Psychiatric-Mental Health Nursing-Videbeck EXAM bank

Document Content and Description Below

Chapter 1 1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having a positive impact on the individual... 's mental health? A) Not needing others for companionship B) The ability to effectively manage stress C) A family history of mental illness D) Striving for total self-reliance 2. Which of the following is true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill. 3. A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be... A) “You may have a temporary mental illness because you are experiencing so much pain.” B) “You are not mentally ill. This is an expected reaction to the loss you have experienced.” C) “Were you generally dissatisfied with your relationship before your husband's death?” D) “Try not to worry about that right now. You never know what the future brings.” 4. The nurse consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment 5. Which of the following would be a reason for a student nurse to use the DSM-5? A) Identifying the medical diagnosis B) Choose clients' treatment C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses.6. Legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care 7. Which one of the following is a result of federal legislation? A) Making it easier to commit people for mental health treatment against their will. B) Making it more difficult to commit people for mental health treatment against their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons. 8. The goal of the 1963 Community Mental Health Centers Act was to... A) ensure clients' rights for the mentally ill B) deinstitutionalize state hospitals C) provide funds to build hospitals with psychiatric units D) treat people with mental illness in a humane fashion 9. The creation of asylums during the 1800s was meant to... A) improve treatment of mental disorders B) provide food and shelter for the mentally ill C) punish people with mental illness who were believed to be possessed D) remove dangerous people with mental illness from the community 10. Which of the following is a major problem with large state institutions? Select all that apply. A) Attendants were accused of abusing the residents B) Stigma associated with residence in an insane asylum C) Clients were geographically isolated from family and community D) Increasing financial costs to individual residents E) Clients were not given proper nutrition or clothed properly 11. A significant change in the treatment of people with mental illness occurred in the 1950s when... A) community support services were established. B) legislation dramatically changed civil commitment procedures. C) the Patient's Bill of Rights was enacted.D) psychotropic drugs became available for use. 12. Before the period of the enlightenment, treatment of the mentally ill included... A) creating large institutions to provide custodial care. B) focusing on religious education to improve their souls. C) placing the mentally ill on display for the public's amusement. D) providing a safe refuge or haven offering protection. 13. The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California B) Illinois C) Massachusetts D) New York 14. What is meant by the term "revolving door effect" in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings 15. Which of the following statements by the nurse to the client's family is true of treatment of people with mental illness in the United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only one in four people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining. 16. The case manager is providing an educational seminar for the nursing staff, she includes objectives from Healthy People 2020. Which of the following is the priority of the objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness 17. Which is a positive aspect of treating clients with mental illness in a community-basedcare? A) “You will not be allowed to go out with your friends while in the program.” B) “You will have to have supervision when you want to go anywhere else in the community.” C) “You will be able to live in your own home while you still see a therapist regularly.” D) “You will have someone in your home at all times to ask questions if you have any concerns.” 18. One of the unforeseen effects of the movement toward community mental health services is... A) fewer clients suffering from persistent mental illnesses. B) an increased number of hospital beds available for clients seeking treatment. C) an increased number of admissions to available hospital services. D) Longer hospital stays for people needing mental health services. 19. Which is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness 20. A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes... A) medical management of symptoms. B) daily psychotherapy. C) constant staff supervision. D) psychological stabilization. 21. There are many areas of practice in psychiatric mental health nursing. One of those is advanced-level practice. Which of the following is considered an advanced-level function? A) Case management B) Counseling C) Evaluation D) Health teaching 22. Nursing education has become broad in practice settings. The addition of Psychiatric nursing became a requirement in nursing education in 1950 by whom?A) State Boards of Nursing B) American Nurses Association C) National League of Nursing D) Nurse Practice Act 23. A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including... A) providing clinical supervision. B) using effective communication skills. C) adjusting client medications. D) directing program development. 24. Which of the following is one of the American Nurses Association standards of practice for psychiatric–mental health nursing? A) Prescriptive authority is granted to psychiatric–mental health registered nurses. B) All aspects of Standard 5: Implementation may be carried out by psychiatric–mental health registered nurses. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatric–mental health advanced practice nurses. D) Psychiatric–mental health advanced practice nurses are the only ones who may provide milieu therapy. 25. The nurse knows that mental health issues are constantly changing. Which of the following is a standard of professional performance to keep in current practice? A) Assessment B) Education C) Planning D) Implementation 26. Which of the following is a standard of practice? A) Quality of care B) Outcomes identification C) Collegiality D) Performance appraisal 27. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions? Select all that apply. A) Tells the client about personal events and interestsB) Discusses the anxious feelings with the instructor C) Assumes that the client's unwillingness to talk to a student nurse is a personal insult or failure D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises F) Gravitates to clients that the student may know personally 28. The appropriate action for a student nurse who says the wrong thing is to... A) pretend that the student nurse did not say it. B) restate it by saying, “That didn't come out right. What I meant was...” C) state that it was a joke. D) ignore the error, since no one is perfect. 29. The newly licensed RN has been hired at the local hospital in the Geri-Psych unit. Today is her first day of orientation to this facility. What would be the nurse's priority action if a client becomes aggressive? A) assist other staff on the unit to take down the client safely B) maintain a safe distance from the client C) keep the client secluded from others D) reinforce boundaries when aggression is seen to maintain a safe environment 30. The Geri-Psych nurse understands that the DSM-5 describes all mental disorders with specific criteria. The DSM-5 has the following purposes: Select all that apply. A) to provide the practitioner with standards of care for all clients. B) to provide a standardized nomenclature and language for all mental health professionals. C) to provide standards for hospital and community based institutions. D) to present defining characteristics or symptoms that differentiate specific diagnoses. E) to assist in identifying the underlying causes of disorders. 31. If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief? A) "A rabbit's foot has never brought me luck. I don't know why people carry them." B) "Yes, the rabbit's foot can bring luck to some." C) "I can accept that you feel it is lucky, so let's get to our activities for the day." D) "It is not appropriate to harm small animals for their parts." 32. A client with schizophrenia has been non-compliant with medications. The client requires frequent admissions to the psychiatric unit for acute psychotic episodes. What is this process called?A) escalated admissions B) revolving door C) deinstitutionalization D) boarding 33. What organization developed and maintains standards of practice that are used to determine safe quality care, and that can be used legally, if incorporated into the state practice act or nurse's rules and regulations, that guide the nursing profession? A) APNA (American Psychiatric Nurses Association) B) DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5th ed.) C) ANA (American Nurses Association) D) USDHHS (U. S. Department of Health and Human Services)Answer Key 1. B 2. C 3. B 4. D 5. D 6. A 7. B 8. B 9. B 10. A, C, E 11. D 12. C 13. C 14. B 15. C 16. D 17. C 18. C 19. B 20. A 21. C 22. C 23. B 24. C 25. B 26. B 27. B, D, E 28. B 29. B 30. B, D, E 31. C 32. B 33. CChapter 2 1. The nurse is assessing a client suffering a head injury as a result of an altercation with two other individuals. The client has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala 2. The nurse is educating the client and family regarding schizophrenia. She explains to them that it is associated with an abnormality of which of the following structures of the cerebrum? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes 3. A client diagnosed with bipolar disorder asks the nurse, "Why did I get this illness? I don't want to be sick." What response should the nurse provide to best answer the client's question? A) "People who develop mental illnesses often had very traumatic childhood experiences." B) "There is some evidence that contracting a virus during childhood can lead to mental disorders." C) "Sometimes people with mental illness have an overactive immune system." D) "We don't fully understand the cause, but mental illnesses do seem to run in families." 4. Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors. 5. The nurse is teaching the client with anxiety about the mechanisms of benzodiazepines. Which of the following is increased with this medication? A) Dopamine B) GABA C) NorepinephrineD) Epinephrine 6. When the physician orders a neurotransmitter for a client who has difficulty in regulating some chemicals in the brain. The nurse knows which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA 7. The nurse is preparing a client for an MRI scan of the head. The nurse should ask the client... A) "Have you ever had an allergic reaction to radioactive dye?" B) "Have you had anything to eat in the last 24 hours?" C) "Does your insurance cover the cost of this scan?" D) "Are you anxious about being in tight spaces?" 8. How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease. 9. A client is being seen in the crisis unit reporting that poison letters are coming in the mail. The client has no history of psychiatric illness. Which of the following medications would the client most likely be started on? A) Aripiprazole B) Risperidone C) Fluphenazine D) Fluoxetine 10. Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine B) SertralineC) Imipramine D) Phenelzine 11. The nurse knows that the client understands the rationale for dietary restrictions when taking an MAOI when the client makes which of the following statements? A) "I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate." B) "Certain foods will cause me to have sexual dysfunction when I take this medication." C) "Foods that are high in tyramine will reduce the medication's effectiveness." D) "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels." 12. In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose 13. A mother is concerned about her child being given stimulant medication for ADHD. The nurse tells the mother, which of the following medications was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate B) Amphetamine C) Atomoxetine D) Pemoline 14. When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram, the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication. 15. When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) “This is a good medication! It will be effective within 20 minutes of the first dose.”B) “You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.” C) “It will probably take months for the medication to work. In the meantime, you should work on improving your attitude.” D) “If you believe it will work, then it will. You have to have faith!” 16. A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time. 17. A client is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The client is symptom-free and therefore does not need to adhere to the medication regimen. B) The client cannot clearly see the instructions written on the prescription bottle. C) The client dislikes the weight gain associated with antipsychotic therapy. D) The client sells the antipsychotics to addicts in the neighborhood. 18. Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy 19. The nurse is educating a client and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time.20. The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) “I'm glad I can eat pizza since it's my favorite food.” B) “I must follow this diet or I will have severe vomiting.” C) “It will be difficult for me to avoid pepperoni.” D) “None of the foods that are restricted are part of a regular daily diet.” 21. When teaching a client about restrictions for tranylcypromine, the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods 22. A nurse is formulating a teaching plan with the client and the client's family. The client has been newly diagnosed with depression, and the teaching plan includes medication, activities, and family support. For the client, the nurse knows that teaching is effective when the client and/or family state: A) Medication should be taken only when the client is feeling depressed and resists family activities. B) Medication should be taken on schedule only, and activities should be twice a week to prevent weight gain. C) Missed dosages should be taken right away, even when it is close to the next dose time, and activities should be increased. D) It may take a few weeks for the medication to become effective; activity will help to foster compliance. 23. A nurse is instructing a client on taking lithium for bipolar disorder. The client will need to have blood draws every 2 to 3 days initially to determine what about the drug level? A) its rebound effect B) its efficacy C) its potency D) its half-life 24. A nurse is administering an MAO to a client with depression. The nurse must be aware of what effects this drug can have? Select all that apply. A) hypertensive crisis if food with tyramines are ingested B) interaction with other MAO's and antidepressants C) diminished thoughts of suicide in depressed clientsD) decreased sedation and anticholinergic effects E) can be given safely with meperidine 25. A nurse is recording subjective information from the family of an aggressive client who was brought to the ED via ambulance. The client is non-compliant with the medication regimen. What statement by the family informs the nurse of their understanding of mental illness? A) "We know the intention was not to take medications, as it was relayed medication was no longer needed." B) "Because of mental illness, my brother cannot think clearly or understand the need for meds." C) "This situation occurs because of thoughts that no one cares and because he is getting attention." D) "This 'mental illness' has been used as an excuse to get away with this behavior for years." 26. A child with ADHD just started school. The mother visits with the school nurse regarding administration of his medications during school hours and to learn about behavior and effects of the medication. The mother asks, "Is there any medications that do not require being given at school?" Which is the appropriate response to the mother? A) "Yes, there are medications that are sustained release and would not require being given at school." B) "You will need to speak to the superintendent about medications regarding your child." C) "Only the nurse can administer stimulants to a child during school hours." D) "You child will need to bring his or her medications to me each day."Answer Key 1. A 2. B 3. D 4. D 5. B 6. A 7. D 8. B 9. A 10. B 11. D 12. D 13. C 14. B 15. B 16. D 17. C 18. B, E 19. B, C, E 20. C 21. A 22. D 23. B 24. A, B, D 25. B 26. AChapter 3 1. A nurse is teaching decision-making skills to a client with dependent personality disorder. According to Erikson, the likely cause of the client developing dependent personality is failure to meet the critical task of which developmental stage? A) Trust B) Autonomy C) Initiative D) Industry 2. The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome? A) The patient will identify possible causes for the crisis. B) The patient will discover a new sense of self-sufficiency in coping. C) The patient will resume the precrisis level of functioning. D) The patient will express anger regarding the crisis event. 3. A client who has been working on controlling impulsive behavior shows a strengthening ego through which of the following behaviors? A) Going to therapy only when there is nothing more desirable to do B) Weighing the advantages and disadvantages before making a decision C) Telling others in the group the right way to act D) Reporting having fun at a recent social event 4. A client has just been told she has cervical cancer. When asked about how this is impacting her, she states, "It's just an infection; it will clear up." The statement indicates that this patient… A) needs education on cervical cancer. B) is unable to express her true emotions. C) should be immediately referred to a cancer support group. D) is using denial to protect herself from an emotionally painful thought. 5. A teenage client defies the nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, "You sound just like my mother at home!" and continues to play the video game. The nurse understands that this statement likely indicates… A) the need for stricter discipline at home. B) early signs of oppositional defiant disorder. C) the presence of transference. D) expression of developing autonomy.6. A client reports a pattern of being suspicious of others, causing difficulty in sustaining lasting relationships. Which stage according to Erikson's psychosocial development was not successfully completed? A) Trust vs. Mistrust B) Autonomy vs. Shame and Doubt C) Initiative vs. Guilt D) Industry vs. Inferiority 7. The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the nurse. The relationship has entered which phase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution 8. A nurse is meeting with a crisis support group. In efforts to help patients identify with one another, the nurse explains which of the following about the crisis experience? A) "Even happy events can cause a crisis if the stress is overwhelming." B) "Only people who have unfortunate life events will experience a crisis." C) "A person has no control over how a crisis will affect him or her." D) "People can prevent all crises if they develop good coping skills early." 9. A client presents to the ED with a flat affect and disheveled appearance. The nurse objectively can see that the client has experienced an adventitious crisis. Which of the following are examples of adventitious crises? Select all that apply. A) Death of a loved one B) Natural disasters C) Violent crimes D) War E) Leaving home for the first time 10. A nursing supervisor reprimands an employee for being chronically late for work. If the employee handles the reprimand using the defense mechanism of displacement, he would most likely do which of the following? A) Argue with the supervisor that he is usually on time B) Make a special effort to be on time tomorrow C) Tell fellow employees that the supervisor is picking on him D) Tell the unit housekeeper that his (the unit housekeeper's) work is sloppy11. The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms? A) Dissociation B) Displacement C) Intellectualization D) Suppression 12. A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, “I have to work too much and don't have time to study. It wouldn't matter anyway because the teacher is so unreasonable.” The defense mechanisms the student is using are... A) denial and displacement B) rationalization and projection C) reaction formation and resistance D) regression and compensation 13. A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the nurses. He also yells that they are lazy and incompetent. The client's behavior is an example of which of the following defense mechanisms? A) Introjection B) Projection C) Rationalization D) Reaction formation 14. A client begins to take stock of his life and look into the future. The nurse assesses that this client is in which of Erikson's developmental stages? A) Identity versus role confusion B) Industry versus inferiority C) Integrity versus despair D) Generativity versus stagnation 15. A basic assumption of Freud's psychoanalytic theory is that... A) all human behavior can be caused and can be explained. B) human behavior is entirely unconscious. C) free association is the key to understanding. D) sexuality does not relate to behavior.16. The nurse is assisting a middle-age couple with marital counseling. Which of the following is a major developmental task of middle adulthood? A) Developing intimacy B) Learning to manage conflict C) Reexamining life goals D) Resolving the past 17. A mother is concerned about her child's development. The nurse knows which cognitive mode, according to Harry Stack Sullivan, begins in early childhood as the child begins to connect experiences in sequence? A) Prototaxic mode B) Parataxic mode C) Bitaxic mode D) Syntaxic mode 18. Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The nurse leader recognizes that the group is in which stage of group development? A) Planning B) Initial C) Working D) Termination 19. The family members of a patient with bipolar disorder express frustration with the proposed treatment plan of their loved one. Which group should the nurse suggest as most helpful to this family? A) Family therapy group B) Family education group C) Psychotherapy group D) Self-help support group 20. A student nurse attends a self-help group as part of a class assignment. While there the student recognizes a family friend. Upon returning home, the student talks about the friend's attendance with the family. The student's actions can be described as... A) appropriate; persons familiar with group members are allowed self-help group membership. B) appropriate; self-help groups are not professional and therefore are open to public knowledge. C) inappropriate; most self-help groups have a rule of confidentiality.D) inappropriate; the student should not have been allowed to attend the group. 21. The nurse would recommend individual therapy for the client who expresses a desire to A) bring about personal changes. B) gain a sense of belonging. C) develop leadership skills. D) learn more about treatment. 22. Which one of the following statements is most accurate regarding the cohesiveness of a group in group therapy? A) It is commonly present in the first meeting of the group. B) It is necessary for the group to have maximum cohesiveness, the more the better. C) Group cohesiveness is the degree to which members think alike and many things are left unspoken. D) Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. 23. The client asks the nurse how to select a therapist to help with support and understanding of mental illness. Which one of the following is an important characteristic of an effective therapist-client relationship in individual psychotherapy? A) Homogeneity between the client and the therapist. B) Mutual benefit for the client and the therapist. C) The client must adapt to the therapist's style of therapy and theoretical beliefs. D) Match between the theoretical beliefs and style of therapy and the client's needs and expectations of therapy. 24. Which of the following is most essential when planning care for a client who is experiencing a crisis? A) Explore previous coping strategies B) Explore underlying personality dynamics C) Focus on emotional deficits D) Offer a referral to a self-help group 25. During the initial interview with a client in crisis, the initial priority is to... A) assess the adequacy of the support system. B) assess for substance use. C) determine the precrisis level of functioning. D) evaluate the potential for self-harm.26. The nurse on the Psych unit reinforces to the clients that they can earn off-unit privileges for daily use of socially appropriate behavior. This is an example of employing which concept of behavior modification? A) Systematic desensitization B) Negative reinforcement C) Classical conditioning D) Operant conditioning 27. A patient states, "I hate spending time with my family. They're always on my back about something! I won't do 'anything' they ask me to do." Which response by the nurse reflects a behavioral perspective? A) "Do you feel that being argumentative makes you right and them wrong?" B) "Some medicines really help with anger. Are you interested in talking to your physician about starting you on something?" C) "That's probably your way of getting back at them for being strict with you when you were younger." D) "If you agree to start doing what your parents request, then they have agreed to respect your privacy more." 28. A nurse is working with a patient with an eating disorder who refuses to eat a muffin. The nurse asks the patient "Is there any way that you could see the muffin as just flour and water, basic nutrients your body needs?" In this statement, the nurse is using which type of therapy? A) Rational emotive therapy B) Cognitive therapy C) Gestalt therapy D) Reality therapy 29. A patient is blaming his impending divorce on the fact that his wife goes out frequently with her girlfriends. If using reality therapy, the nurse would help the patient with which of the following responses? A) "If you really love her, she should love you as well." B) "What does being divorced mean for you?" C) "How do you feel about your marriage ending?" D) "What role do you think you have played in the end of your marriage?" 30. A nurse is assisting a patient who is working on the technique of systematic desensitization. When the patient feels anxious, the nurse can best use the principles of this technique by stating... A) "Use the deep breathing techniques we practiced yesterday." B) "What is the worst that will happen if you confront this fear?" C) "Tell me how you are feeling right now."D) "I can see you are anxious. Let's stop for a minute." 31. The nurse is working with a client who has a history of inflicting spousal abuse. Although the nurse does not condone domestic violence, the nurse treats the client with unconditional positive regard through which of the following? A) The nurse tries to understand the feelings that might have led to violent behavior. B) The nurse uses honest emotional expression in relating to client. C) The client is still viewed as someone worthy of respect and assistance. D) The nurse relates to the client as if he were her own spouse. 32. A patient is being admitted to an inpatient unit for treatment of anorexia nervosa. Of the following assessment data, which should the nurse place as highest priority in the plan of care? A) Weight 24% below normal for height B) Distorted body image C) Feelings of inadequacy D) Frequent vomiting after meals 33. Which of the following considerations should have the most influence in the nurse's choice of the treatment for the client? A) The client's feelings and perceptions about his or her situation B) The nurse's beliefs about the theories of psychosocial development C) The nurse's familiarity with the type of treatment D) Any approach to treatment should work with any client. 34. Which approach to therapy is most effective when planning for a client with negative thinking? A) Behavior modification B) Client-centered therapy C) Cognitive therapy D) Reality therapy 35. Which of the following theories could be classified as humanistic theories? Select all that apply. A) Cognitive therapy B) Maslow's hierarchy of needs C) Gestalt therapy D) Rogers' client-centered therapy E) Rational emotive therapy F) Piaget's cognitive stages of development36. A client has asked about complementary and alternative therapies. The nurse replies that the client will need to discuss this with the physician and that the physician will order any additional therapies. Which of the following are complementary and alternative therapies? Select all that apply. A) massage and osteopathic therapy B) support group therapy C) aromatherapy D) self-help therapy E) music and art therapy 37. A nurse has a difficult client has become frustrated. Which entry in nursing documentation is considered nonjudgmental in reporting findings? A) The client is displaying bizarre behavior. B) The client demonstrates deceitful behavior. C) The client does not recognize family members. D) The client is uncooperative. 38. A client tells a nurse that he or she is using herbal supplements in addition to prescription medications. What would be the nurse's best response? A) "Herbs are not classified as drugs in the United States, so there is no contraindication to using them." B) "Herbs have pharmacological effects on the body and can interact with some prescription medications." C) "It is never permissible to use herbal supplements with prescription medications." D) "I will refer you to an herbalist who can help you decide which medications you can take." 39. A nurse is participating in a group therapy session along with four clients. One client is experiencing moderate anxiety. Which of the following are indicators of moderate anxiety? Select all that apply. A) diaphoresis B) nausea C) higher pitched voice D) increased pulse rate E) unable to communicate verbally 40. According to Peplau, there are several roles of the nurse in a therapeutic relationship. These can be seen individually with the client or in a group setting. Which role would be used to offer direction to the client or group? A) resource personB) teacher C) counselor D) leaderAnswer Key 1. D 2. C 3. B 4. D 5. C 6. A 7. B 8. A 9. B, C, D 10. D 11. C 12. B 13. B 14. C 15. A 16. C 17. B 18. C 19. B 20. C 21. A 22. D 23. D 24. A 25. D 26. D 27. D 28. B 29. D 30. A 31. C 32. D 33. A 34. C 35. B, C, D 36. A, C, E 37. C 38. B 39. A, C, D 40. DChapter 4 1. Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy 2. The factor having the most influence on the current trend in treatment settings is the fact in recent years... A) funding for community programs has been inadequate. B) laws have enabled more people to be committed to treatment. C) state hospitals have expanded to meet the demand. D) community programs have been fully developed to meet treatment needs. 3. A client who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this client at this time? A) Partial hospitalization B) Residential treatment C) Inpatient hospital treatment D) Clubhouse 4. A client with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes… A) leisure skills. B) self-monitoring of treatment. C) skills for daily living. D) talk therapy. 5. Which of the following is the highest priority for admission to inpatient care? A) Confusion or disorientation B) Need for medication changes C) Safety of self or others D) Withdrawal from alcohol or other drugs 6. The priority of inpatient care for people with severe mental illness is... A) family issues.B) insight into illness. C) social skills. D) symptom management. 7. Discharge planning from inpatient care for people with severe mental illness must address which of the following to be effective? Select all that apply. A) Finding housing for the client B) Finding a job for the client C) Finding transportation for the client D) Improving family support E) Identifying ideal recreational activities 8. Which type of community residential treatment setting is most likely to be permanent in any state? A) Halfway house B) Respite housing C) Independent living programs D) Evolving consumer household 9. A client is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually do what? A) meet with a therapist on a weekly basis B) resolve crises within a shorter time period C) fulfill daily responsibilities without supervision D) use the increased emotional support of paid staff 10. What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood? A) To provide information to correct misinformation related to stereotypes of persons with mental illnesses B) To persuade neighborhood residents that mentally ill people need safe, affordable, and desirable housing C) To provide for the safety and security of the neighborhood D) To ensure the security of persons in the group home 11. What are the two essential components of transitional care discharge model that is used in Canada and Scotland? A) Peer support and bridging staff B) Collaboration and funding C) Relapse and hospitalizationD) Poverty and entitlements 12. Some residential treatment settings are transitional. This means that clients are eventually expected to do which of the following? A) no longer need therapy B) find employment C) no longer need medication D) relocate to another setting 13. The primary advantage of an evolving consumer household is that clients… A) are provided with adequate income to combat poverty. B) do not have to relocate as they become more independent. C) have on-site staff supervision 24 hours a day. D) receive on-site medical care. 14. The primary goal of a psychiatric rehabilitation program is to promote... A) return to prior level of functioning. B) medication compliance. C) quality of life. D) stabilization and management of symptoms. 15. The nurse is working with the discharge planner for her client's discharge to a facility that uses a transitional care model. The nurse knows this model is effective in promoting the client's health and well-being and preventing relapse and rehospitalization due to which of the following? Select all that apply. A) Collaboration B) Administrative support C) Adequate funding D) Family support E) Completely different providers F) Isolation from peers who successfully live in the community 16. A client has just begun daily participation in a community-based partial hospitalization program. The patient can expect the nurse and staff to assist with which of the following treatment goals? Select all that apply. A) Stabilizing psychiatric symptoms B) Finding a better job C) Improving activities of daily living D) Learning to structure time E) Improved family supportF) Developing social skills 17. The nurse has referred a client to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include which of the following? Select all that apply. A) continuous monitoring of symptoms B) increased independence C) increased involvement in treatment decisions D) recovery from mental illness E) increased community integration F) greater opportunities for personal growth 18. The nurse is discharging her client today to be placed in a community rehabilitation area that will provide the client with meaningful work, relationships, a place to come to and a place to return if necessary. Which type of referral will she make? A) Clubhouse model B) Assertive community treatment C) Group homes D) Respite housing 19. The nurse wants her client to have some face-to-face interaction in his home or community. The Assertive Community Treatment (ACT) is such a program, which can attend to his needs. What does this program have? A) Setting limits on mundane life issues B) Making a wide range of referrals C) Providing services in offices D) Problem-solving orientation 20. Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply. A) It is a residential treatment setting. B) It is more likely to help a client to perceive his or her situation more accurately. C) It is designed to assist clients in dealing with mental health crises without hospitalization. D) The client may feel better about asking for help. E) The client must meet multiple criteria to receive this type of care. 21. A nurse is meeting with the city council to advocate for mentally ill persons and the establishment of a group home in a neighborhood where the plans have been strongly opposed by the neighbors. The nurse can effectively educate the public on the realitiesof group home by citing research that indicates… A) property values quickly rebound in neighborhoods that have group homes. B) police surveillance will be increased to avert any violence by residents. C) most people with mental illness do not represent a significant danger to others. D) neighborhoods that provide park areas provide children a centralized and safe place to play. 22. A client with bipolar disorder has a long history of both hospitalizations and incarcerations. The client has no permanent residence and has infrequent contact with his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse documents all of the following in the record. Which of the following data most suggests a positive outcome for this client? A) Client reports meeting with the same case manager monthly for the last 3 years B) History of residential stays at several local homeless shelters C) Last contact with siblings 4 years ago D) Income from day labor for 2 days last month 23. A nurse is orienting to a new position working the infirmary in the state penitentiary. When working with prisoners who are also mentally ill, the nurse examines her own attitudes. Which of the following beliefs should the nurse discuss with her supervisor before caring for incarcerated patients? A) People with mental illness are inherently violent. B) The mentally ill can get better treatment in prison than in the community. C) People with mental illness are more vulnerable to victimization when incarcerated. D) Many mentally ill would not be in prison if they were stabilized on medication. 24. The nurse is part of a group setting up a mobile crisis service in conjunction with the local police department. Community education on which of the following will the team's focus include? A) Teaching police officers counseling skills B) Crisis counseling services to be provided in the prison system C) Educating about the dangers of the mentally ill in the community D) Assisting police officers to recognize mental illness 25. A client has been started on antidepressants. The interdisciplinary team member most responsible for monitoring effectiveness and side effects of this new medication is the... A) pharmacist. B) psychiatrist. C) psychiatric nurse. D) psychologist.26. A client is encouraged to join in daily outdoor games with peers on the unit. The interdisciplinary team member who will monitor the client's involvement will be the… A) occupational therapist. B) recreation therapist. C) vocational rehabilitation therapist. D) psychiatric nurse. 27. A client with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reaction to the lithium and immediately notifies the... A) psychiatrist. B) psychiatric nurse. C) nurse manager. D) recreation therapist. 28. A nurse documents that a patient has successfully acquired a job performing janitorial services at a local manufacturing company. The goal of which of the following levels of prevention has been achieved? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Community prevention 29. A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Informing parents of the early signs of attention deficit disorder in children 30. A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop? A) Self-esteem building with a local after-school program B) Social skills training for chronic schizophrenics C) Parenthood classes at a local community center D) Depression screening in an assisted living facility31. Which element would be present in an assertive community treatment (ACT) program? A) 24-hour-a-day services B) Infrequent contact with clients C) Many clients to each staff member D) Limited length of service 32. An inmate is brought to the ED via ambulance after a severe altercation at the prison. Which characteristics should a nurse expect to observe in a person who has been in jail? Select all that apply. A) non-educated B) homeless C) frequently changes jobs D) acute and chronic mental illness E) poor functioning level 33. Military veterans with mental issues often do not seek treatment. The nurse in a VA hospital knows which disorder is moderately higher in veterans than in the general population? A) bipolar disorder B) paranoid disorder C) obsessive-compulsive disorder D) depressive disorder 34. A nurse is planning to discharge a client. A client's ability to remain in the community is closely related to what? A) living environment B) participation in social events C) taking meals at the food bank D) supporting neighborhood watch programs 35. A nurse reviews a client's history and knows that in preparation for discharge planning of the client, success of planning can be impeded by which of the following? Select all that apply. A) alcohol and drug abuse B) inability to secure employment C) evolving community D) violent or criminal behaviors E) medication non-complianceAnswer Key 1. B 2. A 3. C 4. D 5. C 6. D 7. A, C 8. D 9. C 10. A 11. A 12. D 13. B 14. C 15. A, B, C 16. A, C, D, F 17. B, C, D, E, F 18. A 19. D 20. B, C, D 21. C 22. A 23. A 24. D 25. C 26. B 27. A 28. C 29. B 30. D 31. A 32. B, D, E 33. C 34. A 35. A, D, EChapter 5 1. Which of the following statements is true of empathy? Select all that apply. A) It is the ability to place oneself into the experience of another for a moment in time. B) It involves interjecting the nurse's personal experiences and interpretations of the situation. C) It is developed by gathering information from the client. D) It results in negative therapeutic outcomes. E) The client must learn to develop empathy for the nurse. 2. The nurse understands that empathy is essential to the therapeutic relationship. When a client makes the statement, "I am just devastated that my marriage is falling apart"; the nurse can best show empathy through which of the following responses? A) "I feel so bad for what you are going through." B) "You feel like your world is falling apart right now." C) "I have been divorced, too. I know how hard it is." D) "It will get better; let's talk about it." 3. The nurse is working with a client who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the client, the nurse shows positive regard through which statement? A) "How is not working right now affecting you?" B) "How do you expect your kids to be provided for?" C) "You need to somehow find a way to support your children." D) "Can the children's mother can get by for a while until you get better?" 4. Which of the following statements is true of the component of a therapeutic relationship termed "acceptance"? A) The nurse accepts the presence of any inappropriate behavior. B) It is avoiding judgments of the person, no matter what the behavior is. C) It involves punishment for inappropriate behavior. D) It is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client. 5. Which of the following behaviors by the nurse demonstrates positive regard? Select all that apply. A) Communicating judgments about the client's behavior B) Calling the client by name C) Spending time with the clientD) Responding openly E) Considering the client's ideas and preference when planning care 6. The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to... A) alleviate stressors in life. B) allow the client to know the nurse's feelings. C) establish relationships. D) facilitate a positive change. 7. Which of the following is the most important skill the nurse must bring to the therapeutic nurse-client relationship? A) Confrontation B) Empathy C) Humor D) Reframing 8. The nurse must be able to make decisions that are based on the principles of right and wrong. What is the standard for establishing such a code of conduct for living? A) Acceptance B) Empathy C) Values D) Positive regard 9. A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this client how to make better choices. He has been here many times before and goes back home and does the same thing." As the supervisor addresses the nurse and her statement, the supervisor understands the nurse is sharing which of the following? A) Value B) Awareness C) Belief D) Attitude 10. The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as… A) confrontation. B) countertransference. C) incongruence. D) transference.11. The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is, A) "I am sure there are other people in your life who are your friends; besides, we just met." B) "It makes me feel good that you trust me so much; it is important for the work we are doing together." C) "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." D) "We are not friends. This is strictly professional." 12. A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques? A) Defining boundaries B) Defining therapy C) Letting the client down gently D) Reprimanding the client 13. Which one of the following statements about the nurse and ethnocentrism is true? A) Nurses have a tendency to inwardly view their own culture as superior to others. B) Ethnocentrism is a desirable trait in a nurse. C) Nurses must deny their ethnocentrism. D) A nurse must not think of his or her own attitudes and beliefs. 14. A nurse is using the Johari window to identify the degree to which he feels comfortable communicating with others. After completing the exercise, the nurse discovers that quadrant 1 has the longest list of qualities. This indicates which of the following about the nurse? A) The nurse conceals personal information about himself. B) The nurse needs to increase insight into his own characteristics. C) The nurse is open to others. D) The client is sharing more than the nurse in the therapeutic relationship. 15. A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek guidance from the supervisor? A) When the nurse desires to assist the client to change values B) when the nurse wants to discuss goals and the plan of care C) When the nurse begins to empathize with the client D) When the nurse identifies anxieties regarding the client's values and sexuality16. While in the day room of the psych unit the nurse notices a client sitting quietly alone, eyes downcast, and looking sad. The nurse says to the client, "You look like something is bothering you." Which pattern of knowing did the nurse use to respond to the client? A) Empirical knowing B) Personal knowing C) Ethical knowing D) Aesthetic knowing 17. The nurse assesses fine hand tremors in a client with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper? A) Aesthetic knowing B) Ethical knowing C) Personal knowing D) Empirical knowing 18. While the nurse and client are interacting during a therapy session, the nurse openly admits to not being able to relate to a client's experience. According to Munhall, this will most likely have what influence on the therapeutic relationship? A) The nurse will avoid imposing any values on the client. B) The client will not trust the nurse's professional abilities. C) The nurse will more likely be manipulated by the client. D) The client will be less likely to self-disclose to the nurse. 19. The nurse and client are visiting about upcoming sporting events of which they both share an interest. This form of interaction has the potential to threaten the nurse-client relationship by which of the following? A) influencing whether the patient likes the nurse or not B) avoiding serious work that can hinder the client from reaching set goals C) letting the client know that the nurse is genuine with diverse interests D) overstepping ethical boundaries that the nurse should maintain 20. The nurse is mindful of maintaining relationships with clients that are therapeutic. Certain characteristics of the relationships the nurse will foster include which of the following? Select all that apply. A) Offering sound advice to the client. B) Establishing boundaries for both the nurse and client. C) Maintaining a client-focus at all times. D) Sharing personal feelings openly with the client.E) Avoiding concern with whether the client likes the nurse. 21. What is the primary differences between social and therapeutic relationships? A) The amount of emotion invested. B) The degree of satisfaction obtained. C) The kind of information given. D) The focus of the relationship 22. The nurse is meeting with her client for the first time. During the orientation phase of the nurse-client relationship, the nurse directs the client to do which of the following? A) Identify problems to examine B) Express needs and feelings C) Develop interpersonal skills D) Identify self-care strategies 23. The nurse has been working with a client with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurse-patient relationship? Select all that apply. A) Exploring perceptions of reality B) Promoting a positive self-concept C) Explaining the boundaries of the relationship D) Working through resistance E) Assisting in identifying problems 24. A client being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the client. The nurse can best assist the client in this stage of the relationship with which of the following responses? A) "We have to go over these instructions before you can go. Please try to listen." B) "Would you rather not be discharged today?" C) "I can sense you are angry this morning. Tell me how you feel about being discharged today." D) "You should be able to regulate your feelings better by now. Why are you angry?" 25. During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client says, "I'm old, and my life has no purpose anymore. But promise me you won't tell anyone." How should the nurse respond? A) "Don't worry, I won't tell anyone else." B) "I'm sorry, but I can't keep that kind of secret."C) "Let's talk about something to cheer you up." D) "What can we do to help you feel better? 26. What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it a secret that the client plans to kill a family member? A) The student nurse must respect the client's privacy and not tell anyone. B) The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. C) The student nurse must tell the client that the student nurse will keep the secret and then tell the instructor and/or staff members. D) The student nurse must tell the instructor and then ask the instructor to keep it secret. 27. During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems? A) Comparing past and present coping strategies B) Encouraging the client to clarify feelings and behavior C) Identifying possible solutions for the client's problems D) Referring the client to a self-help group 28. Nurses must be aware of the importance of boundaries, not only for the client but also for the nurse. Which of the following occurrences is considered a breach of professional boundaries? A) Patient asking a nurse for her phone number B) Refusing a gift from a patient C) Changing the subject in response to a patient compliment D) Having a lengthy social conversation with a patient 29. Which of the following statements correctly depict the problem of feeling sympathy toward the client? Select all that apply. A) This can cause the nurse to feel sad and be unable to help the client. B) When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. C) The client is discouraged from exploring his or her problems, thoughts, and feelings. D) The client is discouraged from growth. E) The client feels dependent on the nurse. 30. The client is getting ready to be discharged from the psych unit. A nurse and client has just completed reviewing the client's take-home medications. The nurse is exemplifying which role during this intervention? A) AdvocateB) Caregiver C) Teacher D) Parent Surrogate 31. The nurse is caring for her client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest? A) Teacher B) Caregiver C) Advocate D) Parent surrogate 32. During a therapeutic communication session, the nurse tells the client of a past experience. Which of the following statements is true about a nurse's self-disclosure? A) It is the basis for effective communication. B) Self-disclosure should be used with all clients to some degree. C) The more the nurse discloses, the more the client will disclose. D) Self-disclosure on the nurse's part should benefit the client. 33. A tool the nurse uses to learn more about his or her qualities and communication with others is called? A) Carper's Pattern B) Johari Window C) Peplau's Preconceptions D) Nursing Boundary Index 34. A client recently experienced a panic attack. A nurse has worked with the client to redirect the client's thoughts and to aid in calming the situation even though it is past the nurse's shift. This is an example of which pattern of knowing? A) empirical B) personal C) ethical D) aesthetic 35. What are possible warnings or signals of abuse of the nurse-client relationship? Select all that apply. A) nurse making exceptions to client B) keeping secrets C) talking to team members about clients D) inappropr [Show More]

Last updated: 1 year ago

Preview 1 out of 18 pages