Psychiatric Mental Health Nursing 8th Edition, Mary C Townsend Test Bank

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Test Bank For Psychiatric Mental Health Nursing 8th Edition, Mary C Townsend. Note: This is not a text book. Description: ISBN-13: 978-0803640924, ISBN-10: 0803640927.

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Test Bank Psychiatric Mental Health Nursing 8th Mary Townsend

Chapter 1. The Concept of Stress Adaptation

Multiple Choice

1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.

2. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client’s appraisal of the job loss stressor?
A. Irrelevant B. Harm/loss C. Threatening D. Challenging

3. Which client statement should alert a nurse that a client may be responding maladaptively to stress?
A. “I’ve found that avoiding contact with others helps me cope.”
B. “I really enjoy journaling; it’s my private time.”
C. “I signed up for a yoga class this week.”
D. “I made an appointment to meet with a therapist.”

4. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing?
A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight-or-flight stage

5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client’s mother states, “That’s not something to be stressed about!” Which is the most appropriate nursing response?
A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”

6. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time?
A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling
7. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?
A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.

8. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’s reaction to her perceived problem?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.

9. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess?
A. An achieved state of relaxation
B. An achieved insight into one’s feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem-solve

10. A distraught, single, first-time mother cries and asks a nurse, “How can I go to work if I can’t afford childcare?” What is the nurse’s initial action in assisting the client with the problem – solving process?
A. Determine the risks and benefits for each alternative.
B. Formulate goals for resolution of the problem.
C. Evaluate the outcome of the implemented alternative.
D. Assess the facts of the situation.

Chapter 2. Mental Health/Mental Illness: Historical and Theoretical Concepts

1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client’s behaviors?
A. The client’s behaviors demonstrate mental illness in the form of depression.
B. The client’s behaviors are extensive, which indicates the presence of mental illness.
C. The client’s behaviors are not congruent with cultural norms.
D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.

2. At what point should the nurse determine that a client is at risk for developing a mental disorder?
A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria
B. When maladaptive responses to stress are coupled with interference in daily functioning
C. When the client communicates significant distress
D. When the client uses defense mechanisms as ego protection
3. A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents?
A. Reactions to stress are relative rather than absolute; individual responses to stress vary.
B. It is abnormal for identical twins to react differently to similar stressors.
C. Identical twins should share the same temperament and respond similarly to stress.
D. Environmental influences weigh more heavily than genetic influences on reactions to stress.

4. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, “I work hard to provide for my family. I don’t see why I can’t drink to relax.” The nurse recognizes the use of which defense mechanism?
A. Projection
B. Rationalization
C. Regression
D. Sublimation

5. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
A. A Jewish, female journalist
B. A Baptist, homeless male
C. A Catholic, black male
D. A Protestant, Swedish business executive

6. A new psychiatric nurse states, “This client’s use of defense mechanisms should be eliminated.” Which is a correct evaluation of this nurse’s statement?
A. Defense mechanisms can be self-protective responses to stress and need not be eliminated. B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated.
C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated.
D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

7. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s
best response?
A. “It’s just a routine part of our assessment. All clients are asked these same questions.”
B. “Why are you concerned about these types of questions?”
C. “Psychological factors, like excessive stress, have been found to affect medical conditions.”
D. “We can skip these questions, if you like. It isn’t imperative that we complete this section.”

8. Which statement reflects a student nurse’s accurate understanding of the concepts of mental health and mental illness?
A. “The concepts are rigid and religiously based.”
B. “The concepts are multidimensional and culturally defined.”
C. “The concepts are universal and unchanging.”
D. “The concepts are unidimensional and fixed.”

9. A mental health technician asks the nurse, “How do psychiatrists determine which diagnosis to give a patient?” Which of these responses by the nurse would be most accurate?
A. Psychiatrists use pre-established criteria from the APA’s Diagnostic and Statistical Manual of
Mental Disorders (DSM-5).
B. Hospital policy dictates how psychiatrists diagnose mental disorders.
C. Psychiatrists assess the patient and identify diagnoses based on the patient’s unhealthy responses and contributing factors.
D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from.

10. The nurse is preparing to provide medication instruction for a patient. Which of the following understandings about anxiety will be essential to effective instruction?
A. Learning is best when anxiety is moderate to severe.
B. Learning is enhanced when anxiety is mild.
C. Panic level anxiety helps the nurse teach better.
D. Severe anxiety is characterized by intense concentration and enhances the attention span.

Chapter 3. Theoretical Models of Personality Development

Multiple Choice

1. According to Erikson’s developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client?
A. To develop a basic trust in others
B. To achieve a sense of self-confidence and recognition from others
C. To reflect back on life events to derive pleasure and meaning
D. To achieve established life goals and consider the welfare of future generations

2. A jilted college student is admitted to a hospital following a suicide attempt and states, “No one will ever love a loser like me.” According to Erikson’s theory of personality development, a nurse should recognize a deficit in which developmental stage?
A. Trust versus mistrust
B. Initiative versus guilt
C. Intimacy versus isolation
D. Ego integrity versus despair

3. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According
to Peplau, which psychological stage of development should the nurse recognize that this child has completed?
A. “Learning to count on others”
B. “Learning to delay satisfaction”
C. “Identifying oneself”
D. “Developing skills in participation”

4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should recognize that according to Mahler’s developmental theory, this child’s development is at which phase?
A. The autistic phase
B. The symbiotic phase
C. The differentiation subphase of the separation–individuation phase
D. The rapprochement subphase of the separation–individuation phase

5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau’s interpersonal theory, in which stage of development should the nurse identify a need for improvement?
A. “Learning to count on others”
B. “Learning to delay satisfaction”
C. “Identifying oneself”
D. “Developing skills in participation”

6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?
A. The role of technical expert
B. The role of resource person
C. The role of surrogate
D. The role of leader

7. A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau’s framework for psychodynamic nursing, what therapeutic role is
this nurse assuming?
A. The role of technical expert
B. The role of resource person
C. The role of teacher
D. The role of leader

8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept?
A. A possible genetic basis for the client problems
B. The structure and dynamics of the personality
C. Behavioral responses to stressors
D. Maladaptive cognitions

9. Which underlying concept should a nurse associate with interpersonal theory when assessing clients?
A. The effects of social processes on personality development
B. The effects of unconscious processes and personality structures
C. The effects on thoughts and perceptual processes
D. The effects of chemical and genetic influences

10. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?
A. Establishing the ability to control emotional reactions
B. Establishing a strong sense of ethics and character structure
C. Establishing and maintaining self-esteem
D. Establishing a career, personal relationships, and societal connections

Chapter 4. Concepts of Psychobiology

Multiple Choice

1. A depressed client states, “I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again.” Which nursing response is appropriate?
A. “Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors.”
B. “Because biological factors are the sole cause of depression, medications will improve your mood.”
C. “Environmental factors have been shown to exert the most influence in the development of depression.”
D. “Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).”

2. A client diagnosed with major depressive disorder asks, “What part of my brain controls my emotions?” Which nursing response is appropriate?
A. “The occipital lobe governs perceptions, judging them as positive or negative.”
B. “The parietal lobe has been linked to depression.”
C. “The medulla regulates key biological and psychological activities.”
D. “The limbic system is largely responsible for one’s emotional state.”

3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
A. Peripheral nervous system
B. Somatic nervous system
C. Sympathetic nervous system
D. Parasympathetic nervous system

4. Which client statement reflects an understanding of the effect of circadian rhythms on a person’s ability to function?
A. “When I dream about my mother’s horrible train accident, I become hysterical.”
B. “I get really irritable during my menstrual cycle.”
C. “I’m a morning person. I get my best work done in the a.m.”
D. “Every February, I tend to experience periods of sadness.”

5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
A. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy
B. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill
C. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents
D. Studies in which monozygotic twins were raised together by mentally ill biological parents
E. All of the above

6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?
A. The study of neuroendocrinology
B. The study of psychoimmunology
C. The study of diagnostic technology
D. The study of neurophysiology

7. A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being implicated in this behavior?
A. Dendrites
B. Axons
C. Neurotransmitters
D. Synapses

8. An instructor is teaching nursing students about neurotransmitters. Which term best explains
the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
A. Regeneration
B. Reuptake
C. Recycling
D. Retransmission

9. A nurse concludes that a restless, agitated client is manifesting a “fight-or-flight” response. The nurse should associate this response with which neurotransmitter?
A. Acetylcholine
B. Dopamine
C. Serotonin
D. Norepinephrine

10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client’s neurotransmitters should a nurse expect to be elevated?
A. Serotonin
B. Dopamine
C. Gamma-aminobutyric acid (GABA)
D. Histamine

Chapter 5. Ethical and Legal Issues in Psychiatric/Mental Health Nursing

Multiple Choice

1. In response to a student’s question regarding choosing a psychiatric specialty, a charge nurse states, “Mentally ill clients need special care. If I were in that position, I’d want a caring nurse also.” From which ethical framework is the charge nurse operating?
A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism

2. During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework?
A. “I would want to be treated in a caring manner if I were mentally ill.”
B. “This job will pay the bills, and the workload is light enough for me.”
C. “I will be happy caring for the mentally ill. Working in Med/Surg kills my back.”
D. “It is my duty in life to be a psychiatric nurse. It is the right thing to do.”

3. Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse’s coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker’s lack of involvement?
A. Taking no action is still considered an action by the coworker.
B. Taking no action releases the coworker from ethical responsibility.
C. Taking no action is advised when potential adverse consequences are foreseen.
D. Taking no action is acceptable, because the coworker is only a bystander.

4. Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The unit manager’s policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager’s policy preserve?
A. Justice
B. Autonomy
C. Veracity
D. Beneficence

5. Which is an example of an intentional tort?
A. A nurse fails to assess a client’s obvious symptoms of neuroleptic malignant syndrome. B. A nurse physically places an irritating client in four-point restraints.
C. A nurse makes a medication error and does not report the incident. D. A nurse gives patient information to an unauthorized person.

6. An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit?
A. Verbally redirect the client, and then limit one-on-one interaction.
B. Involve the hospital’s security division as soon as possible.
C. Notify the client that documenting personal staff information is against hospital policy.
D. Continue professional attempts to establish a positive working relationship with the client.

7. Which statement should a nurse identify as correct regarding a client’s right to refuse treatment?
A. Clients can refuse pharmacological but not psychological treatment.
B. Clients can refuse any treatment at any time.
C. Clients can refuse only electroconvulsive therapy (ECT).
D. Professionals can override treatment refusal if the client is actively suicidal or homicidal.

8. Which client should a nurse identify as a potential candidate for involuntarily commitment?
A. A client living under a bridge in a cardboard box
B. A client threatening to commit suicide
C. A client who never bathes and wears a wool hat in the summer
D. A client who eats waste out of a garbage can

9. A client diagnosed with schizophrenia refuses to take medication, citing the right of
autonomy. Under which circumstance would a nurse have the right to medicate the client against the client’s wishes?
A. When the client makes inappropriate sexual innuendos to a staff member
B. When the client constantly demands inappropriate attention from the nurse
C. When the client physically attacks another client after being confronted in group therapy
D. When the client refuses to bathe or perform hygienic activities

10. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations?
A. Refusing to give any information to the caller, citing rules of confidentiality
B. Refusing to give any information to the caller by hanging up
C. Affirming that the person has been seen at the facility but providing no further information
D. Suggesting that the caller speak to the client’s therapist

Chapter 6. Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing

Multiple Choice

1. An African American youth, growing up in an impoverished neighborhood, presents in the emergency department with bruises to his face, chest, and arms. He appears to be upset, is speaking in a dialect that is difficult for the nurse to understand, and is standing within 6 inches of the nurse’s personal space. What cultural consideration should a nurse identify as playing a role in this youth’s behavior?
A. African Americans frequently speak in different tongues when they are upset.
B. Most African Americans have learned to be aggressive when they have to see a health professional.
C. African Americans tend to use dialects and invasion of personal space to intimidate others.
D. Some African Americans speak in a dialect that is different from standard English and tend toward smaller personal space than that of the dominant culture.

2. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of mental disorders?
A. Dissociative disorders
B. Neurocognitive disorders
C. Stress-related disorders
D. Schizophrenia spectrum disorders

3. A community health nurse is planning a health fair at a local shopping mall. Which middle- class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care?
A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans

4. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture?
A. Extremes of emotional expression prevent accurate assessment of this culture.
B. Suspicion of Western civilization has resulted in minimal cultural research.
C. The small size of this subpopulation makes research virtually impossible.
D. The Asian American culture includes individuals from many different countries.

5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client’s decision?
A. Future orientation causes the client to devalue assertiveness skills.
B. Decreased emotional expression makes it difficult to be assertive.
C. Assertiveness techniques may not be aligned with the client’s definition of the female role.
D. Religious prohibitions prevent the client’s participation in assertiveness training.

6. A Latino American man refuses to acknowledge responsibility for hitting his wife, stating instead, “It’s the man’s job to keep his wife in line.” Which cultural belief may be associated with this client’s behavior?
A. Traditional Latino American families are male dominated with clear male–female role distinctions.
B. Religious tenets of Latino American culture support the use of violence within a marriage.
C. Latino American families are female dominated and the mother possesses ultimate authority.
D. Marriage dynamics are controlled by dominant females in Latin American families.

7. When working with clients of any culture, which action should a nurse avoid?
A. Maintaining eye contact, based on cultural norms
B. Assuming that all individuals who share a culture or ethnic group are similar
C. Supporting the client in participating in cultural and spiritual rituals
D. Using an interpreter to clarify communication

8. To effectively care for Asian American clients, a nurse should be aware of which cultural norm?
A. Obesity and alcoholism are common problems.
B. Older people maintain positions of authority within the culture.
C. Milk is a staple in the Asian American diet.
D. Asian Americans are likely to seek psychiatric help.

9. A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate?
A. Assist the client in contacting a shaman of his choice.
B. Explain to the client that “voodoo” medicine will not heal the ulcerated toe.
C. Ask the client to explain what the shaman can do that the physician cannot.
D. Inform the client that refusing treatment is a client’s right.

10. When planning care for a Latino American client, the nurse should be aware of which cultural influence that may impact access to health care?
A. The root doctor may be the first contact made when illness is encountered.
B. The “yin” and “yang” practitioner may be the first contact made when illness is encountered.
C. The shaman may be the first contact made when illness is encountered.
D. The curandero may be the first contact made when illness is encountered.

Chapter 7. Relationship Development

Multiple Choice

1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
A. To clarify personal attitudes, values, and beliefs
B. To obtain thorough assessment data
C. To determine the client’s length of stay
D. To establish personal goals for the interaction

2. A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following?
A. Sympathy
B. Trust
C. Veracity
D. Manipulation

3. Which is the best nursing action when a client demonstrates transference toward a nurse?
A. Promoting safety and immediately terminating the relationship with the client
B. Encouraging the client to ignore these thoughts and feelings
C. Immediately reassigning the client to another staff member
D. Helping the client to clarify the meaning of the current nurse–client relationship

4. What is the priority nursing action during the orientation (introductory) phase of the nurse–client relationship?
A. Acknowledge the client’s actions and generate alternative behaviors.
B. Establish rapport and develop treatment goals.
C. Attempt to find alternative placement.
D. Explore how thoughts and feelings about this client may adversely impact care.

5. Which client response should a nurse expect during the working phase of the nurse–
client relationship?
A. The client gains insight and incorporates alternative behaviors.
B. The client and nurse establish rapport and mutually develop treatment goals.
C. The client explores feelings related to reentering the community.
D. The client explores personal strengths and weaknesses that impact behaviors.

6. What should be the nurse’s primary goal during the preinteraction phase of the nurse–
client relationship?
A. To evaluate goal attainment and ensure therapeutic closure
B. To establish trust and formulate a contract for intervention
C. To explore self-perceptions
D. To promote client change

7. Which phase of the nurse–client relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client- centered goals?
A. Preinteraction
B. Orientation
C. Working
D. Termination

8. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse–client relationship?
A. “I can’t bear the thought of leaving here and failing.”
B. “I might have a hard time working with you. You remind me of my mother.”
C. “I can’t tell my husband how I feel; he wouldn’t listen anyway.”
D. “I’m not sure that I can count on you to protect my confidentiality.”

9. A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy?
A. “You are feeling very depressed. I felt the same way when I decided to leave my husband.”
B. “I can understand you are feeling depressed. It was a difficult decision. I’ll sit with you.”
C. “You seem depressed. It was a difficult decision to make. Would you like to talk about it?”
D. “I know this is a difficult time for you. Would you like a prn medication for anxiety?”

10. A mother who has learned that her child was killed in a tragic car accident states, “I can’t bear to go on with my life.” Which nursing statement conveys empathy?
A. “This situation is very sad, but time is a great healer.”
B. “You are sad, but you must be strong for your other children.”
C. “Once you cry it all out, things will seem so much better.”
D. “It must be horrible to lose a child; I’ll stay with you until your husband arrives.”

Chapter 8. Therapeutic Communication

Multiple Choice

1. Which therapeutic communication technique is being used in this nurse–client interaction?
Client: “When I get angry, I get into a fistfight with my wife or I take it out on the kids.”
Nurse: “I notice that you are smiling as you talk about this physical violence.”
A. Encouraging comparison
B. Exploring
C. Formulating a plan of action
D. Making observations

2. Which therapeutic communication technique is being used in this nurse–client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
A. Restatement
B. Offering general leads
C. Focusing
D. Accepting

3. Which therapeutic communication technique is being used in this nurse–client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
A. Reflecting
B. Making observations
C. Formulating a plan of action
D. Giving recognition

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a “general lead”?
A. “Do you know why you are here?”
B. “Are you feeling depressed or anxious?”
C. “Yes, I see. Go on.”
D. “Can you chronologically order the events that led to your admission?”

5. A nurse states to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
A. The therapeutic technique of “giving advice”
B. The therapeutic technique of “defending”
C. The nontherapeutic technique of “presenting reality”
D. The nontherapeutic technique of “giving false reassurance”

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening?
A. “What occurred prior to the rape, and when did you go to the emergency department?”
B. “What would you like to talk about?”
C. “I notice you seem uncomfortable discussing this.”
D. “How can we help you feel safe during your stay here?”

7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations?
A. “You appear to be talking to someone I do not see.”
B. “Please describe what you are seeing.”
C. “Why do you continually look in the corner of this room?”
D. “If you hum a tune, the voices may not be so distracting.”

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
A. S
B. O
C. L
D. E E. R

9. An instructor is correcting a nursing student’s clinical worksheet. Which instructor statement is the best example of effective feedback?
A. “Why did you use the client’s name on your clinical worksheet?”
B. “You were very careless to refer to your client by name on your clinical worksheet.”
C. “I noticed that you used the client’s name in your written process recording. That is a breach of confidentiality.”
D. “It is disappointing that after being told, you’re still using client names on your worksheet.”

10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, “I’m so proud of you for being assertive. You are so good!” Which communication technique has the leader employed?
A. The nontherapeutic technique of giving approval
B. The nontherapeutic technique of interpreting
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observations

Chapter 9. The Nursing Process in Psychiatric/Mental Health Nursing

Multiple Choice

1. Which data-gathering technique is employed during the assessment phase of the nursing process?
A. Asking the client to rate mood after administering an antidepressant
B. Asking the client to verbalize understanding of previously explained unit rules
C. Asking the client to describe any thoughts of self-harm
D. Asking the client if the group on assertiveness skills was helpful

2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?
A. Medical history is of little significance and can be eliminated from the nursing assessment.
B. Assessment provides a holistic view of the client, including biopsychosocial aspects.
C. Comprehensive assessments can be performed only by advanced practice nurses.
D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

3. Which nursing diagnosis should a nurse identify as being correctly formulated?
A. Schizophrenia R/T biochemical alterations AEB altered thought
B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance
C. Depressed mood R/T multiple life stressors
D. Developmental disability R/T early-onset schizophrenia AEB hallucinations

4. Which expected client outcome should a nurse identify as being correctly formulated?
A. Client will feel happier by discharge.
B. Client will demonstrate two relaxation techniques.
C. Client will verbalize triggers to anger by end of session.
D. Client will initiate interaction with one peer during free time within 2 days.

5. Which statement regarding nursing interventions should a nurse identify as accurate?
A. Nursing interventions are independent from the treatment team’s goals.
B. Nursing interventions are directed solely by written physician orders.
C. Nursing interventions occur independently but in concert with overall treatment team goals.
D. Nursing interventions are standardized by policies and procedures.

6. Within the nurse’s scope of practice, which function is exclusive to the advance practice psychiatric nurse?
A. Teaching about the side effects of neuroleptic medications
B. Using psychotherapy to improve mental health status
C. Using milieu therapy to structure a therapeutic environment
D. Providing case management to coordinate continuity of health services
7. A nurse charts “Verbalizes understanding of the side effects of Prozac.” This is an example of which category of focused charting?
A. Data
B. Problem
C. Action
D. Response

8. The nurse should recognize which acronym as representing problem-oriented charting?

9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)?
A. CIWA scale
D. CAPS scale

10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation?
A. Mood B. Perception C. Orientation D. Affect

Chapter 10. Therapeutic Groups

Multiple Choice

1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify?
A. The task role of gatekeeper
B. The individual role of recognition seeker
C. The maintenance role of dominator
D. The task role of elaborator

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style?
A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?
A. The nurse mandates that all group members reveal an embarrassing personal situation.
B. The nurse asks for a show of hands to determine group topic preference.
C. The nurse sits silently as the group members stray from the assigned topic.
D. The nurse shuffles through papers to determine the facility policy on length of group.

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?
A. Democratic
B. Autocratic
C. Laissez-faire
D. Bureaucratic

5. Which situation should a nurse identify as an example of an autocratic leadership style?
A. The president of Sigma Theta Tau assigns members to committees to research problems.
B. Without faculty input, the dean mandates that all course content be delivered via the Internet.
C. During a community meeting, a nurse listens as clients generate solutions.
D. The student nurses’ association advertises for candidates for president.

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom’s curative group factors does this illustrate?
A. Imparting of information
B. Instillation of hope
C. Altruism
D. Universality

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, “I relapsed three times, but now have been sober for 15 years.” Which of Yalom’s curative group factors does this illustrate?
A. Imparting of information
B. Instillation of hope
C. Catharsis
D. Universality

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom’s curative group factor of imparting information?
A. “I found a Web site explaining the different types of brain tumors and their treatment.”
B. “My brother also had a brain tumor and now is completely cured.”
C. “I understand your fear and will be by your side during this time.”
D. “My mother was also diagnosed with cancer of the brain.”

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom’s curative group factor of altruism?
A. “I’ll give you the name of a friend that rents inexpensive rooms.”
B. “The last time we helped a family, they got back on their feet and prospered.”
C. “I can give you all of my baby clothes for your little one.”
D. “I can appreciate your situation. I had to declare bankruptcy last year.”

10. During an inpatient educational group, a client shouts out, “This information is worthless. Nothing you have said can help me.” These statements indicate to the nurse leader that the client is assuming which group role?
A. The group role of aggressor
B. The group role of initiator
C. The group role of gatekeeper
D. The group role of blocker

Chapter 11. Intervention With Families

Multiple Choice

1. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why?
A. Abnormal; the grandmother should be concerned with issues other than childrearing.
B. Abnormal; a two-parent household is the most advantageous arrangement for parenting.
C. Normal; cultural variations exist in the family life cycle.
D. Normal; because of their wisdom, older adults make better parenting figures.

2. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen’s family systems theory, how should the community health nurse interpret the teenager’s action?
A. The teenager is attempting to differentiate self. B. The teenager is triangulating self.
C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

3. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home?
A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present.
B. The grandparental subsystem is not successfully managing separation from the parental subsystem.
C. Extended family living arrangements are common in some cultures.
D. The nuclear family living arrangement is the preferred environment for childrearing.

4. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, “That ’s wonderful. I’ll be fine all alone.” How would the nurse interpret the mother’s statements?
A. The mother is withholding supportive messages.
B. The mother is expressing denigrating remarks.
C. The mother is communicating indirectly.
D. The mother is using double-bind communication.

5. In a family that is in the life cycle stage called “The Family with Adolescents ,” which changes must occur for the family to proceed developmentally?
A. Making adjustments within the marital system to meet the responsibilities of parenthood
B. Establishing a new identity as a couple by realigning relationships with extended family
C. Redefining the level of dependence so that adolescents are provided with greater autonomy
D. Reestablishing the bond of the dyadic marital relationship

6. A clinic nurse is caring for a 40-year-old client who lives with his parents. The client’s mother continues to do the client’s laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize?
A. Taking over
B. Communicating indirectly
C. Belittling feelings
D. Making assumptions

7. A 30-year-old client seeking therapy states, “My mom cries when she is not included in all my social activities and thinks of my friends as her own.” How would the nurse describe the boundaries between this family’s parent and child subsystems?
A. The boundaries are rigid.
B. The boundaries are restructured.
C. The boundaries are enmeshed.
D. The boundaries are disengaged.

8. A nurse enters an inpatient room and finds the family disagreeing about the client’s living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts?
A. All family members should use past incidents to make their point.
B. One family member should act as a gatekeeper in order to avoid family confrontation.
C. One family member should act as a compromiser to preserve harmony in the family system.
D. All family members should respect differing opinions and use compromise and negotiation.

9. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child’s behavioral issues, the marital relationship confli ct decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept?
A. Differentiation of self
B. Triangulation
C. Fusion
D. Emotional cutoff

10. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement?
A. An adult child considers, but is not governed by, the advice of his or her parents.
B. An adult child appears to listen, but ignores, the advice of his or her parents.
C. An adult child respects and is governed by the wishes of his or her parents.
D. An adult child never requests advice or feedback from his or her parents.

Chapter 12. Milieu Therapy—The Therapeutic Community

Multiple Choice

1. An angry client on an inpatient unit approaches a nurse, stating, “Someone took my lunch! People need to respect others, and you need to do something about this now!” The nurse’s response should be guided by which basic assumption of milieu therapy?
A. Conflict should be avoided at all costs on inpatient psychiatric units.
B. Conflict should be resolved by the nursing staff.
C. Every interaction is an opportunity for therapeutic intervention.
D. Conflict resolution should be addressed only during group therapy.

2. A client on an inpatient unit angrily states to a nurse, “Peter is not cleaning up after himself in the community bathroom. You need to address this problem.” Which is the appropriate nursing response?
A. “I’ll talk to Peter and present your concerns.”
B. “Why are you overreacting to this issue?”
C. “You should bring this to the attention of your treatment team.”
D. “I can see that you are angry. Let’s discuss ways to approach Peter with your concerns.”

3. A newly admitted client asks, “Why do we need a unit schedule? I’m not going to these groups. I’m here to get some rest.” Which is the most appropriate nursing reply?
A. “Group therapy provides the opportunity to learn and practice new coping skills.”
B. “Group therapy is mandatory. All clients must attend.”
C. “Group therapy is optional. You can go if you find the topic helpful and interesting.”
D. “Group therapy is an economical way of providing therapy to many clients concurrently.”

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment?
A. Peer pressure
B. Structured programming
C. Visitor restrictions
D. Mandated activities

5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration?
A. Encourage clients to request their medications at the appropriate times.
B. Refuse to administer medications unless clients request them at the appropriate times.
C. Allow the clients to determine appropriate medication times.
D. Take medications to the clients’ bedside at the appropriate times.

6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic?
A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

7. What is the best rationale for including the client’s family in therapy within the inpatient milieu?
A. To structure a program of social and work-related activities
B. To facilitate discharge from the hospital
C. To provide a concrete demonstration of caring
D. To encourage the family to model positive behaviors

8. How does a democratic form of self-government in the milieu contribute to client therapy?
A. By setting punishments for clients who violate the community rules
B. By dealing with inappropriate behaviors as they occur
C. By setting community expectations wherein all clients are treated on an equal basis
D. By interacting with professional staff members to learn about therapeutic interventions

9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results?
A. The psychiatrist
B. The psychiatric social worker
C. The clinical psychologist
D. The clinical nurse specialist

10. In the role of milieu manager, which activity should the nurse prioritize?
A. Setting the schedule for the daily unit activities
B. Evaluating clients for medication effectiveness
C. Conducting therapeutic group sessions
D. Searching newly admitted clients for hazardous objects

Chapter 13. Crisis Intervention

Multiple Choice

1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis?
A. This type of crisis is precipitated by unexpected external stressors.
B. This type of crisis is precipitated by preexisting psychopathology.
C. This type of crisis is precipitated by an acute response to an external situational stressor.
D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, “I can’t function any longer under all this stress.” Which type of crisis is the client experiencing?
A. Maturational/developmental crisis
B. Psychiatric emergency crisis
C. Anticipated life transition crisis
D. Traumatic stress crisis

3. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this client’s crisis?
A. The client will change his or her type A personality traits to more adaptive ones by week 1.
B. The client will list five positive self-attributes.
C. The client will examine how childhood events led to an overachieving orientation.
D. The client will return to previous adaptive levels of functioning by week 6.

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client?
A. Ineffective coping R/T situational crisis AEB powerlessness
B. Anxiety R/T fear of failure
C. Risk for self-directed violence R/T hopelessness
D. Risk for low self-esteem R/T loss events AEB suicidal ideations

5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?
A. “Are you currently thinking about harming yourself?”
B. “Why do you want to harm yourself?”
C. “Have you thought about the consequences of your actions?”
D. “Who is your emergency contact person?”

6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior?
A. Initiate forced medication protocol.
B. Help the client to explore the source of anger.
C. Ignore the act to avoid reinforcing the behavior.
D. With staff support and a show of solidarity, set firm limits on the behavior.

7. A college student who was nearly raped while jogging completes a series of appointments
with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?
A. “You’ve really been helpful. Can I count on you for continued support?”
B. “I don’t work out anymore.”
C. “I’m really glad I didn’t go home. It would have been hard to come back.”
D. “I carry mace when I jog. It makes me feel safe and secure.”

8. A despondent client, who has recently lost her husband of 30 years, tearfully states, “I’ll feel a lot better if I sell my house and move away.” Which nursing reply is most appropriate?
A. “I’m confident you know what’s best for you.”
B. “This may not be the best time for you to make such an important decision.”
C. “Your children will be terribly disappointed.”
D. “Tell me why you want to make this change.”

9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression?
A. The client requests prn medications.
B. The client has a tense facial expression and body language.
C. The client refuses to eat lunch.
D. The client sits in group therapy with back to peers.

10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being “taken down” after a violent outburst?
A. To reinforce unit rules with the client population
B. To create protocols for the future release of tensions associated with anger
C. To process feelings and concerns related to the witnessed intervention
D. To discuss the client problems that led to inappropriate expressions of anger

Chapter 14. Assertiveness Training

Multiple Choice

1. During a psychoeducational group on assertiveness training, a client asks, “Why do we need to learn about this stuff?” Which is the most appropriate nursing reply?
A. “Because your doctor requires you to attend this group.”
B. “Being assertive is the ability to stand up for yourself while respecting the rights of others.”
C. “Assertiveness training teaches you how to ask for what you want, when you want it.”
D. “Assertive people place the needs and rights of others before their own.”

2. Two clients are roommates on an inpatient psychiatric unit. At breakfast, client “A,” who had been missing her gold locket, notices client “B” wearing it. Which should a nurse recognize as a nonassertive or passive behavioral response from client “A”?
A. Client “A” ignores the situation.
B. Client “A” discusses the situation with her nurse and develops a plan of action.
C. Client “A” immediately approaches client “B” and pulls the necklace off her neck.
D. Client “A” offers to wash client “B’s” clothes and “accidentally” spills bleach in the water.

3. A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits into his soup. How would the nurse document this interaction?
A. “Client is displaying assertive behaviors.”
B. “Client is displaying aggressive behaviors.”
C. “Client is displaying passive behaviors.”
D. “Client is displaying passive–aggressive behaviors.”

4. A client continually waits more than an hour before being seen at the mental health clinic. The client approaches the nurse and states, “When I have to wait for more than an hour to be seen, I feel like my time is not important.” The nurse recognizes this as what type of behavior?
A. Aggressive behavior
B. Assertive behavior
C. Passive–aggressive behavior
D. Passive behavior

5. During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply?
A. “Several techniques, including meditation and progressive muscle relaxation, appear helpful.”
B. “There’s not much that can be done about aggressive behavior because of biological responses.”
C. “Certain types of medications have been proven effective in promoting assertive communication.”
D. “There are several techniques, including ‘I statements,’ role playing, and thought stopping, that can help promote assertive behaviors and decrease aggressive behaviors.”

6. During an assertiveness training group, a nurse suggests using “I statements.” The group questions the usefulness of this communication technique. Which explanation by the nurse is most appropriate?
A. “When ‘I statements’ are used, opinions are communicated without blaming others.”
B. “When ‘I statements’ are used, anger is displaced by using indirect means.”
C. “When ‘I statements’ are used, responsibility for one’s behavior is attributed to another.”
D. “When ‘I statements’ are used, eye contact is promoted.”

7. While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an “I statement.” Which of the following statements is the best example of this assertive communication technique?
A. “I would like to know why you came home late without calling me.”
B. “I hate it when you think you can just come home late without calling anyone to let them know where you are.”
C. “I feel angry when you come home late without calling.”
D. “I think you don’t care about me, because if you did, you’d call me if you were planning on coming home late.”
8. After vying for a nurse management position, nurse “A” is chosen over nurse “B.” When nurse manager “A” calls for staff meetings, nurse “B” is chronically late or absent. Nurse “B” is exhibiting which type of behavior?
A. Passive B. Assertive C. Aggressive D. Passive–aggressive

9. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness?
A. Disturbed personal identity B. Disturbed thought processes C. Defensive copingD. Impaired verbal communication

10. Two clients get into a heated argument regarding TV program selections. The nurse turns off the TV and asks the clients to go to their rooms to cool off, after which they will discuss and attempt to resolve the problem. The nurse’s action is promoting which assertive technique?
A. Defusing
B. Clouding or fogging
C. Responding as a broken record
D. Shifting from content to process

Chapter 15. Promoting Self-Esteem

Multiple Choice

1. A nurse is working in a nursing home. How best can this nurse foster self-esteem in the residents of this facility?
A. Allowing them to remain in their rooms as much as they desire to maintain privacy
B. Administering anti-anxiety medications as ordered
C. Providing a sense of mastery over their environment by giving choices when appropriate
D. Teaching assertiveness skills and self-esteem principles

2. A client shows a nurse a piece of artwork that took 3 days to create. How will this achievement improve the client’s self-esteem?
A. By providing a framework for assertive behavior
B. By providing an expression of feelings and a sense of competence and pride
C. By providing a positive perception of body image
D. By providing appropriate boundaries for relationship establishment

3. A nurse is running a group on self-esteem. A client asks, “Where does self-esteem come from?” Which is the most appropriate nursing reply?
A. “Many factors, over the life span, influence development and maintenance of self -esteem.”
B. “Self-esteem is determined by factors outside of an individual’s control.”
C. “Self-esteem is established in childhood and remains relatively fixed throughout life.”
D. “Genetics are the single largest contributor to an individual’s self-esteem.”

4. In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Erikson’s psychosocial developmental stages?
A. Through basic need fulfillment and environmental predictability
B. Through exploration and experimentation, resulting in self-confidence in ability to perform
C. Through positive reinforcement of creativity and recognition of performance
D. Through receiving recognition when learning, competing, and performing successfully

5. The nurse is working with a 15-year-old client suffering from low self-esteem. According to Erikson’s psychosocial developmental theory, which factor has most probably influenced this client’s self-esteem?
A. Regret over life choices
B. Lack of personal concern for others
C. Inconsistent, overly harsh, or absent parental discipline
D. Parental labeling of the child as “good” regardless of their behavior.

6. On the basis of Erikson’s theory, how should a nurse encourage a 40-year-old client to improve his or her self-esteem?
A. Encourage the client to review life goals and accomplishments.
B. Encourage the client to volunteer at a school, reading to underprivileged children.
C. Encourage the client to form lasting intimate relationships.
D. Encourage the client to seek recognition for task achievement.

7. Which is an appropriate initial nursing intervention for a client with chronic low self-esteem?
A. Assessing the content of negative self-talk
B. Administering anxiolytic medications
C. Using reassurance and physical touch
D. Using distraction techniques

8. A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Erikson’s theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task?
A. Trust
B. Initiative
C. Intimacy
D. Ego integrity

9. A 40-year-old female client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Erikson’s developmental stage of intimacy versus isolation. What is the instructor’s most appropriate reply?
A. “Erikson’s stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age.”
B. “Erikson’s stages of development are assessed by task achievement, not chronological age. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age.”
C. “Erikson’s stages of development are assessed by task achievement , not chronological age. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age.”
D. “Erikson’s stages of development are assessed by chronological age, not task achievement. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age.”

10. A home health nurse visits an 18-year-old client who lives with his mother. The client has been assessed as having low self-esteem. The nurse refers the client for individual counseling. During the next home visit, which assessed client behavior clearly indicates treatment success?
A. The client wants to buy a dog but has not yet asked his mother’s permission.
B. The client asks his mother for permission to buy a dog.
C. The client tells his mother he plans to buy a dog.
D. The client buys a dog and hides it in the garage.

Chapter 16. Anger/Aggression Management

Multiple Choice

1. A student nurse has just entered a psychiatric rotation. The student asks a nursing instructor, “ How will we know if someone may get violent?” Which is the most appropriate reply by the nursing instructor?
A. “You can’t really say for sure. There are limited indicators of potential violence.”
B. “Certain behaviors indicate a potential for violence. They are labeled as a ‘prodromal syndrome’ and include rigid posture, clenched fists, and raised voice.”
C. “Any client can become violent, so it is best to be aware of your surroundings at all times.”
D. “When a client suddenly becomes quiet, is withdrawn, and maintains a flat affect, this is an indicator of potential violence.”

2. A nursing instructor is teaching about the concept of anger. Which student statement indicates the need for further instruction?
A. “Anger is physiological arousal.”
B. “Anger and aggression are essentially the same.”
C. “Anger expression is a learned response.”
D. “Anger is not a primary emotion.”

3. Which client statement demonstrates improvement in anger/aggression management?
A. “I realize I have a problem expressing my anger appropriately.”
B. “I know I can’t use physical force anymore, but I can intimidate someone with my words.”
C. “It’s bad to feel as angry as I feel. I’m working on eliminating this poisonous emotion entirely.”
D. “Because my wife seems to be the one to set me off, I’ve decided to remain separated from her.”

4. A client is served divorce papers while on the inpatient psychiatric unit. When a nurse tells the client the unit telephone cannot be used after hours, the client raises his fists, swears, and spits at the nurse. Which negative coping mechanism has the client exhibited?
A. The defense mechanism of projection
B. The defense mechanism of reaction formation
C. The defense mechanism of sublimation
D. The defense mechanism of displacement
5. A nurse is caring for four clients. Which client should the nurse identify as least prone to developing problems with anger and aggression?
A. A child raised by a physically abusive parent
B. An adult with a history of epilepsy
C. A young adult living in the ghetto of an inner city
D. An adolescent raised by Scandinavian immigrant parents
6. After less restrictive means have been attempted, an order for client restraints has been obtained for a hostile, aggressive 30- year-old client. If client aggression continues, how long will the nurse expect the client to remain in restraints without a physician order renewal?
A. 1 hour B. 2 hour s C.3 hour s D.4 hour s

7. An adult client assaults another client and is placed in restraints. Which statement from the client while in restraints should alert a nurse that further assessment is necessary?
A. “I hate all of you!”
B. “My fingers are tingly.”
C. “You wait until I tell my lawyer.”
D. “I have a sinus headache.”

8. After restraints are removed from a client, the staff discusses the incident and establishes guidelines for the client’s return to the therapeutic milieu. Which unit procedure is the staff implementing?
A. Milieu reenactment B. Treatment planning C. Crisis intervention D. Debriefing

9. Once the nurse initiates restraint for an out-of-control 45-year-old patient, what must occur within 1 hour, according to JCAHO standards?
A. The patient must be let out of restraint.
B. A physician or other licensed independent practitioner must conduct an in-person evaluation.
C. The patient must be bathed and fed.
D. The patient must be included in debriefing.

10. For select clients, physical restraint is considered to be a beneficial intervention. This is based on which premise?
A. Clients with poor boundaries do not respond to verbal redirection, and they need firm and consistent limit setting.
B. Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others.
C. Clients with antisocial tendencies need to submit to authority.
D. Clients with behavioral dysfunction need behavioral interventions.

Chapter 17. The Suicidal Client

Multiple Choice
1. A nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action?
A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note
B. Establishing room restrictions, because the client’s threat is an attempt to manipulate the staff
C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide
D. Calling an emergency treatment team meeting, because the client’s threat must be addressed

2. During the planning of care for a suicidal client, which correctly written outcome should be a nurse’s first priority?
A. The client will not physically harm self.
B. The client will express hope for the future by day 3.
C. The client will establish a trusting relationship with the nurse.
D. The client will remain safe during the hospital stay.

3. A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse’s priority intervention at this time?
A. Obtaining an order for locked seclusion until client is no longer suicidal
B. Conducting 15-minute checks to ensure safety
C. Placing the client on one-to-one observation while monitoring suicidal ideations
D. Encouraging client to express feelings related to suicide

4. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for
1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse’s priority at this time?
A. Give the client off-unit privileges as positive reinforcement.
B. Encourage the client to share mood improvement in group.
C. Increase frequency of client observation.
D. Request that the psychiatrist reevaluate the current medication protocol.

5. A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health- care provider orders amitriptyline (Elavil) for the client. Which intervention related to
this medication should be initiated to maintain this client’s safety upon discharge?
A. Provide a 6-month supply of Elavil to ensure long-term compliance.
B. Provide a 1-week supply of Elavil with refills contingent on follow-up appointments.
C. Provide a pill dispenser as a memory aid.
D. Provide education regarding the avoidance of foods containing tyramine.

6. During a one-to-one session with a client, the client states, “Nothing will ever get better,” and “Nobody can help me.” Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time?
A. Powerlessness R/T altered mood AEB client statements
B. Risk for injury R/T altered mood AEB client statements
C. Risk for suicide R/T altered mood AEB client statements
D. Hopelessness R/T altered mood AEB client statements

7. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team’s decision?
A. No previous admissions for major depressive disorder
B. Vital signs stable; no psychosis noted
C. Able to comply with medication regimen; able to problem-solve life issues
D. Able to participate in a plan for safety; family agrees to constant observation

8. The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide?
A. Address only serious suicide threats to avoid the possibility of secondary gain.
B. Promote trust by verbalizing a promise to keep suicide attempt information within the family.
C. Offer a private environment to provide needed time alone at least once a day.
D. Be available to actively listen, support, and accept feelings.

9. A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information?
A. “Your grieving will subside within 1 year; until then I recommend antidepressants.”
B. “Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area.”
C. “The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them.”
D. “Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone.”

10. After years of dialysis, an 84-year-old states, “I’m exhausted, depressed, and done with these attempts to keep me alive.” Which question should the nurse ask the spouse when preparing a discharge plan of care?
A. “Have there been any changes in appetite or sleep?”
B. “How often is your spouse left alone?”
C. “Has your spouse been following a diet and exercise program consistently? ”
D. “How would you characterize your relationship with your spouse?”

Chapter 18. Behavior Therapy

Multiple Choice

1. A kindergarten rule states that if unacceptable behavior occurs, a child’s personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy?
A. Classical conditioning B. Conditioned response C. Positive reinforcement D. Negative reinforcement

2. An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior?
A. Shaping
B. Modeling
C. Premack principle
D. Reciprocal inhibition

3. A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child’s parent?
A. “Your child will receive green tokens for completing homework that can be cashed in for desired rewards.”
B. “Your child will receive red tokens when homework is incomplete and this will result in school suspension.”
C. “Your child will receive a time out for each homework assignment not completed.”
D. “Your child, with your assistance, will envision receiving rewards for completed homework.”

4. A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, “What’s that?” Which is the most appropriate nursing reply?
A. “At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon.”
B. “By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve.”
C. “Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety.”
D. “In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.”

5. A client reports, “My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious.” Which technique was the friend’s therapist most likely using?
A. Extinction
B. Covert sensitization
C. Systematic desensitization
D. Reciprocal inhibition

6. A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents?
A. “You are shaping your child’s behavior.”
B. “Your child has modeled your behavior.”
C. “You are positively reinforcing your child’s behavior.”
D. “You are negatively reinforcing your child’s behavior.”

7. A child always chooses to ask mother over father when seeking special privileges. The father
is more apt to disagree than agree with the child’s requests, whereas the mother usually consents. The child’s choice is the result of which component of operant conditioning?
A. Conditioned stimuli
B. Unconditioned stimuli
C. Aversive stimuli
D. Discriminative stimuli

8. Parents decide to try the nurse practitioner’s suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents?
A. “Correct your child’s behavior by spanking for a specified time period.”
B. “Ignore the child’s negative behavior.”
C. “Add positive reinforcement for acceptable behavior.”
D. “Temporarily move your child to an area where behavior is not being reinforced.”

9. Parents of a 3-year-old have noticed an improvement in behavior because of using a “time out” behavioral approach. What aspect of “time out” therapy may be responsible for this chil d’s improved behavior?
A. “Negative reinforcement discourages maladaptive behavior.”
B. “Positive reinforcement is removed.”
C. “Covert sensitization is being applied.”
D. “Reciprocal inhibition is eliminated.”

10. A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of “flooding.” Which intervention best exemplifies this technique?
A. Giving rewards for demonstrating a decrease in fear of spiders
B. Encouraging the client to sit through the movie “Spiderman”
C. Accompanying the client to a 1-hour visit to the local zoo’s spider room
D. Offering a computer program that progressively presents anxiety-producing spider scenarios

Chapter 19. Cognitive Therapy

Multiple Choice

1. A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content?
A. “The therapist provides information about the process of cognitive therapy.”
B. “The therapist uses guided imagery in an effort to elicit automatic thoughts.”
C. “The therapist provides information about how cognitive therapy works.”
D. “The therapist uses reading assignments to reinforce learning.”

2. A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client?
A. “Thought patterns are triggered by specific stressful stimuli.”
B. “Thought patterns contain the client’s fundamental beliefs and assumptions.”
C. “Thought patterns are flexible and based on personal experience.”
D. “Thought patterns include a predominance of automatic thoughts.”

3. A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the client’s thinking is reflective of which cognitive error?
A. Minimization
B. Dichotomous thinking
C. Arbitrary inference
D. Personalization

4. A nursing student states, “The instructor gave me a failing grade on my research paper. I know it’s because the instructor doesn’t like me.” Which cognitive error does a nurse recognize in this student’s statement?
A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

5. An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, “What’s cognitive therapy and how can it help me?” Which is the nurse’s most appropriate reply?
A. “It is a system of techniques in which you use positive thinking to improve your mood.”
B. “It is a long-term interpersonal approach that emphasizes the role of early childhood experiences.”
C. “It is an interpersonal treatment approach that specifically targets magical thinking.”
D. “It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors.”

6. A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion?
A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

7. An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client’s concerns. What is the purpose of this nursing intervention?
A. To identify important areas needing concentration during therapy
B. To increase self-esteem and decrease feelings of helplessness
C. To modify maladaptive behaviors by the use of role-play
D. To divert away from intrusive thoughts and depressive ruminations

8. When a client’s husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husband’s tardiness. What technique is the nurse using?
A. Examination of the evidence
B. Decatastrophizing
C. Generating alternatives
D. Reattribution

9. A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of “examining the evidence.” Which response exemplifies this technique?
A. “Let’s look at the potential reasons why your partner has not participated.”
B. “How would you define irresponsibility?”
C. “Has it occurred to you that your partner may be working on the project at home?”
D. “Are you telling me that you feel totally responsible for this project?”

10. A nursing assistant has failed a prerequisite course toward admission to nursing school and states, “I will always be only a nursing assistant and never an RN.” Her nursing advisor understands this is an example of which automatic thought?
A. Arbitrary inference
B. Overgeneralization
C. Dichotomous thinking
D. Personalization

Chapter 20. Electroconvulsive Therapy

Multiple Choice

1. A nurse administers pure oxygen to a client during and after electroconvulsive therapy. What is the nurse’s rationale for this procedure?
A. To prevent increased intracranial pressure resulting from anoxia
B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation
C. To prevent anoxia due to medication-induced paralysis of respiratory muscles
D. To prevent blocked airway resulting from seizure activity

2. Immediately after electroconvulsive therapy, in which position should a nurse place the client?
A. On his or her side to prevent aspiration
B. In semi-Fowler’s position to promote oxygenation
C. In Trendelenburg’s position to promote blood flow to vital organs
D. In prone position to prevent airway blockage

3. A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred
A. “During ECT a state of euphoria is induced.”
B. “ECT induces a grand mal seizure.”
C. “During ECT a state of catatonia is induced.”
D. “ECT induces a petit mal seizure.”

4. A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT, a nurse should recognize the continued need for which critical intervention?
A. Suicide assessment must continue throughout the ECT course.
B. Antidepressant medications are contraindicated throughout the ECT course.
C. Discourage expressions of hopelessness throughout the ECT course.
D. Encourage a high-caloric diet throughout the ECT course.

5. After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, “I can’t even remember eating breakfast, so I want to stop the ECT.” Which is the most appropriate nursing reply?
A. “After you begin the course of treatments, you must complete all of them.”
B. “You’ll need to talk with your doctor about what you’re thinking.”
C. “It is within your right to discontinue the treatments, but let’s talk about your concerns.”
D. “Memory loss is a rare side effect of the treatment. I don’t think it should be a concern.”

6. Immediately after an initial electroconvulsive therapy (ECT) procedure, a client states, “I’m not hungry and just want to stay in bed and sleep.” On the basis of this information, which is the most appropriate nursing intervention?
A. Allow the client to remain in bed.
B. Encourage the client to join the milieu to promote socialization.
C. Obtain a physician’s order for parenteral nutrition.
D. Involve the client in physical activities to stimulate circulation.

7. A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a client’s electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication?
A. Robinul decreases anxiety during the ECT procedure.
B. Robinul induces an unconscious state to prevent pain during the ECT procedure.
C. Robinul prevents severe muscle contractions during the ECT procedure.
D. Robinul decreases secretions to prevent aspiration during the ECT procedure.

8. A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred?
A. “Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT.”
B. “Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration.”
C. “Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious.”
D. “Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure.”

9. A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. On the basis of this observation, which is the most appropriate nursing action?
A. The nurse notifies the client’s physician of the situation and cancels the ECT.
B. The nurse removes the breakfast tray and assists the client to the ECT procedure room.
C. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m.
D. The nurse increases the client’s fluid intake to facilitate the digestive process.

10. A client who is learning about electroconvulsive therapy (ECT) asks a nurse, “Isn’t this treatment dangerous?” Which is the most appropriate nursing reply?
A. “No, this treatment is side-effect free.”
B. “There can be temporary paralysis, but full functioning returns within 3 hours of treatment.”
C. “There are some risks, but a thorough examination will determine your candidacy for ECT.”
D. “Transient ischemic attacks (TIAs) can occur but are rare.”