Test Bank - Varcarolis' Foundations of Psychiatric Mental Health Nursing (8th Edition)

Test Bank - Varcarolis' Foundations of Psychiatric Mental Health Nursing (8th Edition) Table of Contents Table of Contents 1 Chapter 01: Mental Health and Mental Illness Chapter 02: Theories and Therapies Chapter 03: Psychobiology and Psychopharmacology Chapter 04: Treatment Settings Chapter 05: Cultural Implications Chapter 06: Legal and Ethical Considerations Chapter 07: The Nursing Process and Standards of Care Chapter 08: Therapeutic Relationships Chapter 09: Therapeutic Communication Chapter 10: Stress Responses and Stress Management Chapter 11: Childhood and Neurodevelopmental Disorders Chapter 12: Schizophrenia Spectrum Disorders Chapter 13: Bipolar and Related Disorders Chapter 14: Depressive Disorders Chapter 15: Anxiety and Obsessive-Compulsive Disorders Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders Chapter 17: Somatic Symptom Disorders Chapter 18: Eating and Feeding Disorders Chapter 19: Sleep-Wake Disorders Chapter 20: Sexual Dysfunctions, Gender Dysphoria, and Paraphilias Chapter 21: Impulse Control Disorders Chapter 22: Substance Related and Addictive Disorders Chapter 23: Neurocognitive Disorders Chapter 24: Personality Disorders Chapter 25: Suicide and Nonsuicidal Self-Injury Chapter 26: Crisis and Disaster Chapter 27: Anger, Aggression, and Violence Chapter 28: Child, Older Adult, and Intimate Partner Violence Chapter 29: Sexual Assault Chapter 30: Dying, Death, and Grieving Chapter 31: Older Adults Chapter 32: Serious Mental Illness Chapter 33: Forensic Nursing Chapter 34: Therapeutic Groups Chapter 35: Family Interventions Chapter 36: Integrative Care 2 14 30 45 62 78 92 106 120 132 144 157 175 192 207 223 237 250 264 276 288 299 315 329 344 357 370 383 394 405 415 431 447 458 472 485 Chapter 01: Mental Health and Mental Illness MULTIPLE CHOICE 1. A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a. Conduct mental health assessments. c. Establish therapeutic relationships. b. Prescribe psychotropic medication. d. Individualize nursing care plans. ANS: B In most states, prescriptive privileges are granted to masters-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 15 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 2. When a nursing student expresses concerns about how mental health nurses lose all their nursing skills, the best response by the mental health nurse is: a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients problems. b. Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations. c. Thats a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me. ANS: B The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 10 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery c. Advocacy b. Attending d. Evidence-based practice ANS: C An advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter- writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 16 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 4. Which comment best indicates that a patient perceived the nurse was caring? My nurse: a. always asks me which type of juice I want to help me swallow my medication. b. explained my treatment plan to me and asked for my ideas about how to make it better. c. spends time listening to me talk about my problems. That helps me feel like I am not alone. d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner. ANS: C Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 7 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 5. Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient: a. reports occasional sleeplessness and anxiety. b. reports a consistently sad, discouraged, and hopeless mood. c. is able to describe the difference between as if and for real. d. perceives difficulty making a decision about whether to change jobs. ANS: B The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 6. Which finding best indicates that the goal Demonstrate mentally healthy behavior was achieved? A patient: a. sees self as capable of achieving ideals and meeting demands. b. behaves without considering the consequences of personal actions. c. aggressively meets own needs without considering the rights of others. d. seeks help from others when assuming responsibility for major areas of own life. ANS: A The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 2 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 7. A nurse encounters an unfamiliar psychiatric disorder on a new patients admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. A behavioral health reference manual d. Wikipedia ANS: B The DSM-5 gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 3 TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment 8. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. The ANAs Psychiatric-Mental Health Nursing Scope and Standards of Practice d. International Statistical Classification of Diseases and Related Health Problems (ICD-10) ANS: B The DSM-5 details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 10 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 9. Which individual is demonstrating the highest level of resilience? One who: a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for two years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job. ANS: D Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and depression are unhealthy. Living in a shelter for two years shows a failure to move forward after a tragedy. See related audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 3 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 10. Complete this analogy. NANDA: clinical judgment: NIC: a. patient outcomes c. diagnosis b. nursing actions d. symptoms ANS: B Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing care activities may be direct or indirect. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: 13 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 11. A college student said, Most of the time Im happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it. Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5 a. 1 b. 2 c. 3 d. 4 e. ANS: E 5 The student is happy and has an adequate self-concept. The student is reality-oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is always happy. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which disorder is a culture-bound syndrome? a. Epilepsy c. Running amok b. Schizophrenia d. Major depression ANS: C Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 5 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies: a. deviant behaviors. c. people with mental disorders. b. present disability or distress. d. mental disorders people have. ANS: D The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a schizophrenic or alcoholic, for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 10 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 14. A citizen at a community health fair asks the nurse, What is the most prevalent mental disorder in the United States? Select the nurses best response. a. Schizophrenia c. Dissociative fugue b. Bipolar disorder d. Alzheimers disease ANS: D The 12-month prevalence for Alzheimers disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder. See related audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 9 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 15. In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing Gods voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met. ANS: A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: 4 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 16. A patients relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work c. Productive activities b. Communication skills d. Fulfilling relationships ANS: D The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 17. Which belief will best support a nurses efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a persons cultural patterns. ANS: D A nurse who understands that a patients symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 4 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Incidence c. Co-morbidity b. Prevalence d. Clinical epidemiology ANS: D Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Co-morbidity refers to having more than one mental disorder at a time.Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. See related audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 9 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 19. The spouse of a patient diagnosed with schizophrenia says, I dont understand how events from childhood have anything to do with this disabling illness. Which response by the nurse will best help the spouse understand the cause of this disorder? a. Psychological stress is the basis of most mental disorders. b. This illness results from developmental factors rather than stress. c. Research shows that this condition more likely has a biological basis. d. It must be frustrating for you that your spouse is sick so much of the time. ANS: C Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouses level of knowledge about the cause of the disorder. The other distracters are not established facts. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 6 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 20. A category 5 tornado occurred in a community of 400 people resulting in destruction of many homes and businesses. In the 2 years after this disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence c. Incidence b. Co-morbidity d. Parity ANS: C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill. Parity refers to equivalence, and legislation required insurers that provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. Co-morbidity refers to having more than one mental disorder at a time PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 9 TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Safe, Effective Care Environment 21. Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health. ANS: B The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety, and informatics. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 8 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 22. Select the best response for the nurse who receives a question from another health professional seeking to understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and a nursing diagnosis. a. There is no functional difference between the two. Both identify human disorders. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology. d. The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing. ANS: D The medical diagnosis is concerned with the patients disease state, causes, and cures, whereas the nursing diagnosis focuses on the patients response to stress and possible caring interventions. Both tools consider culture. The DSM-5 is multiaxial. Nursing diagnoses also consider potential problems. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 10 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 23. Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse only? a. Coordination of care c. Milieu therapy b. Health teaching d. Psychotherapy ANS: D Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a staff nurses scope of practice. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 14 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment MULTIPLE RESPONSE 1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you instantly know how to take care of psychotic patients. What information should the new graduate consider when analyzing thi comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients needs guides effective psychiatric nurses. ANS: A, B Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 7 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Safe, Effective Care Environment 2. Which findings are signs of a person who is mentally healthy? Select all that apply. a. Says, I have some weaknesses, but I feel Im important to my family and friends. b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs. ANS: A, D, E Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. A patient in the emergency department says, Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat. Which aspects of the patients mental health have the greatest and most immediate concern to the nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept ANS: B, C, E The aspects of mental health of greatest concern are the patients appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patients control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 2 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity Chapter 02: Theories and Therapies MULTIPLE CHOICE 1. A parent says, My 2-year-old child refuses toilet training and shouts No! when given directions. What do you think is wrong? Select the nurses best reply. a. Your child needs firmer control. It is important to set limits now. b. This is normal for your childs age. The child is striving for independence. c. There may be developmental problems. Most children are toilet trained by age 2. d. Some undesirable attitudes are developing. A child psychologist can help you develop a plan. ANS: B This behavior is typical of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the childs behavior is abnormal. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 21 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 2. A 26-month-old displays negative behavior, refuses toilet training, and often says, No! Which stage of psychosexual development is evident? a. Oral c. Phallic b. Anal d. Genital ANS: B The anal stage occurs from age 1 to 3 years and has as its focus toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year. The phallic stage occurs between 3 and 5 years, and the genital stage occurs between age 13 and 20 years. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. A 26-month-old displays negative behavior, refuses toilet training, and often says, No! Which psychosocial crisis is evident? a. Trust versus mistrust c. Industry versus inferiority b. Initiative versus guilt d. Autonomy versus shame and doubt ANS: D The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. A 4-year-old grabs toys from siblings and says, I want that now! The siblings cry, and the childs parent becomes upset with the behavior. According to Freudian theory, this behavior is a product of impulses originating in which system of the personality? a. Id c. Superego b. Ego d. Preconscious ANS: A The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mothers wrath. The superego would oppose the impulsive behavior as not nice. The preconscious is a level of awareness. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 19 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports this use of praise related to these behaviors. These qualities are likely to be internalized and become part of which system of the personality? a. Id c. Superego b. Ego d. Preconscious ANS: C The superego contains the thou shalts, or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 19 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 6. A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt c. Humility b. Anxiety d. Self-esteem ANS: D The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect because each represents a negative feeling. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 7. An adult says, I never know the answers, and My opinion doesnt count. Which psychosocial crisis was unsuccessfully resolved for this adult? a. Initiative versus guilt c. Autonomy versus shame and doubt b. Trust versus mistrust d. Generativity versus self-absorption ANS: C These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self- absorption that limits the ability to grow as a person. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy? a. I have very warm and close friendships. b. Im afraid to allow anyone to really get to know me. c. Im always absolutely right, so dont bother saying more. d. Im ashamed that I didnt do things correctly in the first place. ANS: B According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. Warm, close relationships suggest the developmental task of infancy was successfully completed; rigidity and self-absorption are reflected in the belief one is always right; and shame for past actions suggests failure to resolve the crisis of initiative versus guilt. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral c. Phallic b. Anal d. Genital ANS: A The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the patients needs? a. Latency c. Anal b. Phallic d. Oral ANS: D Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 11. A nurse listens to a group of recent retirees. One says, I volunteer with Meals on Wheels, coach teen sports and do church visitation. Another laughs and says, Im too busy taking care of myself to volunteer to help others. Which developmental task do these statements contrast? a. Trust and mistrust c. Industry and inferiority b. Intimacy and isolation d. Generativity and self-absorption ANS: D Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self- absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and the ability to love and commit oneself. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 21 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. Although ego defense mechanisms and security operations are mainly unconscious and designed to relieve anxiety, the major difference is that: a. defense mechanisms are intrapsychic and not observable. b. defense mechanisms cause arrested personal development. c. security operations are masterminded by the id and superego. d. security operations address interpersonal relationship activities. ANS: D Sullivans theory explains that security operations are interpersonal relationship activities designed to relieve anxiety. Because they are interpersonal, they are observable. Defense mechanisms are unconscious and automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviors. Frequent, continued use of many defense mechanisms often results in reality distortion and interference with healthy adjustment and emotional development. Occasional use of defense mechanisms is normal and does not markedly interfere with development. Security operations are ego-centered. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 32 TOP: Nursing Process: Analysis MSC: Client Needs: Health Promotion and Maintenance 13. A student nurse says, I dont need to interact with my patients. I learn what I need to know by observation. An instructor can best interpret the nursing implications of Sullivans theory to this student by responding: a. Interactions are required in order to help you develop therapeutic communication skills. b. Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills. c. Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions. d. It is important to pay attention to patients behavioral changes, because these signify adjustments in personality. ANS: B The nurses role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivans theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The other distracters relate to Maslow and behavioral theory. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 32 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 14. A nurse consistently encourages patient to do his or her own activities of daily living (ADLs). If the patient is unable to complete an activity, the nurse helps until the patient is once again independent. This nurses practice is most influenced by which theorist? a. Betty Neuman c. Dorothea Orem b. Patricia Benner d. Joyce Travelbee ANS: C Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this has relevance to the seriously and persistently mentally ill patient. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 29 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 15. A nurse uses Maslows hierarchy of needs to plan care for a patient with mental illness. Which problem will receive priority? The patient: a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. is unaware of medication action and side effects. ANS: A The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: 30 TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Safe, Effective Care Environment 16. Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? a. Encourage the child to observe others talking. b. Include the child in small group activities. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques. ANS: C Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 26 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 17. The parent of a child diagnosed with schizophrenia tearfully asks the nurse, What could I have done differently to prevent this illness? Select the nurses best response. a. Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance. b. Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your childs illness. c. There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment. d. Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting. ANS: B The parents comment suggests feelings of guilt or inadequacy. The nurses response should address these feelings as well as provide information. Patients and families need reassurance that the major mental disorders are biological in origin and are not the fault of parents. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 32 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. A nurse influenced by Peplaus interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on: a. rewarding desired behaviors. b. use of assertive communication. c. changing the patients self-concept. d. administering medications to relieve anxiety. ANS: B The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the patient learn to use assertive communication will improve the patients interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 19. A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behavior therapy c. Cognitive-behavioral therapy b. Psychodynamic psychotherapy d. Operant conditioning ANS: B The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 19 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. Consider this comment from a therapist: The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation. Which perspective is evident in the speaker? a. Theory of interpersonal relationships c. Psychosexual theory b. Classical conditioning theory d. Behaviorism theory ANS: A The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the patient problem. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 23 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 21. A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy? a. Identifying the patients strengths and assets b. Praising the patient for describing feelings of isolation c. Focusing on feelings developed by the patient toward the therapist d. Providing psychoeducation and emphasizing medication adherence ANS: C Positive or negative feelings of the patient toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common homework assignment used in cognitive therapy. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 20 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 22. A person says, I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and Im better now. Which type of therapy was used? a. Milieu therapy c. Behavior modification b. Psychoanalysis d. Interpersonal psychotherapy ANS: D Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the patient understand what is going on in his life. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 23 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 23. Which technique is most applicable to aversion therapy? a. Punishment c. Role modeling b. Desensitization d. Positive reinforcement ANS: A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 27 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 24. A patient says to the nurse, My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child. Which term applies to the patients comment? a. Superego c. Reality testing b. Transference d. Counter-transference ANS: B Transference refers to feelings a patient has toward the health care workers that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 20 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 25. A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient? a. Psychoanalysis c. Systematic desensitization b. Milieu therapy d. Short-term dynamic therapy ANS: C Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental factors. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 26 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 26. A patient would benefit from therapy in which peers as well as staff have a voice in determining patients privileges and psychoeducational topics. Which approach would be best? a. Milieu therapy c. Short-term dynamic therapy b. Cognitive therapy d. Systematic desensitization ANS: A Milieu therapy is based on the idea that all members of the environment contribute to the planning and functioning of the setting. The distracters are individual therapies that do not fit the description. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: 32 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 27. A patient repeatedly stated, Im stupid. Which statement by that patient would show progress resulting from cognitive behavioral therapy? a. Sometimes I do stupid things. b. Things always go wrong for me. c. I always fail when I try new things. d. Im disappointed in my lack of ability. ANS: A Im stupid is a cognitive distortion. A more rational thought is Sometimes I do stupid things. The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 28 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 28. A patient says, All my life Ive been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent. This patient is experiencing a: a. self-esteem deficit. c. deficit in motivation. b. cognitive distortion. d. deficit in love and belonging. ANS: B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 28 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 29. A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and patient then stand in an elevator with the door open for five minutes and later with the elevator door closed for five minutes. Which technique has the therapist used? a. Classic psychoanalytic therapy c. Rational emotive therapy b. Systematic desensitization d. Biofeedback ANS: B Systematic desensitization is a form of behavior modification therapy that involves the development of behavior tasks customized to the patients specific fears. These tasks are presented to the patient while using learned relaxation techniques. The patient is incrementally exposed to the fear. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: 27 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 30. A patient says, I always feel good when I wear a size 2 petite. Which type of cognitive distortion is evident? a. Disqualifying the positive c. Catastrophizing b. Overgeneralization d. Personalization