Test Bank Psychiatric Mental Health Nursing 5th Edition, Fortinash
Chapter 01: Psychiatric Nursing: Theory, Principles, and Trends
1. Which understanding is the basis for the nursing actions focused on minimizing mental health promotion of families with chronically mentally ill members?
a. Family members are at an increased risk for mental illness.
b. The mental health care system is not prepared to deal with family crises.
c. Family members are seldom prepared to cope with a chronically ill individual.
d. The chronically mentally ill receive care best when delivered in a formal setting.
2. Which nursing activity shows the nurse actively engaged in the primary prevention of mental disorders?
a. Providing a patient, whose depression is well managed, with medication on time
b. Making regular follow-up visits to a new mother at risk for post-partum depression
c. Providing the family of a patient, diagnosed with depression, information on suicide prevention
d. Assisting a patient who has obsessive compulsive tendencies prepare and practice for a job interview
3. Which intervention reflects attention being focused on the patient’s intentions regarding his diagnosis of severe depression?
a. Being placed on suicide precautions
b. Encouraging visits by his family members
c. Receiving a combination of medications to address his emotional needs
d. Being asked to decide where he will attend his prescribed therapy sessions
4. When a patient’s family asks why their chronically mentally ill adult child is being discharged to a community-based living facility, the nurse responds:
a. “It is a way to meet the need for social support.”
b. “It is too expensive to keep stabilized patients in acute care settings.”
c. “This type of facility will provide the specialized care that is needed.”
d. “Being out in the community will help provide hope and purpose for living.”
5. What is the best explanation to offer when the mother of a chronically ill teenage patient asks, “Under what circumstances would he be considered incompetent?”
a. “When you can provide the court with enough evidence to show that he is not able to care for himself safely.”
b. “It is not likely that someone his age would be determined to be incompetent regardless of his mental condition.”
c. “He would have to engage in behavior that would result in harm to himself or to someone else; like you or his siblings.”
d. “If the illness becomes so severe that his judgment is impaired to the point where the decisions he makes are harmful to himself or to others.”
6. Which psychiatric nursing intervention shows an understanding of integrated care?
a. A chronically abused woman is assessed for anxiety.
b. A manic patient is taken to the gym to use the exercise equipment.
c. The older adult diagnosed with depression is monitored for suicidal ideations.
d. A teenager who refuses to obey the unit’s rules is not allow to play video games.
7. What reason does the nurse give the patient for the emphasis and attention being paid to the recovery phase of their treatment plan?
a. Recovery care, even when intensive, is less expensive than acute psychiatric care.
b. Effective recovery care is likely to result in fewer relapses and subsequent hospitalizations.
c. Planning for recovery care is time consuming and involves dealing with many complicated details.
d. Recovery care is usually done on an outpatient basis and so is generally better accepted by patients.
8. The nurse is attending a neighborhood meeting where a half-way house is being proposed for the neighborhood when a member of the community states, “We don’t want the facility; we especially don’t want violent people living near us.” The response by the nurse that best addresses the public’s concern is:
a. “In truth, most individuals with psychiatric disorder are passive and withdrawn and pose little threat to those around them.”
b. “The mentally ill seldom behave in the manner they are portrayed by movies; they are people just like the rest of us.”
c. “Patients with psychiatric disorder are so well medicated that they do not display violent behaviors.”
d. “The mentally ill deserve a safe, comfortable place to live among people who truly care for them.”
9. Which activity shows that a therapeutic alliance has been established between the nurse and patient?
a. The nurse respects the patient’s right to privacy when visitors are spending time with the patient.
b. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors.
c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse.
d. The nurse dutifully administers the patient’s medications on time and with appropriate knowledge of the potential side effects.
10. Mental health care reform has called for parity between psychiatric and medical diagnoses. Which is an example of such parity?
a. Depression treatment is not paid for as readily as is treatment for asthma.
b. The mentally ill patient will be protected by law against social stigma.
c. Medical practitioners are trained to be proficient at treating mental disorders.
d. Psychiatric service reimbursement will be equivalent to that of medical services.
Chapter 02: Nursing Practice in the Clinical Setting
1. Which nursing action is a reflection of Hildegard Peplau’s theoretic framework regarding psychiatric mental health nursing?
a. Basing patient outcomes on expected instinctual responses
b. Discussing a patient’s feelings regarding parents and siblings
c. Providing the patient with clean clothes and wholesome food
d. Centering professional practice in a state run psychiatric facility
2. The nurse is attempting to provide a safe environment for a patient at great risk for self-harm. Which intervention shows an understanding of evidence-based practice (EBP)?
a. Using physical restraints only after all other options have been proven ineffective
b. Referring to the facility’s policies manual for guidelines for applying physical restraints
c. Collecting data regarding the short-term effects of using physical restraints on an aggressive patient
d. Requiring constant monitoring of a patient whose inability to self-regulate anger has required the use of physical restraints
3. Which statement by the patient reflects patient education that was based on the concept of integrated patient care?
a. “I know I’m anxious when I get a tension headache.”
b. “My anxiety is a result of stressors I don’t cope well with.”
c. “Medication has helped me tremendously with anxiety control.”
d. “Anxiety runs in my family; my entire family is trying to deal with it.”
4. The nurse demonstrates objective patient care when:
a. Being sympathetic to the patient’s recent loss of a spouse
b. Protecting the anxious patient by eliminating stressors in the milieu
c. Responding to the patient by stating, “I know exactly how you feel.”
d. Facilitating the patient’s exploration of various stress reduction techniques
5. Which nursing intervention would be appropriately addressed during the orientation phase of the nurse–patient relationship?
a. Self reflection by the nurse regarding personal biases and prejudices regarding the patient
b. Patient works at prioritizing personal needs and develops realistic expected outcomes
c. Establishing the contract between the nurse and the patient regarding mutual needs and expectations
d. Patient commits to the reinforcement of positive personal characteristics while working on problems and concerns
6. Which action on the part of a novice psychiatric mental health nurse shows a need for future development of altruism?
a. Excusing a patient from attending group because, “all that talking makes me so anxious”
b. Not permitting two patients who are physically attracted to each other to engage in public displays of affection
c. Placing a physically aggressive patient in restraints when they are unable to internally calm their anger
d. Self-reflecting on “why I continue to work with patients who are so emotionally damaged they will never be normal”
7. The greatest negative outcome resulting from a nurse’s fear of a mentally ill patient is that the:
a. Nurse will reinforce negative stereotyping of the mentally ill.
b. Patient will experience increased bias against the nursing staff.
c. Public’s fearfulness of the mentally ill will continue to be exaggerated.
d. Therapeutic alliance between the nurse and patient will not develop effectively.
8. Which action on the part of a novice mental health nurse will best minimize fear related to effectively working with the psychotic patient?
a. Be knowledgeable about psychotropic medications and their affect on psychosis.
b. Always arrange for staff support when working one-on-one with a psychotic patient.
c. Take advantage of opportunities to attend workshops devoted to the care of the psychotic patient.
d. Recognize that the psychotic patient is not in control of their behaviors due to their altered though processes.
9. Which response by the nurse manager to a novice mental health nurse is most effective when the nurse asks, “How do I justify not keeping a patient’s secret?”
a. “Never promise the patient that you will keep a secret for them.”
b. “Always stop the patient from telling you something as a secret.”
c. “Let the patient know that you will not keep a secret that could ultimately cause harm or affect their treatment.”
d. “Keep reminding yourself that you are not the patient’s friend but rather a professional mental health provider.”
10. The nurse is effectively facilitating the nurse-patient relationship when:
a. Sharing with an angry patient who is verbally abusive that, “Although I can accept that you are angry, I cannot and will not accept your verbal abuse.”
b. Focusing on the patient’s life experience without relating to the similarities of one’s own experiences
c. Objectively providing constructive criticism that is directed to helping the patient identify inappropriate behaviors
d. Refraining from abandoning the patient regardless of the frustration the interaction causes
Chapter 03: The Nursing Process and Standards of Practice
1. The patient asks the nurse, “I’ve heard the student nurses talk about the nursing process. Why is there so much emphasis on using the nursing process?” The response that explains the need for nurses to understand and use the nursing process is:
a. “Do you think you have a better method we might use?”
b. “The nursing process is a systematic problem-solving method encompassing all components necessary to care for patients.”
c. “Using the nursing process is a way of legitimizing our profession and placing us on an equal footing with the pure sciences.”
d. “The nursing process is a unidimensional, static, linear approach used to guide nurses as they make clinical judgments.”
2. When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ED) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by:
a. Reviewing the ED chart
b. Contacting the admitting physician
c. Directing the questions to the family members
d. Establishing a line of communication with the patient
3. The nurse shows the ability to effectively state a nursing diagnosis reflective of the implications of depression on a patient’s life processes when stating in the patient’s plan of care that:
a. Patient outcomes were partially attained. Implementation of present plan to continue.
b. Patient will initiate and support conversation with nurse therapist by (date 3 weeks in future).
c. Oral medication for anxiety should be administered when depression is assessed to be at the moderate level.
d. Impaired verbal communication r/t impoverished thoughts secondary to depression as evidenced by monosyllabic responses.
4. When engaging in outcomes identification, the nurse:
a. Interviews and collects patient-focused data
b. Re-assesses the patient’s physical and emotional status evaluation
c. Reviews the patient’s existing problems and projects the results of the nursing care
d. Considers the patient’s presenting symptoms and identifies nursing-related problems
5. While discussing assessment of suicidal patients, a novice nurse mentions, “I was taught to always base my care on concrete, evidence-based scientific reasoning and never to rely on intuition.” Which response by the experienced nurse shows understanding of intuitive reasoning?
a. “That’s wise, because intuition went out of favor with the scientific revolution.”
b. “Critical thinking and intuition are at opposite poles. Keep relying on your expertise.”
c. “It’s possible that intuition about suicidality is generated by transfer of feelings from the patient to the nurse.”
d. “It’s been determined that intuition is nothing more that extrasensory perception, so some folks have it, and some don’t.”
6. A nurse shows effective critical thinking skills directed towards nursing care of a cognitively impaired patient who continues to socially isolate by:
a. Clearly stating that the patient must socially interact once daily
b. Documenting that the patient continues to resist socialization
c. Asking the patient to identify which unit activity they are willing to attend
d. Suggesting that staff take the patient with them when running errands off the unit
7. A depressed patient shares with the nurse that he, “has been thinking about ending it all”. Based on NANDA recommendations, the nurse:
a. Implements suicide precautions for this patient
b. Includes ‘Risk for Self Harm’ to the patient’s care plan
c. Documents regarding the patient’s safety every 15 minutes
d. Reviews the patient’s chart for references to past incidences of hopeless
8. The nurse shows an understanding of the appropriate use of nursing outcomes regarding triggers for a patient diagnosed with chronic alcohol abuse when stating:
a. “Can you work on identifying three situations that cause you to abuse alcohol?”
b. ”I’ll help you to identify three triggers for your drinking during today’s session.”
c. ”I’m pleased you’ve identified three situations that trigger your abuse of alcohol.”
d. “Do you think you will be able to avoid the three triggers that cause you to drink?”
9. When a patient experiencing acute depression asks what the difference is between a medical and a nursing diagnosis, the nurse responds best when stating:
a. Actually they are very similar in that they both are concerned with helping you get better and lead a happier life.
b. Medical diagnoses are focused on why you are depressed whereas nursing diagnoses are concerned about making your life less sad.
c. Nursing diagnoses are more directed at caring for you, unlike medical diagnoses that focus on finding the cause for your problem.
d. The medical diagnosis identifies that you are experiencing depression whereas the nursing diagnosis identifies how the depression is affecting you.
10. A nurse best shows an understanding of the role of evidence-based research in achieving therapeutic patient care outcomes when:
a. Subscribing to and reading a monthly psychiatric research nursing journal
b. Working on a committee to revise current facility policies regarding the use of chemical restraints
c. Registering to attend a psychiatric workshop on newly developed psychotropic medication therapies
d. Asking an experienced staff member to review the interventions being proposed for a newly admitted patient
Chapter 04: Therapeutic Communication
1. An example of an environmental factor that would cause a nurse to modify a planned critical interaction occurs when the:
a. Patient expresses a personal dislike for the nurse
b. Patient is in total denial about her condition
c. Nurse lacks the degree of knowledge required for the interaction
d. Nurse learns that the patient’s mother has been hospitalized with a stroke
2. The nurse suspects that the patient’s communication is being negatively influenced by personal attitude when he is heard stating:
a. “They think I’m mentally ill but I’m not; I just get a little depressed at times.”
b. “I can’t concentrate on anything besides getting out of here and back to my kids.”
c. “Obviously my therapist can’t understand where I’m coming from because our lives are so different.”
d. “There isn’t anyone here in this hospital I can trust enough to talk to about why I abuse alcohol and drugs.”
3. The nature of the communication characterized in this exchange between a nurse and a chronically depressed patient is:
Nurse: Is it true that you enjoy knitting?
Patient: Yes, I’ve done it for years and am pretty good at it.
Nurse: I’m just a beginner. Do you think you could give me some tips?
Patient: I guess so. What would you like to know?
4. A patient expresses a sense of genuineness in the nurse providing care when sharing with family members that:
a. “I believe the nurse can feel what I’m feeling.”
b. “I always know what the nurse expects of me; the explanations are always clear.”
c. “I can tell the nurse is sincere because the face supports what the mouth is saying.”
d. “I may not always like what the nurse has to say but I can always depend on what I’m told.”
5. When providing discharge teaching to a patient for whom English is a second language, what technique will the nurse use to assess the patient’s understanding of the information being shared verbally?
a. Continuously evaluating the patient’s nonverbal cues
b. Periodically asking the patient if they have any questions
c. Asking the patient to repeat the information they are given
d. Providing the information in concise, written form
6. When communicating with a psychotic, schizophrenic patient, the nurse avoids the use of slang phrases most importantly because:
a. Such phrases have different meanings for different people.
b. Such phrases will likely trigger anxiety and frustration in the patient.
c. The use of such phrases is not appropriate when communicating therapeutically with a patient.
d. This patient’s altered thought processes will serve to make understanding such phrases very unlikely.
7. The nurse is considering the need for both effective means of communication and safety when caring for a patient with impulse control issues and poor social skills. Which nursing intervention is most appropriate to address these needs?
a. Reminding the patient with each interaction what space boundaries are considered safe and desired
b. Asking the patient to describe and set space boundaries that feel safe and facilitate effective communication
c. Clearly setting space boundaries for the patient so both patient and staff feel safe and can communicate more effectively
d. Discussing the need for space boundaries and how they help both the patient and the staff feel safe and aide in communicating effectively
8. During the termination phase of the nurse-patient relationship with a dependent patient, the nurse evaluates the effectiveness of coping techniques learned by:
a. Role playing with the patient in order to practice being assertive
b. Asking the patient to define the difference between being assertive and being aggressive.
c. Discussing how her father effectively used both assertiveness and aggressiveness to control her
d. Asking, “When you used assertiveness to deal with your father during his visit, how did it work?”
9. The nurse has developed a plan in which nursing interventions are used to reinforce the patient’s healthy behaviors. Which statement by the nurse will positively reinforce the patient’s efforts regarding the plan?
a. “How can a stress reduction plan help you at home?”
b. “It sounds like you have the incentive to make healthy choices.”
c. “When you tried to follow the plan, how well did it work for you?”
d. “It sounds as though making healthy choices is very important to you.”
10. A patient indicates that he is about to share information about his illness that is shocking and embarrassing. Which nursing intervention has priority in this situation in facilitating the communication process?
a. Reassuring the patient that talking will be therapeutic
b. Assuring the patient the information will be kept confidential
c. Responding to the patient’s information in an accepting manner
d. Providing the patient with a private place for the discussion to occur
Chapter 05: Adaptation to Stress
1. Although stress may result from either a positive or a negative event, the physical effects are similar. Which statement best describes the long term effects of stress?
a. Eustress is likely to result in short term stress.
b. Chronic distress can take a toll on the individual.
c. Stress usually manifests in physical symptoms first.
d. Distress generally results in more effective coping skills.
2. When explaining the fight-or-flight response to stress, the nurse identifies that the role of the pituitary gland is to:
a. Minimize the secretion of cortisol.
b. Facilitate the conservation of energy.
c. Secrete adrenocorticotropic hormone.
d. Encourage fleeing from the stressor.
3. It is believed that an individual’s locus of control has a major role to play in how stress will be handled. Which statement characterizes an internal locus of control?
a. “I’ll need to manage my money better in order to get out of debt.”
b. “The economy has really caused my finances to be in a real mess.”
c. “I don’t think I’ll ever be able to save enough to pay off my bills.”
d. “Having a family makes being able to stay out of debt really difficult.”
4. A nurse manager is attempting to address issues of work-related stress and dissatisfaction on the unit. Which administrative intervention has been identified through research as providing the most positive impact on staff morale even when job demands are high?
a. Scheduling so that all staff gets two weekends off a month
b. Arranging for extra staff when patient activity is above the unit average
c. Offering a paid vacation day to anyone who has no absents for six months
d. Assuring that no staff will be mandated overtime more than twice monthly
5. The nurse suggests that a patient help manage the stressors that are triggering generalized anxiety by implementing compartmentalization. Which activity provides proof that the patient is employing this healthy defense mechanism?
a. Attends a meditation class 3 times a week right after work
b. Uses chocolate as a reward when keeping stress under control
c. Counts to 10 before responding to a coworker who is a source of stress
d. Shares with the office manager the situations that regularly cause increased stress
6. The spouse of a patient exhibiting symptoms of chronic stress asks how they can help their spouse. Which suggestion by the nurse shows an understanding of a family member’s role in the management of stress?
a. Offer to discuss the problem with the person who is most responsible for causing their spouse’s stress.
b. Listen attentively when their spouse talks about the stressors and provide hugs to show your support.
c. Help the spouse limit the amount of time each day they devote to discussing and otherwise dwelling on the stress.
d. Provide the spouse with a variety of options and techniques for dealing with the stressors and the resulting physical symptoms.
7. The patient is being introduced to mindfulness-based stress reduction to help manage chronic stress. The patient is first taught to focus on:
a. What is causing the stress
b. Both inhaling and exhaling
c. Relaxing each major muscle group
d. Visualizing their life without the stress
Chapter 06: Neurobiology in Mental Health and Mental Disorder
1. A patient with depression mentions to the nurse, “My mother says depression is a chemical disorder. What does she mean?” The nurse’s response is based on the theory that depression primarily involves which of the following neurotransmitters?
a. Cortisol and GABA
b. COMT and glutamate
c. Monamine and glycine
d. Serotonin and norepinephrine
2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damage to the Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis?
a. Observing the patient pick up a spoon
b. Asking the patient to recite the alphabet
c. Monitoring the patient’s blood pressure
d. Comparing the patient’s grip strength in both hands
3. The patient diagnosed with schizophrenia asks why psychotropic medications are always prescribed by the doctor. The nurse’s answer will be based on information that the therapeutic action of psychotropic drugs is the result of their effect on:
a. The temporal lobe; especially Wernicke’s area
b. Dendrites and their ability to transmit electrical impulses
c. The regulation of neurotransmitters especially dopamine
d. The peripheral nervous system sensitivity to the psychotropic medications
4. A student nurse mutters that it seems entirely unnecessary to have to struggle with understanding the anatomy and physiology of the neurologic system. The mentor would base a response on the understanding that it is:
a. Necessary but generally for psychiatric nurses who focus primarily on behavioral interventions
b. A complex undertaking that advance practice psychiatric nurses frequently use in their practice
c. Important primarily for the nursing assessment of patients with brain trauma–caused cognitive symptoms
d. Necessary for planning psychiatric care for all patients especially those experiencing psychiatric disorders
5. A patient asks the nurse, “My wife has breast cancer. Could it be caused by her chronic depression?” Which response is supported by research data?
a. “Too much stress has been proven to cause all kinds of cancer.”
b. “There have been no research studies done on stress and disease yet.”
c. “Stress does cause the release of factors that suppress the immune system.”
d. “There appears to be little connection between stress and diseases of the body”
6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitation needs. Of the aspects of functioning listed, which will the nurse identify as a focus of nursing intervention?
a. Expression of emotion
b. Detecting auditory stimuli
c. Receiving visual images
d. Processing associations
7. At admission, the nurse learns that some time ago the patient had an infarct in the right cerebral cortex. During assessment, the nurse would expect to find that the patient:
a. Demonstrates major deficiencies in speech
b. Is unable to effectively hold a spoon in the left hand
c. Has difficulty explaining how to go about using the telephone
d. Cannot use his right hand to shave himself or comb his own hair
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The patient will be discharged on low doses of haloperidol. The nurse will need to individualize the patient’s medication teaching by:
a. Including the patient’s caregiver in the education
b. Being careful to stress the importance of taking the medication as prescribed
c. Providing the education at a time when the patient is emotionally calm and relaxed
d. Encouraging the patient to crush or dissolve the medication to help with swallowing
9. The physician tells the nurse, “The medication I’m prescribing for the patient enhances the g-aminobutyric acid (GABA) system.” Which patient behavior will provide evidence that the medication therapy is successful?
a. The patient is actively involved in playing cards with other patients.
b. The patient reports that, “I don’t feel as anxious as I did a couple of days ago.”
c. The patient reports that both auditory and visual hallucinations have decreased.
d. The patient says that, “I am much happier than before I came to the hospital.”
10. The patient’s family asks whether a diagnosis of Parkinson’s disease creates an increased risk for any mental health issues. What question would the nurse ask to assess for such a comorbid condition?
a. “Has your father exhibited any signs of depression?”
b. “Does your father seem to experience mood swings?”
c. “Have you noticed your father talking about seeing things you can’t see?”
d. “Is your dad preoccupied with behaviors that he needs to repeat over and over?”
Chapter 07: Human Development Across the Life Span
1. The nurse leading parent education classes bases instruction on Erikson’s developmental stages. It follows that the nurse will plan to instruct the parents that a helpful strategy to foster a child’s initiative would be to:
a. Offer several different options for dressing and encourage the child to select one of them.
b. Allow the child to help wash the unbreakable dishes used to serve breakfast.
c. Provide one-on-one parent–child time each evening before bed.
d. Enroll the child in a weekend, age-appropriate sports program.
2. Which of the following responses would the nurse expect from a 12-year-old regarding stealing?
a. “You are never allowed to steal.”
b. “You go to jail is you steal someone else’s things.”
c. “My parents would punish me if I was caught stealing.”
d. “Stealing food when you don’t have anything to eat is alright.”
3. A nursing diagnosis of hopelessness would be considered for an individual who:
a. Was consistently overprotected by family members
b. Was raised by parents who were strict disciplinarians
c. Had inconsistent, unpredictable physical care as an infant
d. As a teenager always felt unaccepted by his social peers
4. An adolescent has been a consistently, poor academic student due to a learning disorder. Which statement overheard by the nurse would support the possibility of a problem with the developmental stage competence versus inferiority?
a. “It’s too hard to get good grades.”
b. “I’ll never be able to get into a good college.”
c. “My parents are disappointed that I do so poorly in school.”
d. “I don’t want people to know I can barely read or write.”
5. A parent is concerned with the interpersonal skills of her 12-year-old son. Based on interpersonal theory, the nurse asks:
a. “Does your son belong to team or club with friends or classmates?”
b. “Does he feel bad when he does something he knows he shouldn’t do?”
c. “How does he tend to act when he doesn’t get exactly what he wants?”
d. “How confident is he in situations that are generally unfamiliar for him?”
6. The parents of an 8-year-old are attempting to help their child comprehend new information. Which intervention suggested by the nurse shows an understanding of the cognitive development theory for this age group?
a. The use of drawing and illustrations
b. Comparing the child’s experiences to the new material
c. Encouraging the child to talk about this new information
d. Asking the child to give a reason for how they feel about new information
7. According to Piaget, which of the following would the nurse consider normal when assessing a 6-year-old?
a. Playing with an “imaginary friend”
b. Talking about their “best friend”
c. Enjoying putting puzzles together
d. Knowing its wrong to tell a lie
8. Which developmental level would be characterized by a child being able to focus, to coordinate, and to imagine a series of events?
b. Concrete operational
c. Formal operational
9. Which strategy will the nurse include in the plan of care for a 6-year-old child for whom operant conditioning has been recommended?
a. Periodically asking the child to attempt to solve increasingly difficult puzzles
b. Consistently offering praise when the child puts his dirty clothes in the hamper
c. Expecting the child to rinse and to place his dirty dishes in the sink
d. Conditioning the child to expect punishment when he misbehaves
10. A child who has been physically abused becomes emotionally distorted when told that the parent will no longer be allowed to visit. Which principle of social learning theory is most likely for the child’s response?
a. The child views the abuse to be more desirable than the parent leaving.
b. The parent has fostered a fear in the child that increases when they are apart.
c. The child believes that he is responsible for the parent now being punished.
d. The parent has likely told the child that he deserved the abuse as a punishment.
Chapter 08: Culture, Ethnicity, and Spirituality
1. To include a cultural focus in patient care planning, which belief about faith will the nurse incorporate? Faith is a:
a. Belief of body and mind
b. Manner of expressing spirituality
c. Use of spiritual resources without empiric proof
d. Search for the sacred, transcendent, or universal
2. A culturally diverse patient refuses to participate in a group because of the presence of a person who “can put spells on.” The nurse recognizes a priority need to explore this patient’s:
a. Economic status
b. Home environment
c. Health-illness beliefs
d. Educational background
3. An Asian-American patient diagnosed with depression explains to the nurse that eating two specific foods will restore the balance of hot and cold and she will be cured. The nurse should:
a. Explain that foods cannot cure mental disorders.
b. Arrange for the patient to talk with the dietitian.
c. Change the subject to focus on medication compliance.
d. Accept that cultural beliefs about illness die slowly.
4. When working with a patient newly emigrated from Asia who has been assessed as having xenophobia, the nurse could anticipate making the assessment that the individual:
a. Resists sharing food with others
b. Would be reluctant to ride an elevator
c. Is unlikely to talk with nonfamily members
d. Fears the consequences of going out of doors
5. The nurse plans to use pamphlets to teach a newly immigrated Vietnamese patient about diabetes mellitus. Before initiating this education, the priority information for the nurse to obtain is the patient’s:
a. Ability to read and understand English
b. Readiness and ability to learn this material
c. Previous knowledge and interest in the subject
d. Willingness to participate and follow instructions
6. A nurse is planning to incorporate a culturally sensitive focus in her nursing care. Which of these underlying principles concerning cultural heritage will be included?
a. A group is formed from among individuals who share similar ancestral origins.
b. A condition of belonging to a group is that all members share a unique heritage.
c. Learned patterns of behavior and thinking are shared by members of a cultural group.
d. The classification of humans into cultural groups is generally based on physical characteristics.
7. A patient diagnosed with paranoid schizophrenia is describing religiously-based delusions that other patients find offensive. Which nursing intervention will the nurse implement to provide a therapeutic milieu?
a. Engaging the delusional patient in prayer in order to redirect the problematic behavior
b. Explaining to the delusional patient that such talk is offensive to some of the milieu and will not be allowed
c. Asking for the pastoral counselor to visit the unit and talk with both the delusional patient as well as the rest of the milieu
d. Removing the delusional patient from the milieu when staff is unable to successfully refocus the conversation to a non-religious topic
8. A patient confides to the nurse that she feels guilty about the poor relationship she had with her mother-in-law, who is now deceased. The patient tells the nurse that she is sure God will punish her for this and that she needs to confess her sins to someone. Which of the following is the best response by the nurse?
a. “Would you like to speak to the chaplain when he comes later today? In the meantime, we could talk about your relationship with your mother-in-law.”
b. “It sounds as if you need to talk about this. Let’s sit down in a private area. I’d like to know more about your relationship with your mother-in-law.”
c. “We all have trouble with our in-laws occasionally. God doesn’t punish us for that.”
d. “What’s done is done. We need to focus on your positive qualities.”
9. A patient is dealing with the loss of a spouse. Which response shows an understanding of the role spirituality plays in the management of grief?
a. “He’s in a better place; my faith tells me that is true.”
b. “I find that my faith is stronger now that I’m alone.”
c. “I’m told that a sense of spiritual connection will help me go on with life.”
d. “My faith helps me deal and gives me renewed hope; I rely on it to help me heal.”
10. The nurse identifies a patient as being in spiritual distress. Which patient statement supports this nursing diagnosis?
a. “I’ve never felt so alone before in my entire life.”
b. “I don’t know if I could get through this without faith in God.”
c. “I’ve always relied on my faith in God but now I feel I’ve been abandoned.”
d. “Why do bad things happen to good people? I’ve always been a good person.”
Chapter 09: Legal and Ethical Aspects in Clinical Practice
1. An advanced practice nurse evaluates a patient for emergency commitment because of the likelihood the patient will do serious harm to others. Which statement best reflects the nurse’s role as patient advocate during the assessment process?
a. “Tell me about any delusions you are experiencing.”
b. “I understand you have had some difficulty today.”
c. “Tell me why you need to threaten or hurt others around you.”
d. “Threatening to hurt others will require that you be committed to the hospital.”
2. A patient was placed in restraints for 2 hours in order to help manage impulsive, destructive, unsafe behavior. Which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort?
a. “How did this situation get so out of control?”
b. “You all know that restraints are used only as a last resort.”
c. “Can anyone tell me why restraints were used on this patient?”
d. “Let’s review what exactly happened that led to the use of restrains.”
3. The nurse is explaining the advantage of advanced directives to a patient diagnosed with schizophrenia. Which psychiatric outcome is a result of such preplanning?
a. Allows healthcare providers to manage the patient’s mental health care
b. Decreases the possibility that the patient will be committed involuntarily
c. Directly impacts the type of care the patient will receive as the disease progresses
d. Assures that the patient will retain continued autonomy and independence of living
4. A patient is being treated in the inpatient unit for paranoid delusions that his wife is unfaithful resulting in threats to “get her for this whenever I get out.” Which intervention to assure his wife’s safety will his primary therapist include in the discharge plan?
a. Sharing the threats he has made with his wife
b. Requiring mandatory day hospital attendance
c. Advising the patient that he needs continued outpatient services
d. Informing the patient of the consequences of harming his wife
5. A patient who has schizoaffective disorder is being treated with lithium carbonate. He repeatedly resists his medication based on his fine hand tremors as proof of drug poisoning. Which nursing intervention addresses both the patient’s need to comply with treatment and patient rights?
a. Informing staff that the patient is exhibiting manipulative behavior
b. Providing the patient with effective education regarding medication side effects
c. Assuring the patient the tremors are a result of the disorder, not of the medication
d. Providing an assessment to determine if the patient is exhibiting paranoia as well
6. A patient diagnosed with schizophrenia is hospitalized under an emergency commitment. Which nursing explanation is most effective when the patient asks, “Why am I being kept here?”
a. “The court believed you needed mental health care.”
b. “Your mental condition became unstable and you relapsed.”
c. “You couldn’t stop doing things that could likely have hurt you.”
d. “I’d suggest that you exercise your patient right to speak to a lawyer.”
7. A patient has been hospitalized and is now being mandated outpatient mental health treatment as a condition for discharge. Which intervention best addresses the nurse’s role of patient advocate when this patient resists the recommendation?
a. Helping the patient identify advantages of outpatient versus inpatient therapy
b. Sharing that outpatient therapy is less expensive than inpatient hospitalization
c. Stressing that outpatient therapy can minimize the need for future hospitalization
d. Discussing the patient’s opposition to outpatient treatment with the treatment team
8. A patient admitted for treatment of symptoms related to paranoid schizophrenia refuses to sign a consent form allowing the nurse to discuss any aspect of his hospitalization with his parents. Which statement by the nurse best respects the patient’s rights while providing effective care?
a. Reminding the parents that, “I can’t discuss your son even though I want to.”
b. Asking the patient to, “please talk with me about why you don’t trust your parents?”
c. Telling the patient that, “Keeping your parents uninvolved in your care is very painful for them.”
d. Telling the parents that, “While I can’t discuss his care with you, you can tell me anything you think I need to know.”
9. Electroconvulsive therapy (ECT) has been prescribed for a patient diagnosed with chronic depression. Which statement by the patient helps assure the nurse that the patient’s right to informed consent has been respected?
a. “ECT treatment will cure my depression.”
b. “ECT is dangerous but I’m almost out of treatments.”
c. “I may not remember things that happened just before the ECT treatment.”
d. “I’m likely to permanently lose memory of things like dates and numbers.”
10. A 15-year-old who shows poor impulse control and resistance to authority is prescribed outpatient therapy. The parents are insistent that the treatment include commitment to an inpatient facility. Which response by the nurse best supports the outpatient treatment modality?
a. “Your child has a right to receive treatment in the least restrictive manner.”
b. “Outpatient therapy is better accepted by teens that are authority resistant.”
c. “This form of treatment is less expensive and usually covered by insurance.”
d. “Short-term therapy like this is usually done in an outpatient environment setting.”
Chapter 10: Anxiety and Anxiety Disorders
1. A patient who was savagely attacked by a bear has no memory of the event. Which statement best explains the patient’s inability to remember the attack?
a. The woman lost consciousness and was not cognitively aware of what happened during the attack
b. The brain has produced a chemical anemia that will repress the memories of the attack indefinitely.
c. The patient is unconsciously using a defense mechanism to protect against the repeated memory of the attack.
d. It is a temporary suppression of the attack; her memory will return when she is physically and emotionally ready to handle the memories.
2. Which assessment finding exhibited by a patient being assessed for posttraumatic stress disorder (PTSD) would be considered a defining behavior and support such a diagnosis?
a. Can describe the attack in great detail
b. Experiences dramatic swings in affect
c. Describes vivid “flashbacks” of being attacked
d. Is preoccupied with the need to “tell someone about the attack”
3. What is the basis for assessing a male patient who is agoraphobic for panic attacks?
a. Men are more likely to experience panic attacks.
b. An overwhelming number of agoraphobic patients also have panic attacks.
c. Patients are often unaware that the symptoms they are experiencing are those of panic.
d. Panic attacks are generally the cause of a patient developing phobias like agoraphobia.
4. Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale (HAS). When asked by the patient to explain the purpose of the assessment the nurse responds:
a. “It is an assessment tool used to evaluate the symptoms of anxiety.”
b. “The tool is used to help confirm the diagnosis of anxiety disorder.”
c. “This tool helps determine if your symptoms have improved with treatment.”
d. “It helps identify the presence of any other disorder associated with anxiety.”
5. A patient is admitted for treatment for persistent, severe anxiety. Which nursing diagnosis would help effectively direct patient care?
a. Disturbed sensory perception related to narrowed perceptual field
b. Risk for injury related to closed perception
c. Hopelessness related to total loss of control
d. Risk for other-directed violence related to combative behavior
6. The patient was an awkward child who was ridiculed by his father for his inability to catch a ball. As an adult, the patient developed panic attacks at the time his company established after-work team sporting activities. Which data discussed during the nursing interview provides insight to the possible cause of this anxiety disorder when applying the behavioral model?
a. He always avoids sports because “I’m short and not the least bit athletic.”
b. When in fifth grade, the patient caused his team to “lose the big softball game.”
c. The company he works for places tremendous emphasis of successful team work.
d. As a child he wore a leg brace that prevented him from participating in school sports.
7. The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan?
a. The thoughts, images, and impulses are voluntary.
b. The family should pay immediate attention to symptoms.
c. The thoughts, images, and impulses tend to worsen with stress.
d. OCD is a chronic disorder that does not respond to treatment.
8. Which question would assist the nurse in determining whether the patient has been experiencing anxiety?
a. “Have you had difficulty concentrating lately?”
b. “Have you been feeling sad and especially lonely?”
c. “Do you have a history of failed personal relationships?”
d. “Do you frequently experience difficulty controlling your anger?”
9. The nurse working with patients diagnosed with posttraumatic stress disorder (PTSD) is aware of the need to intervene early in order to de-escalate a patient’s increasing anxiety level. Which patient behavior is likely an early indication of escalating anxiety?
a. Talking rapidly
b. Pacing around the unit
c. Staring out the window
d. Refusing to go to therapy
10. The nurse has been working with a patient who experiences anxiety. Which intervention should the nurse implement initially when the patient is observed pacing and wring her hands?
a. Asking how she has managed anxiety effectively in the past
b. Distracting her by offering to help her make a telephone call
c. Asking her what she believes is causing her increased anxiety
d. Teaching her to take deep, relaxing breaths to manage the anxiety
Chapter 11: Somatoform, Factitious, and Dissociative Disorders
1. Which question would the nurse performing an admission interview for a patient with suspected dissociative amnesia disorder identify as a priority?
a. “What help would you like us to give you?”
b. “Are you experiencing a high level of anxiety?”
c. “Do you find rituals make you feel more comfortable?”
d. “How would you describe your childhood memories?”
2. Which nursing assessment finding would support a diagnosis of somatoform disorder?
a. Patient reports a family history of depression
b. The onset of symptoms beginning at age 38
c. An abnormality of the patient’s left heart ventricle
d. Complaints of diarrhea and an erratic menstrual cycle
3. To differentiate between somatoform and conversion disorders, the nurse will direct the assessment to determine the presence of the critical defining factor associated with conversion disorder. Which is true about a conversion reaction?
a. Symptoms are generally associated with pain or sexual function.
b. Symptoms are not accounted for by a medical condition.
c. Symptoms are precipitated by psychological factors.
d. Symptoms are under the patient’s voluntary control.
4. A diagnosis of dissociative identity disturbance has been identified for a patient who has stated that he is unable to distinguish between himself and his surroundings. What is an appropriate outcome for this patient?
a. Refers to himself as “the patient”
b. Identifies the onset of increasing anxiety
c. Uses manipulative behaviors to meet needs
d. Displays ability to suppress feelings of dissatisfaction
5. A patient comes to the ED stating that he suddenly became deaf. It is determined that his wife has recently asked for a divorce. What is the basis for the possibility that this patient is experiencing a conversion disorder?
a. Inventing the symptom helps in diverting attention from the marital problems.
b. Such a traumatic life change is likely to result in some form of mental illness.
c. The loss is a protective mechanism to help deal with overwhelming anxiety.
d. Men often exhibit this disorder since it is more accepted than showing sadness.
6. A patient reports severe pain during intercourse since being sexually assaulted three years ago. What is the first step in confirming the diagnosis of a pain disorder?
a. Evaluating the patient’s understanding of the emotional effects of the assault
b. Asking the patient to keep a journal of her feelings regarding the assault
c. Assessing the patient for posttraumatic stress disorder
d. Ruling out a physical cause of the pain
7. A patient has developed an acute loss of hearing and is diagnosed with a conversion disorder. Which nursing diagnosis would be most appropriate?
a. Hearing impairment
b. Panic-level anxiety
c. Disturbed sensory perception
d. Denial due to a medical condition
8. A patient experiencing the sudden onset of blindness is diagnosed with a conversion disorder. Which nursing intervention would be most therapeutic?
a. Suggesting to the patient that this is possibly malingering
b. Assisting him to make an appointment with an ophthalmologist
c. Providing nursing care in a supportive but matter-of-fact manner
d. Providing an occupational therapy consult to address the needs of a blind person
9. A patient is being evaluated for the diagnosis of hypochondriasis. Which assessment observation of the patient would serve to confirm this diagnosis?
a. Reports, “Pain in my back is certainly from a spinal tumor.”
b. Patient expresses no concern over her sudden loss of hearing.
c. Patient shows insight into the role stress plays in the illness.
d. Reports, “I don’t like doctors and so I haven’t been to one in years.”
10. A patient who inaccurately believes he has stomach cancer is recommended cognitive theory to help address this false believe. Which intervention is most consistent with a cognitive theory approach?
a. Continuing to challenge the patient about the rationality of his belief
b. Assisting him to reinterpret the meaning of the sensations his body is creating
c. Urging him to have a ‘second opinion’ consult with another medical specialist
d. Rewarding him with praise and acceptance when he states, “I do not have cancer.”
Chapter 12: Mood Disorders: Depression, Bipolar, and Adjustment Disorders
1. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom?
a. “I can’t do anything anymore.”
b. “I’m the world’s most astute financier.”
c. “I can understand why my wife is upset that I overspend.”
d. “I can’t understand where all the money in our family goes.”
2. The nurse will base a discussion of dysthymia on the fact that the condition:
a. Typically has an acute onset
b. Involves delusional thinking
c. Is chronic low-level depression
d. Does not include suicidal ideation
3. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?
a. Risk for injury
b. Chronic low self-esteem
4. A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptom of:
a. Seasonal episodes
b. Leaden paralysis
c. Psychomotor agitation
d. Increased depression in the morning
5. An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on:
a. Assessing needs for food, liquids, and rest
b. Setting strict limits on dress and behavior
c. Conducting an in-depth suicide assessment
d. Obtaining a complete psychosocial assessment
6. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen?
a. “I will restrict my daily salt intake.”
b. “I will take my medications with food.”
c. “I will have my blood drawn on schedule.”
d. “I will drink 8 to 12 glasses of liquids daily.”
7. The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states:
a. “I can stop my lithium when I feel better.”
b. “I can continue with my diuretic and cardiac medications.”
c. “I will probably need to take the lithium for the rest of my life.”
d. “I will taper my lithium when a therapeutic serum level is achieved.”
8. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage?
a. HydroDIURIL daily
b. Navane bid
c. Ativan at bedtime
d. Cefobid daily
9. Which outcomes would be appropriate to determine early favorable response to antidepressant medication?
a. The patient will complete own self-care activities.
b. The patient will demonstrate assertive communication skills.
c. The patient will describe signs and symptoms of major depression.
d. The patient will make plans to attend one community social activity a week.
10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patient’s:
a. Mood and affect
b. Activity level
c. Cognitive ability to understand information about the medication
d. Support network and its members’ willingness to participate in treatment
Chapter 13: Schizophrenia and Other Psychotic Disorders
1. A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis?
a. Uses a rhyming form of speech
b. Refuses to eat any unwrapped foods
c. Laughs when watching a sad movie
d. Maintains an immobilized state for hours
2. What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence?
a. Decide their own daily schedule.
b. Decide which unit groups they will attend.
c. Choose which clinic staff member to work with.
d. Choose between two outfits to wear each morning.
3. What is the priority nursing diagnosis for a catatonic patient?
a. Ineffective coping
b. Impaired physical mobility
c. Impaired social interaction
d. Risk for deficient fluid volume
4. Which nursing diagnosis is appropriate for a patient who insists being called “Your Highness” and demonstrates loosely associated thoughts?
a. Risk for violence
b. Defensive coping
c. Impaired memory
d. Disturbed thought processes
5. Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?
a. Accept that delusion is illogical.
b. Distinguish external boundaries.
c. Explain the basis for the delusions.
d. Engage in reality-oriented conversation.
6. Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking?
a. Confronting the delusion
b. Refuting the delusion with logic
c. Exploring reasons the patient has the delusion
d. Focusing on feelings suggested by the delusion
7. Which assessment observation supports a patient’s diagnosis of disorganized schizophrenia?
a. Reports suicidal ideations
b. Last relapse was 6 years ago
c. Consistent inappropriate laughing
d. Believes that “the government is out to get me”
8. A patient tried to gouge out his eye in response to auditory hallucinations commanding, “If thine eye offends thee, pluck it out.” The nurse would analyze this behavior as indicating:
b. Inappropriate affect
c. Impaired impulse control
d. Inability to manage anger
9. An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be:
a. Providing large muscle activities to relieve stress
b. Attempting to determine triggers to hallucinations
c. Engaging patient in activities designed to permit success
d. Encouraging verbalization of feelings in a safe environment
10. A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the patient’s condition as:
a. Social isolation
b. Disturbed thinking
c. Altered mood states
d. Poor impulse control
Chapter 14: Personality Disorders
1. When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnosis would be pertinent to his care?
a. Risk for self-mutilation
b. Disturbed personal identity
c. Impaired social interaction
d. Social isolation
2. Which observation is supportive of a diagnosis of avoidant personality disorder?
a. Talks about “my three failed marriages”
b. Cries loudly whenever requests are denied
c. Fears criticism from others, including staff
d. Shows no remorse when accidentally breaking another patient’s bracelet
3. Which behavior is supportive of a diagnosis of dependent personality disorder?
a. Perceives personal behavior to be embarrassing
b. Believes they are incapable of functioning independently
c. Tends to exaggerate the potential dangers of ordinary situations
d. Demands excessive attention from others whenever in a group situation
4. When planning care for a patient with antisocial personality disorder, which consideration has greatest importance?
a. Addressing the demand for constant attention
b. Teaching coping skills related to frustration tolerance
c. Identifying behaviors related to well-developed superegos
d. Managing the manipulative behaviors resulting from a charming persona
5. When a patient diagnosed with borderline personality disorder experiences the death of a beloved parent, which characteristic response will the nurse anticipate?
a. Denies the death for a protracted period of time
b. Exhibits several different psychotic thought processes
c. Expresses extreme anger and rage by burning the parent’s clothes
d. Becomes uncharacteristically helpful and attends to the funeral arrangements
6. A 27-year-old woman diagnosed with borderline personality disorder displays a labile affect, impulsivity, frequent angry outbursts, and difficulty tolerating her angry feelings without self-injury. A priority nursing diagnosis for this patient is:
b. Risk for self-mutilation
c. Risk for other-directed violence
d. Ineffective coping
7. Which outcome has priority for a patient with borderline personality disorder being discharged from an outpatient treatment environment?
a. Patient demonstrates control over self-destructive impulses.
b. Patient can identify symptoms that indicate a need for psychotherapy.
c. Patient demonstrates an understanding of the importance of medication compliance.
d. Patient actively participates in a community 12-step group related to relevant care.
8. A patient who is diagnosed with schizoid personality disorder is isolative, does not speak to her peers, and sits through the community meeting without speaking. Her mother describes her as shy and having few friends. Which would be an appropriate nursing diagnosis for this patient?
a. Anxiety related to a new environment as evidenced by isolation and not talking with peers
b. Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
c. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
d. Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others
9. The nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a patient believed to be exhibiting characteristics of a personality disorder?
a. These patients are generally experiencing chronic depression and are severely impaired socially.
b. A high stimulus environment will cause the patient to exhibit exacerbated behaviors that are loud and attention seeking.
c. The patient is easily intimidated and may become so withdrawn that the assessment will be difficult if not impossible to complete.
d. This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the patient feels threatened.
10. When facilitating change in the behavior of a patient diagnosed with a personality disorder, which intervention will have the greatest impact on success?
a. Collaborating with the patient when establishing treatment goals
b. Educating the patient to the importance of complying with treatment interventions
c. Evaluating the patient’s understanding of the etiology of the prescribed medications
d. Conducting regular assessments so the treatment can be changed when necessary
Chapter 15: Substance-Related Disorders and Addictive Behaviors
1. When asked, “What causes alcoholism?” the nurse’s response will be based on the fact that:
a. The response to alcohol is a result of a brain-based disorder.
b. Alcoholism is believed to be an allergic response to the alcohol.
c. Every individual has the same susceptibility for developing alcoholism.
d. It is a physical response to alcohol but it’s etiology is not fully understood.
2. Which patient response would support the conclusion that the patient has moved into the ‘dark side’ of a narcotic addition?
a. “I’ve been abusing drugs for at least 10 years.”
b. “Drugs makes me feel good; that why I use them.”
c. “I don’t like the way I feel when I don’t use drugs.”
d. “Drugs are something that I can either take or leave”
3. A substance use disorder (SUD) is a likely comorbid mental illness in which patient?
a. The soldier diagnosed with posttraumatic stress disorder
b. The teenager demonstrating symptoms of poor impulse control
c. The older adult diagnosed with early stage Alzheimer’s disease
d. The new mother exhibiting symptoms of postpartum depression
4. Which group would be the target population for educational material on the dangers of binge drinking?
a. Full-time college students
b. Blue-collared young adults
c. Older widows and widowers
d. High school juniors and seniors
5. Which social factor has the greatest impact on the changing nature of alcohol abuse treatment?
a. Development of new pharmaceutical treatment options
b. Dramatic increase of alcoholism among young adult males
c. Raising cost of both inpatient and outpatient treatment programs
d. Women’s substance abuse only recently acknowledge by society
6. Which assessment data poses the greatest risk for injury in a patient who abuses alcohol?
a. Takes a baby aspirin each morning
b. Uses over-the-counter antihistamines for seasonal allergies
c. Has been taking a tricyclic antidepressant for more than 2 years
d. Took a narcotic for 1 week to manage post–dental surgery pain
7. If an individual is admitted with a diagnosis of Wernicke-Korsakoff’s syndrome, the nurse would expect to assess:
a. Peptic ulcer
b. Vivid illusions
c. Cognitive deficits
d. Auditory hallucinations
8. Which sociological aspect, vital to relapse prevention, is greatly affected when a patient is found to have a dual diagnosis of psychosis and alcoholism?
a. Ability to afford the cost of outpatient services
b. A supportive, reliable, accessible support system
c. Protection from both physical and emotional abuse
d. Access to reasonable housing and employment opportunities
9. Which nursing intervention best demonstrates an understanding of the relationship between confirmed intravenous drug abuse and specific infections?
a. Screening the patient for hepatitis B virus (HBV)
b. Assessing the patient for potentially infected injection sites
c. Determining if the patient has ever been tested for human immunodeficiency virus (HIV)
d. Evaluating the patient’s understanding of the increased risk for developing sexually transmitted diseases
10. Which assessment data would bring into question a patient’s statement that, “I have only a few drinks on special occasions.”?
a. History of treatment for glaucoma
b. Fasting serum blood glucose level of 182 mg/dL
c. Patient reports numbness in hands and feet bilaterally
d. Red rash observed over neck, shoulders, and upper chest
Chapter 16: Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders
1. A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking, “What should I do when he lies to me about unimportant things?” Upon what rationale should the nurse’s response be based?
a. Changing the topic provides diversion.
b. Delusions should be confronted to clarify thinking.
c. Ignoring memory deficit avoids catastrophic reactions.
d. This isn’t lying but rather a way to fill in the memory gaps.
2. The nurse is to perform a complete assessment of a patient in her home, using the Mini-Mental State Examination (MMSE) as one component. When the nurse arrives, the patient is seated at the table with her husband, the TV is on, and several grandchildren are visiting. The patient is quiet, but her hands are gripped tightly, and she is staring at the ceiling. The best action for the nurse to take would be which of the following?
a. Ask the husband to make an appointment to bring his wife to the clinic for testing.
b. Explain to the husband that accurate data will be sought, and ask him to stay with the grandchildren in another room.
c. Do not perform the test during the assessment (because it will not be valid) and rely on observations and reports from the family.
d. Explain the importance of the testing process and make an appointment for another day when the environment can be better controlled.
3. A patient has been admitted with a diagnosis of hypoactive delirium. Which nursing intervention is supported by this diagnosis?
a. Encouraging fluids to minimize constipation
b. Frequently assessing both visual and auditory hallucinations
c. Scheduling frequent changing of position to prevent skin breakdown
d. Dimming the lights to help control eye discomfort resulting from cataracts
4. Which of the following should the nurse use as a basis for explaining the etiology of Alzheimer’s disease to the family of a patient with this disease?
a. It is a secondary dementia indicated by loss of recent memory and disorientation to time and place.
b. It is a primary dementia that is incurable, irreversible, and fatal. It is caused by the presence of a beta-amyloid protein in the neurons resulting in senile plaques.
c. It is a secondary dementia that is treatable with analysis of the diet and removal of toxic substances from the diet and environment.
d. It is a primary dementia characterized by stepwise decreases in cognitive abilities. It is irreversible but treatable with antihypertensive medications.
5. Which outcome is realistic for a patient with stage 1 Alzheimer’s disease?
a. Caregiver will assume role of decision maker for patient to reduce stress.
b. The patient will maintain the highest possible functional level to preserve autonomy.
c. Arrangements will be made for appropriate long-term placement to minimize risk of injury.
d. The patient will retain full physical functioning through cognitive and occupational therapies.
6. The home care nurse is visiting a patient who was discharged to home after a procedure at an ambulatory surgical center. The patient lives alone in a senior retirement community. The nurse’s assessment documents mild dysphasia. The patient repeatedly asks, “Why is there a bandage on my arm?” and is not able to state the appropriate day and year. Appropriate planning for the patient should include:
a. Assessing diet and meal preparation, assessing environment for safety problems, referral to a dementia program
b. Attending English class to improve speech, transferring finances to a conservator, employing an aide to help with medications
c. Arranging Meals on Wheels, attending speech therapy, relocation to a skilled nursing facility if no improvement in 1 month
d. Arranging an appointment at a geriatric assessment program, OT referral for swallowing therapy, teaching to manage public transportation
7. A patient diagnosed with Alzheimer’s disease has a catastrophic reaction during an activity involving simultaneous playing of music and working on a craft project. The patient starts shouting “no, no, no” and rushes out of the room. The nurse should:
a. Discontinue the activity program since it upsets the patients.
b. Follow the patient, reassure her, and redirect her to a quieter activity.
c. Isolate the patient until she is calm, and then direct her back to the activity.
d. Give the patient prn antianxiety medication and restrict her activity participation.
8. Which behaviors would indicate that a therapeutic activity program for a patient with Alzheimer’s disease had been successful?
a. Accurate recent memory, positive emotional response, and increased verbal expression
b. Increased attention span, verbal expression of remote memory, and positive emotional response
c. Positive use of perseveration, reduction in use of habitual skills, and improved abstract reasoning
d. Positive emotional response, ability to remember multiple steps, and accurate recent memory
9. A patient has been diagnosed with dementia secondary to cerebral disease. The family members note the patient “has not been as sharp as he once was” and that he has developed urinary incontinence and a gait disturbance. Which pathophysiology can cause such symptoms?
a. Normal pressure hydrocephalus
b. Vitamin B12 deficiency
c. Hepatic disease
10. When asked about the prognosis for a patient diagnosed with a dementia secondary to normal pressure hydrocephalus the nurse replies:
a. “Unfortunately the prognosis is for a downhill course ending in death.”
b. “There will be good days and bad days for the rest of the patient’s life.”
c. “The symptoms generally remit after a shunt is inserted to drain fluid.”
d. “We’ll try our very best, but only time will tell how successful we are.”
Chapter 17: Disorders of Infancy, Childhood, and Adolescence
1. Which complaint is representative of anxiety in a 6-year-old child?
a. “I worry that my dad will get hurt at work.”
b. “I get a stomach ache when it’s my weekend at my dad’s house.”
c. “I can’t sleep when I stay at Grandma’s because I worry about my mom.”
d. “I’m not going to sports camp because I don’t like being away from my friends.”
2. Which of the following meets the DSM-IV-TR criteria for moderate mental retardation?
a. Requires constant one-on-one supervision and total physical care
b. Advanced as far as the sixth grade and works at a warehouse every day and supports himself
c. Advanced as far as the second grade and provides her own personal care with supervision
d. Attends the local community college for developmental English and math courses
3. The nurse is assessing a child with autism. Which of the following behaviors would the nurse expect to observe?
a. Referring to their imaginary friend, Skipper
b. Asking to telephone ‘my friends’ on the weekends
c. Repeating, ‘milk, milk, milk, milk’ until given a drink
d. Is insistent that a dim light be left on in the bedroom at night
4. Which behavior best supports the diagnosis of attention-deficit/hyperactivity disorder in an 8-year-old child?
a. Cries when separated from his mother or father
b. Refuses to pick up toys as instructed by his parents
c. Is fascinated with spinning and moving toys and objects
d. Can concentrate on school work for only very short periods of time
5. Which behavior is most characteristic of a conduct disorder?
a. Frequently getting up and interrupting while being read to
b. Only apologizes for hitting a friend to avoid being punished
c. Finds it difficult to spend the night away from family members
d. Becomes extremely agitated when the television is turned off
6. Which assessment finding should be considered a high risk factor for adolescent suicide?
a. Being sexually abused
b. Having experienced panic attacks
c. Being mildly cognitively impaired
d. Having a diagnosis of type 1 diabetes
7. Planning for a patient with Asperger’s disorder will be facilitated if the nurse understands that this disorder is different from autism. The nurse will base care on knowledge that Asperger’s disorder is characterized by:
a. Repetitive patterns of behavior
b. Age-appropriate language development
c. Stereotypic movements and speech patterns
d. Obsession with objects that move in a spinning motion
8. Which behaviors would support a diagnosis of oppositional-defiant disorder?
a. Exhibits involuntary facial twitching and blinking and makes barking sounds
b. Negative, hostile, and spiteful toward parents and blames others for misbehavior
c. Displays high anxiety when away from parents, has nightmares, and fears being kidnapped
d. Violates others rights, is cruel to people or animals, lies and steals, and is truant from school
9. Which child’s history is a risk for developing a reactive attachment disorder?
a. Father is a chronic alcoholic
b. Was born with a congenital cardiac disorder
c. Experienced head trauma at age 7 months of age
d. Spent first 12 months of life in an Asian orphanage
10. Which intervention will best help a teenager manage aggressive behavior?
a. Administering prescribed medication as ordered
b. Supporting the patient’s interest in writing poetry
c. Reenacting situations that may trigger aggression
d. Providing information on anger management techniques
Chapter 18: Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
1. The mother of a teen with an eating disorder expresses a concern that the family is responsible for the problem. Which question will best help the nurse identify another influence that is likely to have played a role in the teenager’s eating disorder?
a. “Does she have an after-school job?”
b. “Does she have access to nutritious foods?”
c. “Is there a family history of underweight adults?”
d. “Is your daughter interested in clothes and fashion?”
2. Long-term prognosis for eating disorders is improved dramatically when treatment includes long-term cognitive-behavioral therapy. What statement provides the best explanation to the patient for this component to the treatment plan?
a. “This will help you identify a healthy, weight restoration diet.”
b. “Medication alone will not help you from relapsing back to your old habits.”
c. “In order to manage your disorder, you have to understand the root problems.”
d. “Prognosis has been proven to be much better with both medication and therapy.”
3. The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa. Which outcome has the greatest impact on long-term prognosis?
a. Verbalize underlying psychological issues.
b. Demonstrate effective coping skills related to conflict management.
c. Demonstrate improvement in body imagine reflecting a realistic viewpoint.
d. Consume adequate calories appropriate for age, height, and metabolic needs.
4. Which statement is the basis for the cross-cultural assessment practices of eating disorders?
a. Mediterranean cultures are more likely to exhibit symptoms.
b. Male-dominated cultures are more likely to accept this disorder.
c. Westernized cultures tend to have similar numbers of diagnosed cases.
d. Access to food is the primary factor in determining incidence of the disorder.
5. The nurse observes a distorted thinking pattern in a teenage patient diagnosed with an eating disorder. Which statement characterizes personalization by the patient?
a. “I’ve got to be thin to get a good job.”
b. “There is no such thing as a healthy carbohydrate.”
c. “My mother and dad fight all the time because I’m fat.”
d. “My whole family will be disgraced if I don’t get into a good college.”
6. A 16-year-old patient has anorexia nervosa. Which term used to describe the menstrual history is characteristic of this disorder?
c. Premenstrual syndrome
d. Heavy menstrual flow
7. A 14-year-old patient newly admitted to the eating disorders unit refuses to eat meals and angrily shouts at the nurse, “You can’t make me eat! I’ll do whatever I want to do.” Which nursing intervention demonstrates an understanding of the priority safety issue for this anorexic patient?
a. Placing the patient’s favorite low calorie beverages in open view
b. Assigning a staff member to one-on-one observation of the patient
c. Unlocking the patient’s bathroom only at specific times during the day
d. Explaining to the patient that they will be required to keep an eating journal
8. A nursing intervention that will be planned to occur early in the nurse-patient relationship with a patient with an eating disorder is:
a. Using confrontation to attack denial
b. Placing the patient in a therapeutic group
c. Formulating a therapeutic nurse-patient alliance
d. Attacking enmeshment by separating patient and family
9. A patient is being assessed for a binge-eating–associated eating disorder. Which assessment question is directed towards collecting data on the most commonly abused substance among this patient population?
a. “How much alcohol do you drink on a weekly basis?”
b. “Do you use amphetamines to help control your weight?”
c. “Do you rely on laxatives to control your bowel movements?”
d. “How many packs of cigarettes do you smoke on a daily basis?”
10. The nurse is caring for a patient who is being treated for comorbid eating and affective disorders. For which medication would the nurse expect to prepare a patient teaching plan?
a. Fluoxetine (Prozac)
b. Diazepam (Valium)
c. Lorazepam (Ativan)
Chapter 19: Sleep Disorders: Dyssomnias and Parasomnias
1. Which assessment observation would not support a diagnosis of narcolepsy?
a. Sleep study reports excessive, loud snoring.
b. Sleep study shows evidence of sleep paralysis.
c. Patient reports “needing to drink pots of coffee to stay awake at work.”
d. Patient reports, “When I get sleepy I actually see things that aren’t really there.”
2. An adult patient diagnosed with narcolepsy is being educated on the medication therapy that is prescribed. Which explanation is provided for the central nervous system stimulant dextroamphetamine (Dexedrine)?
a. The apnea will be lessened by this medication.
b. It will help control the sporadic loss of muscle tone.
c. This medication will minimize the daytime sleepiness.
d. Dexedrine will manage the inflammation that causes the snoring.
3. A pediatric patient has been diagnosed with obstructive sleep apnea (OSA). Which statement would the nurse use as a basis for explaining the etiology of this disorder?
a. Melatonin is not being released in sufficient quantity.
b. This condition is often due to adenotonsillar hypertrophy.
c. Children have a high ratio of REM sleep that can result in frequent gasping.
d. This can be related to a sleep position which compromises chest movement.
4. Which outcome is appropriate for an adult patient recently diagnosed with primary insomnia?
a. Demonstrate an understanding of the cerebral stimulants prescribed.
b. Recognize that the prescribed flurazepam (Dalmane) can be used for up to 2 months.
c. Demonstrate the proper use of continuous positive airway pressure (CPAP) ventilation.
d. Recognize physical and psychosocial stressors that exacerbate the sleep disturbance.
5. A 10-year-old is diagnosed with somnambulism as a result of frequent episodes of sleepwalking. Which topic should be included when considering patient and family education?
a. Medication therapy seldom prescribed for this disorder
b. Safety issues such as sleeping in the ground level bedroom
c. The likely connection between sleepwalking and narcolepsy
d. The need for short-term cognitive and behavioral therapy
6. Which patient statement would support a diagnosis of a circadian rhythm sleep disturbance?
a. “I just started on the night shift at work.”
b. “My mother was seriously depressed for years.”
c. “I wake up gasping for breath, and it is really scary.”
d. “I don’t think I drink any more than my buddies do.”
7. Which physical assessment finding is supportive of a diagnosis of obstructive sleep apnea?
a. Barrel chest
b. Raccoon eyes
c. Enlarged nasal nares
d. Large neck circumference
8. When the family of a child diagnosed with a nightmare disorder asks the nurse about prognosis, the nurse replies with the knowledge that:
a. The disorder is frequently self-limiting in children.
b. If the child is obese, it is likely the nightmares will continue.
c. High doses of diazepam (Valium) are needed to cure the disorder.
d. With the use of antipsychotic medication, the disorder will not worsen.
9. Which of the statements made by the patient would be most indicative of dyssomnia?
a. “I think I am seeing things when I wake up.”
b. “My wife says I snore and even stop breathing.”
c. “I go to sleep okay but then wake up several times at night.”
d. “My wife says I sit straight up in bed at 2 AM and then say strange things.”
10. A patient with obstructive sleep apnea (OSA) is being discharged. What patient statement indicates the need for further teaching?
a. “I hope to lose some weight.”
b. “My antidepressants seem to be helping.”
c. “I will try the oral appliance that the doctor suggested.”
d. “A glass of wine at bedtime will help relax my airways.”
Chapter 20: Sexual Disorders: Sexual Dysfunctions and Paraphilias
1. Which of these individuals is experiencing a symptom of the DSM-IV-TR diagnosis sexual aversion disorder?
a. The patient who has genital pain associated with intercourse
b. The patient who avoids genital sexual contact with a partner
c. The patient who has absence of desire to engage in sexual activity
d. The patient who has delayed orgasm following sexual excitement
2. A patient who has a sexual disorder mentions to the nurse, “I don’t know why I bother looking for help. They don’t know much about sex problems.” Which statement best describes the evolution of research on sexuality and should serve as the basis for the nurse’s response?
a. Increased knowledge about sexual dysfunction has been available since the late 1960s.
b. Masters and Johnson were the first persons to explore the area of sexual dysfunction.
c. Kaplan was instrumental in identifying the need for psychoanalysis in treating sexual dysfunction.
d. Sigmund Freud, a sexologist, based his work on scientific data from studying human sexual behavior.
3. A patient who is being treated at the community health clinic complains of lack of sexual desire and mentions the problems this is causing in her marriage. Which of the following data is likely related to her sexual dysfunction?
a. Being an adopted only child
b. Taking an antidepressant medication
c. Growing up in a dysfunctional family
d. Living in an isolated area in the country
4. When a patient’s wife asks the nurse about fetishism, which example could the nurse give as part of an explanation?
a. Being sexually aroused only by touching female shoes
b. Standing on the street corner exposing genitals to others
c. Feeling sexually attracted to a 10-year-old child who lives next door
d. Achieving sexual pleasure from rubbing against a stranger in an elevator
5. Which assessment question will be most informative when interviewing a Hispanic female who reports having a sexual aversion?
a. “In your culture is the female expected to be subservient?”
b. “How old were you when you first became sexually active?”
c. “What are your religious beliefs regarding sexual intercourse?”
d. “When did you first begin experiencing pain during intercourse?”
6. A sexual history begins with the nurse asking the patient when she experienced her first menstrual period. What is the basis for beginning the assessment with this type of question?
a. Medical history is the initial focus of all history assessments.
b. Female sexual dysfunction has its roots in pre-pubescent experiences.
c. Females are more comfortable discussing physical issues than emotional ones.
d. To minimize embarrassment, the history is begun with nonthreatening questions.
7. What is the basis of the nurse’s response when a husband reports that, “Our problem is that my wife never initiates sex?”
a. Initiation of sex is generally viewed as the male’s role.
b. Communication between partners is vital to satisfying sex.
c. Men often enjoy sex that is initiated by their female partners.
d. Some women may become aroused only after they experience foreplay.
8. Which comment would support the sexual diagnosis of dyspareunia?
a. “I experience genital pain during intercourse.”
b. “I do not enjoy sexual intercourse and try to avoid it.”
c. “I cannot maintain adequate lubrication during intercourse.”
d. “My perineal muscles contract at the wrong times during intercourse.”
9. Which patient statement shows achievement of an expected outcome for a patient being treated for a paraphilic disorder who is receiving Depo-Provera injections?
a. “The vaginal pain issue is almost totally resolved.”
b. “I don’t have those sexual fantasies nearly as often now.”
c. “Sex is more pleasurable now that I’m getting the injections.”
d. “I haven’t had a problem maintaining an erection since I started the medication.”
10. Which assessment question demonstrates knowledge of possible risk factors for the development of a paraphilic disorder?
a. “When were you first diagnosed with schizophrenia?”
b. “Are you aware of a family history of obsessive-compulsive disorder?”
c. “When did you begin relying on printed pornography as a sexual stimulant?”
d. “Why do you find it difficult to take your prescribed antianxiety medication?”
AND MUCH MORE