TEST BANK FOR
Varcarolis Essentials of Psychiatric Mental
Health Nursing 4th Edition by Fosbre,
All Chapters 1 – 28 Full Complete
TABLE OF CONTENTS
Chapter 01: Practicing the Science and the Art of Psychiatric Nursing
MULTIPLECHOICE
1. Which outcome, focused on recovery, would be expected in the plan of care for a
patient living in the community and diagnosed with serious and persistent mental
illness? Within 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. Which statement is an example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your
depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.
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 nontherapeutic.
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. Select the 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 (4th 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 prejudiced information?
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. Two nursing students discuss career plans after graduation. One student wants
to enterpsychiatric 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-topatient 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 4- year-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 (4th 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
self- absorption 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 (4th 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 (4th 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
self- absorption. 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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 alpha1- norepinephrine 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 (4th 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 (4th 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 (4th 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 (4th 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 (4th 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
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
donc8246@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
donc8246@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT