1. A patient with depression mentions to the nurse, My mother says depression is a chemical disorder. What does she mean? The nurses response is based on
... [Show More] the theory that depression primarily involves which of the following neurotransmitters?
1. Cortisol and GABA
2. COMT and glutamate
3. Monamine and glycine
4. 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?
1. Observing the patient pick up a spoon
2. Asking the patient to recite the alphabet
3. Monitoring the patients blood pressure
4. Comparing the patients grip strength in both hands
3. The patient diagnosed with schizophrenia asks why psychotropic medications are always prescribed by the doctor. The nurses answer will be based on information that the therapeutic action of psychotropic drugs is the result of their effect on:
1. The temporal lobe; especially Wernickes area
2. Dendrites and their ability to transmit electrical impulses
3. The regulation of neurotransmitters especially dopamine
4. 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:
1. Necessary but generally for psychiatric nurses who focus primarily on behavioral interventions
1. A complex undertaking that advance practice psychiatric nurses frequently use in their practice
1. Important primarily for the nursing assessment of patients with brain traumacaused cognitive symptoms
1. 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?
1. Too much stress has been proven to cause all kinds of cancer.
2. There have been no research studies done on stress and disease yet.
3. Stress does cause the release of factors that suppress the immune system.
4. 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?
1. Expression of emotion
2. Detecting auditory stimuli
3. Receiving visual images
4. 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:
1. Demonstrates major deficiencies in speech
2. Is unable to effectively hold a spoon in the left hand
3. Has difficulty explaining how to go about using the telephone
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 patients medication teaching by:
1. Including the patients caregiver in the education
2. Being careful to stress the importance of taking the medication as prescribed 3.
Providing the education at a time when the patient is emotionally calm and relaxed
1. Encouraging the patient to crush or dissolve the medication to help with swallowing
9. The physician tells the nurse, The medication Im prescribing for the patient enhances the gaminobutyric acid (GABA) system. Which patient behavior will provide evidence that the medication therapy is successful?
1. The patient is actively involved in playing cards with other patients.
2. The patient reports that, I dont feel as anxious as I did a couple of days ago.
3. The patient reports that both auditory and visual hallucinations have decreased.
4. The patient says that, I am much happier than before I came to the hospital.
10. The patients family asks whether a diagnosis of Parkinsons disease creates an increased risk for any mental health issues. What question would the nurse ask to assess for such a comorbid condition?
1. Has your father exhibited any signs of depression?
2. Does your father seem to experience mood swings?
3. Have you noticed your father talking about seeing things you cant see?
4. Is your dad preoccupied with behaviors that he needs to repeat over and over?
11. Which explanation for the prescription of donepezil (Aricept) would the nurse provide for a patient in the early stage of Alzheimers
disease?
1. It will increase the metabolism of excess GABA.
2. Excess dopamine will be prevented from attaching to receptor sites.
3. Serotonin deficiency will be managed through a prolonged reuptake period.
4. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
12. There remains a stigma attached to psychiatric illnesses. The psychiatric nurse makes the greatest impact on this sociological problem when:
1. Providing educational programming for patients and the public
2. Arranging for adequate and appropriate social support for the patient
3. Assisting the patient to achieve the maximum level of independent functioning 4.
Regularly praising the patient for seeking and complying with appropriate treatment
13. The wife of a patient with paranoid schizophrenia tells the nurse, Ive learned that my husband has several close relatives with the same disorder. Does this problem run in families? The response based on recent discoveries in the field of genetics would be:
1. Your children should be monitored closely for the disorder.
2. Research tends to support a familiar tendency to schizophrenia.
3. There is no concrete evidence; it is just as likely a coincidence.
4. Only bipolar disorder has been identified to have a genetic component.
14. A patient whose symptoms of mild depression have been managed with antidepressants is concerned about the affect of accepting a promotion that will require working the night shift. What will be the basis of the response the nurse gives to address the patients concern?
1. The connection between a new job and possible depression does exist.
2. The medication can be adjusted to manage any increase in depression.
3. The interruption in normal wake-sleep patterns can influence mood disorders. 4. The change in sleep routine can be managed with a healthy sleep hygiene routine.
15. The nurse is discouraged because the patient exhibiting negative symptoms of schizophrenia has shown no improvement with the planned interventions to reduce the symptoms. The mentors remark that helps place the problem in perspective is:
1. You arent responsible for the behavior of any other person.
2. Patients can be perverse and cling to symptoms despite our efforts.
3. Negative symptoms have been associated with genetic pathology.
4. It will take several trail and error attempts to get the right combination care.
MULTIPLE RESPONSE
1. What assessment data would reinforce the diagnosis of temporal lobe injury in patient who experienced head trauma? Select all that apply.
1. Inability to balance a checkbook
2. Uncharacteristically aggressive
3. Affect fluctuates dramatically
4. Increased interest in sexual behaviors
5. Difficulty remembering the names of family members
2. A patient has begun experiencing dysfunction of the hypothalamus. What nursing interventions will the nurse include in the patients plan of care? Select all that apply.
1. Reinforcing clear physical boundaries
2. Assisting the patient with completing daily menus
3. Learning about healthy sleep hygiene habits
4. Monitoring and recording temperature every 4 hours
5. Monitoring and recording blood pressure every 4 hours
3. The nurse is preparing a patient for a positron emission tomography (PET) scan. Which instructions will the nurse include? Select all that apply.
1. There will likely be a 30 to 45 minute wait between the injection and the beginning of the scan.
1. A blindfold and earplugs may be used to help decrease reaction to the environment during the scan.
1. Make every attempt to lie still during the scan because movement will affect the imaging produced.
1. No food or fluids are to be ingested for at least 8 full hours before the scan and none during the scan.
1. Staying awake during the scan is important since the results are altered when the patient is in any phase of the sleep state.
4. A patient with schizophrenia is described as having difficulty with executive functions. What patient dysfunction can the nurse expect to assess behaviorally? Select all that apply.
1. Invades the personal space of others frequently
2. Consistently fails to bring money when going to buy snacks
3. Cannot remember the names of staff who often provide care
4. Requires repeated reinforcement on how to make a sandwich
5. Frequently speaks of hurting himself or of hurting other patients
5. The unit physicians have ordered magnetic resonance imaging (MRI) tests for the following patients. For which patients would the nurse decline to make test arrangements without further discussion with the physician? Select all that apply.
1. A patient who is claustrophobic
2. A patient who is breastfeeding
3. A patient who has an allergy to iodine
4. A patient who had a total knee replacement
5. A patient who is taking a neuroleptic medication Chapter 2: Contributions of the Psychosocial Sciences
MULTIPLE CHOICE
1. Which understanding is the basis for the nursing actions focused on minimizing mental health promotion of families with chronically mentally ill members?
1. Family members are at an increased risk for mental illness.
2. The mental health care system is not prepared to deal with family crises.
3. Family members are seldom prepared to cope with a chronically ill individual.
4. 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?
1. Providing a patient, whose depression is well managed, with medication on time
2. Making regular follow-up visits to a new mother at risk for post-partum depression
1. Providing the family of a patient, diagnosed with depression, information on suicide prevention
1. Assisting a patient who has obsessive compulsive tendencies prepare and practice for a job interview
3. Which intervention reflects attention being focused on the patients intentions regarding his diagnosis of severe depression?
1. Being placed on suicide precautions
2. Encouraging visits by his family members
3. Receiving a combination of medications to address his emotional needs
4. Being asked to decide where he will attend his prescribed therapy sessions
4. When a patients family asks why their chronically mentally ill adult child is being discharged to a community-based living facility, the nurse responds:
1. It is a way to meet the need for social support.
2. It is too expensive to keep stabilized patients in acute care settings.
3. This type of facility will provide the specialized care that is needed.
4. 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?
1. When you can provide the court with enough evidence to show that he is not able to care for himself safely.
1. It is not likely that someone his age would be determined to be incompetent regardless of his mental condition.
1. He would have to engage in behavior that would result in harm to himself or to someone else; like you or his siblings.
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 chronically abused woman is assessed for anxiety.
A manic patient is taken to the gym to use the exercise equipment.
The older adult diagnosed with depression is monitored for suicidal ideations. A teenager who refuses to obey the units 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?
1. Recovery care, even when intensive, is less expensive than acute psychiatric care.
1. Effective recovery care is likely to result in fewer relapses and subsequent hospitalizations.
1. Planning for recovery care is time consuming and involves dealing with many complicated details.
1. 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 dont want the facility; we especially dont want violent people living near us. The response by the nurse that best addresses the publics concern is:
1. In truth, most individuals with psychiatric disorder are passive and withdrawn and pose little threat to those around them.
1. The mentally ill seldom behave in the manner they are portrayed by movies; they are people just like the rest of us.
1. Patients with psychiatric disorder are so well medicated that they do not display violent behaviors.
1. 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?
1. The nurse respects the patients right to privacy when visitors are spending time with the patient.
1. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors.
1. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse.
1. The nurse dutifully administers the patients 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?
1. Depression treatment is not paid for as readily as is treatment for asthma.
2. The mentally ill patient will be protected by law against social stigma.
3. Medical practitioners are trained to be proficient at treating mental disorders.
4. Psychiatric service reimbursement will be equivalent to that of medical services.
MULTIPLE RESPONSE
1. Which assessment findings suggest to the nurse that this patient has characteristics seen in an individual who has reached self-actualization. Select all that apply.
Reports to have, found peace and security in my religious faith Effectively changed occupations when a chronic vision problem worsened
Has consistently earned a six-figure salary as an architect for the last 10 years Has been in a supportive, loving relationship with the same individual for 15 years Provides free literacy tutoring help at the local homeless shelter 3 evenings a week
2. Which nursing activities represent the tertiary level of mental health care? Select all that apply. Providing a depression screening at a local college
Helping a mental-challenged patient learn to make correct change
Reporting an incidence of possible elder abuse to the appropriate legal agency Regularly assessing a patients understanding of their prescribed antidepressants Providing a 6-week parenting class to teenage parents through a local high school
3. Which nursing actions indicate an understanding of the priority issues currently facing psychiatric mental health nursing today? Select all that apply.
1. Working on the facilitys Safe Use of Restraints Policy revision committee 2. Advocating for increased salaries for all levels of psychiatric mental health nurses
1. Attending a political rally for increased state funding for mental health service providers
1. Offering an in-service to facility staff regarding the cultural implications of caring for the Hispanic patient
1. Joining the state nursing committee working on the role and scope of practice of
the advanced practice psychiatric nurse
4. Which assessment findings describe risk factors that increase the potential risk for mental illness? Select all that apply.
1. Possesses high tolerance for stress
2. Is very curious about how things work
3. Admits to being a member of an ethnic gang
4. Only practicing Jew among school classmates
5. Has a younger sibling who is mentally challenged
5. Which nursing actions show a focus on the fundamental goals that guide psychiatric mental health nurses in providing patient care? Select all that apply.
1. Offering an informational session of identifying signs of depression at a local senior center
1. Attending a workshop on evidence practice interventions for the chronically depressed patient
1. Keeping strict but appropriate boundaries with a patient diagnosed with a personality disorder
1. Asking a parent who has just experienced the death of a child if they could consider talking with a grief counselor
1. Identifying what help a patient diagnosed with Alzheimers disease will need with instrumental activities of daily living (IADLs)
Chapter 3: Contributions of the Sociocultural Sciences
MULTIPLE CHOICE
1. Which nursing action is a reflection of Hildegard Peplaus theoretic framework regarding psychiatric mental health nursing?
1. Basing patient outcomes on expected instinctual responses
2. Discussing a patients feelings regarding parents and siblings
3. Providing the patient with clean clothes and wholesome food
4. 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 selfharm. Which intervention shows an understanding of evidence-based practice (EBP)? 1.
Using physical restraints only after all other options have been proven ineffective
1. Referring to the facilitys policies manual for guidelines for applying physical restraints
1. Collecting data regarding the short-term effects of using physical restraints on an aggressive patient
1. 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?
1. I know Im anxious when I get a tension headache.
2. My anxiety is a result of stressors I dont cope well with.
3. Medication has helped me tremendously with anxiety control.
4. Anxiety runs in my family; my entire family is trying to deal with it.
4. The nurse demonstrates objective patient care when:
5. Being sympathetic to the patients recent loss of a spouse
6. Protecting the anxious patient by eliminating stressors in the milieu
7. Responding to the patient by stating, I know exactly how you feel.
8. Facilitating the patients exploration of various stress reduction techniques
5. Which nursing intervention would be appropriately addressed during the orientation phase of the nursepatient relationship?
1. Self reflection by the nurse regarding personal biases and prejudices regarding the patient
1. Patient works at prioritizing personal needs and develops realistic expected outcomes
1. Establishing the contract between the nurse and the patient regarding mutual needs and expectations
1. 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?
1. Excusing a patient from attending group because, all that talking makes me so anxious
1. Not permitting two patients who are physically attracted to each other to engage in public displays of affection
1. Placing a physically aggressive patient in restraints when they are unable to internally calm their anger
1. 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 nurses fear of a mentally ill patient is that the:
8. Nurse will reinforce negative stereotyping of the mentally ill.
9. Patient will experience increased bias against the nursing staff.
10. Publics fearfulness of the mentally ill will continue to be exaggerated.
11. 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?
1. Be knowledgeable about psychotropic medications and their affect on psychosis. 2. Always arrange for staff support when working one-on-one with a psychotic patient.
1. Take advantage of opportunities to attend workshops devoted to the care of the psychotic patient.
1. 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 patients secret?
1. Never promise the patient that you will keep a secret for them.
2. Always stop the patient from telling you something as a secret.
3. Let the patient know that you will not keep a secret that could ultimately cause harm or affect their treatment.
1. Keep reminding yourself that you are not the patients friend but rather a professional mental health provider.
10. The nurse is effectively facilitating the nurse-patient relationship when:
11. 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.
1. Focusing on the patients life experience without relating to the similarities of ones own experiences
1. Objectively providing constructive criticism that is directed to helping the patient identify inappropriate behaviors
1. Refraining from abandoning the patient regardless of the frustration the interaction causes
11. An often expressed intrinsic reward of psychiatric mental health nursing is:
12. Seeing the seriously ill recover their health
13. Working with patients of all ages and walks of life
14. Working with well-trained, caring health care providers
15. Having time to really focus on the human who is the patient
12. Which statement is an example of an inference?
13. He is an alcoholic because his wife nags a lot.
14. He states he binges after arguing with his wife.
15. You say your alcohol intake exceeds a quart a day.
16. So you are saying that you were drinking earlier today.
MULTIPLE RESPONSE
1. Which interactions are likely outcomes of a well-established therapeutic alliance? Select all that apply.
1. The nurse states, Im not here to judge but rather to help.
2. The patient states, I really think I can handle this problem now.
3. The patient asks his abusive father to attend counseling with him.
4. The nurse sets boundaries for a patient who has few social skills.
5. The patient with anger issues voluntarily goes into the seclusion room.
2. Which nursing interventions are directly related to the principles on which a therapeutic alliance is based? Select all that apply.
1. Graciously declining to, Come visit when I get discharged.
2. Establishing the topic to be discussed at each group session
3. Explaining to the patient the purpose of terminating the alliance
4. Sharing how the nurse also has experienced the same problems
5. Providing subjective feedback to the patients efforts at therapy
3. The nurse is attempting to minimize the groups display of resistance during a therapy session.
Which patients are at risk for displaying such behavior? Select all that apply
1. The patient who is cognitively impaired
2. The patient who is older and well educated
3. The patient who is aggressive and attention seeking
4. The patient who has attended similar therapy groups in the past
5. The patient who has been diagnosed with paranoid schizophrenia Chapter 4: Theories of Personality and Psychopathology
Test Bank MULTIPLE CHOICE
1. The nurse leading parent education classes bases instruction on Eriksons developmental stages. It follows that the nurse will plan to instruct the parents that a helpful strategy to foster a childs initiative would be to:
1. Offer several different options for dressing and encourage the child to select one of them.
1. Allow the child to help wash the unbreakable dishes used to serve breakfast.
2. Provide one-on-one parentchild time each evening before bed.
3. 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?
1. You are never allowed to steal.
2. You go to jail is you steal someone elses things.
3. My parents would punish me if I was caught stealing.
4. Stealing food when you dont have anything to eat is alright.
3. A nursing diagnosis of hopelessness would be considered for an individual who:
4. Was consistently overprotected by family members
5. Was raised by parents who were strict disciplinarians
6. Had inconsistent, unpredictable physical care as an infant
7. 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?
1. Its too hard to get good grades.
2. Ill never be able to get into a good college.
3. My parents are disappointed that I do so poorly in school.
4. I dont 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:
1. Does your son belong to team or club with friends or classmates?
2. Does he feel bad when he does something he knows he shouldnt do?
3. How does he tend to act when he doesnt get exactly what he wants?
4. 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?
1. The use of drawing and illustrations
2. Comparing the childs experiences to the new material
3. Encouraging the child to talk about this new information
4. 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?
1. Playing with an imaginary friend
2. Talking about their best friend
3. Enjoying putting puzzles together
4. 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?
1. Preoperational
2. Concrete operational
3. Formal operational
4. Postoperational
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?
1. Periodically asking the child to attempt to solve increasingly difficult puzzles
2. Consistently offering praise when the child puts his dirty clothes in the hamper
3. Expecting the child to rinse and to place his dirty dishes in the sink
4. 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 childs response?
1. The child views the abuse to be more desirable than the parent leaving.
2. The parent has fostered a fear in the child that increases when they are apart.
3. The child believes that he is responsible for the parent now being punished.
4. The parent has likely told the child that he deserved the abuse as a punishment.
11. Which nursing intervention supports the principles on which the cross-links theory of aging is based?
1. Applying an elastin sustaining moisturizer to an adult patients skin
2. Assessing a patients family history for genetic diseases and disorders
3. Questioning a patient regarding long-term exposure to environmental toxins
4. Assisting an adult patient is selecting foods that are high in vitamins A, C, and E
12. The nurse determines that a patient is showing a decline in explicit memory. Which characterizes such a deficiency?
1. Inability to remember how to operate a common kitchen appliance
2. Difficulty remembering the name of a place visited 20 years ago
3. Being unsuccessful at retaining new information
4. Forgetting the ingredients of a favorite recipe
13. A patient is experiencing distress with midlife transition. Which statement provides support that the patient is successfully managing this stressor?
1. I wont give up on my dream to be rich.
2. Being rich doesnt necessarily make a person happy.
3. Ill never be rich but I can save enough to live comfortably.
4. I wasnt being realistic when I set being rich as my lifes goal.
14. According to Maslows hierarchy of needs, the nursing strategies a psychiatric nurse would
use to assist in meeting self-esteem needs of elderly patients would include:
1. Providing privacy when spouses are visiting
2. Arranging for the spouses to dine with the patients when visiting
3. Including both the patients and spouses in all educational sessions
4. Attending to patient hygiene and dress in preparation for spousal visits
15. A patient is involved in a smoking cessation program that encourages self-control therapy interventions. Which intervention would the nurse suggest to this patient? 1. Limiting the act of smoking to certain times of the day
2. Keeping a behavioral diary that tracks when the patient smokes
3. Identifying the factors that initially encouraged the patient to start smoking
4. Making plans that involve spending the money saved when the smoking stops
16. A 70-year-old male has the nursing diagnosis situational low self-esteem related to forced retirement. Using Maslows hierarchy of human needs, the nurse is confident the patient is meeting the outcome of experiencing self-worth when the patient:
1. Moves to a secure apartment building
2. Exercises regularly with friends at the gym
3. Attends his grandchildrens school functions
4. Volunteers at the local homeless shelter each week
17. The spouse of a patient recently diagnosed with early stage Alzheimers disease asks, Is there anything I can do to help delay the progression of this disease? Which strategy has the greatest potential for preserving the protective abilities of immune cells related to the disease?
1. Minimize contact with the public during cold and flu season.
2. Enroll the patient in an exercise program that meets regularly.
3. Provide supplements to enhance the patients immune system.
4. Identify creative ways to keep the patient mentally challenged. [Show Less]