Test Bank for Varcarolis Essentials of Psychiatric Mental
Health Nursing 5th Edition Fosbre
All Chapters 1 - 28 + NCLEX Case Studies with Answers
Full Complete 2024
TABLE OF CONTENTS
Chapter 01: Practicing the Science and the Art of Psychiatric Nursing MULTIPLE CHOICE
1. Which outcome, focused on recovery, would be expected in the plan of care for a patient
living in the community and diagnosed with serious and persistent mental illness? Within 3
months, the patient will: a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
ANSWER: B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving
role performance.
The goal of recovery is to empower the individual with mental illness to achieve a sense of
meaning and satisfaction in life and to function at the highest possible level of wellness. The
incorrect options focus on the classic medical model rather than recovery.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Outcomes Identification
MSC: NCLEX: Health Promotion and Maintenance
2. In the shift-change report, an off-going nurse criticizes a patient who wears heavy
makeup. Which comment by the nurse who receives the report best demonstrates
advocacy?
a. This is a psychiatric hospital. Craziness is what we are all about.
b. Lets all show acceptance of this patient by wearing lots of makeup too.
c. Your comments are inconsiderate and inappropriate. Keep the report objective.
d. Our patients need our help to learn behaviors that will help them get along in society.
ANSWER: D
Accepting patients needs for self-expression and seeking to teach skills that will contribute
to their well-being demonstrate respect and are important parts of advocacy. The on-
coming nurse needs to take action to ensure that others are not prejudiced against the
patient. Humor can be appropriate within the privacy of a shift report but not at the
expense of respect for patients. Judging the off-going nurse in a critical way will create
conflict.
Nurses must show compassion for each other.
DIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
3. A nurse assesses a newly admitted patient diagnosed with major depressive disorder.
Whichstatement is an example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.
ANSWER: D
Attending is a technique that demonstrates the nurses commitment to the relationship and
reduces feelings of isolation. This technique shows respect for the patient and
demonstrates caring. Generalizations, probing, and false reassurances are non-therapeutic.
DIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a
divorce. Selectthe nurses most caring comment.
a. Lets discuss some means of coping other than suicide when you have these feelings.
b. I understand why youre so depressed. When I got divorced, I was devastated too.
c. You should forget about your marriage and move on with your life.
d. How did you get so depressed that hospitalization was necessary?
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 3
ANSWER: A
The nurses communication should evidence caring and a commitment to work with the
patient. This commitment lets the patient know the nurse will help. Probing and advice are
not helpful or therapeutic interventions.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. A patient shows the nurse an article from the Internet about a health problem. Which
characteristic of the web sites address most alerts the nurse that the site may have biased
and prejudicedinformation?
a. Address ends in .org.
b. Address ends in .com.
c. Address ends in .gov.
d. Address ends in .net.
ANSWER: B
Financial influences on a site are a clue that the information may be biased. .com at the end
of the address indicates that the site is a commercial one. .gov indicates that the site is
maintained by a government entity.
.org indicates that the site is nonproprietary; the site may or may not have reliable
information, but it does not profit from its activities. .net can have multiple meanings.
DIF: Cognitive Level: Comprehension (Understanding) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
6. A nurse says, When I was in school, I learned to call upset patients by name to get their
attention; however, I read a descriptive research study that says that this approach does not
work. I plan to stop calling patients by name. Which statement is the best appraisal of this
nurses comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse
specialists.
c. New research findings should be incorporated into clinical algorithms before using them
in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not
change.
ANSWER: A
Descriptive research findings provide evidence for practice but must be viewed in relation
to other studies before practice changes. One study is not enough. Descriptive studies are
low on the hierarchy of evidence.
Clinical algorithms use flow charts to manage problems and do not specify one response to
a clinical problem.
Classic tenets of practice should change as research findings provide evidence for change.DIF:
Cognitive Level: Analysis (Analyzing) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
7. Twonursing students discuss career plans after graduation. One student wants to enter
psychiatric nursing.
The other student asks, Why would you want to be a psychiatric nurse? All they do is talk.
You will lose your skills. Select the best response by the student interested in psychiatric
nursing.
a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient
ratios must be better because of the nature of patients problems.
b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve
multidimensional problems. Im challenged by those situations.
c. I think I will be good in the mental health field. I do not like clinical rotations in school, so
I do not want to continue them after I graduate.
d. Psychiatric nurses do not have to deal with as much pain and suffering as medical
surgical nurses. That appeals to me.
ANSWER: B
The practice of psychiatric nursing requires a different set of skills than medical surgical
nursing, although substantial overlap does exist. Psychiatric nurses must be able to help
patients with medical and mental health problems, reflecting the holistic perspective these
nurses must have. Nurse-patient ratios and workloads in psychiatric settings have
increased, similar to other specialties. Psychiatric nursing involves clinical practice,
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 4
not simply documentation. Psychosocial pain is real and can cause as much suffering as
physical pain.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
8. Which research evidence would most influence a group of nurses to change their
practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
ANSWER: B
Research findings are graded using a hierarchy of evidence. A systematic review of
randomized controlled trials is Level A and provides the strongest evidence for changing
practice. Expert committee recommendations and descriptive studies lend less powerful
and influential evidence. A critical pathway is not evidence; it incorporates research
findings after they have been analyzed.
DIF: Cognitive Level: Comprehension (Understanding) REF: 3
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment
9. A bill introduced in Congress would reduce funding for the care of people diagnosed with
mental illnesses.
A group of nurses write letters to their elected representatives in opposition to the
legislation. Which role have the nurses fulfilled?
a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
ANSWER: A
An advocate defends or asserts anothers cause, particularly when the other person lacks
the ability to do that for himself or herself. Examples of individual advocacy include helping
patients understand their rights or make decisions. On a community scale, advocacy
includes political activity, public speaking, and publication in the interest of improving the
individuals with mental illness; the letter-writing campaign advocates for that cause on
behalf of patients who are unable to articulate their own needs.
DIF: Cognitive Level: Comprehension (Understanding) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
10. An informal group of patients discuss their perceptions of nursing care. Which
comment best indicates a patients perception that his or her nurse is caring?
a. My nurse always asks me which type of juice I want to help me swallow my medication.
b. My nurse explained my treatment plan to me and asked for my ideas about how to make
it better.
c. My nurse told me that if I take all the medicines the doctor prescribes I will get
discharged soon.
d. My nurse spends time listening to me talk about my problems. That helps me feel like Im
not alone.
ANSWER: D
Caring evidences empathic understanding, as well as competency. It helps change pain and
suffering into a shared experience, creating a human connection that alleviates feelings of
isolation. The incorrect options give examples of statements that demonstrate advocacy or
giving advice.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 11. A patient who
immigrated to the United States from Honduras was diagnosed with schizophrenia. The
patient took an antipsychotic medication for 3 weeks but showed no improvement. Which
resource should the treatment team consult for information on more effective medications
for this patient?
a. Clinical algorithm
b. Clinical pathway
c. Clinical practice guideline
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 5
d. International Statistical Classification of Diseases and Related Health Problems (ICD)
ANSWER: A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches
drawn from large databases of information. These guidelines help the treatment team make
decisions cognizant of an individual patients needs, such as ethnic origin, age, or gender. A
clinical pathway is a map of interventions and treatments related to a specific disorder.
Clinical practice guidelines summarize best practices about specific health problems. The
ICD classifies diseases.
DIF: Cognitive Level: Application (Applying) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 12. Which
historical nursing leader helped focus practice to recognize the importance of science in
psychiatric nursing?
a. Abraham Maslow
b. Hildegard Peplau
c. Kris Martinsen
d. Harriet Bailey
ANSWER: B
Although all these leaders included science as an important component of practice,
Hildegard Peplau most influenced its development in psychiatric nursing. Maslow was not a
nurse, but his theories influence how nurses prioritize problems and care. Bailey wrote a
textbook in the 1930s on psychiatric nursing interventions.
Kris Martinsen emphasized the importance of caring in nursing practice.DIF:
Cognitive Level: Knowledge (Remembering) REF: 4
TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity 13. A nurse consistently
strives to demonstrate caring behaviors during interactions with patients. Which reaction
by a patient indicates this nurse is effective? A patient reports feeling:
a. distrustful of others.
b. connected with others.
c. uneasy about the future.
d. discouraged with efforts to improve.
ANSWER: B
A patient is likely to respond to caring with a sense of connectedness with others. The
absence of caring can make patients feel distrustful, disconnected, uneasy, and discouraged.
DIF: Cognitive Level: Comprehension (Understanding) REF: 7
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity MULTIPLE
RESPONSE
1. An experienced nurse says to a new graduate, When youve practiced as long as I have,
you will instantly know how to take care of psychotic patients. What is the new graduates
best analysis of this comment? Select all that apply.
a. The experienced nurse may have lost sight of patients individuality, which may
compromise the integrity of practice.
b. New research findings must be continually integrated into a nurses practice to provide
the most effective care.
c. Experience provides mental health nurses with the tools and skills needed for effective
professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients
through trial and error.
e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients
needs.
ANSWER: A, B
Evidence-based practice involves using research findings to provide the most effective
nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on
experience. The effective nurse also maintains
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 6
respect for each patient as an individual. Overgeneralization compromises that perspective.
Intuition and trial and error are unsystematic approaches to care.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 2. Which
patient statements identify qualities of nursing practice with high therapeutic value?
(Select all that apply.) My nurse:
a. talks in language I can understand.
b. helps me keep track of my medications.
c. is willing to go to social activities with me.
d. lets me do whatever I choose without interfering.
e. looks at me as a whole person with different needs.
ANSWER: A, B, E
Each correct answer demonstrates caring is an example of appropriate nursing foci:
communicating at a level understandable to the patient, using holistic principles to guide
care, and providing medication supervision.
The incorrect options suggest a laissez-faire attitude on the part of the nurse, when the
nurse should instead provide thoughtful feedback and help patients test alternative
solutions or violate boundaries.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 7
Chapter 02: Mental Health and Mental Illness
MULTIPLE CHOICE
1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo.
Which behavior by this patient best demonstrates resilience? The patient: a. says, I knew
this would happen eventually.
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, I dont need that silly thing.
d. says, Maybe some physical therapy will help me with my balance.
ANSWER: D
Resiliency is the ability to recover from or adjust to misfortune and change. The correct
response indicates that the patient is hopeful and thinking positively about ways to adapt to
the vertigo. Saying I knew this would happen eventually and discontinuing healthy
activities suggest a hopeless perspective on the health change.
Refusing to use a walker indicates denial.
DIF: Cognitive Level: Comprehension (Understanding) REF: 14
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2. A patient is admitted to the psychiatric hospital. Which assessment finding best
indicates that thepatient has a mental illness? The patient:
a. describes coping and relaxation strategies used when feeling anxious.
b. describes mood as consistently sad, discouraged, and hopeless.
c. can perform tasks attempted within the limits of own abilities.
d. reports occasional problems with insomnia.
ANSWER: B
A patient who reports having a consistently negative mood is describing a mood alteration.
The incorrect options describe mentally healthy behaviors and common problems that do
not indicate mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. The goal for apatient is to increase resiliency. Which outcome should a nurse add to the
plan of care?
Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
ANSWER: C
The patients ability to identify healthy coping behaviors indicates adaptive, healthy
behavior and demonstrates an increased ability to recover from severe stress. Describing
feelings associated with loss and stress does not move the patient toward adaptation. The
remaining options are maladaptive behaviors.
DIF: Cognitive Level: Analysis (Analyzing) REF: 14
TOP: Nursing Process: Outcomes Identification
MSC: NCLEX: Psychosocial Integrity
4. Which organization actively seeks to reduce the stigma associated with mental illness
through public presentations such as In Our Own Voice (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS) d. North American
Nursing Diagnosis Association International (NANDA-I) ANSWER: B
Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI
actively seeks to
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 8
dispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses.
The APA publishes the DSM 5. The USDHHS regulates and administers health policies.
DIF: Cognitive Level: Knowledge (Remembering) REF: 19
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment
5. A nursemust assess several new patients at a community mental health center.
Conclusions concerning current functioning should be made on the basis of:
a. the degree of conformity of the individual to societys norms.
b. the degree to which an individual is logical and rational.
c. a continuum from mentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
ANSWER: C
Because mental health and mental illness are relative concepts, assessment of functioning
is made by using a continuum. Mental health is not based on conformity; some mentally
healthy individuals do not conform to societys norms. Most individuals occasionally display
illogical or irrational thinking. The rate of intellectual and emotional growth is not the most
useful criterion to assess mental health or mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Diagnosis| Nursing Process: Analysis MSC: NCLEX: Psychosocial
Integrity
6. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a
patients insurance form.
Which resource should the nurse consult to discern the criteria used to establish this
diagnosis?
a. A psychiatric nursing textbook
b. NANDA International (NANDA-I )
c. A behavioral health reference manual
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ANSWER: D
The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses
on nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manual
may not contain diagnostic criteria.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis MSC: NCLEX: Safe, Effective
Care Environment
7. A 40-year-old adult living with parents states, Im happy but I dont socialize much. My
work is routine.
When new things come up, my boss explains them a few times to make sure I understand.
At home, my parents make decisions for me, and I go along with them. A nurse should
identify interventions to improve this patients:
a. self-concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
ANSWER: A
The patient feels the need for multiple explanations of new tasks at work and, despite being
40 years of age, allows both parents to make all decisions. These behaviors indicate a
poorly developed self-concept. Although the patient reports being happy, the subsequent
comments refute that self-appraisal. The patients comments do not indicate that he/she is
out of touch with reality. The patients needs are broader than control over own behavior.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 8. A patient tells a
nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one of
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 9
my friends or relatives has these problems. Select the nurses best response.
a. Comparing yourself with others has no real advantages.
b. Why do you blame yourself for having a psychiatric illness?
c. Mental illness affects 50% of the adult population in any given year.
d. It sounds like you are concerned that others dont experience the same challenges as you.
ANSWER: D
Mental illness affects many people at various times in their lives. No class, culture, or creed
is immune to the challenges of mental illness. The correct response also demonstrates the
use of reflection, a therapeutic communication technique. It is not true that mental illness
affects 50% of the population in any given year.
Asking patients if they blame themselves is an example of probing.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 9. A critical care
nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the
psychiatric nurses best response.
a. No functional difference exists between the two diagnoses. Both serve to identify a
human deviance.
b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural
variables.
c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis
considers past and present responses to actual mental health problems.
d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a
framework to identify interventions for problems a patient has or may experience.
ANSWER: D
The medical diagnosis, defined according to the DSM-5, is concerned with the patients
disease state, causes, and cures, whereas the nursing diagnosis focuses on the patients
response to stress and possible caring interventions. Both the DSM-5 and a nursing
diagnosis consider culture. Nursing diagnoses also consider potential problems.
DIF: Cognitive Level: Application (Applying) REF: 16
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10.
The spouse of a patient diagnosed with schizophrenia says, I dont understand why
childhood experiences have anything to do with this disabling illness. Select the nurses
response that will best help the spouse understand this condition.
a. Psychological stress is actually at the root of most mental disorders.
b. We now know that all mental illnesses are the result of genetic factors.
c. It must be frustrating for you that your spouse is sick so much of the time.
d. Although this disorder more likely has a biological rather than psychological origin, the
support and involvement of caregivers is very important.
ANSWER: D
Many of the most prevalent and disabling mental disorders have been found to have strong
biological influences. Helping the spouse understand the importance of his or her role as a
caregiver is also important.
Empathy is important but does not increase the spouses level of knowledge about the cause
of the patients condition. Not all mental illnesses are the result of genetic factors.
Psychological stress is not at the root of most mental disorders.
DIF: Cognitive Level: Application (Applying) REF: 14
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
11. Which belief by a nurse supports the highest degree of patient advocacy during a
multidisciplinary patient care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are constant from culture to culture.
d. Some symptoms of mental disorders may reflect a persons cultural patterns.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 10
ANSWER: D
A nurse who understands that a patients symptoms are influenced by culture will be able to
advocate for the patient to a greater degree than a nurse who believes that culture is of little
relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar
disorder are cross-cultural disorders, but this understanding has little relevance to patient
advocacy. Symptoms of mental disorders change from culture to culture.
DIF: Cognitive Level: Application (Applying) REF: 18
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 12. A
patients history shows intense and unstable relationships with others. The patient initially
idealizes an individual and then devalues the person when the patients needs are not met.
Which aspect of mental health is a problem?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANSWER: D
The information provided centers on relationships with others, which are described as
intense and unstable.
The relationships of mentally healthy individuals are stable, satisfying, and socially
integrated. Data are not present to describe work effectiveness, communication skills, or
activities.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 13. In the majority
culture of the United States, which individual is at greatest risk to be incorrectly labeled
mentally ill?
a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy person
who gives $20 bills to needy individuals in the community c. Person with an optimistic
viewpoint about life and getting his or her own needs met d. Person who attends a
charismatic church and describes hearing Gods voice ANSWER: D
Hearing voices is generally associated with mental illness; however, in charismatic religious
groups, hearing the voice of God or a prophet is a desirable event. In this situation, cultural
norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals
described in the other options are less likely to be labeled as mentally ill.
DIF: Cognitive Level: Application (Applying) REF: 17
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 14. A participant at
a community education conference asks, What is the most prevalent type of mental
disorder in the United States? Select the nurses best response.
a. Why do you ask?
b. Schizophrenia
c. Affective disorders
d. Anxiety disorders
ANSWER: D
The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders
(e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders
is 13.3%.
DIF: Cognitive Level: Comprehension (Understanding) REF: 15
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with
schizophrenia. Which resource should the nurse consult?
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 11
a. U.S. Department of Health and Human Services
b. Journal of the American Psychiatric Association
c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) ANSWER: D
The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have
useful information but are not the best resources for finding a description of the diagnostic
criteria for a psychiatric disorder.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis MSC: NCLEX: Health Promotion
and Maintenance
MULTIPLE RESPONSE
1. A patient in the emergency department reports, I hear voices saying someone is stalking
me. They want to kill me because I found the cure for cancer. I will stab anyone that
threatens me. Which aspects of mental health have the greatest immediate concern to a
nurse? Select all that apply.
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept
ANSWER: B, C, E
The aspects of mental health of greatest concern are the patients appraisal of and control
over behavior. The patients appraisal of reality is inaccurate, and auditory hallucinations
are evident, as well as delusions of persecution and grandeur. In addition, the patients
control over behavior is tenuous, as evidenced by the plan to stab anyone who seems
threatening. A healthy self-concept is lacking. Data are not present to suggest that the other
aspects of mental health (happiness and effectiveness in work) are of immediate concern.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment 2. Which
statements most clearly reflect the stigma of mental illness? Select all that apply.
a. Many mental illnesses are hereditary.
b. Mental illness can be evidence of a brain disorder.
c. People claim mental illness so they can get disability checks.
d. If people with mental illness went to church, they would be fine.
e. Mental illness is a result of the breakdown of the American family.
ANSWER: C, D, E
Stigma is represented by judgmental remarks that discount the reality and validity of
mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show
changes associated with some mental illnesses.
DIF: Cognitive Level: Analysis (Analyzing) REF: 19
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 12
Chapter 03: Theories and Therapies
MULTIPLE CHOICE
1. A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet
training and shouts, No! when given direction. What do you think is wrong? Select the
nurses best reply.
a. This is normal for your childs age. The child is striving for independence.
b. The child needs firmer control. Punish the child for disobedience and say, No.
c. There may be developmental problems. Most children are toilet trained by age 2 years.
d. Some undesirable attitudes are developing. A child psychologist can help you develop a
remedial plan.
ANSWER: A
These negative behaviors are typical of a child around the age of 2 years whose
developmental task is to develop autonomy. The incorrect options indicate the childs
behavior is abnormal.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2.
A 26-month-old child displays negative behavior, refuses toilet training, and often shouts,
No! when given directions. Using Freuds stages of psychosexual development, a nurse
would assess the childs behavior is based on which stage?
a. Oral
b. Anal
c. Phallic
d. Genital
ANSWER
:B
In Freuds stages of psychosexual development, the anal stage occurs from age 1 to 3 years
and has, as its focus, toilet training and learning to delay immediate gratification. The oral
stage occurs between birth and 1
year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between
13 and 20 years.
DIF: Cognitive Level: Comprehension (Understanding) REF: 20
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A
26-month-old child displays negative behavior, refuses toilet training, and often shouts, No!
when given direction. The nurses counseling with the parent should be based on the
premise that the child is engaged in which of Eriksons psychosocial crises?
a. Trust versus Mistrust
b. Initiative versus Guilt
c. Industry versus Inferiority
d. Autonomy versus Shame and Doubt
ANSWER: D
The crisis of Autonomy versus Shame and Doubt is related to the developmental task of
gaining control of self and environment, as exemplified by toilet training. This psychosocial
crisis occurs during the period of early childhood. Trust versus Mistrust is the crisis of the
infant, Initiative versus Guilt is the crisis of the preschool and early school-aged child, and
Industry versus Inferiority is the crisis of the 6- to 12-year-old child.
DIF: Cognitive Level: Comprehension (Understanding) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. A 4year-old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and the
childs parent becomes upset with the behavior. Using the Freudian theory, a nurse can
interpret the childs behavior as a product of impulses originating in the:
a. id.
b. ego.
c. superego.
d. preconscious.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 13
ANSWER: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The
ego acts as a mediator of behavior and weighs the consequences of the action, perhaps
determining that taking the toy is not worth the parents wrath. The superego would oppose
the impulsive behavior as not nice. The preconscious is a level of awareness.
DIF: Cognitive Level: Application (Applying) REF: 20
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. The
parent of a 4-year-old rewards and praises the child for helping a younger sibling, being
polite, and using good manners. A nurse supports the use of praise because, according to
the Freudian theory, these qualities will likely be internalized and become part of the
childs: a. id.
b. ego.
c. superego.
d. preconscious.
ANSWER: C
In the Freudian theory, the superego contains the thou shalts or moral standards
internalized from interactions with significant others. Praise fosters internalization of
desirable behaviors. The id is the center of basic instinctual drives, and the ego is the
mediator. The ego is the problem-solving and reality-testing portion of the personality that
negotiates solutions with the outside world. The preconscious is a level of awareness from
which material can be easily retrieved with conscious effort.
DIF: Cognitive Level: Comprehension (Understanding) REF: 20
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6.
A nurse supports parental praise of a child who is behaving in a helpful way. When the
individual behaves with politeness and helpfulness in adulthood, which feeling will most
likely result?
a. Guilt
b. Anxiety
c. Loneliness
d. Self-esteem
ANSWER: D
The individual will be living up to the ego ideal, which will result in positive feelings about
self. The other options are incorrect; each represents a negative feeling.
DIF: Cognitive Level: Comprehension (Understanding) REF: 22
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7.
A patient comments, I never know the right answer and My opinion is not important. Using
Eriksons theory, which psychosocial crisis did the patient have difficulty resolving?
a. Initiative versus Guilt
b. Trust versus Mistrust
c. Autonomy versus Shame and Doubt
d. Generativity versus Self-Absorption
ANSWER: C
These statements show severe self-doubt, indicating that the crisis of gaining control over
the environment is not being successfully met. Unsuccessful resolution of the crisis of
Initiative versus Guilt results in feelings of guilt. Unsuccessful resolution of the crisis of
Trust versus Mistrust results in poor interpersonal relationships and suspicion of others.
Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results in selfabsorption that limits the ability to grow as a person.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8.
Which patient statement would lead a nurse to suspect that the developmental task of
infancy was not
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 14
successfully completed?
a. I have very warm and close friendships.
b. Im afraid to let anyone really get to know me.
c. I am always right and confident about my decisions.
d. Im ashamed that I didnt do it correctly in the first place.
ANSWER: B
According to Erikson, the developmental task of infancy is the development of trust. The
patients statement that he or she is afraid of becoming acquainted with others clearly
shows a lack of ability to trust other people.
Having warm and close friendships suggests the developmental task of infancy was
successfully completed.
Believing one is always right suggests rigidity rather than mistrust. Feelings of shame
suggest failure to resolve the crisis of Initiative versus Guilt.
DIF: Cognitive Level: Analysis (Analyzing) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 9. A
nurse assesses that a patient is suspicious and frequently manipulates others. Using the
Freudian theory, these traits are related to which psychosexual stage?
a. Oral
b. Anal
c. Phallic
d. Genital
ANSWER
:A
According to Freud, each of the behaviors mentioned develops as the result of attitudes
formed during the oral stage, when an infant first learns to relate to the environment. Anal
stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic stage
traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties
with sexual identity. Genital stage traits include the ability to form satisfying sexual and
emotional relationships with members of the opposite sex, emancipation from parents, and
a strong sense of personal identity.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. An
adult expresses the wish to be taken care of and often behaves in a helpless fashion. This
adult has needs related to which of Freuds stages of psychosexual development?
a. Latency
b. Phallic
c. Anal
d. Oral
ANSW
ER: D
According to Freud, fixation at the oral stage sometimes produces dependent infantile
behaviors in adults.
Latency fixations often result in a difficulty identifying with others and developing social
skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having
difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in
retentiveness, rigidity, messiness, destructiveness, and cruelty.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. A
nurse listens to a group of recent retirees. One says, I volunteer with Meals on Wheels,
coach teen sports, and do church visitation. Another laughs and says, Im too busy taking
care of myself to volunteer. I dont have time to help others. These comments contrast which
developmental tasks?
a. Trust versus Mistrust
b. Industry versus Inferiority
c. Intimacy versus Isolation
d. Generativity versus Self-Absorption
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 15
ANSWER: D
Both retirees are in middle adulthood, when the developmental crisis to be resolved is
Generativity versus Self-Absorption. One exemplifies generativity; the other embodies selfabsorption. The developmental crisis of Trust versus Mistrust would show a contrast
between relating to others in a trusting fashion and being suspicious and lacking trust.
Failure to negotiate the developmental crisis of Industry versus Inferiority would result in a
sense of inferiority or difficulty learning and working as opposed to the ability to work
competently.
Behaviors that would be contrasted in the crisis of Intimacy versus Isolation would be
emotional isolation and the ability to love and commit to oneself.
DIF: Cognitive Level: Application (Applying) REF: 22
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12.
Cognitive therapy was provided for a patient who frequently said, Im stupid. Which
statement by the patient indicates the therapy was effective?
a. Im disappointed in my lack of ability.
b. I always fail when I try new things.
c. Things always go wrong for me.
d. Sometimes I do stupid things.
ANSWER: D
Im stupid is a cognitive distortion or irrational thought. A more rational thought is,
Sometimes I do stupid things. The latter thinking promotes emotional self-control. The
incorrect options reflect irrational thinking.
DIF: Cognitive Level: Application (Applying) REF: 26
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 13. A student nurse
tells the instructor, I dont need to interact with my patients. I learn what I need to know by
observation. The instructor can best interpret the nursing implications of Sullivans theory
to the student by responding:
a. Nurses cannot be isolated. We must interact to provide patients with opportunities to
practice interpersonal skills.
b. Observing patient interactions can help you formulate priority nursing diagnoses and
appropriate interventions.
c. I wonder how accurate your assessment of the patients needs can be if you do not
interact with the patient.
d. Noting patient behavioral changes is important because these signify changes in
personality.
ANSWER: A
Sullivan believed that the nurses role includes educating patients and assisting them in
developing effective interpersonal relationships. Mutuality, respect for the patient,
unconditional acceptance, and empathy are cornerstones of Sullivans theory. The nurse
who does not interact with the patient cannot demonstrate these cornerstones.
Observations provide only objective data. Priority nursing diagnoses usually cannot be
accurately established without subjective data from the patient. The third response
pertains to Maslows theory. The fourth response pertains to behavioral theory.
DIF: Cognitive Level: Application (Applying) REF: 21
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 14. A
psychiatric technician says, Little of what takes place on the behavioral health unit seems to
be theory based. A nurse educates the technician by identifying which common use of
Sullivans theory?
a. Structure of the therapeutic milieu of most behavioral health units b. Frequent use of
restraint and seclusion for behavior modification c. Assessment tools based on ageappropriate versus arrested behaviors d. Use of the nursing process to determine the best
sequence for nursing actions ANSWER: A
The structure of the therapeutic environment has, as its foci, an accepting atmosphere and
provision of opportunities for practicing interpersonal skills. Both constructs are directly
attributable to Sullivans theory of interpersonal relationships. Sullivans interpersonal
theory did not specifically consider the use of restraint or seclusion. Assessment based on
the developmental level is associated with Eriksons theories. The nursing
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 16
process applies concepts from multiple theories.
DIF: Cognitive Level: Application (Applying) REF: 21
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 15. A
nurse uses Maslows hierarchy of needs to plan care for a psychotic patient. Which problem
will receive priority? The patient:
a. refuses to eat or bathe.
b. reports feelings of alienation from family.
c. is reluctant to participate in unit social activities.
d. needs to be taught about medication action and side effects.
ANSWER: A
The need for food and hygiene is physiological and therefore takes priority over
psychological or meta-needs in care planning.
DIF: Cognitive Level: Analysis (Analyzing) REF: 25
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 16. Operant
conditioning will be used to encourage speech in a child who is nearly mute. Which
technique would a nurse include in the treatment plan?
a. Ignore the child for using silence.
b. Have the child observe others talking.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques, then coax speech.
ANSWER: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats
are rewards to reinforce speech. Ignoring the child will not change the behavior. Having the
child observe others describes modeling. Teaching relaxation techniques and then coaxing
speech is an example of systematic desensitization.
DIF: Cognitive Level: Application (Applying) REF: 25
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 17. The parent of a
child diagnosed with schizophrenia tearfully asks a nurse, What could I have done
differently to prevent this illness? Select the nurses most caring response.
a. Although schizophrenia is caused by impaired family relationships, try not to feel guilty.
No one can predict how a child will respond to parental guidance.
b. Most of the damage is done, but there is still hope. Changing your parenting style can
help your child learn to cope more effectively with the environment.
c. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You
are not to blame for your childs illness.
d. Most mental illnesses result from genetic inheritance. Your genes are more at fault than
your parenting.
ANSWER: C
Patients and families need reassurance that the major mental disorders are biological in
origin and are not the fault of parents. Knowing the biological nature of the disorder
relieves feelings of guilt over being responsible for the illness. The incorrect responses are
neither wholly accurate nor reassuring; they fall short of being reassuring and place the
burden of having faulty genes on the shoulders of the parents.
DIF: Cognitive Level: Application (Applying) REF: 30
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. A nurse
uses Peplaus interpersonal therapy while working with an anxious, withdrawn patient.
Interventions should focus on:
a. changing the patients perceptions about self.
b. improving the patients interactional skills.
c. using medications to relieve anxiety.
d. reinforcing specific behaviors.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 17
ANSWER: B
The nurse-patient relationship is structured to provide a model for adaptive interpersonal
relationships that can be generalized to others. Changing the patients perceptions about
his- or herself would be appropriate for cognitive therapy. Reinforcing specific behaviors
would be used in behavioral therapy. Using medications is the focus of biological therapy.
DIF: Cognitive Level: Application (Applying) REF: 28
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 19. A patient
underwent psychotherapy weekly for 3 years. The therapist used free association, dream
analysis, and facilitated transference to help the patient understand unconscious processes
and foster personality changes. Which type of therapy was used?
a. Short-term dynamic psychotherapy
b. Transactional analysis
c. Cognitive therapy
d. Psychoanalysis
ANSWER: D
The therapy described is traditional psychoanalysis. Short-term dynamic psychotherapy
would last less than 1
year. Neither transactional analysis nor cognitive therapy makes use of the techniques
described.
DIF: Cognitive Level: Comprehension (Understanding) REF: 20
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 20. An advanced
practice nurse determines a group of patients would benefit from therapy in which peers
and interdisciplinary staff all have a voice in determining the level of the patients privileges.
The nurse would arrange for:
a. milieu therapy
b. cognitive therapy
c. short-term dynamic therapy
d. systematic desensitization
ANSWER: A
Milieu therapy is based on the idea that all members of the environment contribute to the
planning and functioning of the setting. The other therapies are all individual therapies that
do not fit the description.
DIF: Cognitive Level: Comprehension (Understanding) REF: 36
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 21. A nurse
psychotherapist works with an anxious, dependent patient. The therapeutic strategy most
consistent with the framework of psychoanalytic psychotherapy is: a. emphasizing
medication compliance.
b. identifying the patients strengths and assets.
c. offering psychoeducational materials and groups.
d. focusing on feelings developed by the patient toward the nurse.
ANSWER: D
Positive or negative feelings of the patient toward the nurse or therapist represent
transference. Transference is a psychoanalytic concept that can be used to explore
previously unresolved conflicts. Emphasizing medication compliance is more related to
biological therapy. Identifying patient strengths and assets would be consistent with
supportive psychotherapy. The use of psychoeducational materials is a common homework
assignment used in cognitive therapy.
DIF: Cognitive Level: Application (Applying) REF: 21
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 22. A person
tells a nurse, I was the only survivor in a small plane crash, but three business associates
died. I got anxious and depressed and saw a counselor three times a week for a month. We
talked about my feelings
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 18
related to being a survivor, and now Im fine, back to my old self. Which type of therapy was
used?
a. Milieu therapy
b. Psychoanalysis
c. Behavior modification
d. Interpersonal therapy
ANSWER: D
Interpersonal therapy returns the patient to the former level of functioning by helping the
patient come to terms with the loss of friends and guilt over being a survivor. Milieu
therapy refers to environmental therapy.
Psychoanalysis calls for a long period of exploration of unconscious material. Behavior
modification focuses on changing a behavior rather than helping the patient understand
what is going on in his or her life.
DIF: Cognitive Level: Comprehension (Understanding) REF: 21
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 23. A cognitive
strategy a nurse could use to assist a very dependent patient would be to help the patient:
a. reveal dream content.
b. take prescribed medications.
c. examine thoughts about being autonomous.
d. role model ways to ask for help from others.
ANSWER: C
Cognitive theory suggests that ones thought processes are the basis of emotions and
behavior. Changing faulty learning makes the development of new adaptive behaviors
possible. Revealing dream content would be used in psychoanalytical therapy. Taking
prescribed medications is an intervention associated with biological therapy. A dependent
patient needs to develop independence.
DIF: Cognitive Level: Application (Applying) REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
24. A single parent is experiencing feelings of inadequacy related to work and family since
one teenaged child ran away several weeks ago. The parent seeks the help of a therapist
specializing in cognitive therapy. The psychotherapist who uses cognitive therapy will treat
the patient by: a. discussing ego states.
b. focusing on unconscious mental processes.
c. negatively reinforcing an undesirable behavior.
d. helping the patient identify and change faulty thinking.
ANSWER: D
Cognitive therapy emphasizes the importance of changing erroneous ways people think
about themselves.
Once faulty thinking changes, the individuals behavior changes. Focusing on unconscious
mental processes is a psychoanalytic approach. Negatively reinforcing undesirable
behaviors is behavior modification, and discussing ego states relates to transactional
analysis.
DIF: Cognitive Level: Comprehension (Understanding) REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 25. A person
received an invitation to be in the wedding of a friend who lives across the country. The
individual is afraid of flying. What type of therapy should the nurse recommend?
a. Psychoanalysis
b. Milieu therapy
c. Systematic desensitization
d. Short-term dynamic therapy
ANSWER: C
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior,
such as the fear of flying. Psychoanalysis and short-term dynamic therapy are aimed at
uncovering conflicts. Milieu therapy involves environmental factors.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 19
DIF: Cognitive Level: Analysis (Analyzing) REF: 25
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE
1. A basic level registered nurse works with patients in a community setting. Which groups
should this nurse expect to lead? Select all that apply.
a. Symptom management
b. Medication education
c. Family therapy
d. Psychotherapy
e. Self-care
ANSWER:
A, B, E
Symptom management, medication education, and self-care groups represent
psychoeducation, a service provided by the basic level registered nurse. Advanced practice
registered nurses provide family therapy and psychotherapy.
DIF: Cognitive Level: Application (Applying) REF: 34
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2.
A patient states, Im starting cognitive behavioral therapy. What can I expect from the
sessions? Which responses by the nurse are appropriate? Select all that apply.
a. The therapist will be active and questioning.
b. You may be given homework assignments.
c. The therapist will ask you to describe your dreams.
d. The therapist will help you look at ideas and beliefs you have about yourself.
e. The goal is to increase your subjectivity about thoughts that govern your behavior.
ANSWER: A, B, D
Cognitive therapists are active rather than passive during therapy sessions because they
help patients to reality test their thinking. Homework assignments are given and completed
outside the therapy sessions. Homework is usually discussed at the next therapy session.
The goals of cognitive therapy are to assist the patient to identify inaccurate cognitions, to
reality test their thinking, and to formulate new, accurate cognitions. Dream describing
applies to psychoanalysis, not cognitive behavioral therapy. The desired outcome of
cognitive therapy is to assist patients in increasing their objectivity, not subjectivity, about
the cognitions that influence behavior.
DIF: Cognitive Level: Application (Applying) REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 20
Chapter 04: Biological Basis for Understanding Psychopharmacology MULTIPLE CHOICE
1. A patient asks a nurse, What are neurotransmitters? My doctor says mine are out of
balance. The best reply would be:
a. You must feel relieved to know that your problem has a physical basis.
b. Neurotransmitters are chemicals that pass messages between brain cells.
c. It is a high-level concept to explain. You should ask the doctor to tell you more.
d. Neurotransmitters are substances we eat daily that influence memory and mood.
ANSWER: B
Stating that neurotransmitters are chemicals that pass messages between brain cells gives
the most accurate information. Neurotransmitters are messengers in the central nervous
system. They are released from the axon terminal, diffuse across the synapse, and attach to
specialized receptors on the postsynaptic neuron. The incorrect responses do not answer
the patients question, are demeaning, and provide untrue and misleading information.
DIF: Cognitive Level: Comprehension (Understanding) REF: 39
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. The parent
of an adolescent diagnosed with schizophrenia asks a nurse, My childs doctor ordered a
positron-emission tomography (PET) scan. What is that? Select the nurses best reply.
a. PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does
your teenager have any metal implants?
b. Its a special type of x-ray image that shows structures of the brain and whether a brain
injury has ever occurred.
c. PET is a scan that passes an electrical current through the brain and shows brain wave
activity. PET can help diagnose seizures.
d. PET is a special scan that shows blood flow and activity in the brain.
ANSWER: D
The parent is seeking information about PET scans. It is important to use terms the parent
can understand. The correct option is the only reply that provides factual information
relevant to PET scans. The incorrect responses describe magnetic resonance imaging (MRI),
computed tomographic (CT) scans, and electroencephalography (EEG).
DIF: Cognitive Level: Application (Applying) REF: 38
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 3. A patient has
dementia. The health care provider wants to make a differential diagnosis between
Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse
expect to prepare the patient for first?
a. Computed tomography (CT) scan
b. Positron emission tomography (PET) scan
c. Functional magnetic resonance imaging (fMRI)
d. Single-photon emission computed tomography (SPECT) scan ANSWER: A
A CT scan shows the presence or absence of structural changes, including cortical atrophy,
ventricular enlargement, and areas of infarctioninformation that will be helpful to the
health care provider. The other tests focus on brain activity and are more expensive; they
may be ordered later.
DIF: Cognitive Level: Analysis (Analyzing) REF: 38
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 4. A patient has
delusions and hallucinations. Before beginning treatment with a psychotropic medication,
the health care provider wants to rule out the presence of a brain tumor. For which test will
a nurse need to prepare the patient?
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 21
a. Cerebral arteriogram
b. Functional magnetic resonance imaging (fMRI)
c. Computed tomography (CT) scan or magnetic resonance imaging (MRI) d. Positron
emission tomography (PET) or single-photon emission computed tomography (SPECT)
ANSWER: C
A CT scan and an MRI visualize neoplasms and other structural abnormalities. A PET scan,
SPECT scan, and fMRI, which give information about brain function, are not indicated. An
arteriogram would not be appropriate.
DIF: Cognitive Level: Application (Applying) REF: 38
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 5. The nurse wants to
assess for disturbances in circadian rhythms in a patient admitted for major depressive
disorder. Which question best implements this assessment?
a. Do you ever see or hear things that others do not?
b. Do you have problems with short-term memory?
c. What are your worst and best times of day?
d. How would you describe your thinking?
ANSWER: C
Mood changes throughout the day are related to circadian rhythms. Questions about sleep
pattern would also be relevant to circadian rhythms. The question about seeing or hearing
things is relevant to the assessment for illusions and hallucinations. The question about
thinking is relevant to the assessment of thought processes.
The other question is relevant to assessment of memory.
DIF: Cognitive Level: Application (Applying) REF: 38
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 6. A nurse
administers a medication that potentiates the action of gamma-aminobutyric acid (GABA).
Which finding would be expected?
a. Reduced anxiety
b. Improved memory
c. More organized thinking
d. Fewer sensory perceptual alterations
ANSWER: A
Increased levels of GABA reduce anxiety; thus any potentiation of GABA action should
result in anxiety reduction. Memory enhancement is associated with acetylcholine and
substance P. Thought disorganization is associated with dopamine. GABA is not associated
with sensory perceptual alterations.
DIF: Cognitive Level: Application (Applying) REF: 48
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 7. On the basis of
current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan
for a patient with memory difficulties may include medications designed to: a. inhibit GABA
production.
b. increase dopamine sensitivity.
c. decrease dopamine at receptor sites.
d. prevent destruction of acetylcholine.
ANSWER: D
Increased acetylcholine plays a role in learning and memory. Preventing the destruction of
acetylcholine by acetylcholinesterase results in higher levels of acetylcholine, with the
potential for improved memory. GABA is known to affect anxiety level rather than memory.
Increased dopamine causes symptoms associated with schizophrenia or mania rather than
improves memory. Decreasing dopamine at receptor sites is associated with Parkinson
disease rather than improving memory.
DIF: Cognitive Level: Comprehension (Understanding) REF: 41
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 22
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 8. A patient has
disorganized thinking associated with schizophrenia. Neuroimaging would most likely
show dysfunction in which part of the brain?
a. Brainstem
b. Cerebellum
c. Temporal lobe
d. Prefrontal cortex
ANSWER: D
The prefrontal cortex is responsible for intellectual functioning. The temporal lobe is
responsible for the sensation of hearing. The cerebellum regulates skeletal muscle
coordination and equilibrium. The brainstem regulates internal organs.
DIF: Cognitive Level: Application (Applying) REF: 35
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. A nurse should
assess a patient taking a medication with anticholinergic properties for inhibited function
of the:
a. parasympathetic nervous system.
b. sympathetic nervous system.
c. reticular activating system.
d. medulla oblongata.
ANSWER: A
Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic
nervous system.
When acetylcholine action is inhibited by anticholinergic drugs, parasympathetic
symptoms such as blurred vision, dry mouth, constipation, and urinary retention appear.
The functions of the sympathetic nervous system, the reticular activating system, and the
medulla oblongata are not affected by anticholinergic medications.
DIF: Cognitive Level: Comprehension (Understanding)
REF: 39
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 10. The therapeutic
action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake,
causing:
a. increased concentration of neurotransmitters in the synaptic gap.
b. decreased concentration of neurotransmitters in serum.
c. destruction of receptor sites.
d. limbic system stimulation.
ANSWER: A
If the reuptake of a substance is inhibited, then it accumulates in the synaptic gap and its
concentration increases, permitting the ease of the transmission of impulses across the
synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with a
normal rather than a depressed mood. The other options are not associated with blocking
neurotransmitter reuptake.
DIF: Cognitive Level: Comprehension (Understanding) REF: 46
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. A patient
taking medication for mental illness develops restlessness and an uncontrollable need to be
in motion. A nurse can correctly analyze that these symptoms are related to which drug
action?
a. Anticholinergic effects
b. Dopamine-blocking effects
c. Endocrine-stimulating effects
d. Ability to stimulate spinal nerves
ANSWER: B
Medications that block dopamine often produce disturbances of movement such as
akathisia because dopamine
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 23
affects neurons involved in both the thought processes and movement regulation.
Anticholinergic effects include dry mouth, blurred vision, urinary retention, and
constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.
DIF: Cognitive Level: Application (Applying) REF: 46
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 12. A patient has
anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high
concentration of which neurotransmitter?
a. GABA
b. Histamine
c. Acetylcholine
d. Norepinephrine
ANSWER: D
Norepinephrine is the neurotransmitter associated with sympathetic nervous system
stimulation, preparing the individual for the fight or flight response. GABA is a mediator of
anxiety level. A high concentration of histamine is associated with an inflammatory
response. A high concentration of acetylcholine is associated with parasympathetic nervous
system stimulation.
DIF: Cognitive Level: Application (Applying) REF: 44
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 13. A patient has
symptoms of acute anxiety related to the death of a parent in an automobile accident 2
hours earlier. The nurse should anticipate administering a medication from which group?
a. Tricyclic antidepressants
b. Atypical antipsychotics
c. Anticonvulsants
d. Benzodiazepines
ANSWER: D
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat
symptoms of depression.
Anticonvulsants are used to treat bipolar disorder or seizures. Antipsychotic drugs are used
to treat psychosis.
DIF: Cognitive Level: Application (Applying) REF: 48
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 14. A patient is
hospitalized for major depressive disorder. Of the medications listed, a nurse can expect to
provide the patient with teaching about:
a. chlordiazepoxide (Librium).
b. fluoxetine (Prozac).
c. clozapine (Clozaril).
d. tacrine (Cognex).
ANSWER: B
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), an antidepressant that blocks
the reuptake of serotonin with few anticholinergic and sedating side effects; clozapine
(Clozaril) is an antipsychotic medication; chlordiazepoxide (Librium) is an anxiolytic drug;
and tacrine (Cognex) is used to treat Alzheimer disease.
DIF: Cognitive Level: Application (Applying) REF: 42
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 15. A patient
hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A
nurse begins the care plan based on the expectation that the health care provider is most
likely to prescribe a medication classified as a(n):
a. anticholinergic.
b. mood stabilizer.
c. psychostimulant.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 24
d. tricyclic antidepressant.
ANSWER: B
The symptoms describe a manic attack. Mania is effectively treated by the antimanic drug
lithium and selected anticonvulsants such as carbamazepine, valproic acid, and lamotrigine.
No drugs from the other classifications listed are effective in the treatment of mania.
DIF: Cognitive Level: Application (Applying) REF: 49
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 16. A drug causes
muscarinic-receptor blockade. A nurse will assess the patient for: a. dry mouth.
b. gynecomastia.
c. pseudoparkinsonism.
d. orthostatic hypotension.
ANSWER: A
Muscarinic-receptor blockade includes atropine-like side effects such as dry mouth, blurred
vision, and constipation. Gynecomastia is associated with decreased prolactin levels.
Movement defects are associated with dopamine blockade. Orthostatic hypotension is
associated with alpha1-receptor antagonism.
DIF: Cognitive Level: Application (Applying) REF: 50
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 17. A patient begins
therapy with a phenothiazine medication. What teaching should a nurse provide related to
the drugs strong dopaminergic effect?
a. Chew sugarless gum.
b. Increase dietary fiber.
c. Arise slowly from bed.
d. Report muscle stiffness.
ANSWER: D
Phenothiazines are conventional antipsychotic medications that block dopamine receptors
in both the limbic system and basal ganglia. Dystonia is likely to occur early in the course of
treatment and is often heralded by sensations of muscle stiffness. Early intervention with
an antiparkinsonian medication can increase the patients comfort and prevent dystonic
reactions.
DIF: Cognitive Level: Application (Applying) REF: 50
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. A nurse can
anticipate anticholinergic side effects are likely to occur when a patient is taking: a. lithium
(Lithobid).
b. buspirone (BuSpar).
c. risperidone (Risperdal).
d. fluphenazine (Prolixin).
ANSWER: D
Fluphenazine, a first-generation antipsychotic medication, exerts muscarinic blockade,
resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy
is more often associated with fluid balance problems, including polydipsia, polyuria, and
edema. Risperidone therapy is more often associated with movement disorders, orthostatic
hypotension, and sedation. Buspirone is associated with anxiety reduction without major
side effects.
DIF: Cognitive Level: Application (Applying) REF: 50
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 19. Priority teaching
for a patient taking clozapine (Clozaril) should include which instruction?
a. Report sore throat and fever immediately.
b. Avoid foods high in polyunsaturated fat.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 25
c. Use water-based lotions for rashes.
d. Avoid unprotected sex.
ANSWER: A
Clozapine therapy may produce agranulocytosis; therefore signs of infection should be
immediately reported to the health care provider. In addition, the patient should have white
blood cell levels measured weekly. The other options are not relevant to clozapine
administration.
DIF: Cognitive Level: Application (Applying) REF: 51
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 20. A nurse cares for
patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol),
trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the
patient taking: a. buspirone.
b. haloperidol.
c. trazodone.
d. phenelzine.
ANSWER: D
Patients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent
hypertensive crisis.
DIF: Cognitive Level: Application (Applying) REF: 46
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 21. A nurse caring for
a patient taking a serotonin reuptake inhibitor (SSRI) will develop outcome criteria related
to:
a. mood improvement.
b. logical thought processes.
c. reduced levels of motor activity.
d. decreased extrapyramidal symptoms.
ANSWER: A
SSRIs affect mood, relieving depression in many patients. SSRIs do not act to reduce
thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity.
SSRIs do not produce extrapyramidal symptoms.
DIF: Cognitive Level: Application (Applying) REF: 46
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 22. A patients spouse,
who is a chemist, asks a nurse how serotonin reuptake inhibitors (SSRIs) lift depression.
The nurse should explain that SSRIs:
a. destroy increased amounts of neurotransmitters.
b. make more serotonin available at the synaptic gap.
c. increase production of acetylcholine and dopamine.
d. block muscarinic and alpha1-norepinephrine receptors.
ANSWER: B
Depression is thought to be related to the lowered availability of the neurotransmitter
serotonin. SSRIs act by blocking the reuptake of serotonin, leaving a higher concentration
available at the synaptic cleft. They actually prevent the destruction of serotonin, have no
effect on acetylcholine and dopamine production, and do not block muscarinic or alpha1norepinephrine receptors.
DIF: Cognitive Level: Comprehension (Understanding) REF: 46
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 23. A patient
has taken many conventional antipsychotic drugs over years. The health care provider, who
is concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A
nurse planning care for this patient understands that atypical antipsychotics: a. are less
costly.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 26
b. have higher potency.
c. are more readily available.
d. produce fewer motor side effects.
ANSWER: D
Atypical antipsychotic drugs often exert their action on the limbic system rather than the
basal ganglia. The limbic system is not involved in motor disturbances. Atypical
antipsychotic medications are not more readily available. They are not considered to be of
higher potency; rather, they have different modes of action.
Atypical antipsychotic drugs tend to be more expensive.
DIF: Cognitive Level: Comprehension (Understanding) REF: 40
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 24. The laboratory
report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3
and a granulocyte count of 1500 mm3. The nurse should: a. report the laboratory results to
the health care provider.
b. give the next dose as prescribed.
c. administer aspirin and force fluids.
d. repeat the laboratory tests.
ANSWER: A
These laboratory values indicate the possibility of agranulocytosis, a serious side effect of
clozapine therapy.
These results must be immediately reported to the health care provider. The drug should be
withheld because the health care provider will discontinue it. The health care provider may
repeat the laboratory test, but, in the meantime, the drug should be withheld. Giving aspirin
and forcing fluids are measures that are less important than stopping the administration of
the drug.
DIF: Cognitive Level: Analysis (Analyzing) REF: 51
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 25. A nurse
administering psychotropic medications should be prepared to intervene when giving a
drug that blocks the attachment of norepinephrine to alpha1 receptors because the patient
may experience: a. increased psychotic symptoms.
b. severe appetite disturbance.
c. orthostatic hypotension.
d. hypertensive crisis.
ANSWER: C
Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure
in the upright position. Blockage of alpha1 receptors leads to vasodilation and orthostatic
hypotension. Orthostatic hypotension may cause fainting and falls. Patients should be
taught ways of minimizing this phenomenon.
DIF: Cognitive Level: Application (Applying)
REF: 39
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity MULTIPLE
RESPONSE
1. A nurse prepares to administer an antipsychotic medication to a patient diagnosed with
schizophrenia.
Additional monitoring of the medications effects and side effects will be most important if
the patient is also diagnosed with which health problem? Select all that apply.
a. Parkinson disease
b. Graves disease
c. Osteoarthritis
d. Epilepsy
e. Diabetes
ANSWER:
A, D, E
Antipsychotic medications may produce weight gain, which complicates the care of a
patient with diabetes or
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 27
lowers the seizure threshold or both, which complicates the care of a patient with epilepsy.
Parkinson disease involves changes in transmission of dopamine and acetylcholine;
therefore these drugs also complicate the care of a patient with the disorder. Osteoarthritis
and Graves disease should have no synergistic effect with this medication.
DIF: Cognitive Level: Analysis (Analyzing) REF: 50
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 2. The spouse of a
patient diagnosed with schizophrenia asks, Which neurotransmitters are more active when
a person has schizophrenia? The nurse should state, The current thinking is that the
thought disturbances are related to increased activity of: (Select all that apply.) a. GABA.
b. substance P.
c. histamine.
d. dopamine.
e. norepinephrine.
ANSWER: D, E
Dopamine plays a role in the integration of thoughts and emotions, and excess dopamine is
implicated in the thought disturbances of schizophrenia. Increased activity of
norepinephrine also occurs. Substance P is most related to the pain experience. Histamine
decrease is associated with depression. Increased GABA is associated with anxiety
reduction.
DIF: Cognitive Level: Application (Applying) REF: 40
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 3. An individual
is experiencing problems associated with memory. Which cerebral structures are most
likely to be involved in this deficit? Select all that apply.
a. Prefrontal cortex
b. Occipital lobe
c. Temporal lobe
d. Parietal lobe
e. Basal ganglia
ANSWER: A, C,
D
The prefrontal cortex, parietal, and temporal lobes of the cerebrum play a key role in the
storage and processing of memories. The occipital lobe is predominantly involved with
vision. The basal ganglia influence the integration of physical movement, as well as some
thoughts and emotions.
DIF: Cognitive Level: Comprehension (Understanding) REF: 35
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 28
Chapter 05: Settings for Psychiatric Care
MULTIPLE CHOICE
1. Planning for patients with mental illness is facilitated by understanding that inpatient
hospitalization is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
c. have no support systems in the community.
d. develop new symptoms during the course of an illness.
ANSWER: A
Hospitalization is justified when the patient is a danger to self or others, has dangerously
decompensated, or needs intensive medical treatment. The incorrect options do not
necessarily describe patients who require inpatient treatment.
DIF: Cognitive Level: Comprehension (Understanding) REF: 56
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 2. A patient
is hospitalized for a reaction to a psychotropic medication and then is closely monitored for
24
hours. During a predischarge visit, the case manager learns the patient received a notice of
eviction on the day of admission. The most appropriate intervention for the case manager is
to: a. cancel the patients discharge from the hospital.
b. contact the landlord who evicted the patient to discuss the situation.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
d. document that the adverse medication reaction was feigned because the patient had
nowhere to live.
ANSWER: C
The case manager should intervene by arranging temporary shelter for the patient until
suitable housing can be found. This is part of the coordination and delivery of services that
falls under the case manager role. The other options are not viable alternatives.
DIF: Cognitive Level: Application (Applying) REF: 56
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 3. A
multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after
a suicide attempt. Members of the team report their assessments. What outcome can be
expected from this meeting?
a. A treatment plan will be formulated.
b. The health care provider will order neuroimaging studies.
c. The team will request a court-appointed advocate for the patient.
d. Assessment of the patients need for placement outside the home will be undertaken.
ANSWER: A
Treatment plans are formulated early in the course of treatment to streamline the
treatment process and reduce costs. It is too early to determine the need for alternative
post-discharge living arrangements. Neuroimaging is not indicated for this scenario.
DIF: Cognitive Level: Application (Applying) REF: 56
TOP: Nursing Process: Outcomes Identification MSC:
NCLEX: Safe, Effective Care Environment
4. The relapse of a patient diagnosed with schizophrenia is related to medication
noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the
patients thoughts are now more organized. The patients family members are upset and say,
Its too soon for discharge. Hospitalization is needed for at least a month.
The nurse should:
a. call the psychiatrist to come explain the discharge rationale.
b. explain that health insurance will not pay for a longer stay for the patient.
c. call security to handle the disturbance and escort the family off the unit.
d. explain that the patient will continue to improve if medication is taken regularly.
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 29
ANSWER: D
Patients no longer stay in the hospital until every vestige of a symptom disappears. The
nurse must assume responsibility to advocate for the patients right to the least restrictive
setting as soon as the symptoms are under control and for the right of citizens to control
health care costs. The health care provider will use the same rationale. Shifting blame will
not change the discharge. Calling security is unnecessary. The nurse can handle this matter.
DIF: Cognitive Level: Application (Applying) REF: 59
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 5. A
nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no
one is smoking, the janitors closet is locked, and all sharp objects are being used under staff
supervision. These observations relate to:
a. management of milieu safety.
b. coordinating care of patients.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
ANSWER: A
Members of the nursing staff are responsible for all aspects of milieu management. The
observations mentioned in this question directly relate to the safety of the unit. The other
options, although part of the nurses concerns, are unrelated to the observations cited.
DIF: Cognitive Level: Application (Applying) REF: 56
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 6.
The following patients are seen in the emergency department. The psychiatric unit has one
bed available.
Which patient should the admitting officer recommend for admission to the hospital? The
patient who: a. is experiencing dry mouth and tremor related to side effects of haloperidol
(Haldol).
b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years.
c. self-inflicted a superficial cut on the forearm after a family argument.
d. is a single parent and hears voices saying, Smother your infant.
ANSWER: D
Admission to the hospital would be justified by the risk of patient danger to self or others.
The other patients have issues that can be handled with less restrictive alternatives than
hospitalization.
DIF: Cognitive Level: Analysis (Analyzing) REF: 56
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis MSC: NCLEX: Safe, Effective
Care Environment
7. A student nurse prepares to administer oral medications to a patient diagnosed with
major depressive disorder, but the patient refuses the medication. The student nurse
should: a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication.
b. tell the patient, Refusing your medication is not permitted. You are required to take it.
c. discuss the patients concerns about the medication, and report to the staff nurse.
d. document the patients refusal of the medication without further comment.
ANSWER: C
The patient has the right to refuse medication in most cases. The patients reason for
refusing should be ascertained, and the refusal should be reported to a unit nurse.
Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats
and manipulation are inappropriate. Medication refusal should be reported to permit
appropriate intervention.
DIF: Cognitive Level: Application (Applying) REF: 59
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 8. A
nurse surveys the medical records for violations of patients rights. Which finding signals a
violation?
Test Bank: Essentials of Psychiatric Mental Health Nursing (5th Edition by Varcarolis) 30
a. No treatment plan is present in record.
b. Patient belongings are searched at admission.
c. Physical restraint is used to prevent harm to self.
d. Patient is placed on one-to-one continuous observation.
ANSWER: A
The patient has the right to have a treatment plan. Inspecting a patients belongings is a
safety measure. Patients have the right to a safe environment, including the right to be
protected against impulses to harm self that occur as a result of a mental disorder.
DIF: Cognitive Level: Application (Applying) REF: 56
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 9. Which
principle takes priority for the psychiatric inpatient staff when addressing behavioral
crises?
a. Resolve behavioral crises using the least restrictive intervention possible.
b. Rights of the majority of patients supersede the rights of individual patients.
c. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
d. Allow patients opportunities to regain control without intervention if the safety of other
patients is not compromised.
ANSWER: A
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IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
donc8246@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT