Test Bank Varcarolis' Foundations of Psychiatric-MentalHealth Nursing A Clinical 9th EditionTable ofContents
Chapter 01: Mental Health and Mental Illness
... [Show More] ......................................................................................... 2 Chapter 02: Theories and Therapies .......................................................................................................11 Chapter 03: Psychobiology and Psychopharmacology .............................................................................26 Chapter 04: Treatment Settings ..............................................................................................................39 Chapter 05: Cultural Implications ...........................................................................................................54 Chapter 06: Legal and Ethical Considerations .........................................................................................66 Chapter 07: The Nursing Process and Standards of Care .........................................................................79 Chapter 08: Therapeutic Relationships ...................................................................................................91 Chapter 09: Therapeutic Communication ............................................................................................. 102 Chapter 10: Stress Responses and Stress Management ......................................................................... 112 Chapter 11: Childhood and Neurodevelopmental Disorders .................................................................. 122 Chapter 12: Schizophrenia Spectrum Disorders .................................................................................... 133 Chapter 13: Bipolar and Related Disorders ........................................................................................... 148 Chapter 14: Depressive Disorders ........................................................................................................ 163 Chapter 15: Anxiety and Obsessive-Compulsive Disorders .................................................................... 175 Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders ........................................................ 189 Chapter 17: Somatic Symptom Disorders ............................................................................................. 201 Chapter 18: Eating and Feeding Disorders ............................................................................................ 211 Chapter 19: Sleep–Wake Disorders ...................................................................................................... 222 Chapter 20: Sexual Dysfunctions, Gender Dysphoria, and Paraphilias .................................................... 232 Chapter 21: Impulse Control Disorders ................................................................................................ 243 Chapter 22: Substance-Related and Addictive Disorders ........................................................................ 251 Chapter 23: Neurocognitive Disorders .................................................................................................. 264 Chapter 24: Personality Disorders........................................................................................................ 276 Chapter 25: Suicide and Nonsuicidal Self-Injury ................................................................................... 288 Chapter 26: Crisis and Disaster ............................................................................................................ 298 Chapter 27: Anger, Aggression, and Violence ........................................................................................ 309 Chapter 28: Child, Older Adult, and Intimate Partner Violence ............................................................... 319 Chapter 29: Sexual Assault ................................................................................................................... 328 Chapter 30: Dying, Death, and Grieving ................................................................................................ 337 Chapter 31: Older Adults ...................................................................................................................... 345 Chapter 32: Serious Mental Illness ....................................................................................................... 358 Chapter 33: Forensic Nursing ............................................................................................................... 371 Chapter 34: Therapeutic Groups .......................................................................................................... 381 Chapter 35: Family Interventions ......................................................................................................... 392 Chapter 36: Integrative Care ................................................................................................................ 403
1 | P a g eChapter 01: Mental Health and Mental Illness
MULTIPLE CHOICE
1. A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced
practice nurse to perform which additional intervention? a. Conduct mental health
assessments.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANS: B
In most states, prescriptive privileges are granted to master‘s-prepared nurse practitioners
andclinical nurse specialists who have taken special courses on prescribing medication. The
nurseprepared at the basic level is permitted to perform mental health assessments, establish
relationships, and provide individualized care planning.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-23
TOP:Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
2. A nursing student expresses concerns that mental health nurses ―lose all their clinical nursing
skills.‖ Select the best response by the mental health nurse.
a. ―Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient
ratios must be better because of the nature of the patients‘ problems.‖
b. ―Psychiatric nurses use complex communication skills as well as critical thinking to solve
multidimensional problems. I am challenged by those situations.‖
c. ―That‘s a misconception. Psychiatric nurses frequently use high technology monitoring
equipment and manage complex intravenous therapies.‖
d. ―Psychiatric nurses do not have to deal with as much pain and suffering as medical–
surgical nurses do. That appeals to me.‖
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical–surgical
nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients
with medical as well as mental health problems, reflecting the holistic perspective these
nurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased,
just like other specialties. Psychiatric nursing involves clinical practice, not just
documentation. Psychosocial pain and suffering are as real as physical pain and suffering.
PTS: 1
REF: Pages 1-2, 21
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
3. When a new bill introduced in Congress reduces funding for care of persons diagnosed with
mental illness, a group of nurses write letters to their elected representatives in opposition
tothe legislation. Which role have the nurses fulfilled?
a. Recovery
b. Attending
2 | P a g ec. Advocacy
d. Evidence-based practice
ANS: C
An advocate defends or asserts another‘s cause, particularly when the other person lacks the
ability to do that for self. Examples of individual advocacy include helping patients
understand their rights or make decisions. On a community scale, advocacy includes political
activity, public speaking, and publication in the interest of improving the human condition.
Since funding is necessary to deliver quality programming for persons with mental illness, the
letter-writing campaign advocates for that cause on behalf of patients who are unable to
articulate their own needs.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-26
TOP:Nursing Process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
4. A family has a long history of conflicted relationships among the members. Which family
member‘s comment best reflects a mentally healthy perspective?
a. ―I‘ve made mistakes but everyone else in this family has also.‖
b. ―I remember joy and mutual respect from our early years together.‖
c. ―I will make some changes in my behavior for the good of the family.‖
d. ―It‘s best for me to move away from my family. Things will never change.‖
ANS: C
The correct response demonstrates the best evidence of a healthy recognition of the
importance of relationships. Mental health includes rational thinking, communication skills,
learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may
be healthy, but the correct response shows a higher level ofmental health. The other incorrect
responses show blaming and avoidance.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 1-2, 3, 32 (Figure 1-1)
TOP: Nursing Process: Assessment
MSC:Client Needs: Psychosocial Integrity
5. Which assessment finding most clearly indicates that a patient may be experiencing a mental
illness? The patient
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between ―as if‖ and ―for real.‖
d. perceives difficulty making a decision about whether to change jobs.
ANS: B
The correct response describes a mood alteration, which reflects mental illness. The
distracters describe behaviors that are mentally healthy or within the usual scope of
humanexperience.
PTS: 1
REF: Pages 1-2 to 4
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process:
AssessmentMSC: Client Needs: Psychosocial Integrity
3 | P a g e6. Which finding best indicates that the goal “Demonstrate mentally healthy behavior‖ was
achieved for an adult patient? The patient
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of own life.
ANS: A
The correct response describes an adaptive, healthy behavior. The distracters describe
maladaptive behaviors.
PTS: 1
REF: Pages 1-2 to 4
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process:
EvaluationMSC: Client Needs: Psychosocial Integrity
7. A nurse encounters an unfamiliar psychiatric disorder on a new patient‘s admission form.
Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a.
International Statistical Classification ofDiseases and Related Health Problems
(ICD-10)
b. The ANA‟s Psychiatric-Mental Health Nursing Scope and Standards of Practice
c. Diagnostic and Statistical Manual ofMental Disorders (DSM-V)
d. A behavioral health reference manual
ANS: C
The DSM-Vgives the criteria used to diagnose each mental disorder. It is the official guideline
for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a
psychiatric illness.
PTS: 1
REF: Pages 1-18, 19
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process:
AssessmentMSC: Client Needs: Safe, Effective Care Environment
8. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource
would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. DSM-V
c. The ANA‟s Psychiatric-Mental Health Nursing Scope and Standards ofPractice d. ICD-10
ANS: B
The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official
guideline for diagnosing psychiatric disorders. The other references are good resources but do
not define the diagnostic criteria.
PTS: 1
REF: Pages 1-18, 19
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
4 | P a g e9. Which individual is demonstrating the highest level of resilience? One who
a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for 2 years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
ANS: D
Resilience is closely associated with the process of adapting and helps people facing
tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the
resources they need to support their well-being. Repression and depression are unhealthy.
Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related
audience response question.
PTS: 1 DIF: Cognitive Level: Apply (Application)
6TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. Complete this analogy. NANDA: clinical judgment: NIC:
patientoutcomes.
b. nursing actions.
c. diagnosis.
d. symptoms.
ANS: B
Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis
Association, identifies diagnostic statements regarding human responses to actual or potential
health problems. These statements represent clinical judgments. NIC (Nursing Interventions
Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing
care activities may be direct or indirect.
PTS: 1
REF: Pages 1-21, 22
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process:
EvaluationMSC: Client Needs: Safe, Effective Care Environment
11. An adult says, ―Most of the time I‘m happy and feel good about myself. I have learned that
what I get out of something is proportional to the effort I put into it.‖ Which number on this
mental health continuum should the nurse select?
Ment al Illness
Mental
Health
1
a. 1
b. 2
c. 3
d. 4
e. 5
ANS: E
5 | P a g e
2
3
4
5
REF: Pages 1-5,
a.The adult is generally happy and has an adequate self-concept. The statement indicates the
adult is reality-oriented, works effectively, and has control over own behavior. Mental health
does not mean that a person is always happy.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 1-2, 3, 32 (Figure 1-1)
TOP: Nursing Process: Assessment
MSC:Client Needs: Psychosocial Integrity
12. Which disorder is an example of a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depressive disorder
ANS: C
Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized
by people in those cultures. A syndrome recognized in parts of Southeast Asia is running
amok, in which a person (usually a male) runs around engaging in furious, almost
indiscriminate violent behavior.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-7
TOP:Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
13. The DSM-Vclassifies:
a. deviant behaviors.
b. present disability or distress.
c. people with mental disorders.
d. mental disorders people have.
ANS: D
The DSM-V classifies disorders people have rather than people themselves. The terminology
of the tool reflects this distinction by referring to individuals with a disorder rather than as
a
―schizophrenic‖ or ―alcoholic,‖ for example. Deviant behavior is not generally considered a
mental disorder. Present disability or distress is only one aspect of the diagnosis.
PTS: 1
REF: Pages 1-18, 19
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
14. A citizen at a community health fair asks the nurse, ―What is the most prevalent mental disorder
in the United States?‖ Select the nurse‘s correct response. a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer‘s disease
ANS: D
The 12-month prevalence for Alzheimer‘s disease is 10% for persons older than 65% and 50%
6 | P a g efor persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence
of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 1-33 (Table 1-1)
TOP: Nursing Process: Implementation MSC:
ClientNeeds: Health Promotion and Maintenance
15. In the majority culture of the United States, which individual has the greatest risk to be labeled
mentally ill? One who
a. describes hearing God‘s voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals.
d. always has an optimistic viewpoint about life and having own needs met.
ANS: A
The question asks about risk. Hearing voices is generally associated with mental illness, but in
charismatic religious groups, hearing the voice of God or a prophet is a desirable event.
Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The
individuals described in the other options are less likely to be labeled mentally ill.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
4TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
REF: Pages 1-3,
16. A patient‘s relationships are intense and unstable. The patient initially idealizes the significant
other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will
benefit from interventions to develop which aspect ofmental health? a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANS: D
The information given centers on relationships with others that are described as intense and
unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially
integrated. Data are not present to describe work effectiveness, communication skills, or
activities.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 1-32 (Figure 1-1) TOP: Nursing Process: Planning MSC: Client
Needs: Psychosocial Integrity
17. Which belief will best support a nurse‘s efforts to provide patient advocacy during a
multidisciplinary 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 unchanged from culture to culture.
d. Assessment findings in mental illness reflect a person‘s cultural patterns.
ANS: D
7 | P a g eSymptoms must be understood in terms of a person‘s cultural background. A nurse who
understands that a patient‘s 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. The
distracters are untrue statements.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page
1-27 TOP: Nursing Process: Implementation MSC: Client Needs:
Psychosocial Integrity
18. A nurse is part of a multidisciplinary team working with groups of depressed patients. One
group of patients receives supportive interventions and antidepressant medication. The
othergroup receives only medication. The team measures outcomes for each group. Which
type ofstudy is evident?
a. Incidence
b. Prevalence
c. Comorbidity
d. Clinical epidemiology
ANS: D
Clinical epidemiology is a broad field that addresses studies of the natural history (or what
happens if there is no treatment and the problem is left to run its course) of an illness, studies
of diagnostic screening tests, and observational and experimental studies of interventions used
to treat people with the illness or symptoms. Prevalence refers to numbers of new cases.
Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the
number of new cases of mental disorders in a healthy population within a given period. See
related audience response question.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-17
TOP:Nursing Process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
19. The spouse of a patient diagnosed with schizophrenia says, ―I don‘t understand how events
from childhood have anything to do with this disabling illness.‖ Which response by the nurse
will best help the spouse understand the cause of this disorder?
a. ―Psychological stress is the basis ofmost mental disorders.‖
b. ―This illness results from developmental factors rather than stress.‖
c. ―Research shows that this condition more likely has a biological basis.‖
d. ―It must be frustrating for you that your spouse is sick so much of the time.‖
ANS: C
Many of the most prevalent and disabling mental disorders have strong biological influences.
Genetics are only one part of biological factors. Empathy does not address increasing the
spouse‘s level of knowledge about the cause of the disorder. The other distracters are not
established facts.
PTS: 1 DIF: Cognitive Level: Apply (Application)
6TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
8 | P a g e
REF: Pages 1-5,20. A category 5 tornado occurred in a community of 400 people. Many homes and businesses were
destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with
posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases?
a. Prevalence
b. Comorbidity
c. Incidence
d. Parity
ANS: C
Incidence refers to the number of new cases of mental disorders in a healthy population within
a given period of time. Prevalence describes the total number of cases, new and existing, in a
given population during a specific period of time, regardless of when they became ill. Parity
refers to equivalence, and legislation required insurers that provide mental health coverage to
offer annual and lifetime benefits at the same level provided for medical–surgical coverage.
Comorbidity refers to having more than one mental disorder at a time.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 1-16 TOP: Nursing Process: Planning/Outcomes Identification MSC:
Client Needs: Safe, Effective Care Environment
21. Which component of treatment ofmental illness is specifically recognized by Quality and
Safety Education for Nurses (QSEN)? a. All genomes are unique.
b. Care is centered on the patient.
c. Healthy development is vital to mental health.
d. Recovery occurs on a continuum from illness to health.
ANS: B
The key areas of care promoted by QSEN are patient-centered care, teamwork and
collaboration, evidence-based practice, quality improvement, safety, and informatics.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page
1-14 TOP: Nursing Process: Implementation MSC: Client Needs: Safe,
Effective Care Environment
22. Select the best response for the nurse to a question from another health professional
regardingthe difference between a diagnosis in DSM-Vand a nursing diagnosis.
a. ―There is no functional difference between the two. Both identify human disorders.‖
b. ―The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture
into account.‖
c. ―The DSM-Vdiagnosis describes causes of disorders whereas a nursing diagnosis does not
explore etiology.‖
d. ―The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a
framework for identifying interventions for issues a patient is
experiencing.‖
ANS: D
The medical diagnosis is concerned with the patient‘s disease state, causes, and cures, whereas
the nursing diagnosis focuses on the patient‘s response to stress and possible caring
9 | P a g einterventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also
consider potential problems.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 1-21 TOP:
Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
23. Which nursing intervention below is part of the scope of an advanced practice
psychiatric/mental health nurse rather than a basic level registered nurse? a. Coordination
ofcare
b. Health teaching
c. Milieu therapy
d. Psychotherapy
ANS: D
Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters
are within a basic level registered nurse‘s scope of practice.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 1-23, 35 (Table 1-2)
TOP: Nursing Process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
MULTIPLE RESPONSE
1. An experienced nurse says to a new graduate, ―When you‘ve practiced as long as I have, you
automatically know how to take care of patients experiencing psychosis.‖ Which factors should
the new graduate consider when analyzing 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 should be integrated continuously into a nurse‘s practice to provide
the most effective care.
c. Experience provides mental health nurses with the essential tools and skills needed for
effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients
through trial and error.
e. An intuitive sense of patients‘ needs guides effective psychiatric nurses.
ANS: A, B
Evidence-based practice involves using research findings and standards of care to provide the
most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely
on experience. The effective nurse also maintains respect for each patient as an individual.
Overgeneralization compromises that perspective. Intuition and trial and error
areunsystematic approaches to care.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 1-
14 TOP: Nursing Process: Diagnosis/Analysis MSC: Client
Needs: Safe, Effective Care Environment
2. Which findings are signs of a person who is mentally healthy? (Select all that apply.)
10 | P a g ea. Says, ―I have some weaknesses, but I feel I‘m important to my family and friends.‖
b. Adheres strictly to religious beliefs of parents and family of origin.
c. Spends all holidays alone watching old movies on television.
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
ANS: A, D, E
Mental health is a state of well-being in which each individual is able to realize his or her own
potential, cope with the normal stresses of life, work productively, and make a contribution to
the community. Mental health provides people with the capacity for rational thinking,
communication skills, learning, emotional growth, resilience, and self-esteem.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 1-2, 3, 32 (Figure 1-1)
TOP: Nursing Process: Assessment
MSC:Client Needs: Psychosocial Integrity
3. A patient in the emergency department says, ―Voices say someone is stalking me. They want to
kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a
threat.‖ Which aspects of the patient‘s mental health have the greatest and most immediate
concern to the 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 patient‘s appraisal of and control over
behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of
persecution, and delusions of grandeur. In addition, the patient‘s control over behavior is
tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-
concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest
that the other aspects of mental health (happiness and effectiveness in work) are of
immediateconcern.
PTS: 1 DIF: Cognitive Level: Apply (Application)
4TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
Chapter 02: Theories and Therapies
MULTIPLE CHOICE
1. A parent says, ―My 2-year-old child refuses toilet training and shouts „No!‟ when given
directions. What do you think is wrong?‖ Select the nurse‘s best reply.
a. ―Your child needs firmer control. It is important to set limits now.‖
b. ―This is normal for your child‘s age. The child is striving for independence.‖
c. ―There may be developmental problems. Most children are toilet trained by age 2.‖
d. ―Some undesirable attitudes are developing. A child psychologist can help you
11 | P a g e
REF: Pages 1-3,develop a plan.‖
ANS: B
This behavior is conventional of a child around the age of 2 years, whose developmental
task is to develop autonomy. The distracters indicate the child‘s behavior is abnormal.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 2-52 (Table 2-6) TOP: Nursing Process: Implementation MSC: Client Needs:Health
Promotion and Maintenance
2. A nurse wants to find information on current evidence-based research, programs, and practices
regarding mental illness and addictions. Which resource should the nurse consult? a. American
Psychiatric Association
b. American Psychological Association (APA)
c. Clinician‘s Quick Guide to Interpersonal Psychotherapy
d. Substance Abuse and Mental Health Services Administration (SAMHSA)
ANS: D
The SAMHSA maintains a National Registry of Evidence-based Practices and Programs.
New therapies are entered into the database on a regular basis. The incorrect responses
areresources but do not focus on evidence-based information.
PTS: 1
REF: Page 2-32
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client
Needs: Management of Care
3. A 26-month-old displays negative behavior, refuses toilet training, and often says, ―No!‖
Which psychosocial crisis is evident? a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
ANS: D
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining
control of self and environment, as exemplified by toilet training. This psychosocial crisis
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. Industry
versus inferiority is the crisis of the 6- to 12-year-old child.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 2-52 (Table 2-6) TOP: Nursing Process: Assessment MSC: Client Needs:Health
Promotion and Maintenance
4. A 4-year-old grabs toys from other children and says, ―I want that now!‖ From a
psychoanalytic perspective, this behavior is a product of impulses originating in which system
of the personality? a. Id
b. Ego
c. Superego
12 | P a g ed. Preconscious
ANS: 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 mother‘s wrath. The superego would
opposethe impulsive behavior as ―not nice.‖ The preconscious is a level of awareness
rather than an aspect of personality.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 2-4, 5
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
5. The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and
using good manners. These qualities are likely to be internalized and become part of which
system of the personality? a. Id
b. Ego
c. Superego
d. Preconscious
ANS: C
The superego contains the ―shoulds,‖ 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 that negotiates solutions with the outside world.
The preconscious is a level of awareness from which material can be retrieved easily with
conscious effort. This item relates to an audience response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 2-4, 5 TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
6. A nurse supports a parent for praising a child who behaves in helpful ways to others. When this
child behaves with politeness and helpfulness in adulthood, which feeling will most likely
result? a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings about
self. The other options are incorrect because each represents a negative feeling.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 2-4, 5 TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
13 | P a g e7. An adult says, ―I never know the answers,‖ and ―My opinion does not count.‖ Which
psychosocial crisis was unsuccessfully resolved for this adult? 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 over
the environment was not met successfully. 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.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 2-52 (Table 2-6) TOP: Nursing Process: Assessment MSC: Client Needs:Health
Promotion and Maintenance
8. Which statement by a patient would lead the nurse to suspect unsuccessful completion of the
psychosocial developmental task of infancy?
a. ―I know how to do things right, so I prefer jobs where I work alone rather than on a
team.‖
b. ―I do not allow other people to truly get to know me.‖
c. ―I depend on frequent praise from others to feel good about myself.‖
d. ―I usually need to do things several times before I get them right.‖
ANS: B
According to Erikson, the developmental task of infancy is the development of trust. The
correct response is the only statement clearly showing lack of ability to trust others. An
inability to work with others, coupled with a sense of superiority, suggests unsuccessful
completion of the task of intimacy versus isolation. Relying on praise from others suggests
unsuccessful completion of the task of identity versus role confusion. Shame suggests
failure to resolve the crisis of initiative versus guilt.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 2-28, 29, 52 (Table 2-6)
TOP: Nursing Process: Assessment MSC:
Client Needs: Health Promotion and Maintenance
9. A patient is suspicious and frequently manipulates others. To which psychosexual stage do
these traits relate? a. Oral
b. Anal
c. Phallic
d. Genital
ANS: A
14 | P a g eThe behaviors in the stem develop as the result of attitudes formed during the oral stage,
when an infant first learns to relate to the environment. Anal-stage traits include stinginess,
stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness,
pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-
stage traits include the ability to form satisfying sexual and emotional relationships with
members of the opposite sex, emancipation from parents, a strong sense of personal identity,
or the opposites of these traits.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 2-4, 5, 40 (Table 2-1)
TOP: Nursing Process: Assessment MSC: Client
Needs: Health Promotion and Maintenance
10. A patient expresses a desire to be cared for by others and often behaves in a helpless fashion.
Which stage of psychosexual development is most relevant to the patient‘s needs? a. Latency
b. Phallic
c. Anal
d. Oral
ANS: D
Fixation at the oral stage sometimes produces dependent infantile behaviors in adults.
Latency fixations often result in difficulty identifying with others and developing social
skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having
difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in
retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an
audience response question.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 2-40 (Table 2-1) TOP: Nursing Process: Assessment MSC: Client Needs:Health
Promotion and Maintenance
11. A nurse listens to a group of recent retirees. One says, ―I volunteer with Meals on Wheels, coach
teen sports, and do church visitation.‖ Another laughs and says, ―I‘m too busy taking care of
myself to volunteer to help others.‖ Which psychosocial developmental task do these statements
contrast?
a. Trust and mistrust
b. Intimacy and isolation
c. Industry and inferiority
d. Generativity and self-absorption
ANS: D
Both retirees are in middle adulthood, when the developmental crisis to be resolved is
generativity versus self-absorption. One exemplifies generativity; the other embodies self-
absorption. This developmental crisis would show a contrast between relating to others in a
trusting fashion and being suspicious and lacking trust. Failure to negotiate this
developmental crisis would result in a sense of inferiority or difficulty learning and working
as opposed to the ability to work competently. Behaviors that would be contrasted would be
15 | P a g eemotional isolation and the ability to love and commit oneself.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Page 2-52 (Table 2-6) TOP: Nursing Process: Assessment MSC: Client Needs:Health
Promotion and Maintenance
12. An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which
statement by a sibling best indicates a sense of self-actualization?
a. ―Of all of us, I am the most experienced with planning these types of events.‖
b. ―Funerals are supposed to be conducted quietly, respectfully, and according to a social
protocol.‖
c. ―This death was unfair but I hope we can plan a service that everyone feels is a
celebration of life.‖
d. ―This death was probably the consequence of years of selfish and inconsiderate
behavior by our sibling.‖
ANS: C
The correct response shows an accurate perception of reality as well as a focus on solving
the problem in a way that involves others. These factors are characteristic of self-
actualization. The incorrect responses demonstrate self-centeredness, rigidity, and blaming
which are characteristic of a failure to achieve self-actualization.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 2-24, 62 (Box 2-1)
TOP: Nursing Process: Assessment MSC: Client
Needs: Health Promotion and Maintenance
13. A student nurse says, ―I don‘t need to interact with my patients. I learn what I need to know by
observation.‖ An instructor can best interpret the nursing implications of Sullivan‘s theory to
this student by responding:
a. ―Interactions are required in order to help you develop therapeutic
communication skills.‖
b. ―Nurses cannot be isolated. We must interact to provide patients with opportunities
to practice interpersonal skills.‖
c. ―Observing patient interactions will help you formulate priority nursing diagnoses and
appropriate interventions.‖
d. ―It is important to pay attention to patients‘ behavioral changes, because these
signify adjustments in personality.‖
ANS: B
The nurse‘s role includes educating patients and assisting them in developing effective
interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and
empathy are cornerstones of Sullivan‘s theory. The nurse who does not interact with the
patient cannot demonstrate these cornerstones. Observations provide only objective data.
Priority nursing diagnoses usually cannot be accurately established without subjective data
from the patient. The other distracters relate to Maslow and behavioral theory. This item
relates to an audience response question.
PTS: 1
16 | P a g e
DIF: Cognitive Level: Apply (Application)REF: Pages 2-8 to 10
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
14. A nurse consistently encourages patient to do his or her own activities of daily living. If the
patient is unable to complete an activity, the nurse helps until the patient is once again
independent. This nurse‘s practice is most influenced by which theorist? a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
ANS: C
Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this
has relevance to the seriously and persistently mentally ill patient.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 2-44 (Table 2-2) TOP: Nursing Process: Evaluation MSC: Client Needs:
Psychosocial Integrity
15. A nurse uses Maslow‘s hierarchy of needs to plan care for a patient diagnosed with mental
illness. Which problem will receive priority? The patient a. refuses to eat or bathe.
b. reports feelings of alienation from family.
c. is reluctant to participate in unit social activities.
d. is unaware of medication action and side effects.
ANS: A
The need for food and hygiene are physiological and therefore take priority over
psychological or meta-needs in care planning.
PTS: 1
DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 2-23, 24, 39 (Figure 2-5)
TOP: Nursing Process: Planning/Outcomes Identification MSC: Client
Needs: Safe, Effective Care Environment
16. Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly
mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
ANS: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats
are rewards and reinforce speech through positive reinforcement.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 2-12, 13, 23 (Figure 2-3)
Client Needs: Psychosocial Integrity
17 | P a g e
TOP: Nursing Process: Implementation MSC:17. The parent of a child diagnosed with schizophrenia tearfully asks the nurse, ―What could I have
done differently to prevent this illness?‖ Select the nurse‘s best response.
a. ―Although schizophrenia results from impaired family relationships, try not to feel
guilty. No one can predict how a child will respond to parental guidance.‖
b. ―Schizophrenia is a biological illness resulting from changes in how the brain and
nervous system function. You are not to blame for your child‘s illness.‖
c. ―There is still hope. Changing your parenting style can help your child learn to cope
effectively with the environment.‖
d. ―Most mental illnesses result from genetic inheritance. Your genes are more at
fault than your parenting.‖
ANS: B
The parent‘s comment suggests feelings of guilt or inadequacy. The nurse‘s response should
address these feelings as well as provide information. Patients and families need reassurance
that the major mental disorders are biological in origin and are not the ―fault‖ of parents.
One distracter places the burden of having faulty genes on the shoulders of the parents. The
other distracters are neither wholly accurate nor reassuring.
PTS: 1
REF: Pages 2-25 to 27
Needs: Psychosocial Integrity
18. A nurse influenced by Peplau‘s interpersonal theory works with an anxious, withdrawn patient.
Interventions should focus on a. rewarding desired behaviors.
b. use of assertive communication.
c. changing the patient‘s self-concept.
d. administering medications to relieve anxiety.
ANS: B
The nurse–patient relationship is structured to provide a model for adaptive interpersonal
relationships that can be generalized to others. Helping the patient learn to use assertive
communication will improve the patient‘s interpersonal relationships. The distracters apply
to theories of cognitive, behavioral, and biological therapy.
PTS: 1
REF: Pages 2-10, 11
MSC: Client Needs: Psychosocial Integrity
19. A patient participated in psychotherapy weekly for 5 months. The therapist used free
association, dream analysis, and facilitated transference to help the patient understand conflicts
and foster change. Select the term that applies to this method. a. Rational-emotive behavior
therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning
18 | P a g e
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Implementation
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation MSC: ClientANS: B
The techniques are aspects of psychodynamic psychotherapy. The distracters use other
techniques.
PTS: 1
DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 2-7, 8, 49 (Table 2-4)
Needs: Psychosocial Integrity
TOP: Nursing Process: Assessment MSC: Client
20. Consider this comment from a therapist: ―The patient is homosexual but has kept this
preference secret. Severe anxiety and depression occur when the patient anticipates family
reactions to this sexual orientation.‖ Which perspective is evident in the speaker? a. Theory of
interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory
ANS: A
The theory of interpersonal relationships recognizes the anxiety and depression as resulting
from unmet interpersonal security needs. Behaviorism and classical conditioning theories do
not apply. A psychosexual formulation would focus on uncovering unconscious material
that relates to the patient problem.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Page 2-49 (Table 2-4) TOP: Nursing Process: Assessment MSC: Client Needs:Psychosocial
Integrity
21. A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent
with psychoanalytic psychotherapy?
a. Identifying the patient‘s strengths and assets
b. Praising the patient for describing feelings of isolation
c. Focusing on feelings developed by the patient toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
ANS: C
Positive or negative feelings of the patient toward the therapist indicate transference.
Transference is a psychoanalytic concept that can be used to explore previously unresolved
conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of
psychoeducational materials is a common ―homework‖ assignment used in cognitive
therapy.
PTS: 1
DIF: Cognitive Level: Apply (Application)
REF: Pages 2-7, 8, 49 (Table 2-4)
MSC: Client Needs: Psychosocial Integrity
22. A person says, ―I was the only survivor in a small plane crash. Three business associates died. I
got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings
19 | P a g e
TOP: Nursing Process: Implementationrelated to being a survivor, and I‘m better now.‖ Which type of therapy was used? a. Systematic desensitization b. Psychoanalysis c. Behavior modification d. Interpersonal psychotherapy
ANS: D Interpersonal psychotherapy returned the patient to his former level of functioning byhelping him come to terms with the loss of friends and guilt over being a survivor. Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the patient understand what is going on in his life.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 2-8, 9, 49 (Table 2-4) Needs: Psychosocial Integrity 23. Which technique is most applicable to aversion therapy?
a. Punishment b. Desensitization c. Role modeling d. Positive reinforcement
ANS: A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.
PTS: 1 REF: Pages 2-16, 17
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
24. A patient says to the nurse, ―My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child.‖ Which term applies to the patient‘s comment? a. Superego b. Transference c. Reality testing d. Counter-transference
ANS: B Transference refers to feelings a patient has toward the health care workers that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection.
PTS: 1 20 | P a g e DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client [Show Less]