Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)
Table ofContents
Chapter 01: Practicing the Science and the Art
... [Show More] of Psychiatric Nursing .................. 2 Chapter 02: Mental Health and Mental Illness ................................ ...... 9 Chapter 03: Theories and Therapies ................................ ............. 16 Chapter 04: Biological Basis for Understanding Psychopharmacology.................. 29 Chapter 05: Settings for Psychiatric Care................................ .......... 41 Chapter 06: Legal and Ethical Basis for Practice................................ .... 51 Chapter 07: Nursing Process and QSEN: The Foundation for Safe and Effective Care .... 62 Chapter 08: Communication Skills: Medium for All Nursing Practice................... 75 Chapter 09: Therapeutic Relationships and the Clinical Interview..................... 84 Chapter 10: Trauma and Stress-Related Disorders................................ .. 97 Chapter 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders ......... 107 Chapter 12: Somatic System Disorders and Dissociative Disorders ................... 124 Chapter 13: Personality Disorders ................................ .............. 137 Chapter 14: Eating Disorders ................................ .................. 150 Chapter 15: Mood Disorders: Depression ................................ ........ 163 Chapter 16: Bipolar Spectrum Disorders ................................ ......... 178 Chapter 17: Schizophrenia Spectrum Disorders and Other Psychotic Disorders ........ 194 Chapter 18: Neurocognitive Disorders ................................ ........... 211 Chapter 19: Substance-Related and Addictive Disorders ............................ 224 Chapter 20: Crisis and Mass Disaster ................................ ............ 243 Chapter 21: Child, Partner, and Elder Violence ................................ .... 255 Chapter 22: Sexual Violence ................................ ................... 267 Chapter 23: Suicidal Thoughts and Behavior................................ ...... 278 Chapter 24: Anger, Aggression, and Violence ................................ ..... 291 Chapter 25: Care for the Dying and Those Who Grieve ............................. 304 Chapter 26: Children and Adolescents ................................ ........... 318 Chapter 27: Adults ................................ ........................... 329 Chapter 28: Older Adults ................................ ...................... 343
1 | P a g eChapter 01: Practicing the Science and the Art of Psychiatric Nursing
MULTIPLECHOICE
1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living
in the community and diagnosed with serious and persistent mental illness? Within 3months, the
patient will: a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
ANS: B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and improvingrole
performance.
The goal of recovery is to empower the individual with mental illness to achieve a sense of
meaning and satisfaction in life and to function at the highest possible level of wellness. The
incorrect options focus on the classic medical model rather than recovery.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Outcomes Identification MSC:
NCLEX: Health Promotion and Maintenance
2. In the shift-change report, an off-going nurse criticizes a patient who wears heavy
makeup. Which comment by the nurse who receives the report best demonstrates
advocacy?
a. This is a psychiatric hospital. Craziness is what we are all about.
b. Lets all show acceptance of this patient by wearing lots ofmakeup too.
c. Your comments are inconsiderate and inappropriate. Keep the report objective.
d. Our patients need our help to learn behaviors that will help them get along in society.ANS:
D
Accepting patients needs for self-expression and seeking to teach skills that will contributeto
their well-being demonstrate respect and are important parts of advocacy. The on-
coming nurse needs to take action to ensure that others are not prejudiced against thepatient.
Humor can be appropriate within the privacy of a shift report but not at the expense of respect
for patients. Judging the off-going nurse in a critical way will createconflict.
Nurses must show compassion for each other.
2 | P a g eDIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 3. A nurse
assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is
an example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.ANS:
D
Attending is a technique that demonstrates the nurses commitment to the relationship and
reduces feelings of isolation. This technique shows respect for the patient and demonstrates
caring. Generalizations, probing, and false reassurances are non-therapeutic.
DIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 4. A patient is
hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Selectthe
nurses most caring comment.
a. Lets discuss some means of coping other than suicide when you have these feelings.
b. I understand why youre so depressed. When I got divorced, I was devastated too.
c. You should forget about your marriage and move on with your life.
d. How did you get so depressed that hospitalization was necessary?
3ANS: A
The nurses communication should evidence caring and a commitment to work with the patient.
This commitment lets the patient know the nurse will help. Probing and advice arenot helpful or
therapeutic interventions.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. A patient shows
the nurse an article from the Internet about a health problem. Which characteristic of the web
sites address most alerts the nurse that the site may have biased and prejudicedinformation?
a. Address ends in .org.
b. Address ends in .com.
c. Address ends in .gov.
3 | P a g ed. Address ends in .net.
ANS: B
Financial influences on a site are a clue that the information may be biased. .com at the endof the
address indicates that the site is a commercial one. .gov indicates that the site is maintained by a
government entity.
.org indicates that the site is nonproprietary; the site may or may not have reliable information,
but it does not profit from its activities. .net can have multiple meanings.
DIF: Cognitive Level: Comprehension (Understanding) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 6. A nurse says,
When I was in school, I learned to call upset patients by name to get their attention; however, I
read a descriptive research study that says that this approach does notwork. I plan to stop calling
patients by name. Which statement is the best appraisal of this nurses comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse
specialists.
c. New research findings should be incorporated into clinical algorithms before using themin
practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not
change.
ANS: A
Descriptive research findings provide evidence for practice but must be viewed in relationto other
studies before practice changes. One study is not enough. Descriptive studies are low on the
hierarchy of evidence.
Clinical algorithms use flow charts to manage problems and do not specify one response toa
clinical problem.
Classic tenets of practice should change as research findings provide evidence for change.DIF:
Cognitive Level: Analysis (Analyzing) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. Twonursing
students discuss career plans after graduation. One student wants to enter psychiatric nursing.
The other student asks, Why would you want to be a psychiatric nurse? All they do is talk.You
will lose your skills. Select the best response by the student interested in psychiatric nursing.
a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patientratios
must be better because of the nature of patients problems.
b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve
4 | P a g emultidimensional problems. Im challenged by those situations.
c. I think I will be good in the mental health field. I do not like clinical rotations in school, soI do
not want to continue them after I graduate.
d. Psychiatric nurses do not have to deal with as much pain and suffering as medical
surgical nurses. That appeals to me.
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical surgical nursing,
although substantial overlap does exist. Psychiatric nurses must be able to help patients with
medical and mental health problems, reflecting the holistic perspective thesenurses must have.
Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other
specialties. Psychiatric nursing involves clinical practice,
4
not simply documentation. Psychosocial pain is real and can cause as much suffering asphysical
pain.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 8. Which
research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
ANS: B
Research findings are graded using a hierarchy of evidence. A systematic review of randomized
controlled trials is Level A and provides the strongest evidence for changingpractice. Expert
committee recommendations and descriptive studies lend less powerfuland influential evidence.
A critical pathway is not evidence; it incorporates research findings after they have been
analyzed.
DIF: Cognitive Level: Comprehension (Understanding) REF: 3
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment
9. A bill introduced in Congress would reduce funding for the care of people diagnosed with
mental illnesses.
A group of nurses write letters to their elected representatives in opposition to the
legislation. Which role have the nurses fulfilled?
5 | P a g ea. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
ANS: A
An advocate defends or asserts anothers cause, particularly when the other person lacks the
ability to do that for himself or herself. Examples of individual advocacy include helpingpatients
understand their rights or make decisions. On a community scale, advocacy includes political
activity, public speaking, and publication in the interest of improving the individuals with mental
illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable
to articulate their own needs.
DIF: Cognitive Level: Comprehension (Understanding) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10.An
informal group of patients discuss their perceptions of nursing care. Which comment best
indicates a patients perception that his or her nurse is caring?
a. My nurse always asks me which type of juice I want to help me swallow my medication.
b. My nurse explained my treatment plan to me and asked for my ideas about how to makeit
better.
c. My nurse told me that if I take all the medicines the doctor prescribes I will get
discharged soon.
d. My nurse spends time listening to me talk about my problems. That helps me feel like Imnot
alone.
ANS: D
Caring evidences empathic understanding, as well as competency. It helps change pain andsuffering
into a shared experience, creating a human connection that alleviates feelings of isolation. The
incorrect options give examples of statements that demonstrate advocacy or giving advice.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 11. A patient who
immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient
took an antipsychotic medication for 3 weeks but showed no improvement. Whichresource
should the treatment team consult for information on more effective medicationsfor this patient?
a. Clinical algorithm
b. Clinical pathway
6 | P a g ec. Clinical practice guideline
5
d. International Statistical Classification of Diseases and Related Health Problems (ICD)ANS:
A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn
from large databases of information. These guidelines help the treatment teammakedecisions
cognizant of an individual patients needs, such as ethnic origin, age, or gender. A clinical pathway
is a map of interventions and treatments related to a specific disorder.
Clinical practice guidelines summarize best practices about specific health problems. TheICD
classifies diseases.
DIF: Cognitive Level: Application (Applying) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 12. Which
historical nursing leader helped focus practice to recognize the importance of science in
psychiatric nursing?
a. AbrahamMaslow
b. Hildegard Peplau
c. Kris Martinsen
d. Harriet Bailey
ANS: B
Although all these leaders included science as an important component of practice, Hildegard
Peplau most influenced its development in psychiatric nursing. Maslow was not anurse, but his
theories influence how nurses prioritize problems and care. Bailey wrote a textbook in the 1930s
on psychiatric nursing interventions.
Kris Martinsen emphasized the importance of caring in nursing practice.DIF:
Cognitive Level: Knowledge (Remembering) REF: 4
TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity 13. A nurse consistently strives
to demonstrate caring behaviors during interactions with patients. Which reactionby a patient
indicates this nurse is effective? A patient reports feeling:
a. distrustful of others.
b. connected with others.
c. uneasy about the future.
d. discouraged with efforts to improve.
ANS: B
7 | P a g eA patient is likely to respond to caring with a sense of connectedness with others. The absence of
caring can make patients feel distrustful, disconnected, uneasy, and discouraged.
DIF: Cognitive Level: Comprehension (Understanding) REF: 7
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity MULTIPLE
RESPONSE
1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you
will instantly know how to take care of psychotic patients. What is the new graduatesbest
analysis of this comment? Select all that apply.
a. The experienced nurse may have lost sight of patients individuality, which may
compromise the integrity of practice.
b. New research findings must be continually integrated into a nurses practice to providethe
most effective care.
c. Experience provides mental health nurses with the tools and skills needed for effective
professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients
through trial and error.
e. Effective psychiatric nurses should be continually guided by an intuitive sense of patientsneeds.
ANS: A, B
Evidence-based practice involves using research findings to provide the most effective
nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on
experience. The effective nurse also maintains
6
respect for each patient as an individual. Overgeneralization compromises that perspective.Intuition
and trial and error are unsystematic approaches to care.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 2. Whichpatient
statements identify qualities of nursing practice with high therapeutic value? (Select all that
apply.) My nurse:
a. talks in language I can understand.
b. helps me keep track of my medications.
c. is willing to go to social activities with me.
d. lets me do whatever I choose without interfering.
8 | P a g ee. looks at me as a whole person with different needs.
ANS: A, B, E
Each correct answer demonstrates caring is an example of appropriate nursing foci:
communicating at a level understandable to the patient, using holistic principles to guidecare, and
providing medication supervision.
The incorrect options suggest a laissez-faire attitude on the part of the nurse, when thenurse
should instead provide thoughtful feedback and help patients test alternative solutions or violate
boundaries.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7
Chapter 02: Mental Health and Mental Illness
MULTIPLE CHOICE
1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which
behavior by this patient best demonstrates resilience? The patient: a. says, I knewthis would
happen eventually.
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, I dont need that silly thing.
d. says, Maybe some physical therapy will help me with my balance.
ANS: D
Resiliency is the ability to recover from or adjust to misfortune and change. The correct response
indicates that the patient is hopeful and thinking positively about ways to adapt tothe vertigo.
Saying I knew this would happen eventually and discontinuing healthy activities suggest a
hopeless perspective on the health change.
Refusing to use a walker indicates denial.
DIF: Cognitive Level: Comprehension (Understanding) REF: 14
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. A patient is
admitted to the psychiatric hospital. Which assessment finding best indicates that the
patient has a mental illness? The patient:
a. describes coping and relaxation strategies used when feeling anxious.
b. describes mood as consistently sad, discouraged, and hopeless.
9 | P a g ec. can perform tasks attempted within the limits of own abilities.
d. reports occasional problems with insomnia.
ANS: B
A patient who reports having a consistently negative mood is describing a mood alteration.The
incorrect options describe mentally healthy behaviors and common problems that do not indicate
mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 3. The goal for apatient is
to increase resiliency. Which outcome should a nurse add to the plan of care?
Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
ANS: C
The patients ability to identify healthy coping behaviors indicates adaptive, healthy behavior
and demonstrates an increased ability to recover from severe stress. Describingfeelings
associated with loss and stress does not move the patient toward adaptation. Theremaining
options are maladaptive behaviors.
DIF: Cognitive Level: Analysis (Analyzing) REF: 14
TOP: Nursing Process: Outcomes Identification MSC:
NCLEX: Psychosocial Integrity
4. Which organization actively seeks to reduce the stigma associated with mental illness
through public presentations such as In Our Own Voice (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS) d. North American
Nursing Diagnosis Association International (NANDA-I) ANS: B
Stigma represents the bias and prejudice commonly held regarding mental illness. NAMIactively
seeks to
8
10 | P a g edispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses.The
APA publishes the DSM 5. The USDHHS regulates and administers health policies.
DIF: Cognitive Level: Knowledge (Remembering) REF: 19
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 5. A nursemust
assess several new patients at a community mental health center. Conclusions concerning current
functioning should be made on the basis of:
a. the degree of conformity of the individual to societys norms.
b. the degree to which an individual is logical and rational.
c. a continuum frommentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
ANS: C
Because mental health and mental illness are relative concepts, assessment of functioning is
made by using a continuum. Mental health is not based on conformity; some mentally healthy
individuals do not conform to societys norms. Most individuals occasionally displayillogical or
irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion
to assess mental health or mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Diagnosis| Nursing Process: Analysis MSC: NCLEX: PsychosocialIntegrity
6. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a
patients insurance form.
Which resource should the nurse consult to discern the criteria used to establish thisdiagnosis?
a. A psychiatric nursing textbook
b. NANDA International (NANDA-I )
c. A behavioral health reference manual
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ANS: D
The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on
nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manualmay not
contain diagnostic criteria.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis MSC: NCLEX: Safe, EffectiveCare
Environment
11 | P a g e7. A 40-year-old adult living with parents states, Im happy but I dont socialize much. Mywork
is routine.
When new things come up, my boss explains them a few times to make sure I understand.At
home, my parents make decisions for me, and I go along with them. A nurse should identify
interventions to improve this patients:
a. self-concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
ANS: A
The patient feels the need for multiple explanations of new tasks at work and, despite being40
years of age, allows both parents to make all decisions. These behaviors indicate a poorly
developed self-concept. Although the patient reports being happy, the subsequent comments
refute that self-appraisal. The patients comments do not indicate that he/she is out of touch with
reality. The patients needs are broader than control over own behavior.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 8. A patient tells a nurse, I
have psychiatric problems and am in and out of hospitals all the time. Not one of
9my friends or relatives has these problems. Select the nurses best response.
a. Comparing yourself with others has no real advantages.
b. Why do you blame yourself for having a psychiatric illness?
c. Mental illness affects 50% of the adult population in any given year.
d. It sounds like you are concerned that others dont experience the same challenges as you.
ANS: D
Mental illness affects many people at various times in their lives. No class, culture, or creedis
immune to the challenges of mental illness. The correct response also demonstrates the use of
reflection, a therapeutic communication technique. It is not true that mental illness affects 50%
of the population in any given year.
Asking patients if they blame themselves is an example of probing.DIF:
Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 9. A critical carenurse
asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses best
12 | P a g eresponse.
a. No functional difference exists between the two diagnoses. Both serve to identify a
human deviance.
b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural
variables.
c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis
considers past and present responses to actual mental health problems.
d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a
framework to identify interventions for problems a patient has or may experience.
ANS: D
The medical diagnosis, defined according to the DSM-5, is concerned with the patients
disease state, causes, and cures, whereas the nursing diagnosis focuses on the patients
response to stress and possible caring interventions. Both the DSM-5 and a nursing
diagnosis consider culture. Nursing diagnoses also consider potential problems.
DIF: Cognitive Level: Application (Applying) REF: 16
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10.The
spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood
experiences have anything to do with this disabling illness. Select the nurses response that will
best help the spouse understand this condition.
a. Psychological stress is actually at the root ofmost mental disorders.
b. We now know that all mental illnesses are the result of genetic factors.
c. It must be frustrating for you that your spouse is sick so much of the time.
d. Although this disorder more likely has a biological rather than psychological origin, the
support and involvement of caregivers is very important.
ANS: D
Many of the most prevalent and disabling mental disorders have been found to have strong
biological influences. Helping the spouse understand the importance of his or her role as a
caregiver is also important.
Empathy is important but does not increase the spouses level of knowledge about the causeof the
patients condition. Not all mental illnesses are the result of genetic factors.
Psychological stress is not at the root ofmost mental disorders.DIF:
Cognitive Level: Application (Applying) REF: 14
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
11. Which belief by a nurse supports the highest degree of patient advocacy during a
13 | P a g emultidisciplinary patient care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms ofmental disorders are constant from culture to culture.
d. Some symptoms ofmental disorders may reflect a persons cultural patterns.
10ANS: D
A nurse who understands that a patients symptoms are influenced by culture will be able to
advocate for the patient to a greater degree than a nurse who believes that culture is of little
relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder
are cross-cultural disorders, but this understanding has little relevance to patient advocacy.
Symptoms of mental disorders change from culture to culture.
DIF: Cognitive Level: Application (Applying) REF: 18
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 12. A patients
history shows intense and unstable relationships with others. The patient initiallyidealizes an
individual and then devalues the person when the patients needs are not met.Which aspect of
mental health is a problem?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANS: D
The information provided centers on relationships with others, which are described asintense and
unstable.
The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data
are not present to describe work effectiveness, communication skills, oractivities.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 13. In the majorityculture of
the United States, which individual is at greatest risk to be incorrectly labeled mentally ill?
a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy personwho
gives $20 bills to needy individuals in the community c. Person with an optimistic viewpoint
about life and getting his or her own needs met d. Person who attends a charismatic church and
describes hearing Gods voice ANS: D
Hearing voices is generally associated with mental illness; however, in charismatic religiousgroups,
14 | P a g ehearing the voice of God or a prophet is a desirable event. In this situation, cultural norms vary,
making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the
other options are less likely to be labeled as mentally ill.
DIF: Cognitive Level: Application (Applying) REF: 17
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 14. A participant ata
community education conference asks, What is the most prevalent type of mental disorder in the
United States? Select the nurses best response.
a. Why do you ask?
b. Schizophrenia
c. Affective disorders
d. Anxiety disorders
ANS: D
The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g.,
depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.
DIF: Cognitive Level: Comprehension (Understanding) REF: 15
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with
schizophrenia. Which resource should the nurse consult?
11
a. U.S. Department of Health and Human Services
b. Journal of the American Psychiatric Association
c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnosticand
Statistical Manual of Mental Disorders (DSM-5) ANS: D
The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful
information but are not the best resources for finding a description of the diagnosticcriteria for a
psychiatric disorder.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis MSC: NCLEX: Health Promotionand
Maintenance
MULTIPLE RESPONSE
1. A patient in the emergency department reports, I hear voices saying someone is stalkingme.
They want to kill me because I found the cure for cancer. I will stab anyone that threatens me.
15 | P a g eWhich aspects of mental health have the greatest immediate concern to a nurse? Select all that
apply.
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept
ANS: B, C, E
The aspects of mental health of greatest concern are the patients appraisal of and control over
behavior. The patients appraisal of reality is inaccurate, and auditory hallucinations are evident,
as well as delusions of persecution and grandeur. In addition, the patients control over behavior
is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-
concept is lacking. Data are not present to suggest that the otheraspects of mental health
(happiness and effectiveness in work) are of immediate concern.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment 2. Which
statements most clearly reflect the stigma of mental illness? Select all that apply.
a. Many mental illnesses are hereditary.
b. Mental illness can be evidence of a brain disorder.
c. People claim mental illness so they can get disability checks.
d. If people with mental illness went to church, they would be fine.
e. Mental illness is a result of the breakdown of the American family.
ANS: C, D, E
Stigma is represented by judgmental remarks that discount the reality and validity of mental
illness. Many mental illnesses are genetically transmitted. Neuroimaging can showchanges
associated with some mental illnesses.
DIF: Cognitive Level: Analysis (Analyzing) REF: 19
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 12
Chapter 03: Theories and Therapies
MULTIPLE CHOICE
16 | P a g e1. A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet
training and shouts, No! when given direction. What do you think is wrong? Select the nurses best
reply.
a. This is normal for your childs age. The child is striving for independence.
b. The child needs firmer control. Punish the child for disobedience and say, No.
c. There may be developmental problems. Most children are toilet trained by age 2 years.
d. Some undesirable attitudes are developing. A child psychologist can help you develop a
remedial plan.
ANS: A
These negative behaviors are typical of a child around the age of 2 years whose developmental
task is to develop autonomy. The incorrect options indicate the childsbehavior is abnormal.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2.A 26-
month-old child displays negative behavior, refuses toilet training, and often shouts, No! when
given directions. Using Freuds stages of psychosexual development, a nurse would assess the
childs behavior is based on which stage?
a. Oral
b. Anal
c. Phallic
d. Genital
ANS: B
In Freuds stages of psychosexual development, the anal stage occurs from age 1 to 3 years and
has, as its focus, toilet training and learning to delay immediate gratification. The oral stage
occurs between birth and 1
year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between 13
and 20 years.
DIF: Cognitive Level: Comprehension (Understanding) REF: 20
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A 26-
month-old child displays negative behavior, refuses toilet training, and often shouts, No!when
given direction. The nurses counseling with the parent should be based on the premise that the
child is engaged in which of Eriksons psychosocial crises?
a. Trust versus Mistrust
17 | P a g eb. Initiative versus Guilt
c. Industry versus Inferiority
d. Autonomy versus Shame and Doubt
ANS: D
The crisis of Autonomy versus Shame and Doubt is related to the developmental task of gaining
control of self and environment, as exemplified by toilet training. This psychosocialcrisis occurs
during the period of early childhood. Trust versus Mistrust is the crisis of the infant, Initiative
versus Guilt is the crisis of the preschool and early school-aged child, and Industry versus
Inferiority is the crisis of the 6- to 12-year-old child.
DIF: Cognitive Level: Comprehension (Understanding) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. A 4-year-
old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and thechilds
parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the
childs behavior as a product of impulses originating in the:
a. id.
b. ego.
c. superego.
d. preconscious.
13ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego
acts as a mediator of behavior and weighs the consequences of the action, perhaps determining
that taking the toy is not worth the parents wrath. The superego would opposethe impulsive
behavior as not nice. The preconscious is a level of awareness.
DIF: Cognitive Level: Application (Applying) REF: 20
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. Theparent
of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and
using good manners. A nurse supports the use of praise because, according to the Freudian
theory, these qualities will likely be internalized and become part of the childs: a. id.
b. ego.
c. superego.
d. preconscious.
ANS: C
18 | P a g eIn the Freudian theory, the superego contains the thou shalts or moral standards internalized
from interactions with significant others. Praise fosters internalization of desirable behaviors.
The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the
problem-solving and reality-testing portion of the personality thatnegotiates solutions with the
outside world. The preconscious is a level of awareness fromwhich material can be easily
retrieved with conscious effort.
DIF: Cognitive Level: Comprehension (Understanding) REF: 20
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6.A
nurse supports parental praise of a child who is behaving in a helpful way. When the individual
behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
a. Guilt
b. Anxiety
c. Loneliness
d. Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings aboutself. The
other options are incorrect; each represents a negative feeling.
DIF: Cognitive Level: Comprehension (Understanding) REF: 22
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. A
patient comments, I never know the right answer and My opinion is not important. Using
Eriksons theory, which psychosocial crisis did the patient have difficulty resolving?
a. Initiative versus Guilt
b. Trust versus Mistrust
c. Autonomy versus Shame and Doubt
d. Generativity versus Self-Absorption
ANS: C
These statements show severe self-doubt, indicating that the crisis of gaining control overthe
environment is not being successfully met. Unsuccessful resolution of the crisis of Initiative
versus Guilt results in feelings of guilt. Unsuccessful resolution of the crisis of Trust versus
Mistrust results in poor interpersonal relationships and suspicion of others.
Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results in self-
absorption that limits the ability to grow as a person.
DIF: Cognitive Level: Application (Applying) REF: 22
19 | P a g eTOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8.Which patient statement would lead a nurse to suspect that the developmental task of infancy was not
14successfully completed? a. I have very warm and close friendships. b. Im afraid to let anyone really get to know me. c. I am always right and confident about my decisions. d. Im ashamed that I didnt do it correctly in the first place. [Show Less]