Test Bank Psychiatric Nursing Biological & Behavioral Concepts 2nd Edition By Deborah Antai-Otong

Test Bank Psychiatric Nursing Biological &
Behavioral Concepts 2nd Edition By Deborah
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1. A psychoanalytically oriented colleague tells you that the behavior of a client you
are assigned to work with is driven by a strong thanatos. This client is most likely
exhibiting which of the following behaviors?
a. aggression
c. social isolation
b. intrusiveness
d. sexual behaviors
The psychoanalytic theory assumes that humans have two primary drives or forces:
eros, or the drive toward life, and thanatos, which is the drive toward death. Thanatos is
expressed as aggression or hate.
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2. A client is informed by his family that they could not go on vacation because the
cost of his mental health care prevented the family from having enough money
for a vacation. Which of the following responses by the client would be the best
example of the superego at work?
a. refusing further care
c. getting angry at the family
b. having feelings of guilt
d. ignoring this statement
The superego is the conscience that rewards moral behavior and punishes actions that
are not acceptable by creating guilt. An overly strict superego may lead to extremes of
guilt and anxiety.
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3. A client is thinking about suing the hospital and the doctor, even though he
begins to admit to the nurse that his failure to comply with the treatment regimen
may have caused his problems. He begins to share that he feels guilty about
these thoughts of suing although he believes the hospital and doctor will settle
out of court and he needs the money. The nurse understands that according to
psychoanalytic theory, two parts of the client’s personality or two drives are
warring. What drive or part of the client’s mind will mediate if the client is to come
to a healthy decision?
a. id
c. libido
b. ego
d. superego
The superego is the part of the client that is feeling guilty. It is the conscience. The id is
the aggressive and sexual drive, which operates on the pleasure principle to reduce
tension. The ego mediates between the drives, forces, or conflicts of the id and the
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4. The mother of a teenager asks the nurse at what age a child’s personality is
completely formed. A nurse applying psychoanalytic theory to this question would
answer that the personality is almost completely formed by what age?
a. 5
c. 18
b. 8
d. 21
According to psychoanalytic theory, the personality is almost completely formed by 5
years of age.
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5. The nurse is working with a young adult client who has been in an automobile
accident and is fully conscious but seems to have little recall of the event. The
client’s spouse asks the nurse why the client is not able to recall the event. The
best answer by the nurse would be that the client is:
a. in a state of denial
c. repressing details of the event
b. suffering from a concussion
d. suppressing details of the event
Repression is an unconscious process whereby unwanted, unacceptable, and/or painful
memories are filed in the unconscious part of the mind. Repression is the first line of
defense against such memories.
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6. You determine that one of your assigned clients is using defense mechanisms,
some of which are sublimation and projection. You realize that these defense
mechanisms, sublimation and projection, are allowing the client to:
use other people in a way that is not healthy for them or for the client
postpone dealing with problems in an unhealthy way for a long period of
keep unpleasant thoughts in the preconscious mind instead of the
conscious mind
discharge some of the energy needed to keep unwanted thoughts out of
It takes energy to keep unwanted thoughts out of the conscious mind. Energy cannot be
contained indefinitely. Some defense mechanisms such as reaction formation,
projection, and sublimation allow for the energy to be discharged.
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7. The nurse assesses an adult client who admits to being a nail-biter when the
nurse observes extreme shortness and unevenness of the client’s nails. The
nurse recalls that people who bite their nails are said to be fixated at which of the
following stages in Freud’s stages of psychosexual growth and development?
a. oral
c. genital
b. latency
d. prepuberty
The development of orally focused habits such as smoking and nail-biting are
associated with fixation at the oral stage of development in Freud’s theories of the
stages of psychosexual growth and development.
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8. The nursing instructor advises students who are learning how to communicate
with clients with mental health problems not to ask questions beginning with
“Why did you…” for which of the following reasons?
It is an approach of authority.
It hurts the trusting relationship.
Often a person cannot identify unconscious motivation.
The question makes the person feel like a child being parented.
Often the person cannot identify the motivation for his behavior because it is
unconscious. There are more acceptable techniques to foster communication.
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9. When you are working with a client who is very anxious and is using a defense
mechanism, which of the following approaches would be best?
a. Advise the client to stop using the defense mechanism.
b. Discuss the defense mechanism and whether it is helpful or not.
Help the client identify some ways to reduce anxiety before other
Have the client weigh the advantages and disadvantages of the defense
Anxiety needs to be reduced before the defenses can be disengaged. Do not take away
defense mechanisms until there are other ways to deal with anxiety.
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10. One of your colleagues is basing his work with clients on the theories of Erikson.
When explaining personality development, your colleague would say that
personality is:
almost totally inherited
developed over the life span
completely developed by age 5
a result of experiences before age 18
Erik Erikson identified 8 stages of psychosocial development and believed that
personality development continues over the life span.
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11. Erikson saw the major task of life as:
a. trust
c. reproduction
b. identity
d. self-actualization
According to Erik Erikson, the task of identity is seen as the major task of life. All
previous tasks are fundamental to self-discovery, and all adult tasks are predicated on
comfortable resolution of identity.
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12. A young adult on the psychiatric ward asks a nurse for a date. Although the
nurse realizes this is inappropriate and declines, the nurse will also:
make certain the client suffers some appropriate consequences for this
report this client’s behavior to the administrator and refuse to work with the
tell the client that this behavior is inappropriate with a professional nurse
recognize age-appropriate behavior and advise the client of the professional
nature of the relationship
The young adult is seeking a life mate and dealing with the task of intimacy versus
isolation. Although it is inappropriate for the nurse in a professional relationship to
develop an intimate relationship, the nurse needs to recognize the client’s ageappropriate behavior.
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13. A client is discussing some insights gained in therapy in the past and mentions
archetypes of anima and animus. The nurse listening to this client realizes that
this client received therapy based on the theories of:
a. Albert Ellis
c. Carl Jung
b. Eric Berne
d. Sigmund Freud
Carl Jung discovered repeated common images he called archetypes. Two of the most
popular were those of the anima, or feminine archetype in men, and the animus, the
masculine archetype in women.
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14. Closely following the beliefs of Harry Stack Sullivan, a psychiatric nurse working
with clients would look closely at what Sullivan referred to as the persona, which
is best described as the:
a. unconscious
c. dark side
b. “I” or “me”
d. best friend
The persona is what one is talking about when referring to “I” or “me.” It could also be
called self-concept and begins developing in infancy with the idea of “good me” and
“bad me.”
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15. The main focus of Sullivan’s work was on:
a. insight through gestalt
b. learned helplessness
c. interpersonal relationships
d. identifying a purpose in life
Harry Stack Sullivan focused on interpersonal relationships. He looked at the
development of the self-system, which he called personification. Personification
includes all related attitudes, feelings, and concepts about self and another.
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16. You are assigned to work with a client who describes a life of feeling isolated and
helpless with many fears about dangers in the world. The client frequently
demonstrates aggressive behavior or is verbally aggressive. Using Horney’s
theories, you would view this aggressive behavior as:
a failure to develop a healthy personality
incongruent with feeling helpless and isolated
a means to protect what little security they have
stemming from experiences with an aggressive mother
Karen Horney believed that insecure, anxious children develop personality patterns to
help them cope with feelings of isolation and helplessness. They may become
aggressive as a means of protecting what little security they have.
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17. Applying interpersonal theories in the nurse-client relationship, the most
important goal for the nurse and client to set for therapy sessions would be for
the client to:
identify the causes of failed relationships in the past
gain insight into how early relationships shape behavior
deal with repressed anger against self and against significant others in his
verbalize a realistic and hopeful perspective of self in relationships with
In the nurse-client relationship where interpersonal theories are utilized, the client learns
to separate past learning from present and to gain a realistic and hopeful perspective of
self in relationships with others and society.
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18. The nurse is caring for a young child in the hospital. As the child’s visiting parent
prepares to leave, the child appears anxious and begins to cry and cling to the
parent. Using Bowlby’s stages of separation anxiety to explain the child’s
behavior, the child can be said to be in a stage called:
a. anxiety
c. despair
b. protest
d. detachment
John Bowlby described separation anxiety as a predictable process involving the stages
of protest, despair, and detachment. Examples of protest behaviors include increasing
anxiety, crying, clinging, throwing one’s self down, and searching.
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19. A couple is concerned about the amount of time they must spend away from their
infant. Looking at the findings of Bowlby in his work on attachment, you would
most help the clients by setting and meeting which one of the following goals?
Improve the quality of time and interactions.
Leave the child when the child is distracted.
Decrease the period of time between separations.
Increase the amount of overall time with the child.
John Bowlby found that the amount of time spent with early caregivers is less significant
than the quality of time and interactions between the child and caregivers. The nurse
should focus on helping the clients to learn to use behaviors that reinforce the childparent attachment.
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20. When a child is in the final stages of separation anxiety as described by Bowlby
and the primary caregiver returns to the child, the nurse should most likely expect
the child to exhibit which of the following behaviors?
a. acting very excited
c. clinging to caregiver
b. engaging in a tantrum
d. withdrawing from caregiver
The final stage of separation anxiety is detachment in which the child appears listless,
apathetic, and socially isolates and withdraws from the caregiver even when the
caregiver returns.
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21. When the primary caregivers of a hospitalized infant cannot stay in the hospital
with the infant, which of the following diagnoses would the nurse most likely
include in the care plan?
caregiver role strain
interrupted family processes
risk for impaired parent-infant attachment
ineffective therapeutic regimen management
An infant who is hospitalized and left alone by primary caregivers is likely to be at risk of
developing attachment disturbances.
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22. The systematic study of infant-caregiver attachment behaviors using the Strange
Situation protocol was the work of which of the following persons?
a. Mary Ainsworth
c. Karen Horney
b. John Bowlby
d. Bruno Bettelheim
Mary Ainsworth systematically studied infant-caregiver attachments by means of the
Strange Situation protocol. This protocol has provided an empirical template for
delineating and measuring John Bowlby’s attachment theory and has spurred a plethora
of clinical and scholarly contributions that transformed researchers and clinicians’
perceptions of early child-parent interactions.
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23. In his theories, Skinner identified two types of behavior which he referred to as:
a. angelic and demonic
b. respondent and operant
c. good boy and bad boy
d. past oriented and future oriented
1. F. Skinner identified respondent behavior as occurring when a known and
specific stimulus elicits a response and operant behaviors as those that obtain a
response or reinforcement from another person or the environment.
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24. A client comes to the psychiatric nurse for help with social situations. The client is
not comfortable meeting with others. The nurse utilizes the theories of Bandura
and Walters. Which of the following interventions by the nurse would most reflect
application of Bandura and Walter’s theories and techniques?
Ask the client to do the opposite of the expected or desired behavior.
Use a gradually increasing schedule of social contact to desensitize the
Verbally reinforce the client for any attempt to increase socialization
Have the client study a person who is successful at socializing and imitate
Albert Bandura and Richard Walters placed emphasis on the role of modeling in
learning behaviors. The model can be a person, film, or cartoon. A person can take on
new social behaviors quickly when imitating a role model.
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25. When working with clients diagnosed with schizophrenia who have been
hospitalized several times in the last year after failing to fill their prescriptions, the
nurse applies the self-efficacy model. What is the nurse’s primary goal in this
a. Making certain a staff member supervises the clients’ taking the medication.
b. Reminding the clients daily through a phone call that the medication is due.
Finding a source that will pay for, pick up, and deliver the medication to the
Convincing the clients they have the capacity to find a way to get the
prescriptions filled.
The primary goal of self-efficacy is to encourage or persuade the clients that they have
the capacity to make adaptive behavioral changes in an identified problem area.
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26. When trying to reinforce a behavior using behavior modification techniques, the
most effective schedule of reinforcement is:
a. fixed-ratio
c. fixed-interval
b. variable-ratio
d. variable-interval
A fixed-ratio schedule is used in industry when a worker’s pay depends upon the
number of units produced or sold. For interval schedules, the reward is based upon the
passage of time and not on the amount of behavior change.
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27. Beck is best known for his theories about which of the following:
a. behavior modification
c. cognitive patterns
b. interpersonal theories
d. childhood development
Aaron Beck is one of the best known proponents of cognitive psychology because of his
writings on cognitive distortions or thinking errors.
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28. You are working with a client who is upset because he believes one of his
college classmates does not like him. If you were to apply the theories of Ellis,
you would most likely respond:
“Describe the feelings that you have toward this classmate.”
“Tell me what you have done to cause this classmate not to like you.”
“Let’s examine this irrational thought that everyone should like you.”
“This is really something that is wrong with her and not with you at all.”
Albert Ellis developed what he referred to as rational emotive therapy. He believed that
irrational thoughts cause maladaptive behavior and emotional distress. He identified the
thinking that everyone should like you as an irrational thought.
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29. When working with the mother of a young child who is in the later part of Piaget’s
sensorimotor stage of development, you would teach the mother to do which of
the following things to help the child move out of this stage?
play classical music frequently
play peek-a-boo and hide and seek
read the same book to the child every day
reward the child for attempts to use the potty
In the first stage or sensorimotor stage of development from birth to about 2 years of
age, the young child appears to think that only objects that can be seen are those that
exist. As the child grows in experience, the child develops object permanence. Peek-aboo and hide-and-seek prepare the child for realizing that things and people are still
there even when they cannot be seen.
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30. When you administer the atypical antipsychotic agents ordered by the
psychiatrist to a client who has schizophrenia, you realize that this medication is
most likely to do which of the following things?
increase the activity of dopamine
decrease the activity of dopamine
increase the reuptake of serotonin
have no effect on dopamine activity
In schizophrenia and mania, there is hyperactivity of dopaminergic systems that must
be tempered or reduced. In Parkinson’s disease and depression, it is believed that the
dopamine systems are hypoactive and, therefore, medications in those conditions
increase dopamine availability to the body.
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31. When giving antipsychotic medication and atypical antipsychotics to clients with a
diagnosis of schizophrenia, because of the effect of the medication on a specific
neurotransmitter, you would most need to be frequently assessing these clients
a. weight loss
c. ringing in the ears
b. nausea and vomiting
d. fine motor tremors
Dopamine is primarily responsible for fine motor movement, sensory integration, and
emotional behavior. These medications reduce dopamine so the client is apt to lose
some of the fine motor movement and demonstrate tremors.
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32. A client who is experiencing low levels of GABA or fewer GABA receptors is most
vulnerable to which of the following disorders?
a. panic disorder
c. conversion disorder
b. bipolar disorder
d. antisocial personality disorder
A person with low levels of GABA or fewer GABA receptors is more vulnerable to
anxiety disorders or panic symptoms/disorders.
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33. The latest and most popular theory of mental disorders is that the cause is most
a combination of factors
genetically and chemically based
structural differences in the brain
a result of disturbed interpersonal interactions
At the current time, researchers believe that mental disorders are most likely caused by
a variety of factors. Some of the factors include structural differences in the brain and
disturbed interpersonal interactions. Additionally, genetic propensity and chemical
imbalance can be causative factors.
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34. You are working with a client who has been playing tennis and has developed
tendonitis. Which of the following remarks by the client would indicate function in
an integrated way as identified by the theories of Dunn?
“What other sport would be less injurious?”
“I will use heat on my elbow after playing tennis.”
“I will avoid activity and rest my elbow until it is healed.”
“An elbow brace will be a help in preventing further damage.”
Integrating involves using energy efficiently, such as taking measures to conserve
energy so the physical resources needed to reduce swelling and pain are accessible.
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35. Your client has shared a primary appraisal of a wedding he attended. Based on
how he describes his experiences at the wedding, the appraisal could fall into
any one of the three types of primary appraisal described by Lazarus. Which of
the following statements by the client would place it into the benign positive type
of appraisal?
a. “It was all right I guess.”
b. “It was very tastefully done.”
c. “I felt real happy even if I felt guilty not taking a present.”
d. “It was a challenge to get there on time, but I did manage it.”
Benign appraisals are events with a genuinely positive appraisal. These events
generate feelings of pleasure, joy, and happiness, but the feelings may also be
accompanied by guilt or anxiety.
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36. When working with clients using Orem’s nursing theories, you would be most
interested in helping the clients to maximize their:
a. level of mental health
c. spiritual dimension
b. interactions with others
d. ability to care for self
Orem’s model is a self-care model. Clients are assessed in terms of their self-care
agencies. Nursing interventions are planned to maximize the client’s ability to care for
self. Specific nursing actions include actions to provide assistance to client’s unable to
meet their health-related self-care needs.
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37. A basic assumption of Freud’s psychoanalytic theory is that all behavior:
a. is learned
b. has meaning
c. is unconscious
d. is sexually oriented
According to Freud, everything a person does has meaning.
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38. A nurse who follows the therapeutic approach of Rogers, would most likely be
using an approach focused on:
a. reality therapy
c. client-centered therapy
b. directive therapy
d. psychoanalytic therapy
Carl Rogers focused primarily on empathy, warmth, and genuineness in relating. His
form of therapy was coined “client-centered therapy.”
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39. A common form of treatment on psychiatric inpatient units which focuses on the
patient’s environment is known as:
a. milieu therapy
c. encounter therapy
b. reality therapy
d. client-centered therapy
Milieu therapy is the treatment modality that uses the total physical and social
environment to provide psychosocial rehabilitation. The term is sometimes used
interchangeably with therapeutic milieu.
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40. You are caring for a group of mental health patients, and you base your nursing
practice on the belief that your clients should play a major role in their own selfcare. These practices stem from the work of:
a. Martha Rogers
c. Dorothea Orem
b. Hildegard Peplau
d. Ida Jean Orlando
According to Dorothea Orem, people have the ability to perform self-care activities they
initiate and perform independently to maintain life, health, and well-being. She coined
the term describing the ability to care for one’s self, self-care agency.
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41. Dialectical behavior therapy (DBT) was introduced by:
a. B. F. Skinner
b. Sigmund Freud
c. Albert Bandura
d. Marsha Linehan
In 1987, Marsha Linehan introduced dialectical behavior therapy (DBT). This form of
therapy is used to challenge distorted cognitions or schematas that produce enormous
anxiety and stress in clients with borderline personality disorder.
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42. One of your clients constantly complains of feeling nervous even though his
medicines have been administered as prescribed. The doctor orders one sugar
tablet between doses of regularly scheduled medications. After taking the sugar
tablet, the client states “That pill really worked. I feel much better now.” This is
known as the:
a. halo effect
c. placebo effect
b. Skinner effect
d. behavioral effect
The placebo effect is an attitude of optimistic concern and belief in the efficacy of an
intervention. It is one of the best reinforcements nurses can use.
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43. Alterations in the seretonergic system or serotonin (5-hydroglyryptamine, 5HT)
function along with NE have been implicated in the pathogenesis of:
a. schizophrenia
c. depressive syndrome
b. eating disorders
d. personality disorders
Alterations in the serotonerginic system function along with NE have been implicated in
the pathogenesis of depressive syndrome.
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44. The nurse providing care to an alcoholic client administers Antabuse. The
administration of Antabuse would be considered which form of behavioral
a. classic conditioning
c. medical conditioning
b. operant conditioning
d. cognitive conditioning
Operant conditioning includes use of aversion techniques. One form of aversion therapy
includes the use of Antabuse for the treatment of alcohol. Clients who ingest alcohol
while on Antabuse will experience several very uncomfortable symptoms.
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45. A nurse researcher is conducting a study to determine his client’s capacity to
recover or adjust to stressful or life-threatening situations. This ability is known
a. coping
c. adaptability
b. resilience
d. self-efficacy
Resilience is the capacity to recover or adjust to stressful or life-threatening situations.
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1. Which of the following are essential features of DBT? Select all that apply.
daily individual psychotherapy
weekly skills training
encouraging and coaching via telephone
consultation with client
short-term inpatient hospitalization
electroconvulsive therapy (ECT)
Dialectical Behavior Therapy (DBT) has five essential features which include weekly
individual psychotherapy, weekly skills training group, encouragement and coaching via
telephone interactions between sessions, consultation with the client, and the
development of a treatment environment by the DBT directors and case managers. ECT
is not an essential feature of DBT.
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2. When interviewing a client, which of the following statements would indicate that
the client has distorted cognition? Select all that apply.
a. “I’m having a difficult time concentrating on my course work.”
“All of my teachers think I’m hopeless because I did poorly on the last
c. “School is going well. I received an A on the last exam.”
“I’d like to apply for graduate school when I complete the undergraduate
e. “My classmates don’t want to study with me.”
f. “I’m going to try my best in school this semester.”
ANS: A, B, E
Cognitive distortions are characterized by statements
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3. A nurse caring for a 9-year-old client would plan care based on the knowledge
that according to Sullivan’s theory, clients between the ages of 8 and 11 are in
the concrete operational stage. Because of this information, the nurse’s
assessment would most likely reveal a client who can do which of the following?
Select all that apply.
Think scientifically
Attained reversibility
Demonstrate mature cognitive structures
Solve complex verbal problems
Solve conservation problems
Demonstrate egocentric thought and language
Children in the concrete operational stage can solve conservation problems and
reversibility is retained. Egocentric thought and language are characteristic of the
preoperational period (2 to 7 years). It is not until the stage of formal operations period
(11 years to adulthood) that the cognitive structures are mature and the individual is
able to think scientifically and solve complex verbal problems.
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1. According to Fernandez (1999), which group of health care workers is at greatest
risk for physical assault?
a. receptionist
b. female nurses
c. social workers
d. male nurses and doctors
According to Fernandez, male nurses and doctors are at the greatest risk for physical
assault. Receptionists are at lowest risk.
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2. Aggressive and violent behaviors are more common among clients experiencing:
a. anxiety disorders
c. personality disorders
b. psychotic disorders
d. substance abuse disorders
Aggressive and violent behaviors are more common in clients experiencing psychotic
disorders. These individuals are out of touch with reality and may be responding to
auditory hallucinations. Clients who are paranoid may have delusions that others are
out to harm them, and they may respond to nursing staff based on the belief that they
are protecting themselves.
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3. A nurse who practices with the belief that a client’s aggressive behavior is a
result of role modeling would most likely follow which psychodynamic theories?
a. biochemical theories
c. psychodynamic theories
b. social learning theories
d. neuroendocrine theories
Social learning theory views aggression as a learned response that is based on the
assumption that role modeling, identification, and human interactions shape learning
and behavior. Aggression is believed to be learned through observation and imitation.
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4. Contemporary neurophysiologic studies suggest which areas of the brain are
linked to aggressive and violent behaviors?
a. frontal lobe
c. occipital lobe
b. temporal lobe
d. parietal lobe
Contemporary neurophysiologic studies suggest that the temporal lobes of the brain are
linked to aggressive and violent behaviors. EEGs of the brains of violent criminals have
revealed left hemispheric (temporal lobe) abnormalities.
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5. The prevalence and nature of a client’s aggression and violence in health care:
is a recent occurrence
has decreased in the past 10 years
has long been minimized and neglected
has been a major topic of research since the early 20th century
The prevalence and nature of a client’s aggression and violence in health care has long
been minimized and neglected. Client aggression occurs more often than client violence
with a substantial number of psychiatric nurses being threatened. Today, more concern
is placed on client aggression and violence perhaps because of the serious morbidity
for clients and staff.
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6. Which of the following statements is correct?
The incidence of client aggression and violence is equal.
Client aggression occurs more often than client violence.
Client violence occurs more often than client aggression.
Clients very seldom demonstrate aggression and violence.
Client aggression occurs more often than client violence. Aggressive behaviors are
those that are marked by combativeness readiness, driving forceful energy, or initiative.
Violence is the act of kicking, spitting, beating, grabbing, choking, pushing, forcing sex,
or using a weapon.
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7. According to a 1999 study of health care workers in a Vancouver ED,
respondents reported a 1-year prevalence rate of:
52% for physical assault and 57% for physical threat
61% for physical assault and 79% for physical threat
75% for physical assault and 80% for physical threat
92% for physical assault and 97% for physical threat
According to the study, respondents reported a 1-year prevalence rate of 92% for
physical assault and a 97% for physical threat. Additionally, 66% of the respondents
reported verbal abuse at least once per shift.
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8. Which is the priority when caring for potentially hostile, aggressive, or violent
providing a safe environment for self, clients, and others
administering a prescribed medication to address the client’s behavior
exploring with the client reasons for the hostility, aggression, or violence
assisting the client to develop alternative methods for expressing feelings
The priority nursing intervention with a client who is potentially hostile, aggressive, or
violent is to provide a safe environment for client, self, and others. The other
interventions are all important and will be initiated, but safety is always the priority.
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9. You have been caring for a client who previously was described by other nurses
as being extremely hostile. If your client is moving towards recovery and
recognizes the hostility, your assessment would most likely reveal which of the
Hostility will probably increase.
Hostility will probably decrease.
Hostility will remain unchanged.
Hostility will progress to violence.
Assessment of a client who is moving toward recovery and recognizes the hostility
would most likely reveal that the hostility is decreased.
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10. The nurse on a psychiatric unit assessing a newly admitted client for potential
violent behavior knows that when comparing violence among men and women
with psychiatric disorders, research suggests that:
women are violent more often than men
men are violent more often than women
there is no gender difference in terms of violence
women use more physical aggression than men
The research suggests that there is no gender difference in terms of violence between
men and women with psychiatric disorders. Most researchers suggest that there is an
overlap in the expression of violence and in the factors that contribute to its emergence
in men and women, specifically psychosis and behavioral disturbances.
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11. You are caring for a client who is very angry. The client’s mental and motor
activity have increased. Your assessment would reveal that the client is most
likely experiencing which of the following?
a. hostility
c. aggression
b. agitation
d. impatience
The client is most likely experiencing agitation. Agitation is a state of increased mental
and motor activity. Clients exhibiting agitated states are often verbally and physically
threatening and can become abruptly violent.
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12. A nurse whose care is based on a belief that aggression is a basic drive (like
thirst) would be following whose theories?
a. Erik Erikson
c. Sigmund Freud
b. Dorothea Orem
d. Abraham Maslow
According to Freud, aggression is a basic drive (like thirst). From birth to death the
person possesses two conflicting instincts. One instinct is a life instinct (eros) that
encourages a person to grow and survive. The second instinct is a death instinct
(thanatos) that drives the person to redirect the death instinct or self-destructiveness
from self to others.
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13. The psychiatric nurse planning care for clients is aware that violent behaviors
across all age groups
most often with adolescents with juvenile records
less often with elderly clients experiencing dementia
most often with children who have developmental disorders
Violent behavior can occur across all age groups. Research has documented acts of
violence on pediatric units, adolescent units, adult units, and in geriatric settings.
PTS: 1
14. Workplace violence occurs:
a. anywhere
b. in the emergency room
c. in any outpatient clinic
d. on the inpatient psychiatric unit
Workplace violence can occur anywhere. Incidents have been documented on
psychiatric units, emergency rooms, and basically any area of the hospital or clinic.
Violence may be initiated by a client, family member, friend, or staff member.
PTS: 1
15. A client becomes very agitated and begins to use profane language in a very
loud tone of voice. The best response by the nurse is to:
ignore the client
yell back at the client
speak calmly and softly
tell the client the behavior is childish
If a client becomes angry and begins to use profane language in a very loud tone, the
nurse’s best response is to speak calmly and softly to the client. Ignoring the client,
yelling at the client, or telling the client his behavior is childish will only escalate the
PTS: 1
16. You walk into an examination room only to realize that the client is holding a
weapon. What should you do first?
Take the weapon away from the client.
Have security take the weapon away from the client.
Ask the client to place the weapon on a desk or on the floor.
Ignore the fact that the client has a weapon and continue to provide care.
If you walk into an examination room and see a client with a weapon, you should ask
the client to place the weapon on a desk or on the floor. You should never ignore the
weapon. Neither you nor any other staff member should approach the client in an
attempt to take the weapon.
PTS: 1
17. An employer’s major responsibility is to:
provide a safe working environment
screen any client seeking service from the facility
install metal detectors at the entrance of the hospital
hire twice the number of security guards to assure safety
The major responsibility of an employer is to provide a safe working environment for the
employees. This can be accomplished by providing security to escort staff to parking
lots at night. Employers should also provide training to all staff on the proper procedures
to use during situations of aggression, hostility, and violence.
PTS: 1
1. The nurse manager over an emergency department is conducting an in-service
program on workplace violence. The nurse manager would evaluate the
employees as understanding the causes of workplace violence if they identify
which of the following? Select all that apply.
a. loud noises
d. helpful and pleasant staff
b. long waiting periods
e. poor environmental design
c. ignoring a client’s request
f. speaking calmly and softly
ANS: A, B, C, E
Research has shown that common causes of workplace violence include loud noises,
long waiting periods, ignoring a client’s request, poor environmental design,
crowdedness, and access to firearms. Other contributing factors are inadequately or
inappropriately trained security or staff and lack of administrative support for zero
tolerance of violence in the workplace. Speaking calmly and softly to a client and staff
who are helpful and pleasant may reduce the potential for violence.
PTS: 1
2. Hostile clients may demonstrate which of the following behaviors? Select all that
a. rudeness
b. sarcasm
c. kindness
d. faultfinding
e. verbal threats
f. physical violence
ANS: A, B, D, E, F
Hostile clients may demonstrate rudeness, sarcasm, faultfinding, physical violence, or
verbal threats. Hostile clients do not exhibit kindness.
PTS: 1
3. You are the charge nurse on a psychiatric unit. One of the new clients is very
angry and agitated. The client rushes into the nurses’ station where you are
standing and begins to yell and curse at you. What interventions would be
appropriate to de-escalate the situation? Select all that apply.
Use common sense.
Use active listening.
Give suggestions, not orders.
Be concerned about personal safety.
Avoid using threatening body language.
Remain calm and convey being in control.
ANS: A, B, C, D, E, F
All of the above are correct interventions to implement in an attempt to de-escalate a
potentially violent situation.
PTS: 1
4. Data from several studies exploring the risk of violence in inpatient psychiatric
facilities found that violence most likely occurs during which periods? Select all
that apply.
a. mealtimes
d. nursing report
b. visiting hours
e. client transport
c. bathing hours
f. during change of shifts
ANS: A, C, E
Data from several studies exploring risk for violence in inpatient psychiatric facilities
have found violence occurred during high activity and interaction with clients such as
mealtimes, client transport, and bathing hours. During periods of visiting hours, nursing
reports, or change of shifts there is less interaction between staff members and clients
and a reduced possibility of violence.
PTS: 1
5. Which of the following are true about hostility? Select all that apply.
It is a response to a threat.
It never results in violence.
It is always an inappropriate act.
It is a response to invasion of privacy.
It demonstrates a basic character flaw.
It is an attempt to avoid facing situations of helplessness.
ANS: A, D, F
Hostility is a response to a threat or invasion of privacy. It may also be the individual’s
attempt to avoid facing situations of helplessness. Sometimes the act of hostility is
appropriate and other times it is inappropriate. Hostility does not indicate a basic
character flaw. Sometimes hostility results in violence.
PTS: 1
6. Assessment of a violent client would most likely reveal which of the following?
Select all that apply.
a. withdrawn behavior
b. openness to others
c. a history of violence
d. frequent mood swings
e. poor interpersonal skills
f. respect for authority figures
ANS: A, C, D, E
Violent clients tend to demonstrate withdrawn behavior. They may have frequent mood
swings and a history of violence. Most hostile clients have poor interpersonal skills.
Openness to others is not a characteristic of violent clients.
PTS: 1
7. A nurse manager is charged with planning for staff safety in the new Emergency
Department. His plans should include which of the following? Select all that
training only nursing personnel on safety measures
providing security escorts to the parking lot at night
reducing the size of waiting areas to discourage the potential of loitering
developing waiting areas to accommodate and assist visitors and clients
designing the triage area, emergency rooms, and other public areas to
reduce the risk of assault
establishing a call system that alerts teams to assist staff involved in
potential and actual violent situations
ANS: B, D, E, F
In planning for the new Emergency Department, the nurse manager should do all of the
above except for reducing the size of the waiting room. This would cause crowding and
create the potential for clients and visitors to become agitated. Also, all personnel
should be trained on safety measures.
PTS: 1
8. Nurses working on psychiatric units should be prepared to de-escalate or diffuse
potentially violent situations. To prepare for these situations, nurses can do a
self-assessment. Questions that may be asked in the self-assessment include
which of the following? Select all that apply.
a. “How am I reacting?”
d. “How is my tone of voice?”
b. “How’s my body language?”
e. “Do I like the client as a person?”
c. “What are my “gut” feelings?”
f. “Am I wearing anything attractive?”
ANS: A, B, C, D
A self-assessment would include questions related to the nurse’s reactions, body
language, “gut” feelings, and tone of voice. Questions regarding clothing should focus
on whether the nurse is wearing clothing or other items which can put the nurse in
danger of a violent act. Whether the nurse likes or dislikes a client has nothing to do
with being prepared to de-escalate or diffuse a potentially volatile situation.
PTS: 1
1. The degree of positiveness of psychiatric nurses toward research has been
described in the literature in which of the following ways?
a. almost nonexistent
b. about the same as in other fields of nursing
c. paralleling the amount of education possessed by the nurse
d. above the degree of positiveness of nurses in other specialties
In 1992, Poster, Betz, and Randell reported that psychiatric nursing has long trained
other nursing specialties in conducting research. They also reported that positive
attitudes toward research among psychiatric nurses parallel the level of education that a
nurse possesses.
PTS: 1
2. How will research most help nurses?
a. It will identify the right way and the best way to provide care for clients.
Doing research will help nurses learn to be better at mathematics and
It will assist nurses to define and promote their roles in various health care
Doing research will make nurses and nursing more like other professionals
and professions.
Nurses, like other health care providers, must define and promote their roles in various
health care settings and research will help them accomplish this. Through evidencebased research, the nurse will be able to provide care that has been proven to be
effective in the promotion of client health. Also, to be considered a profession, nursing
must continue to develop its own body of knowledge.
PTS: 1
3. Which of the following tools was developed as a result of research into stress in
children and how children deal with stress?
the Holmes and Rahe Child Stress Scale
the Schoolagers Coping Strategy Inventory
the Wechsler Intelligence Scale for Children
the Draw a Person Test for Children
The Schoolagers Coping Strategy Inventory was developed as a result of research into
the type, frequency, and effectiveness of children’s coping behaviors. The Holmes and
Rahe Child Stress Scale only measures stress levels. The Wechsler Intelligence Scale
for Children measures intelligence. One version of the Draw a Person Test for Children
screens for emotional or behavioral disorders. The other version of the test measures
nonverbal intelligence.
PTS: 1
4. When deciding to do a research project, the first step of the scientific research
process involves which of the following activities?
writing the hypothesis
surveying the literature
identifying the problem to be studied
operationally defining the study terms
The first step of the scientific research process is identifying the problem to be studied.
The hypotheses, literature review, and operationally defining study terms occur after the
problem has been clearly identified.
PTS: 1
5. A first time nurse researcher asks, “Why do I have to do a review of the literature
prior to doing research?” In addition to informing this novice researcher that the
review helps determine the study design and may reveal some existing
instruments to use, which of the following reasons would be accurate?
This will help you determine if you would really like to research this area or
To discover what other experts in the field think so you can quote them in
your study.
This is a required part of the research design and must be done whether
helpful or not.
To find out if research has already been done on the area you are interested
in studying.
A literature review is conducted to determine whether any research has already been
conducted in the area proposed for study. The literature review provides the nurse
researcher an opportunity to examine the relevance of previous studies, compare
various studies, and determine what additional research is needed.
PTS: 1
6. Which of the following statements best represents the goal of research?
to build a scientific knowledge base
to find a better way to do something
to find a way to make or save money
to discover something new and exciting
The goal of research is to build a scientific knowledge base. Previously, nursing
knowledge has been obtained through tradition, trial and error, authority, personal
experiences, intuition, reasoning, or borrowing from other fields. As a profession,
nursing is able to expand scientific knowledge regarding nursing through research.
Research is scientific inquiry, the highest level of obtaining knowledge. Nursing
research can thus be used to create, test, and refine theories regarding nursing
education and nursing practice.
PTS: 1
7. When doing research, you will have a large group of interest from which you will
select a subset to study. The large group of interest is referred to by which of the
following terms?
a. colony
c. larger set
b. group set
d. population
The term population is used to represents the larger group of interest from which a
subset has been selected. The subset is most often called the sample. The research
project will be conducted with the sample. If the sample is randomly chosen from the
larger population, generalizability of the results will be possible.
PTS: 1
8. The facts or the pieces of information that you will collect in a research study are
called by which of the following terms?
a. fact set
c. knowledge sets
b. the data
d. informational items
The data are the pieces of information that you collect in a research study. Data can be
obtained by a variety of methods which include results of standardized research tools,
observations, interviews, and case studies.
PTS: 1
9. Which of the following statements is true about the analysis step of research?
If a nurse is not good at statistics, the nurse cannot do acceptable research
Data analysis has become quite simple due to the computer and the aid of
Nurses need to employ a statistician to assist them with the data after the
data is collected.
The analysis step is the hardest and most time-consuming step of the
research project.
Data analysis has become simpler due to the use of computers for data analysis and
the aid of statisticians. Many quantitative research studies that involve large quantities
of numerical data would be almost impossible to analyze without the use of a computer.
The aid of the statistician is frequently needed because his expertise is related to the
analysis of numerical data.
PTS: 1
10. After the nurse researcher has analyzed the findings of a study, the nurse must
try to interpret the findings. The results of the study are compared to which of the
following things?
a. the hypothesis
c. current beliefs
b. earlier studies
d. the literature review
The hypothesis is a statement about the relationship between variables. The results of
the study are compared to the researcher’s expectations that were stated in the
PTS: 1
11. Which of the following statements is true about the role(s) of the generalist
psychiatric mental health nurse in research?
Few, if any, roles exist in research for this level of nurse.
This type of nurse is unqualified to be involved in research.
The generalist nurse has no responsibility for being involved in research.
This nurse uses research data to guide practice and is a consumer of
There are a number of roles that the psychiatric mental health generalist nurse can fulfill
in research. The psychiatric mental health generalist nurse has a responsibility to be
involved in research in various ways such as reading research reports and using
research data to guide practice and provide evidence-based care.
PTS: 1
12. The nurse who is the principal investigator in a relatively large research project
finds that he cannot collect all the data that is required in a study due to time
constraints. Which of the following would probably be the best course of action
for this nurse investigator?
a. abandon the research project
b. train some additional data collectors
c. redesign the study with a smaller group of subjects
d. redesign the study to accommodate a different time frame
Many studies would never be completed without the assistance of additional data
collectors. It is difficult for the principal investigator to do all the data collection that is
required in a large study. Other individuals are trained on the appropriate techniques
and the expectations of their role.
PTS: 1
13. In the role of the client advocate, the nurse who is the principal investigator of a
research project must most do which one of the following things during a
research study?
ensure that clients are happy during the research study and do not leave the
negotiate for the client to assure that the client is well compensated for
make certain that the rights of all prospective and active subjects are
adequately protected
remove weaker clients from any medication or treatment groups and place
them in the control group
In the role of client advocate, the nurse must ensure that the rights of all prospective
and actual subjects are adequately protected. The Nuremberg Code and the
Declaration of Helsinki were pivotal pieces of legislation which formed the foundation
upon which current statements regarding the rights of research subjects are based.
PTS: 1
14. Most research by psychiatric mental health nurses has been conducted on which
of the following age groups?
a. adults
b. adolescents
c. children
d. infants
Most research in psychiatric-mental health nursing has been conducted on adults. This
is the largest group of clients seen by psychiatric nurses. With the increased focus on
the mental health issues of infants, children, and adolescents, the number of evidencebased research studies has increased. In addition, federal funding for these groups of
individuals has been made much more available.
PTS: 1
15. When a nurse researcher wants to interview a group of adult clients on the
inpatient unit where he works, he most needs to secure permission from which of
the following persons or groups before proceeding with the studies?
the family
the ethical committee
the institutional review board
the nursing peer review committee
Unless the client has a guardian, the mentally competent client can give permission
without the family’s consent. Ethics committees and nursing peer review committees do
not normally get involved in issues of permission related to research. It is the
institutional review board that will review the research proposal and determine whether
the research project may proceed. A nursing peer review committee might review the
research proposal for possible funding or the results of a research project for possible
publication in a nursing journal.
PTS: 1
16. Qualitative research focuses on which of the following?
numerical data
use of parametric statistical tests
the meanings of experiences to people
generalizations across groups of people
Qualitative research focuses on the meanings of experiences to people. Quantitative
research focuses on numerical data, using parametric and nonparametric tests.
Qualitative research also is used to make generalizations.
PTS: 1
17. Historically, psychiatric nurses have been instrumental in:
a. research drug trials
b. experimental studies exploring brain patterns in lab animals
c. studies exploring the lived experiences of psychiatric patients
research which focused on outcomes of services provided to mental health
Historically, psychiatric nurses have been instrumental in research drug trials. Currently,
nurses are involved in all aspects of research, including experimental and
nonexperimental research. Many nurses are now the primary researchers on both
quantitative and qualitative research projects.
PTS: 1
18. Which of the following statements is true regarding the framework of a research
It is never used with quantitative research design.
It is synonymous with the review of the literature.
It is developed by the target population of the study.
It provides a knowledge base into which the study results are placed.
The study framework consists of the concepts and constructs that form the study. It
provides a knowledge base into which the study results are placed.
PTS: 1
19. A study conducted by Ahijevych & Bernard found that assessment instruments
used to appraise health promoting behaviors:
suggested a middle-class bias
were found to lack appropriate rigor
documented the importance of stress and coping on mental health
demonstrated a correlation between African American and Hispanic females
Ahijevych & Bernard found that assessment instruments used to appraise healthpromoting behaviors suggested a middle-class bias. The tools were insensitive to
diverse populations such as the economically disadvantaged. Other assessment
instruments sensitive to every segment of the society should be developed.
PTS: 1
20. Which of the following statements is true regarding research design?
a. identifies the concepts and constructs to be analyzed in the project
determines what, if any, research has already been conducted on the
particular problem
provides an analysis of the results of the data obtained and communicates
the study findings
integrates and guides methodological decisions and defines the direction
that the research adopts
The research design integrates and guides methodological decisions and defines the
direction that the research adopts. The nurse researcher will determine whether a
qualitative or quantitative design is appropriate for the study. The literature review will
determine what, if any, research has already been conducted on the particular problem.
Concepts and constructs are identified in the study framework. Data is analyzed in the
analysis of data section of the research project. Findings are communicated through
publications and presentation of results at seminars and conferences.
PTS: 1
21. Which of the following was developed in response to the call of psychiatric
mental health nurse leaders to establish a cadre of researchers with PhDs and
expand the number of psychiatric nurse researchers?
National Institute of Health Revitalization Act
ANA Standards of Psychiatric-Mental Health Nursing
Strategic Plan of the National Institute of Nursing Research
National Institute of Nursing Research/NIMH Mentoring Program
The National Institute of Nursing Research/NIMH Mentoring Program was created in
response to the call from psychiatric mental health leaders to establish a cadre of
researchers with PhDs and expand the number of psychiatric nurse researchers. This
program will prove to be instrumental in improving the health care and quality of life for
clients with mental illness.
PTS: 1
22. The nurse conducting mental health research knows that quantitative research is:
a. subjective
c. seeking patterns
b. reductionistic
d. Reasoning Dialectic, inductive
Quantitative research is reductionistic. It focuses on collecting numeric information.
Data is analyzed using descriptive and/or inferential statistics. Qualitative research
allows for large quantities of data to be reduced in order to find meaning.
PTS: 1
23. As society becomes more diverse, psychiatric nurse researchers must develop
research studies that will:
a. lead to interventions for every segment of the population
b. distinguish novice researchers from expert researchers
be implemented only with elderly clients since they are the fasting growing
age group
focus primarily on first-generation immigrants from Asia and Eastern
European countries
As society becomes more diverse, psychiatric nurse researchers must develop research
studies that will lead to interventions for every segment of the population. New,
culturally relevant data-collecting instruments should be developed if they are to truly
reflect the experiences of a diverse population.
PTS: 1
24. A nurse on an inpatient unit wants to conduct a study to determine the
experiences of his clients receiving ECT. The nurse should use which qualitative
research design:
a. historical design
c. grounded theory design
b. ethnographic design
d. phenomenological design
Phenomenological research design is used to document the lived experiences of the
subjects. This design is a qualitative research design. Data can be gathered through
interviews with the individual clients.
PTS: 1
25. You are a nurse researcher and plan to conduct a study to examine the effects of
psychotropic drugs on fifty African American males. The subjects of your study
will be randomly selected. Your study would be generalizable to which
a. males receiving psychotropic drugs
b. all clients receiving psychotropic drugs
c. African Americans receiving psychotropic drugs
d. African American males receiving psychotropic drugs
Generalizability allows the researcher to make inferences that the results of the study
can be applied to the larger population from which the sample was obtained. If the
nurse researcher’s sample consisted of fifty randomly selected African American males
receiving psychotropic drugs, the sample should be representative of all African
American males receiving psychotropic drugs in the larger population. Generalizability
may not exist with the other options. The first option, “males” includes males from a
variety of ethnic groups. The second option, “all clients” includes women and different
ethnic and age groups. The third option, “African Americans” includes males and
females of all age groups.
PTS: 1
26. A nurse was requested to conduct a research study of a group of children who
had been exposed to a traumatic event at their school. The nurse plans to use
several established research tools including the State Anxiety Scale for Children.
The children’s scores on the tools will be analyzed against demographic
variables such as age, gender, and ethnicity. Which of the following would be the
most appropriate research design for the nurse researcher to choose?
a. quantitative experimental
c. qualitative grounded theory
b. quantitative nonexperimental
d. qualitative phenomenological
The most appropriate research design would be quantitative nonexperimental. The
researcher has chosen to use standardized instruments. These instruments will be
interpreted using statistical analysis. Quantitative research focuses on numeric data.
Also, no treatments or interventions are mentioned so the study would not be
experimental or quasi-experimental.
PTS: 1
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