Essentials of Psychiatric Mental HealthNursing 4th Edition Varcarolis NursingTest Bank.

Essentials of Psychiatric Mental HealthNursing 4th Edition Varcarolis NursingTest Bank. WWW.THENURSINGMASTERY.COM Chapter 01: Science and the Therapeutic Use of Self in Psychiatric Mental Health Nursing Varcarolis: Essentials of Psychiatric Mental Health Nur as b inirbg .c : omA/teCst ommunication Approach to Evidence-Based Care, 4th Edition MULTIPLE CHOICE 1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and paebr n/t temst ental illness? Within 3 months, the patient will demonstrate what behavior? a. Denying suicidal ideation b. Reporting a sense of well-being c. Taking medications as prescribed d. Attending clinic appointments on time ANS: B Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medabic irba . l commo/tedse t l rather than recovery. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Outcomes Identification MSC: NCLEX: Health Promotion and Maintenance 2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse’s most caring comment. a. “Let’s discuss healthy means of coping when you have suicidal feelings.” b. “I understand why you’re so depressed. When I got divorced, I was devastated too.” c. “You should forget about your marriage and move on awbi i r t bh .coy mo /u te r st life.” d. “How did you get so depressed that hospitalization was necessary?” ANS: A The nurse’s communication should evidence caring and a ac bo t /tmese t nt to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful for therapeutic interventions. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 3. In the shift-change report, an off-going nurse criticizes a w/tehsot wears extremely heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. “This is a psychiatric hospital, so we expect our patients to behave bizarrely.” b. “Let’s all show acceptance of this patient by wearing l a o b t i s rb o .c f omm/te a s k t eup too.” c. “Your comments are inconsiderate and inappropriate. Keep the report objective.” d. “Our patients need our help to learn behaviors that will help them get along in society.” ANS: D WWW.NURSYLAB.COM WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Accepting patients’ needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that others are not d/taegstainst the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of “attending”? a. “We all have stress in life. Being in a psychiatric hospital is not the end of the world.” b. “Tell me why you felt you had to be hospitalized to receive treatment for your depression.” c. “You will feel better after we get some antidepressant ambir ebd.c io cma/ t t ieostn started for you.” d. “I’d like to sit with you for a while, so you may feel more comfortable talking with me.” ANS: D Attending is a technique that demonstrates the nurse’s commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are nontherapeutic. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. A patient shows the nurse an article from the Internet abou a t bia rb.h coe mal /t t eh stproblem. Which characteristic of the website’s address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in “.org.” b. Address ends in “.com.” c. Address ends in “.gov.” d. Address ends in “.net.” ANS: B Financial influences on a site are a clue that the information may be biased. “.com” at the end of the address indicates that the site is a commercial one. “.gov” indicates that the site is maintained by a government entity. “.org” indicates that th a e bir s b i .c te om is /te n st onproprietary; the site may or may not have reliable information, but it does not profit from its activities. “.net” can have multiple meanings. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 6. A nurse says, “When I was in school, I learned to call upse a t birp ba .c t o i men /te ts stby name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name.” Which statement is the best appraisal of this nurse’s comment? a. One descriptive research study rarely provides enough evidence to change practice. WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into g/toesrtithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change. ANS: A Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flowcha a r b t i s rb t .c o om m /t a es n t age problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. Two nursing students discuss career plans after graduation a . bOirbn .ce oms / t teu sd t ent wants to enter psychiatric nursing. The other student asks, “Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.” Select the best response by the student interested in psychiatric nursing. a. “Psychiatric nurses’ practice in safer environments than other specialties and nurse-to-patient ratios are better because of the nature of patients’ problems.” b. “Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I’m challenged by ab t irh bo .c s oe m/ s te i s t tuations.” c. “I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.” d. “Psychiatric nurses do not have to deal with as much d/tessutfferingas medical-surgical nurses. That appeals to me.” ANS: B The practice of psychiatric nursing requires a different ll/stestht an medical-surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves cl a i bn ir i bc .a co l mp /t r ea sc t tice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 8. Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway ANS: B WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is level A and provides the strongest evidence for changing practice. Expert committee recommendations and md/tieesst lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed. DIF: Cognitive Level: Comprehension (Understanding) MSC: NCLEX: Safe, Effective Care Environment abirbT .cOomP / : tesNt ursing Process: Planning 9. A bill introduced in Congress would reduce funding for tha ebi crb a.c r o em o/t f es pt eople diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice ANS: A An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for him or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a communitaybi lem, /taesdtvocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10. An informal group of patients discuss their perceptions ofan bu irb r . s c i on mg /tec sa t re. Which comment best indicates a patient’s perception that his or her nurse is caring? a. “My nurse always asks me which type of juice I want to help me swallow my medication.” b. “My nurse explained my treatment plan to me and asked for my ideas about how to make it better.” c. “My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon.” d. “My nurse spends time listening to me talk about my problems. That helps me feel like I’m not alone.” ANS: D Caring evidences empathic 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 incorrect options give examples of d/teesmt onstrate advocacy or giving advice. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM 11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team t /ftoesrt information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems (ICD) ANS: A A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patient’s needs, such mi/tcesotrigin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 12. A team of nurses wants to integrate evidence-based practice into a facility’s clinical pathways. Which step should the team implement first? a. Acquire findings from published literature. b. Apply the research findings to clinical practice. c. Assess the outcomes of using new research findings. d. Ask questions to identify clinical problems that should be changed. ANS: D Integrating evidence-based practice is a multistep process rather than a single change event. The first step is to identify clinical problems that should be changed. Each step must proceed in order when integrated into a clinical environment. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction reported by a patient indicates this nurse is most effective? a. Feeling less distrustful of others b. Sensing a connection with others c. Experiencing only minimal uneasiness about the future d. Being somewhat encouraged with efforts to improve ANS: B A patient is likely to respond most to caring with a sense of connectedness with others. The absence of caring can make patients feel some degree of distrustful, disconnection, unease, and discouragement. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM MULTIPLE RESPONSE 1. An experienced nurse says to a new graduate, “When you’c/tteiscted as long as I have, you will instantly know how to take care of psychotic patients.” What is the new graduate’s best analysis of this 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 must be continually integrated into a nurse’s practice to provide the most effective care. c. Experience provides mental health nurses with the effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guid ae bid rb.b coy ma /tn es i tntuitive sense of patients’ needs. ANS: A, B Evidence-based practice involves using research findings t ao birp b. r co ov mi /d tee st the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Ir/tieaslt and error are unsystematic approaches to care. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 2. Which patient statements identify qualities of nursing practice with high therapeutic value? “My nurse: (Select all that apply.) a. “The nurses talk in language I can understand.” b. “The nursing staff helps me keep track of my medications.” c. “My nurse is willing to go to social activities with me.” d. “The staff lets me do whatever I choose without interfeabri .”m/test e. “My nurses look at me as a whole person with different needs.” ANS: A, B, E Each correct answer demonstrates caring is an example of aa oomp/ r tei sa t te nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse when the nurse should instead provideab t ts f tul feedback and help patients test alternative solutions or violate boundaries. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Pmc/tieasltIntegrity S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Chapter 02: Mental Health and Mental Illness Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care, 4th Edition MULTIPLE CHOICE 1. An 86 year old, previously healthy and independent, falls after an episode of vertigo. Which statement made by this patient best demonstrates resilience? a. “I knew this would happen eventually.” b. “Attending my weekly water aerobics class is too risky.” c. “I don’t need that silly walker to get around by myself.” d. “Maybe some physical therapy will help me with my balance.” ANS: D Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking a p b o ir s b i .c ti o v m e /t l e y st about ways to adapt to the vertigo. Saying “I knew this would happen eventually” and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. Which basic intervention should a psychiatric mental heala th birn b.u co rs me /tep s l tan to provide for a patient diagnosed with a mood disorder? a. Sharing clinical expertise to enhance patient treatment b. Performing individual or group psychotherapy for the t /test c. Using appropriate diagnostic tests to monitor patient condition d. Conducting stress reduction and health maintenance classes ANS: D Conducting stress reduction and health maintenance classes is the basic intervention that should be performed by a psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management clas a s be irb s .ca o r me /te esx tamples of health maintenance classes. Consulting nurses from other disciplines to share clinical expertise and enhance patient treatment is an advanced practice psychiatric mental health nursing intervention. Performing individual and group d/tepsetrforming diagnostic tests like blood pressure, etc., are also advanced practice psychiatric mental health nursing interventions. DIF: Cognitive Level: Application (Applying) MSC: NCLEX: Psychosocial Integrity abirbT .cOomP / : tesNt ursing Process: Planning 3. A patient is admitted to the psychiatric hospital. Which ass a e bi s rb s .mco em n /te t s f t inding best indicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can perform tasks attempted within the limits of own aabbi irlbi .t cioems. /test d. reports occasional problems with insomnia. S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal ANS: B A patient who reports having a consistently negative mood is describing a mood alteration that affects the ability to function optimistically. The incor a r be irc b t .co omp / t t i eo stns describe mentally healthy behaviors and common problems that do not indicate mental illness. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 4. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care to be achieved within 3 days? a. Patient describes feelings associated with loss and stress. b. Patient meet own needs before considering the rights of others. c. Patient will identify healthy coping behaviors in respoa nb s ir eb. t c oom s / t t r e est ssful events. d. Patient will allow others to assume responsibility for major areas of own life. ANS: C The patient’s ability to identify healthy coping behaviors i a nb dir i b c.c ao tm e/ s te ast daptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Outcomes Identification MSC: NCLEX: Psychosocial Integrity 5. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient’s insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. A psychiatric nursing textbook b. NANDA International (NANDA-I) c. A behavioral health reference manual d. Diagnostic and Statistical Manual of Mental Disorder a s b ( irDb.cS oMm/ - te5 s ) t ANS: D The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on nursing diagnoses. A psychiatric nursing textbook or beha av b i io rb r .ca o l mh /te ea st lth reference manual may not contain diagnostic criteria. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Analysis | Nursing Process: Diagnosis MSC: NCLEX: Safe, Effective Care Environment 6. A nurse must assess several new patients at a community mh/teesat lth center. Conclusions concerning current functioning should be made on the basis of what factor? a. The degree of conformity of the individual to society’s norms. b. The degree to which an individual appears logical and rational. c. A continuum from mentally healthy to mentally unhea a l b th irb y .c . om/test d. The rate of their intellectual and emotional growth. ANS: C S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to society’s norms. Most o/tcesctasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Diagnosis | Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity 7. A 40-year-old adult living with parents’ states, “I’m happy but I don’t socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them.” A nurse should identify interventions to improve which patient chaarbaircbt .ceormis/ttei sct? a. Self-concept b. Overall happiness c. Appraisal of reality d. Control over behavior ANS: A The patient feels the need for multiple explanations of newab t ir ab s.c ko sm a/te t swt ork and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Although the patient reports being happy, the subsequent comments refute that self-appraisal. The patient’s comments do not indicate that he/she is out of touch with reality. The patient’s needs are broader than control oavbie rbr .coowm/ntesbtehavior. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 8. A patient tells a nurse, “I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems.” What is the nurse’s best response? a. “Comparing yourself with others has no real advantages.” b. “Why do you blame yourself for having a psychiatric illness?” c. “Mental illness affects 50% of the adult population in any given year.” d. “Are you are concerned that others don’t experience th ae bir s ba .cmome /tc esh tallenges as you.” ANS: D Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct re a s bp iro bn .c s oe m/a te l s s to demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. What is the psychiatric nurse’s best response? a. “No functional difference exists between the two diagnoses. Both serve to identify S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal a human deviance.” b. “The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.” c. “The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.” d. “The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for proble ambi s rba .cop ma / t te i se tnt has or may experience.” ANS: D The medical diagnosis, defined according to the DSM-5, is ab c ir o b. n co c m er /t n es e t d with the patient’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient’s response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider e/tmesst . DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10. The partner of a patient diagnosed with schizophrenia says, “I don’t understand why childhood experiences have anything to do with this disabling illness.” Which nurse’s response will best help the partner understand this conditioanbi? a. “Psychological stress is actually at the root of most mental disorders.” b. “We now know that all mental illnesses are the result of genetic factors.” c. “It must be frustrating for you that your spouse is sick so much of the time.” d. “Research has shown schizophrenia has a biological ra a t bh ire b r .co th ma /tn estpsychological origin.” ANS: D Many of the most prevalent and disabling mental disordersabh irba .v coe mb /te ese tn found to have strong biological influences. Helping the partner understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse’s level of knowledge about the cause of the patient’s condition. Not genetic factors. Psychological stress is not at the root of most mental disorders. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Heabail rtbh.cPomro/tmesot tion and Maintenance 11. Which belief by a nurse supports the highest degree of 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 constant from culture to culture. d. Some symptoms of mental disorders may reflect a persaobinrb’.scocmu/tletsutral patterns. ANS: D A nurse who understands that a patient’s symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse ie/tveests that culture is of little relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from cul a tu bi r rb e .c t o om c /te u s l t ture. S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 12. A patient’s history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient’s needs are not met. Which aspect of mental health is a problem for this patient? a. Effectiveness in work b. Communication skills c. Productive activities d. Maintaining relationships ANS: D The information provided centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy r/etessttable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 13. In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? a. Person who is usually pessimistic but strives to meet personal goals. b. Wealthy person who gives $20 bills to needy individuals in the community. c. Person with an optimistic viewpoint about getting his o/wtesnt needs met. d. Person who expresses strong beliefs about the existence of alien abductions. ANS: D Possessing and expressing unpopular or unsubstantiated f/tteesnt suggests an individual is mentally unstable. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 14. A participant at a community education conference asks, “What is the most prevalent type of mental disorder in the United States?” What is the nurse’s best response? a. “Why do you ask?” b. “Schizophrenia” c. “Affective disorders” d. “Anxiety disorders” ANS: D The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 18.1%. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal 15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult? a. U.S. Department of Health and Human Services b. Journal of the American Psychiatric Association c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ANS: D The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful information but are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Analysis | Nursing Process: Diagnosis MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A patient in the emergency department reports, “I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me.” Which aspects of mental health have the greatest me/tceostncern to a 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 patient’s appraisal of and control over behavior. The patient’s appraisal of reality is inaccurate, and auditory hallucinations are evident, as well as delusions of persecution and grandeur. aI it /t i eosnt , the patient’s control over behavior is tenuous, as evidenced by the plan to “stab” anyone who seems threatening. A healthy self-concept is lacking. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immeda i b air t b e.c co om n/te cs et rn. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment 2. Which statements most clearly reflect the stigma of mental illness? (Select all that apply.) a. “Many mental illnesses are hereditary.” b. “Mental illness can be evidence of a brain disorder.” c. “People claim mental illness, so they can qualify for di a s ba irb b. i c l o i mty /t . e” st d. “If people with mental illness went to church, they would be fine.” e. “Mental illness is a result of the breakdown of the American family.” ANS: C, D, E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses. S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Chapter 03: Theories and Therapies Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care, 4th Edition MULTIPLE CHOICE 1. A 26-month-old child displays negative behaviors. The parent says, “My child refuses toilet training and shouts, ‘No!’ when given direction. What do you think is wrong?” Select the nurse’s best reply. a. “This is normal for your child’s age. The child is striving for independence.” b. “The child needs firmer control. Punish the child for disobedience and say, ‘No.’” c. “There may be developmental problems. Most children are toilet trained by age 2 years.” d. “Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan.” ANS: A These negative behaviors are typical of a child around the age of 2 years whose developmental task is to develop autonomy. The incorrect options indicate the child’s behavior is abnormal. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, “No!” when given directions. Using Freud’s stages of psychosexual development, a nurse would assess the child’s behavior is based on which stage? a. Oral b. Anal c. Phallic d. Genital ANS: B In Freud’s stages of psychosexual development, the anal stage occurs from age 1 to 3 years and has, as its focus, toilet training and learning to delay imabmirbe .cd omia /t t ee stgratification. The oral stage occurs between birth and 1 year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between 13 and 20 years. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A 26-month-old child displays negative behavior, refuses r/ateisnting, and often shouts, “No!” when given direction. The nurse’s counseling with the parent should be based on the premise that the child is engaged in which of Erikson’s psychosocial crises? a. Trust versus Mistrust b. Initiative versus Guilt c. Industry versus Inferiority d. Autonomy versus Shame and Doubt ANS: D S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal The crisis of Autonomy versus Shame and Doubt is related 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 Mm/itesstrt ust is the crisis of the infant, Initiative versus Guilt is the crisis of the preschool and early school-aged child, and Industry versus Inferiority is the crisis of the 6- to 12-year-old child. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. A 4-year-old child grabs toys from siblings, saying, “I wanab t ir t b h.c ao tm t / ote yst now!” The siblings cry, and the child’s parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the child’s behavior as a product of impulses originating in the: a. id. b. ego. c. superego. 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 parent’s wa rbai t rbh. .coTmh/tees st uperego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Assessment MSC: NCLEX: Heabailrtbh.cPomro/tmesot tion 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. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized aa bn ird oe mc /to esmt e what part of the child’s personality? a. Id b. Ego c. Superego d. Preconscious ANS: C In the Freudian theory, 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 personal a i b t i y rb. t c h o a m t /te n s e t gotiates solutions with the outside world. The preconscious is a level of awareness from which material can be easily retrieved with conscious effort. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A nurse supports parental praise of a child who is behavin ag bi i rn omh /e te l sp t ful way. When the individual behaves with politeness and helpfulness in adulthood, which ego ideal will most likely result? a. Curiosity b. Awareness S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal c. Honesty d. Self-esteem ANS: D The individual will be living up to the ego ideal, which will result in positive feelings about self. None of the other characteristics are as closely associated with the ego. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. A patient comments, “I never know the right answer” anda“ bMp/t i enst ion is not important.” Using Erikson’s theory, which psychosocial crisis did the patient have difficulty resolving? a. Initiative versus Guilt b. Trust versus Mistrust c. Autonomy versus Shame and Doubt d. Generativity versus Self-Absorption ANS: C These statements show severe self-doubt, indicating that the crisis of gaining control over the environment is not being successfully met. 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 sus ap b i irc b i .co on mo /te f stothers. Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results in self-absorption that limits the ability to grow as a person. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. Which patient statement would lead a nurse to suspect was not successfully completed? a. “I have very warm and close friendships.” b. “I’m afraid to let anyone really get to know me.” c. “I am always right and confident about my decisions.” d. “I’m ashamed that I didn’t do it correctly in the first place.” ANS: B According to Erikson, the developmental task of infancy i a s b t ir h b e .co d m e / v te e st lopment of trust. The patient’s statement that he or she is afraid of becoming acquainted with others clearly shows a lack of ability to trust other people. Having warm and close friendships suggests the developmental task of infancy was successfully Bev/teinstg one is always right suggests rigidity rather than mistrust. Feelings of shame suggest failure to resolve the crisis of Initiative versus Guilt. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 9. A nurse assesses that a patient is suspicious and imp/ute lsat tes others. Using the Freudian theory, these traits are related to which psychosexual stage? a. Oral b. Anal c. Phallic d. Genital S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal ANS: A According to Freud, each of the behaviors mentioned develops as the result of attitudes formed during the oral stage, when an infant first learns toa r be oe mt /to est 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 ti/stefsyting sexual and emotional relationships with members of the opposite sex, emancipation from parents, and a strong sense of personal identity. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. An adult expresses the wish to be taken care of and often ba ebihrb ems/te inst a helpless fashion. This adult has needs related to which of Freud’s stages of psychosexual development? a. Latency b. Phallic c. Anal d. Oral ANS: D According to Freud, fixation at the oral stage sometimes p a r bo ird bu .cc oe ms /ted se t pendent infantile behaviors in adults. Latency fixations often result in a 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 i/dteesnt tity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: Heabail rtbh.cPomro/tmesot tion 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, “I’m too busy taking care of myself to volunteer. I don’t have time to help other a s b . ir” b.T coh me /t s ee stcomments contrast which developmental tasks? a. Trust versus Mistrust b. Industry versus Inferiority c. Intimacy versus Isolation d. Generativity versus 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. The developmental crisis of Trust versus Mistrust would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate the developmental crisis of Industry versus Inferiority 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 in the crisis of Iu/stesItsolation would be emotional isolation and the ability to love and commit to oneself. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Assessment MSC: NCLEX: He ab a i l r t b h .cP omro /tmes o t tion and Maintenance S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal 12. Cognitive behavioral therapy was provided for a patient who frequently said, “I’m stupid.” Which statement by the patient indicates the therapy was effective? a. “I’m disappointed in my lack of ability.” b. “I always fail when I try new things.” c. “Things always go wrong for me.” d. “Sometimes I do stupid things.” ANS: D “I’m stupid” is a cognitive distortion or irrational thought. A more rational thought is, “Sometimes I do stupid things.” The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 13. A student nurse tells the instructor, “I don’t need to interact with my patients. I learn what I need to know by observation.” The instructor can best interpret the nursing implications of Sullivan’s theory by providing what response? a. “Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills.” b. “Observing patient interactions can help you formulateabpir rb i .coo rmit /ytesnt ursing diagnoses and appropriate interventions.” c. “I wonder how accurate your assessment of the patient’s needs can be if you do not interact with the patient.” d. “Noting patient behavioral changes is important becau a s be irb th .ce omse /te s s i tgnify changes in personality.” ANS: A Sullivan believed that the nurse’s role includes educating p aba i t rb ie .cn o t ms /ta esn td assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan’s theory. The nurse who does not interact with the patient cannot demonstrate r/stetsotnes. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The third response pertains to Maslow’s theory. The fourth response pertains to behavioral theory. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 14. A psychiatric technician says, “Little of what takes place on the behavioral health unit seems to be theory based.” A nurse educates the technician by identifying which common use of Sullivan’s theory? a. Structure of the therapeutic milieu of most behavioral u/tnesitts b. Frequent use of restraint and seclusion for behavior modification c. Assessment tools based on age-appropriate versus arrested behaviors d. Use of the nursing process to determine the best seque a n b c ir e b.c f o o m r / n te u st rsing actions ANS: A S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal The structure of the therapeutic environment has, as its foci, an accepting atmosphere and provision of opportunities for practicing interpersonal skills. Both constructs are directly attributable to Sullivan’s theory of interpersonal relationshaibpirsb..cSomu/ltleisvt an’s interpersonal theory did not specifically consider the use of restraint or seclusion. Assessment based on the developmental level is associated with Erikson’s theories. The nursing process applies concepts from multiple theories. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 15. A nurse uses Maslow’s hierarchy of needs to plan care for a psychotic patient. Which problem will receive priority? a. Refuses to eat or bathe. b. Reports feelings of alienation from family. c. Is reluctant to participate in unit social activities. d. Needs to be taught about medication action and side effects. ANS: A The need for food and hygiene is physiological and therefore takes priority over psychological or meta-needs in care planning. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 16. Operant conditioning will be used to encourage speech in m/wteshto is nearly mute. Which technique would a nurse include in the treatment plan? a. Ignore the child for using silence. b. Have the child observe others talking. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques, then coax speech. ANS: C Operant conditioning involves giving positive reinforceme an bi t rb f .o co r ma /ted se t sired behavior. Treats are rewards to reinforce speech. Ignoring the child will not change the behavior. Having the child observe others describes modeling. Teaching relaxation techniques and then coaxing speech is an example of systematic desensitization. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 17. The parent of a child diagnosed with schizophrenia tearfully asks a nurse, “What could I have done differently to prevent this illness?” Select the nurse’s most caring response. a. “Although schizophrenia is caused by impaired familyab reirb la.c to imo/nte ssht ips, try not to feel guilty. No one can predict how a child will respond to parental guidance.” b. “Most of the damage is done, but there is still hope. Changing your parenting style can help your child learn to cope more effectively with the environment.” c. “Schizophrenia is a biological illness with similarities a t bo irbd . i ca ob me /te te st s and heart disease. You are not to blame for your child’s illness.” d. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.” ANS: C S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Patients and families need reassurance that the major mental disorders are biological in origin and are not the “fault” of parents. Knowing the biological nature of the disorder relieves feelings of guilt over being responsible for the illness. Tre/tcesttresponses are neither wholly accurate nor reassuring; they fall short of being reassuring and place the burden of having faulty genes on the shoulders of the parents. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. A nurse uses Peplau’s interpersonal therapy while workingabwirb i . t c hom a/t nes at nxious, withdrawn patient. What should the focus of the interventions be? a. Changing the patient’s perceptions about self b. Improving the patient’s interactional skills c. Using medications to relieve anxiety d. Reinforcing specific behaviors ANS: B The nurse–patient relationship is structured to provide a mao bd irbe . l co f mo / r tea stdaptive interpersonal relationships that can be generalized to others. Changing the patient’s perceptions about hisor herself would be appropriate for cognitive therapy. Reinforcing specific behaviors would be used in behavioral therapy. Using medications is the foacbuir fmb/t ieos l togical therapy. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 19. A patient underwent psychotherapy weekly for 3 years. The therapist used free association, dream analysis, and facilitated transference to help the patient understand unconscious processes and foster personality changes. Which type of therapy was used? a. Short-term dynamic psychotherapy b. Transactional analysis c. Cognitive therapy d. Psychoanalysis ANS: D The therapy described is traditional psychoanalysis. Short-term dynamic psychotherapy would last less than 1 year. Neither transactional analysis nor t/hteestrapy makes use of the techniques described. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Assessment MSC: NCLEX: Ps a y b c ir h b. o c s o o mc /t i e a s l t Integrity 20. An advanced practice nurse determines that a group of patients would benefit from opportunities to practice appropriate social behaviors and a leb airb r .nco amb/toesut t basic living skills. The nurse would arrange for what form of therapy? a. Milieu therapy b. Cognitive therapy c. Short-term dynamic therapy d. Systematic desensitization ANS: A S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Milieu therapy provides an opportunity for all members of the environment to contribute to the planning and functioning of the setting, practice social behaviors in a safe setting, and gain knowledge in basic living skills. The other therapies are i/dteustal therapies that do not fit the description. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 21. A nurse psychotherapist works with an anxious, dependent patient. What therapeutic strategy is most consistent with the framework of psychoanalytic pa sb yir cb h.c oom th/t ees r t apy? a. Emphasizing medication compliance b. Identifying the patient’s strengths and assets c. Offering psychoeducational materials and groups d. Focusing on feelings developed by the patient toward t ah bie rbn .cu omrs /te est ANS: D Positive or negative feelings of the patient toward the nurse or therapist represent transference. Transference is a psychoanalytic concept that can be useda t bo irbe .x cop mlo /te r se t previously unresolved conflicts. Emphasizing medication compliance is more related to biological therapy. Identifying patient strengths and assets would be consistent with supportive psychotherapy. The use of psychoeducational materials is a common “ rmk/”teast ssignment used in cognitive therapy. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Pmc/tieasltIntegrity 22. A person tells a nurse, “I was the only survivor in a small plane crash, but three business associates died. I got anxious and depressed and saw a counselor three times a week for a month. We talked about my feelings related to being a surav b i iv rbo .c r o , ma /n ted stnow I am at peace with the situation.” Which type of therapy was used? a. Milieu therapy b. Psychoanalysis c. Behavior modification d. Interpersonal therapy ANS: D Interpersonal therapy returns the patient to the former level of functioning by helping the patient come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis calls for a long period of exploration of unconscious material. Behavior modification focuses on c a h b a ir n b g .c i o n m g /te a st behavior rather than helping the patient understand what is going on in his or her life. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 23. What cognitive strategy should a nurse use to assist a very dependent patient achieve independence? a. Reveal dream content. b. Take prescribed medications. c. Examine thoughts about being autonomous. d. Role model ways to ask for help from others. S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal ANS: C Cognitive theory suggests that one’s thought processes are the basis of emotions and behavior. Changing faulty learning makes the development of new a ad ba irbp . t c i ov me /teb se thaviors possible. Revealing dream content would be used in psychoanalytical therapy. Taking prescribed medications is an intervention associated with biological therapy. A dependent patient needs to develop independence. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A single parent is experiencing feelings of inadequacy related to work and family since one teenaged child ran away several weeks ago. The parent seeks the help of a therapist specializing in cognitive therapy. The psychotherapist whoab uirb s . ec s om c/ ote gst nitive therapy will introduce what intervention? a. Discussing ego states b. Focusing on unconscious mental processes c. Negatively reinforcing an undesirable behavior d. Helping the patient identify and change faulty thinking ANS: D Cognitive therapy emphasizes the importance of changingae bi r r r o/teuss t ways people think about themselves. Once faulty thinking changes, the individual’s behavior changes. Focusing on unconscious mental processes is a psychoanalytic approach. Negatively reinforcing undesirable behaviors is behavior modification and discusa sb inirbg.c eomgo/te sst tates relates to transactional analysis. DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Implementation MSC: NCLEX: Pmc/tieasltIntegrity 25. A person received an invitation to be in the wedding of a friend who lives across the country. The individual is afraid of flying. What type of therapy should the nurse recommend? a. Psychoanalysis b. Milieu therapy c. Systematic desensitization 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 c/tetshterapy are aimed at uncovering conflicts. Milieu therapy involves environmental factors. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. A basic level registered nurse works with patients in a community setting. Which groups should this nurse expect to lead? (Select all that apply.) a. Symptom management b. Medication education S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal c. Family therapy d. Psychotherapy e. Self-care ANS: A, B, E Symptom management, medication education, and self-care groups represent psychoeducation, a service provided by the basic level m/nteustrse. Advanced practice registered nurses provide family therapy and psychotherapy. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: He ab a i l r t b h .cP omro /tmes o t tion and Maintenance 2. A patient states, “I’m starting cognitive behavioral therapy. What can I expect from the sessions?” Which responses by the nurse are appropriate? a (bSir eb l .c eo cmt /ate ls l t that apply.) a. “The therapist will be active and questioning.” b. “You may be given homework assignments.” c. “The therapist will ask you to describe your dreams.” d. “The therapist will help you look at ideas and beliefs y ao bu irbh .ca omve /tea stbout yourself.” e. “The goal is to increase your subjectivity about thoughts that govern your behavior.” ANS: A, B, D Cognitive therapists are active rather than passive during therapy sessions because they help patients to reality test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at th/teesrtapy session. The goals of cognitive therapy are to assist the patient to identify inaccurate cognitions, to reality test their thinking, and to formulate new, accurate cognitions. Dream describing applies to psychoanalysis, not cognitive behavioral therapy. The desired outcome of cognitive therapy is to assist patients in increasing their objectivity, not subjecta i bv iri b t .y co , ma /b teo stutthe cognitions that influence behavior. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity S - The Marketplace to Buy and Sell your Study Material WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM Downloaded by: DUKETEST | Distribution of this document is illegal Chapter 04: Biological Basis for Understanding Psychopharmacology Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care, 4th Edition MULTIPLE CHOICE 1. A patient asks a nurse, “What are neurotransmitters? My doctor says mine are out of balance.” What is the nurse’s best response? a. “You must feel relieved to know that your problem s/tiecsat l basis.” b. “Neurotransmitters are chemicals that pass messages between brain cells.” c. “It is a high-level concept to explain. You should ask the doctor to tell you more.” d. “Neurotransmitters are substances we eat daily that influence memory and mood.” ANS: B Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information. Neurotransmitters are messeng a e b r ir s b. i c n om th /te e st central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The incorrect responses do not answer the patient’s question, are demeaning, and provide untrue and misleading information. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. The parent of an adolescent diagnosed with schizophreniaaa b s irk b. s coa mn /teu s r t se, “My child’s doctor ordered a positron-emission tomography (PET) scan. What is that?” What is the nurse’s best response? a. “PET uses a magnetic field and gamma waves to b/telestms areas in the brain. Does your teenager have any metal implants?” b. “It’s a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred.” c. “PET is a scan that passes an electrical current through ab t ih rbe .cob mra /t i en st and shows brain wave activity. PET can help diagnose seizures.” d. “PET is a special scan that shows blood flow and activity in the brain.” ANS: D The parent is seeking information about PET scans. It is important to use terms the parent can understand. The correct option is the only reply that provides factual inform