all that ap p l y.
a. Po sse ss es h i g h tolerance for stress
b. Is ve r y curious about ‘how th in gs work’
c. Admits to b e i n g a m e m b e r of a n ethnic g a n g
d. Only practicing Jew a m o n g school c l a s s m a t e s
e. H a s a y ou nger sib li n g who is men tally c h a l l e n g e d
ANS: C , D , E
R i s k factors are internal pred isp osin g characteristics a n d external in flu en ces that
in crea s e a person’s vulnerability a n d potential for d evelo p in g m en ta l disorders. Ty p e s of
risk factors a n d ex a m p l e s in clu de the following: h a v i n g a men tal ly- ch a l l en g ed family
m e m b e r in the h ome; b elon gin g to a punitive g a n g ; a n d b e i n g the object of reject or
b ullyin g. T h e re ma i n i n g options are protective factors.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 1
5. Which nu r sin g actions show a focus on the f u n da men tal goals that g u i d e psychiat ric
men tal health n u rse s in providing patient care? Sel e ct all that ap p l y.
a. Offering a n informational s es sion of identifying s i g n s of dep ression at a local
senior cen ter
b. Attending a workshop on e v i d e n c e p ractice interventions for the chronically
d e p re s s e d patient
c. Ke e p i n g strict but appropriate boun darie s with a patient d ia gn o s e d with a
personality disorder
d. Askin g a parent who h a s just exp e r i e n ce d the d eath of a child if th ey could
consider talkin g with a grief counselor
e. Identifying what h el p a patient d ia gn o s e d with Alzheimer’s d i s e a s e will n e e d with
instrumental activi ties of daily livin g (IADLs)
ANS: A, B , D , E
, Test Bank - Psychiatric Mental Health Nursing 5th Edition (Fortinash, 2012)
Stan d a rd objectives g u i d e PMH n u r s e s a n d m e m b e r s of related d iscip lin es in the care of
patients (ind ividu als, familie s, commu n ities, a n d organizations). T h e ob jectives a n d
criteria are a s follows: the promotion a n d protection of men tal health, the prevention of
men t al disorders, the treatment of m en tal disorders, a n d recovery a n d rehabilitation.
Ke e p i n g appropriate b o un daries is a ge n e ra li z e d n u rsin g responsibility.
DIF: Cognit ive Le v e l : Analy sis R E F: Pa g e 3
C h a p t e r 02 : N u r s in g Pr actice in t he Clinical S e t t in g
1. Which nu r sin g action is a reflection of Hild ega rd Pep lau’s theoretic framework
rega rd in g psych ia tric m en tal health nursing?
a. B a s i n g patient outcomes on ex p e c t e d instinctual resp on s es
b. D i s c u s s i n g a patient’s feelin gs rega rd in g parents a n d sib lin gs
c. Providing the patient with c l e a n clothes a n d wholesome food
d. Cen terin g professional practice in a state run psychiat ric facility
ANS: B
Pep lau’s pioneering en d eav o r s a n d contributions were la rgely in flu en ced b y
interpersonal p sy ch otherap y. S h e b elie ve d that disorders e v olv ed in the social context of
interpersonal interactions. (i.e., what went on between people). Instinctual resp on ses are
more related to intrapersonal interactions. Florence Nightin gale was instrumental in the
holistic ap p roach to n u rsin g care, whe reas L i n d a Rich ard s’ practice was centered on
institutional care of the men tal ill.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 8
2. T h e nu rse is atte mp tin g to provide a safe en vi ron ment for a patien t at great risk for
self-harm. Which intervention shows a n u n d erst an d in g of e v i d e n c e - b a s e d practice
(EBP)?
a. Usin g p h y s i c a l restraints only after all other options h a v e b e e n proven ineffective
b. Referring to the facility’s policies m a n u a l for gu id e l i n e s for a p p l y i n g p h y s i c a l
restraints
c. Collecting d ata rega rdi n g the short-term effects of u s i n g p h y s ic al restraints on a n
a g g re s s i v e patient
d. Req u irin g constant monitoring of a patient whose inability to self-regulate an g e r
h a s required the u s e of p h y s i ca l restraints
ANS: B
Health ca re s y s t e m s are participating in the shift in n u rsin g practice b y en cou ra gin g
re sea rch in their facilities a n d b y imp l eme n ti n g interventions that in cre a se n u rs es’
knowled ge about EBP. Nurses are participating to m a k e e vi d e n c e - b a s e d n u rsin g
practices av a ilab l e for their u s e , a n d th ey are he l p in g to dete rmine the outcomes that
will benefit patients. T h e re ma in i n g options are e x a m p l e s of long- stan ding practice
related to the u s e of p h y si ca l restraints.
DIF: Cognit ive Le v e l : Application R E F: Pa g e 1 9
3. Which state men t b y the patient reflects patient education that was b a s e d on the
concept of integrated patient care?
a. “I know I’m an xio u s when I get a tension h e a d a c h e . ”
b. “My an xie ty is a result of stressors I don’t cope well with.”
c. “Medication h a s h e l p e d m e tremen d ously with an x ie ty control.”
