Test Bank Essentials Psychiatric Mental Health Nursing 2nd Edition, Elizabeth
Chapter 1: Practicing the Science and Art of Psychiatric Nursing
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 persistent mental illness? Within 3 months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
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 some means of coping other than suicide when you have these 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 with your life.”
d. “How did you get so depressed that hospitalization was necessary?”
3. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy?
a. “This is a psychiatric hospital. Craziness is what we are all about.”
b. “Let’s all show acceptance of this patient by wearing lots of makeup 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.”
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 isn’t 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 medication started for you.”
d. “I’d like to sit with you a while so you may feel more comfortable talking with me.”
5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web site’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.”
6. A nurse says, “When I was in school, I learned to call upset patients by 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.
b. Staff nurses apply new research findings only with the help from clinical nurse specialists.
c. New research findings should be incorporated into clinical algorithms before using them in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
7. Two nursing students discuss career plans after graduation. One student 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. Nurse-to-patient ratios must be 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 those situations.”
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 pain and suffering as medical surgical nurses. That appeals to me.”
8. Which research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
9. A bill introduced in Congress would reduce funding for the care of people 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?
d. Evidence-based practice
10. An informal group of patients discuss their perceptions of nursing care. 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.”
Chapter 2: Mental Health and Mental Illness
1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient:
a. says, “I knew this would happen eventually.”
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, “I don’t need that silly thing.”
d. says, “Maybe some physical therapy will help me with my balance.”
2. Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as “In Our Own Voice” (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS)
d. North American Nursing Diagnosis Association International (NANDA-I)
3. A patient is admitted to the psychiatric hospital. Which assessment finding 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 abilities.
d. reports occasional problems with insomnia.
4. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
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 Disorders (DSM-5)
6. A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of:
a. the degree of conformity of the individual to society’s norms.
b. the degree to which an individual is logical and rational.
c. a continuum from mentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
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 this patient’s:
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
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.” Select 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. “It sounds like you are concerned that others don’t experience the same challenges as you.”
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. Select the psychiatric nurse’s best response.
a. “No functional difference exists between the two diagnoses. Both serve to identify 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 problems a patient has or may experience.”
10. The spouse of a patient diagnosed with schizophrenia says, “I don’t understand why childhood experiences have anything to do with this disabling illness.” Select the nurse’s response that will best help the spouse understand this condition.
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. “Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important.”
Chapter 3: Theories and Therapies
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.”
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?
3. A 26-month-old child displays negative behavior, refuses toilet training, 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
4. A 4-year-old child grabs toys from siblings, saying, “I want that toy 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:
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 and become part of the child’s:
6. A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
7. A patient comments, “I never know the right answer” and “My opinion 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
8. Which patient statement would lead a nurse to suspect that the developmental task of infancy 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.”
9. A nurse assesses that a patient is suspicious and frequently manipulates others. Using the Freudian theory, these traits are related to which psychosexual stage?
10. An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freud’s stages of psychosexual development?
Chapter 4: Biological Basis for Understanding Psychopharmacology
1. A patient asks a nurse, “What are neurotransmitters? My doctor says mine are out of balance.” The best reply would be:
a. “You must feel relieved to know that your problem has a physical 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.”
2. The parent of an adolescent diagnosed with schizophrenia asks a nurse, “My child’s doctor ordered a positron-emission tomography (PET) scan. What is that?” Select the nurse’s best reply.
a. “PET uses a magnetic field and gamma waves to identify problems 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 the brain 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.”
3. A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
a. Computed tomography (CT) scan
b. Positron emission tomography (PET) scan
c. Functional magnetic resonance imaging (fMRI)
d. Single-photon emission computed tomography (SPECT) scan
4. A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?
a. Cerebral arteriogram
b. Functional magnetic resonance imaging (fMRI)
c. Computed tomography (CT) scan or magnetic resonance imaging (MRI)
d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)
5. The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?
a. “Do you ever see or hear things that others do not?”
b. “Do you have problems with short-term memory?”
c. “What are your worst and best times of day?”
d. “How would you describe your thinking?”
6. A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which finding would be expected?
a. Reduced anxiety
b. Improved memory
c. More organized thinking
d. Fewer sensory perceptual alterations
7. On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to:
a. inhibit GABA production.
b. increase dopamine sensitivity.
c. decrease dopamine at receptor sites.
d. prevent destruction of acetylcholine.
8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
c. Temporal lobe
d. Prefrontal cortex
9. A nurse should assess a patient taking a medication with anticholinergic properties for inhibited function of the:
a. parasympathetic nervous system.
b. sympathetic nervous system.
c. reticular activating system.
d. medulla oblongata.
10. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing:
a. increased concentration of neurotransmitters in the synaptic gap.
b. decreased concentration of neurotransmitters in serum.
c. destruction of receptor sites.
d. limbic system stimulation.
Chapter 5: Settings for Psychiatric Care
1. Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
c. have no support systems in the community.
d. develop new symptoms during the course of an illness.
2. A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to:
a. cancel the patient’s discharge from the hospital.
b. contact the landlord who evicted the patient to discuss the situation.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
d. document that the adverse medication reaction was feigned because the patient had nowhere to live.
3. A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting?
a. A treatment plan will be formulated.
b. The health care provider will order neuroimaging studies.
c. The team will request a court-appointed advocate for the patient.
d. Assessment of the patient’s need for placement outside the home will be undertaken.
4. The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patient’s thoughts are now more organized. The patient’s family members are upset and say, “It’s too soon for discharge. Hospitalization is needed for at least a month.” The nurse should:
a. call the psychiatrist to come explain the discharge rationale.
b. explain that health insurance will not pay for a longer stay for the patient.
c. call security to handle the disturbance and escort the family off the unit.
d. explain that the patient will continue to improve if medication is taken regularly.
5. A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor’s closet is locked, and all sharp objects are being used under staff supervision. These observations relate to:
a. management of milieu safety.
b. coordinating care of patients.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
6. The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who:
a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol).
b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years.
c. self-inflicted a superficial cut on the forearm after a family argument.
d. is a single parent and hears voices saying, “Smother your infant.”
7. A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should:
a. tell the patient, “I’ll get an unsatisfactory grade if I don’t give you the medication.”
b. tell the patient, “Refusing your medication is not permitted. You are required to take it.”
c. discuss the patient’s concerns about the medication, and report to the staff nurse.
d. document the patient’s refusal of the medication without further comment.
8. A nurse surveys the medical records for violations of patients’ rights. Which finding signals a violation?
a. No treatment plan is present in record.
b. Patient belongings are searched at admission.
c. Physical restraint is used to prevent harm to self.
d. Patient is placed on one-to-one continuous observation.
9. Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
a. Resolve behavioral crises using the least restrictive intervention possible.
b. Rights of the majority of patients supersede the rights of individual patients.
c. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
10. To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
a. Problem-solving skills
b. Calm and caring manner
c. Ability to cross service systems
d. Knowledge of psychopharmacology
Chapter 6: Legal and Ethical Basis for Practice
1. A psychiatric nurse best implements the ethical principle of autonomy when he or she:
a. intervenes when a self-mutilating patient attempts to harm self.
b. stays with a patient who is demonstrating a high level of anxiety.
c. suggests that two patients who are fighting be restricted to the unit.
d. explores alternative solutions with a patient, who then makes a choice.
2. Which action by a psychiatric nurse best supports a patient’s right to be treated with dignity and respect?
a. Consistently addressing a patient by title and surname.
b. Strongly encouraging a patient to participate in the unit milieu.
c. Discussing a patient’s condition with another health care provider in the elevator.
d. Informing a treatment team that a patient is too drowsy to participate in care planning.
3. Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion:
a. reveals that the nurse values the principle of justice.
b. reinforces the autonomy of the two patients.
c. violates the civil rights of the two patients.
d. represents the intentional tort of battery.
4. In a team meeting a nurse says, “I’m concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision.” Which ethical principle most clearly applies to this situation?
5. Which scenario is an example of a tort?
a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patient’s admission.
b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.
c. A patient’s admission status is changed from involuntary to voluntary after the patient’s hallucinations subside.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.
6. A nurse’s neighbor asks, “Why aren’t people with mental illness kept in state institutions anymore?” What is the nurse’s best response?
a. “Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent.”
b. “Less restrictive settings are now available to care for individuals with mental illness.”
c. “Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed.”
d. “Psychiatric institutions are no longer popular as a consequence of negative stories in the press.”
7. Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, “I’m getting out of here and no one can stop me.” The nurse restrains this patient without a health care provider’s order and then promptly obtains an order.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, “Stay in your room or you’ll be put in seclusion.”
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
8. A patient should be considered for involuntary commitment for psychiatric care when he or she:
a. is noncompliant with the treatment regimen.
b. sells and distributes illegal drugs.
c. threatens to harm self and others.
d. fraudulently files for bankruptcy.
9. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” Select the nurse’s best initial action.
a. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.”
b. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about skipping next month’s dose.”
c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects.
d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.
10. Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
Chapter 7: Nursing Process and QSEN: The Foundation for Safe and Effective Care
1. A new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients?
a. Perform mental health assessment interviews.
b. Establish therapeutic relationships.
c. Prescribe psychotropic medications.
d. Individualize nursing care plans.
2. A newly admitted patient with major depressive disorder has lost 20 pounds over the past month and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis.
a. Imbalanced nutrition: Less than body requirements
b. Chronic low self-esteem
c. Risk for suicide
3. A patient with major depressive disorder has lost 20 pounds in one month has chronic low self-esteem and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention is most directly related to this outcome: “Patient will refrain from gestures and attempts to harm self”?
a. Implement suicide precautions.
b. Frequently offer high-calorie snacks and fluids.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
4. A patient’s nursing diagnosis is Insomnia. The desired outcome is: “Patient will sleep for a minimum of 5 hours nightly by October 31.” On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. Which evaluation should be documented?
a. Consistently demonstrated
b. Often demonstrated
c. Sometimes demonstrated
d. Never demonstrated
5. A patient’s nursing diagnosis is Insomnia. The desired outcome is: “Patient will sleep for a minimum of 5 hours nightly by October 31.” On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse’s next action?
a. Continue the current plan without changes.
b. Remove this nursing diagnosis from the plan of care.
c. Write a new nursing diagnosis that better reflects the problem.
d. Revise the outcome target date and interventions.
6. A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item “Encourage patient to attend one psychoeducational group daily”?
7. Before assessing a new patient, a nurse is told by another health care worker, “I know that patient. No matter how hard we work, there isn’t much improvement by the time of discharge.” The nurse’s responsibility is to:
a. document the other worker’s assessment of the patient.
b. assess the patient based on data collected from all sources.
c. validate the worker’s impression by contacting the patient’s significant other.
d. discuss the worker’s impression with the patient during the assessment interview.
8. A nurse works with a patient to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patient’s best interest. What is the nurse’s best action?
a. Remain silent.
b. Educate the patient that the outcome is not realistic.
c. Explore with the patient possible consequences of the outcome.
d. Formulate a more appropriate outcome without the patient’s input.
9. A patient states, “I’m not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up.” Which nursing intervention should have the highest priority?
a. Self-esteem–building activities
b. Anxiety self-control measures
c. Sleep enhancement activities
d. Suicide precautions
10. Select the best outcome for a patient with this nursing diagnosis: Impaired social interaction, related to sociocultural dissonance as evidenced by stating, “Although I’d like to, I don’t join in because I don’t speak the language very well.” The patient will:
a. demonstrate improved social skills.
b. express a desire to interact with others.
c. become more independent in decision making.
d. select and participate in one group activity per day.
Chapter 8: Communication Skills: Medium for All Nursing Practice
1. A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So, all in all, you feel as though you had a rather poor night’s sleep?”
d. “Can you give me an example of what you mean by ‘stoned’?”
2. A patient diagnosed with schizophrenia tells the nurse, “The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?
a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
3. The patient says, “My marriage is just great. My spouse and I usually agree on everything.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patient’s communication is:
4. A nurse interacts with a newly hospitalized patient. Select the nurse’s comment that applies the communication technique of “offering self.”
a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
b. “Why do you think you had so much difficulty adjusting to this change in your life?”
c. “I hope you will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”
5. Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restate a feeling or thought the patient has expressed.
b. Ask a direct question, such as, “Did you feel angry?”
c. Make a judgment about the patient’s problem.
d. Say, “I understand what you’re saying.”
6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that?8??”
d. “Tell me everything from the beginning.”
7. A patient tells the nurse, “I don’t think I will ever get out of here.” Select the nurse’s most therapeutic response.
a. “Don’t talk that way. Of course you will leave here!”
b. “Keep up the good work and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”
8. Documentation in a patient’s chart shows, “Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘I enjoy spending time with you.’” Which analysis is most accurate?
a. Patient is giving positive feedback about the nurse’s communication techniques.
b. Nurse is viewing the patient’s behavior through a cultural filter.
c. Patient’s verbal and nonverbal messages are incongruent.
d. Patient is demonstrating psychotic behaviors.
9. While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills
10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Patients in a psychiatric setting should not be touched.
Chapter 9: Therapeutic Relationships and the Clinical Interview
1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “The patient is like one of my grandparents . . . so helpless.” What feelings does the nurse describe?
c. Catastrophic reaction
d. Defensive coping reaction
2. Which statement shows a nurse has empathy for a patient who made a suicide attempt?
a. “You must have been very upset when you tried to hurt yourself.”
b. “It makes me sad to see you going through such a difficult experience.”
c. “If you tell me what is troubling you, I can help you solve your problems.”
d. “Suicide is a drastic solution to a problem that may not be such a serious matter.”
3. After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?
a. The patient’s reactions toward the nurse seem realistic and appropriate.
b. The patient states, “Talking to you feels like talking to my parents.”
c. The nurse feels unusually happy when the patient’s mood begins to lift.
d. The nurse develops a trusting relationship with the patient.
4. A patient says, “Please don’t share information about me with the other people.” How should the nurse respond?
a. “I won’t share information with others without your permission, but I will share information about you with other staff members.”
b. “A therapeutic relationship is just between the nurse and the patient. It’s up to you to tell others what you want them to know.”
c. “It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others.”
d. “I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.”
5. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent for most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, “I really need to talk to you right now.” The nurse should:
a. say to the interrupting patient, “I am not available to talk with you at the present time.”
b. end the unproductive session with the current patient and spend time with the patient who has just interrupted.
c. invite the interrupting patient to join in the session with the current patient.
d. tell the patient who interrupted, “This session is 5 more minutes; then, I will talk with you.”
6. Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse:
a. avoids upsetting the patient by shifting focus to other patients before the discharge.
b. gives the patient a personal telephone number and permission to call after discharge.
c. discusses with the patient changes that have happened during the relationship and evaluates the outcomes.
d. offers to meet the patient for coffee and conversation three times a week after discharge.
7. What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:
a. great sense of independence.
b. rapport and trust with the nurse.
c. self-responsibility and autonomy.
d. resolution of feelings of transference.
8. During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?
9. At what point in the nurse-patient relationship should a nurse plan to first address termination?
a. In the orientation phase
b. During the working phase
c. In the termination phase
d. When the patient initially brings up the topic
10. A nurse should introduce the matter of a contract during the first session with a new patient because contracts:
a. specify what the nurse will do for the patient.
b. spell out the participation and responsibilities of each party.
c. indicate the feeling tone established between the participants.
d. are binding and prevent either party from prematurely ending the relationship.
Chapter 10: Stress and Stress-Related Disorders
1. Which scenario best demonstrates an example of eustress? An individual:
a. loses a beloved family pet.
b. prepares to take a 1 week vacation to a tropical island with a group of close friends.
c. receives a bank notice there were insufficient funds in their account for a recent rent payment.
d. receives notification that their current employer is experiencing financial problems and some workers will be terminated.
2. A patient diagnosed with liver failure has been on the transplant waiting list 8 months. The patient says, “Why is it taking so long to have the surgery? Maybe I’m meant to die for all the bad things I’ve done.” The nurse should document the patient’s comment in which section of the assessment?
3. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?
b. Parietal lobe
d. Pituitary gland
4. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system is stimulated in response to this experience?
a. Limbic system
b. Peripheral nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
5. A patient is brought to the emergency department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient’s vital signs are temperature (T), 98.6° F; pulse (P), 72 beats per minute (bpm); and respirations (R), 16 breaths per minute. After being informed that surgery is required for the broken leg, which vital sign readings would be expected?
a. T, 98.6°; P, 64; R, 14
b. T, 98.6°; P, 68; R, 12
c. T, 98.6°; P, 62; R, 16
d. T, 98.6°; P, 84; R, 22
6. As part of the stress response, the HPA axis is stimulated. Which structures make up this system?
a. Hippocampus, parietal lobe, and amygdala
b. Hypothalamus, pituitary gland, and adrenal glands
c. Hind brain, pyramidal nervous system, and anterior cerebrum
d. Hepatic artery, parasympathetic nervous system, and acoustic nerve
7. Cortisol is released in response to a patient’s prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level?
a. Diuresis and electrolyte imbalance
b. Focused and alert mental status
c. Drowsiness and lethargy
d. Restlessness and anxiety
8. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). The nurse’s highest priority is to screen this soldier for which problem?
a. Major depressive disorder
b. Bipolar disorder
9. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). Which comment by the soldier requires the nurse’s immediate attention?
a. “It’s good to be home. I missed my family and friends.”
b. “I saw my best friend get killed by a roadside bomb. It should have been me instead.”
c. “Sometimes I think I hear bombs exploding, but it’s just the noise of traffic in my hometown.”
d. “I want to continue my education but I’m not sure how I will fit in with other college students.”
10. A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with post-traumatic stress disorder (PTSD). The soldier says, “If there’s a loud noise at night, I get under my bed because I think we’re getting bombed.” What type of experience has the soldier described?
d. Auditory hallucination
Chapter 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders
1. A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:
a. Verify the patient’s learning style.
b. Create outcomes and a teaching plan.
c. Lower the patient’s current anxiety level.
d. Assess how the patient uses defense mechanisms.
2. A patient approaches the nurse and impatiently blurts out, “You’ve got to help me! Something terrible is happening. My heart is pounding.” The nurse responds, “It’s almost time for visiting hours. Let’s get your hair combed.” Which approach has the nurse used?
a. Bringing up an irrelevant topic
b. Responding to physical needs
c. Addressing false cognitions
3. A patient experiencing moderate anxiety says, “I feel undone.” An appropriate response for the nurse would be:
a. “Why do you suppose you are feeling anxious?”
b. “What would you like me to do to help you?”
c. “I’m not sure I understand. Give me an example.”
d. “You must get your feelings under control before we can continue.”
4. A patient with a high level of motor activity runs from chair to chair and cries, “They’re coming! They’re coming!” The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:
a. provide for patient safety.
b. increase environmental stimuli.
c. respect the patient’s personal space.
d. encourage the clarification of feelings.
5. A patient with a high level of motor activity runs from chair to chair and cries, “They’re coming! They’re coming!” The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?
a. Risk for injury
b. Self-care deficit
c. Disturbed energy field
d. Disturbed thought processes
6. A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, “I’ve been working on other things.” When asked 4 hours later, the worker says, “Someone else was using the copier, so I couldn’t finish it.” The worker’s behavior demonstrates:
a. acting out.
d. passive aggression.
7. A patient is undergoing diagnostic tests. The patient says, “Nothing is wrong with me except a stubborn chest cold.” The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
8. A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurse’s comments and asks, “What are they going to do?” Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patient’s level of anxiety?
9. A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate?
a. Reassure the patient that all nurses are skilled in providing postoperative care.
b. Describe the procedure again in a calm manner, using simple language.
c. Tell the patient that the staff is prepared to promote recovery.
d. Encourage the patient to express feelings to his or her family.
10. A nurse encourages an anxious patient to talk about feelings and concerns. What is the rationale for this intervention?
a. Offering hope allays and defuses the patient’s anxiety.
b. Concerns stated aloud become less overwhelming and help problem solving to begin.
c. Anxiety is reduced by focusing on and validating what is occurring in the environment.
d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.
Chapter 12: Somatoform Disorders and Dissociative Disorders
1. A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably:
a. readily seek psychiatric counseling.
b. be resistant to accepting psychiatric help.
c. attend psychotherapy sessions without encouragement.
d. be eager to discover the true reasons for physical symptoms.
2. A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurse’s planning for this patient? The patient is:
a. suppressing accurate feelings regarding the problem.
b. relieving anxiety through the physical symptom.
c. meeting needs through hospitalization.
d. refusing to disclose genuine fears.
3. A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should:
a. establish a “buddy” system with other patients who can feed the patient at each meal.
b. expect the patient to feed himself or herself after explaining the arrangement of the food on the tray.
c. direct the patient to locate items on the tray independently and feed himself or herself unassisted.
d. address the needs of other patients in the dining room, and then feed this patient.
4. A patient with blindness related to a functional neurological (conversion) disorder says, “All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don’t find me interesting.” Which nursing diagnosis is most relevant?
a. Social isolation
b. Chronic low self-esteem
c. Interrupted family processes
d. Ineffective health maintenance
5. To assist a patient diagnosed with a somatic system disorder, a nursing intervention of high priority is to:
a. imply that somatic symptoms are not real.
b. help the patient suppress feelings of anger.
c. shift the focus from somatic symptoms to feelings.
d. investigate each physical symptom as soon as it is reported.
6. A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, “My heart misses beats. I’m frequently absent from work. I don’t go out much because I need to rest.” Which health problem is most likely?
a. Body dysmorphic disorder
b. Antisocial personality disorder
c. Illness anxiety disorder (hypochondriasis)
d. Persistent depressive disorder (dysthymia)
7. A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note that the patient:
a. readily sees a relationship between symptoms and interpersonal conflicts.
b. rarely derives personal benefit from the symptoms.
c. has little difficulty communicating emotional needs.
d. has unmet needs related to comfort and activity.
8. To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms:
a. are generally chronic in nature.
b. have a physiological basis.
c. can be voluntarily controlled.
d. provide relief from health anxiety.
9. A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient’s disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will:
a. assume roles and functions of the other family members.
b. demonstrate a resumption of former roles and tasks.
c. focus energy on problems occurring in the family.
d. rely on family members to meet his or her personal needs.
10. A woman wears a size 7 shoe. She says, “My feet are huge. I’ve asked three orthopedists to surgically reduce my feet.” The patient tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely?
a. Dissociative amnesia with fugue
b. Illness anxiety disorder
c. Body dysmorphic disorder
d. Dissociative identity disorder
Chapter 13: Personality Disorders
1. A therapist recently convicted of multiple counts of Medicare fraud says, “Sure I overbilled. Why not? Everyone takes advantage of the government, so I did too.” These statements show:
c. superficial remorse.
d. lack of guilt feelings.
2. Which intervention is appropriate for a patient diagnosed with an antisocial personality disorder who frequently manipulates others?
a. Refer the patient’s requests and questions to the case manager.
b. Explore the patient’s feelings of fear and inferiority.
c. Provide negative reinforcement for acting-out behavior.
d. Ignore, rather than confront, inappropriate behavior.
3. As a nurse prepares to administer a medication to a patient diagnosed with a borderline personality disorder, the patient says, “Just leave it on the table. I’ll take it when I finish combing my hair.” What is the nurse’s best response?
a. Reinforce this assertive action by the patient. Leave the medication on the table as requested.
b. Respond to the patient, “I’m worried that you might not take it. I will come back later.”
c. Say to the patient, “I must watch you take the medication. Please take it now.”
d. Ask the patient, “Why don’t you want to take your medication now?”
4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will:
a. identify when feeling angry.
b. use manipulation only to get legitimate needs met.
c. acknowledge manipulative behavior when it is called to his or her attention.
d. accept fulfillment of his or her requests within an hour rather than immediately.
5. Consider these comments made to three different nurses by a patient diagnosed with an antisocial personality disorder: “You’re a better nurse than the day shift nurse said you were”; “Another nurse said you don’t do your job right”; “You think you’re perfect, but I’ve seen you make three mistakes.” Collectively, these interactions can be assessed as:
d. guilt producing.
6. A nurse reports to the interdisciplinary team that a patient diagnosed with an antisocial personality disorder lies to other patients, verbally abuses a patient diagnosed with dementia, and flatters the primary nurse. This patient is detached and superficial during counseling sessions. Which behavior most clearly warrants limit setting?
a. Flattering the nurse
b. Lying to other patients
c. Verbal abuse of another patient
d. Detached superficiality during counseling
7. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. The psychiatrist suggests the use of a medication. Which type of medication should the nurse expect?
a. Selective serotonin reuptake inhibitor (SSRI)
b. Monoamine oxidase inhibitor (MAOI)
8. A person’s spouse filed charges of battery. The person has a long history of acting-out behaviors and several arrests. Which statement by the person suggests an antisocial personality disorder?
a. “I have a quick temper, but I can usually keep it under control.”
b. “I’ve done some stupid things in my life, but I’ve learned a lesson.”
c. “I’m feeling terrible about the way my behavior has hurt my family.”
d. “I hit because I’m tired of being nagged. My spouse deserved the beating.”
9. What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects?
a. Disturbed sensory perception–auditory
b. Risk for other-directed violence
c. Ineffective denial
d. Ineffective coping
10. A patient diagnosed with a personality disorder has used manipulation to get his or her needs met. The staff decides to apply limit-setting interventions. What is the correct rationale for this action?
a. It provides an outlet for feelings of anger and frustration.
b. It respects the patient’s wishes so assertiveness will develop.
c. External controls are necessary while internal controls are developed.
d. Anxiety is reduced when staff members assume responsibility for the patient’s behavior.
Chapter 14: Eating Disorders
1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
a. Binge eating disorder
b. Anorexia nervosa
c. Bulimia nervosa
2. Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat are congruent with height, frame, age, and sex.
b. Calorie intake is within the required parameters of the treatment plan.
c. Weight reaches the established normal range for the patient.
d. Patient expresses satisfaction with body appearance.
3. A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patient’s oral intake, the nurse should ask:
a. “Do you often feel fat?”
b. “Who plans the family meals?”
c. “What do you eat in a typical day?”
d. “What do you think about your present weight?”
4. A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, “Describe what you think about your present weight and how you look.” Which response by the patient is most consistent with the diagnosis?
a. “I am fat and ugly.”
b. “What I think about myself is my business.”
c. “I am grossly underweight, but that’s what I want.”
d. “I am a few pounds overweight, but I can live with it.”
5. A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patient’s current serum potassium is 2.7 mg/dl. Which nursing diagnosis applies?
a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia
d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia
6. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:
a. weigh self accurately using balanced scales.
b. limit exercise to less than 2 hours daily.
c. select clothing that fits properly.
d. gain 1 to 2 pounds.
7. Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight?
a. Assess for depression and anxiety.
b. Observe for adverse effects of re-feeding.
c. Communicate empathy for the patient’s feelings.
d. Help the patient balance energy expenditure and caloric intake.
8. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?
a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected.
b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment.
c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met.
d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.
9. The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention “Monitor for complications of re-feeding.” Which body system should a nurse closely monitor for dysfunction?
c. Central nervous
10. A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?
a. “What are your feelings about not eating the food that you prepare?”
b. “You seem to feel much better about yourself when you eat something.”
c. “It must be difficult to talk about private matters to someone you just met.”
d. “Being thin does not seem to solve your problems. You are thin now but still unhappy.”
Chapter 15: Mood Disorders: Depression
1. A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, “No one cares about me. I’m not worth anything.” Which response by the nurse would be the most helpful?
a. “Things will look brighter soon. Everyone feels down once in a while.”
b. “The staff here cares about you and wants to try to help you get better.”
c. “It is difficult for others to care about you when you repeatedly say negative things about yourself.”
d. “I’ll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon.”
2. A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, “No one cares about me anymore. I’m not worth anything.” Select an appropriate initial outcome for the nursing diagnosis: Situational low self-esteem, related to feelings of abandonment. The patient will:
a. verbalize realistic positive characteristics about self by (date) .
b. consent to take antidepressant medication regularly by (date) .
c. initiate social interaction with another person daily by (date) .
d. identify two personal behaviors that alienate others by (date) .
3. A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. “You look nice this morning.”
b. “You are wearing a new shirt.”
c. “I like the shirt you’re wearing.”
d. “You must be feeling better today.”
4. An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques
5. A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu.
6. When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies.
7. A patient says to the nurse, “My life does not have any happiness in it anymore. I once enjoyed holidays, but now they’re just another day.” How would the nurse document the complaint?
a. Vegetative symptom
8. A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, “I don’t think I can keep taking these pills. They make me so dizzy, especially when I stand up.” The nurse should:
a. explain how to manage postural hypotension, and educate the patient that side effects go away after several weeks.
b. tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
d. teach the patient how to use pursed-lip breathing.
9. A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
a. Dry mouth
b. Blurred vision
c. Nasal congestion
d. Urinary retention
10. A patient diagnosed with major depressive disorder tells the nurse, “Bad things that happen are always my fault.” To assist the patient in reframing this overgeneralization, the nurse should respond:
a. “I really doubt that one person can be blamed for all the bad things that happen.”
b. “Let’s look at one bad thing that happened to see if another explanation exists.”
c. “You are being exceptionally hard on yourself when you say those things.”
d. “How does your belief in fate relate to your cultural heritage?”
Chapter 16: Bipolar Spectrum Disorders
1. A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
a. Increased muscle tension and anxiety
b. Vegetative signs and poor grooming
c. Poor judgment and hyperactivity
d. Cognitive deficit and sad mood
2. A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient says, “I’ll punch you, munch you, crunch you,” while twirling and shadowboxing. Then the patient says gaily, “Do you like my scarves? Here…they are my gift to you.” How should the nurse document the patient’s mood?
a. Labile and euphoric
b. Irritable and belligerent
c. Highly suspicious and arrogant
d. Excessively happy and confident
3. A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority?
a. Risk for injury
b. Ineffective coping
c. Impaired social interaction
d. Ineffective therapeutic regimen management
4. A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?
a. “Stop that! No one did anything to provoke an attack by you.”
b. “If you do that one more time, you will be secluded immediately.”
c. “Do not hit anyone. If you are unable to control yourself, we will help you.”
d. “You know we will not let you hit anyone. Why do you continue this behavior?”
5. This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select the most appropriate outcome. The patient will:
a. ask staff for assistance with feeding within 4 days.
b. drink six servings of a high-calorie, high-protein drink each day.
c. consistently sit with others for at least 30 minutes at mealtime within 1 week.
d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit.
6. A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will:
a. minimize the side effects of lithium.
b. bring hyperactivity under rapid control.
c. enhance the antimanic actions of lithium.
d. provide long-term control of hyperactivity.
7. A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?
a. phenytoin (Dilantin)
b. clonidine (Catapres)
c. carbamazepine (Tegretol)
d. chlorpromazine (Thorazine)
8. The cause of bipolar disorder has not been determined, but:
a. several factors, including genetics, are implicated.
b. brain structures were altered by stresses early in life.
c. excess norepinephrine is probably a major factor.
d. excess sensitivity in dopamine receptors may exist.
9. The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurse’s best response.
a. “A high proportion of patients diagnosed with bipolar disorders are found among creative writers.”
b. “A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder.”
c. “Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses.”
d. “More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds.”
10. A patient diagnosed with bipolar disorder commands other patients, “Get me a book. Take this stuff out of here,” and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse.
a. Distraction: “Let’s go to the dining room for a snack.”
b. Humor: “How much are you paying servants these days?”
c. Limit setting: “You must stop ordering other patients around.”
d. Honest feedback: “Your controlling behavior is annoying others.”
Chapter 17: Schizophrenia Spectrum Disorders
1. A person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, “They’re all plotting to destroy me.” Select the nurse’s most therapeutic response.
a. “Everyone here is trying to help you. No one wants to harm you.”
b. “Feeling that people want to destroy you must be very frightening.”
c. “That is not true. People here are trying to help if you will let them.”
d. “Staff members are health care professionals who are qualified to help you.”
2. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, “I saw two doctors talking in the hall. They were plotting to kill me.” The nurse may correctly assess this behavior as:
b. an idea of reference.
c. a delusion of infidelity.
d. an auditory hallucination.
3. A patient diagnosed with schizophrenia says, “My co-workers are out to get me. I also saw two doctors plotting to overdose me.” How does this patient perceive the environment?
4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, “I stopped taking those pills. They made me feel like a robot.” What common side effects should the nurse validate with the patient?
a. Sedation and muscle stiffness
b. Sweating, nausea, and diarrhea
c. Mild fever, sore throat, and skin rash
d. Headache, watery eyes, and runny nose
5. A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, “I don’t like taking pills.” Which treatment strategy should the nurse discuss with the health care provider?
a. Use of a long-acting antipsychotic injections
b. Addition of a benzodiazepine, such as lorazepam (Ativan)
c. Adjunctive use of an antidepressant, such as amitriptyline (Elavil)
d. Inpatient hospitalization because of the high risk for exacerbation of symptoms
6. A patient’s care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?
a. Aloofness, haughtiness, suspicion
b. Darting eyes, tilted head, mumbling to self
c. Elevated mood, hyperactivity, distractibility
d. Performing rituals, avoiding open places
7. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight and has hypertension. Which drug should the nurse advocate?
a. clozapine (Clozaril)
b. ziprasidone (Geodon)
c. olanzapine (Zyprexa)
d. aripiprazole (Abilify)
8. A patient diagnosed with schizophrenia tells the nurse, “I eat skiller. Tend to end. Easter. It blows away. Get it?” Select the nurse’s best response.
a. “Nothing you are saying is clear.”
b. “Your thoughts are very disconnected.”
c. “Try to organize your thoughts, and then tell me again.”
d. “I am having difficulty understanding what you are saying.”
9. A patient diagnosed with schizophrenia has catatonia. The patient has little spontaneous movement and waxy flexibility. Which patient needs are of priority importance?
d. Safety and security
10. A patient diagnosed with schizophrenia has catatonia. The patient is stuporous, demonstrates little spontaneous movement, and has waxy flexibility. The patient’s activities of daily living are severely compromised. An appropriate outcome is that the patient will:
a. demonstrate increased interest in the environment by the end of week 1.
b. perform self-care activities with coaching by the end of day 3.
c. gradually take the initiative for self-care by the end of week 2.
d. voluntarily accept tube feeding by day 2.
Chapter 18: Neurocognitive Disorders
1. An older adult takes digoxin and hydrochlorothiazide daily, as well as lorazepam (Ativan) as needed for anxiety. Over 2 days, this adult developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of:
c. amnestic syndrome.
d. Alzheimer disease.
2. A patient experiencing fluctuating levels of awareness, confusion, and disturbed orientation shouts, “Bugs are crawling on my legs! Get them off!” Which problem is the patient experiencing?
c. Tactile hallucinations
d. Mnemonic disturbance
3. A patient experiencing fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, “Someone get these bugs off me.” What is the nurse’s best response?
a. “There are no bugs on your legs. Your imagination is playing tricks on you.”
b. “Try to relax. The crawling sensation will go away sooner if you can relax.”
c. “Don’t worry. I will have someone stay here and brush off the bugs for you.”
d. “I don’t see any bugs, but I know you are frightened so I will stay with you.”
4. What is the priority nursing diagnosis for a patient experiencing fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?
a. Bathing/hygiene self-care deficit, related to altered cerebral function, as evidenced by confusion and inability to perform personal hygiene tasks
b. Risk for injury, related to altered cerebral function, misperception of the environment, and unsteady gait
c. Disturbed thought processes, related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations
d. Fear, related to sensory perceptual alterations, as evidenced by hiding from imagined ferocious dogs
5. What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?
a. Avoidance of physical contact
b. High level of sensory stimulation
c. Careful observation and supervision
d. Application of wrist and ankle restraints
6. Which environmental adjustment should the nurse make for a patient experiencing delirium with perceptual alterations?
a. Keep the patient by the nurse’s desk while the patient is awake. Provide rest periods in a room with a television on.
b. Light the room brightly, day and night. Awaken the patient hourly to assess mental status.
c. Maintain soft lighting day and night. Keep a radio on low volume continuously.
d. Provide a well-lit room without glare or shadows. Limit noise and stimulation.
7. Which description best applies to a hallucination? A patient:
a. looks at shadows on a wall and says, “I see scary faces.”
b. states, “I feel bugs crawling on my legs and biting me.”
c. becomes anxious when the nurse leaves his or her bedside.
d. tries to hit the nurse when vital signs are taken.
8. Consider these health problems: Lewy body disease, Pick disease, and Korsakoff syndrome. Which term unifies these problems?
9. When used for treatment of patients diagnosed with Alzheimer disease, which medication would be expected to antagonize N-methyl-D-aspartate (NMDA) channels rather than cholinesterase?
a. donepezil (Aricept)
b. rivastigmine (Exelon)
c. memantine (Namenda)
d. galantamine (Razadyne)
10. An older adult was stopped by police for driving through a red light. When asked for a driver’s license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident?
d. Memory impairment
Chapter 19: Addictions and Compulsions
1. A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?
a. Between 0800 and 1000 today (6 to 8 hours after drinking stopped)
b. Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)
c. About 0200 on hospital day 3 (72 hours after drinking stopped)
d. About 0200 on hospital day 4 (96 hours after drinking stopped)
2. A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is:
b. dependent on alcohol.
c. healthy but underweight.
d. microcephalic and cognitively impaired.
3. A patient was admitted last night with a hip fracture sustained in a fall while intoxicated. The patient points to the Buck’s traction and screams, “Somebody tied me up with ropes.” The patient is experiencing:
a. an illusion.
b. a delusion.
d. hypnagogic phenomenon.
4. A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, “Snakes are crawling on my bed. I’ve got to get out of here.” What is the most accurate assessment of the situation? The patient:
a. is attempting to obtain attention by manipulating staff.
b. may have sustained a head injury before admission.
c. has symptoms of alcohol withdrawal delirium.
d. is having a recurrence of an acute psychosis.
5. A patient admitted yesterday for injuries sustained in a fall while intoxicated believes snakes are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?
a. Disturbed sensory perception
b. Ineffective coping
c. Ineffective denial
d. Risk for injury
6. A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
a. Monoamine oxidase inhibitor, such as phenelzine (Nardil)
b. Phenothiazine, such as thioridazine (Mellaril)
c. Benzodiazepine, such as lorazepam (Ativan)
d. Narcotic analgesic, such as morphine
7. A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?
a. Check the patient every 15 minutes.
b. Rigorously encourage fluid intake.
c. Provide one-on-one supervision.
d. Keep the room dimly lit.
8. A patient with a history of daily alcohol abuse says, “Drinking helps me cope with being a single parent.” Which response by the nurse would help the individual conceptualize the drinking more objectively?
a. “Sooner or later, alcohol will kill you. Then what will happen to your children?”
b. “I hear a lot of defensiveness in your voice. Do you really believe this?”
c. “If you were coping so well, why were you hospitalized again?”
d. “Tell me what happened the last time you drank.”
9. A patient asks for information about Alcoholics Anonymous (AA). Which is the nurse’s best response?
a. “It is a self-help group with the goal of sobriety.”
b. “It is a form of group therapy led by a psychiatrist.”
c. “It is a group that learns about drinking from a group leader.”
d. “It is a network that advocates strong punishment for drunk drivers.”
10. Police bring a patient to the emergency department after an automobile accident. The patient is ataxic with slurred speech and mild confusion. The blood alcohol level is 400 mg/dl (0.40 mg %). Considering the relationship between behavior and blood alcohol level, which conclusion can the nurse draw? The patient:
a. rarely drinks alcohol.
b. has a high tolerance to alcohol.
c. has been treated with disulfiram (Antabuse).
d. has recently ingested both alcohol and sedative drugs.
Chapter 20: Crisis and Mass Disaster
1. A patient comes to the clinic with superficial cuts on the left wrist. The patient paces around the room sobbing but cringes when approached and responds to questions with only shrugs or monosyllables. Select the nurse’s best initial statement to this patient.
a. “Everything is going to be all right. You are here at the clinic, and the staff will keep you safe.”
b. “I see you are feeling upset. I am going to stay and talk with you to help you feel better.”
c. “You need to try to stop crying so we can talk about your problems.”
d. “Let’s set some guidelines and goals for your visit here.”
2. A patient comes to the clinic with superficial cuts on the left wrist. The patient is pacing and sobbing. After a few minutes with the nurse, the patient is calmer. What should the nurse ask to determine the patient’s perception of the precipitating event?
a. “Tell me why you were crying.”
b. “How did your wrist get injured?”
c. “How can I help you feel more comfortable?”
d. “What was happening just before you started feeling this way?”
3. A patient comes to the crisis center saying, “I’m in a terrible situation. I don’t know what to do.” The triage nurse can initially assume that the patient is:
b. anxious and fearful.
c. misperceiving reality.
d. potentially homicidal.
4. An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The patient told the parents about the uncle’s behavior, but the parents did not believe the adolescent. What type of crisis exists?
5. While conducting the initial interview with a patient in crisis, the nurse should:
a. speak in short, concise sentences.
b. convey a sense of urgency to the patient.
c. be forthright about time limits of the interview.
d. let the patient know that the nurse is in control.
6. An adult seeks counseling after the spouse is murdered. The adult angrily says, “I hate the beast that did this. It has ruined my life. During the trial, I don’t know what I’ll do if the jury doesn’t return a guilty verdict.” What is the nurse’s highest priority question?
a. “Would you like to talk to a psychiatrist about some medication to help you cope during the trial?”
b. “What resources do you need to help you cope with this situation?”
c. “Do you have enough support from your family and friends?”
d. “Are you having thoughts of hurting yourself or others?”
7. A woman says, “I can’t take anymore! Last year my husband had an affair and now we don’t communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college.” What type of crisis is this person experiencing?
8. A woman says, “I can’t take anymore! Last year my husband had an affair and now we don’t communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college.” What is the nurse’s priority assessment?
a. Identifying measures useful to help improve the couple’s communication
b. Discussing the patient’s feelings about the possibility of having a mastectomy
c. Determining whether the husband is still engaged in an extramarital affair
d. Clarifying what the patient means by “I can’t take it anymore!”
9. A woman says, “I can’t take anymore! Last year my husband had an affair and now we don’t communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college.” If this person’s immediate family is unable to provide sufficient situational support, the nurse should:
a. suggest hospitalization for a short period.
b. ask what other relatives or friends are available for support.
c. tell the patient, “You must be strong. Don’t let this crisis overwhelm you.”
d. foster insight by relating the present situation to earlier situations involving loss.
10. A woman says, “I can’t take anymore! Last year my husband had an affair and now we don’t communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college and moving in with her boyfriend.” Which issue should be the focus for crisis intervention?
a. Possible mastectomy
b. Disordered family communication
c. Effects of the husband’s infidelity
d. Coping with the reaction to the daughter’s events
AND MUCH MORE