MH 1

18) The patient's family brings him to the emergency department because he has been threatening suicide. The patient tells the nurse that he is too hungry to talk and she should just go away. The nurse decides to bring the patient some food before she does a complete assessment. Whose theory would most support the nurse's action? 1. Peplau 2. Orlando 3. Neuman 4. Leininger

Explanation: 2. Orlando focuses on responding to the patient's immediate needs. Peplau's theory emphasizes the psychodynamic process. Neuman sees the client as a system that seeks homeostasis. Leininger addresses cultural beliefs and values.

22) Which nursing model was developed by Catherine McCauley in 19th century Ireland? 1. Careful nursing 2. Tidal model of care 3. Healing environment 4. Curative point nursing

Answer: 1 Explanation: 1. "Careful nursing" was a 19th-century model of nursing care developed in Ireland by Catherine McCauley. This model provided an early contribution to holistic psychiatric mental health nursing. Matilda Coskery, a Sisters of Charity nurse, wrote about the "curative point" in the care of clients. The Sisters of Charity also promoted the idea of a healing environment. Dr. Phil Barker, a British psychiatric nurse, is known internationally for creating the Tidal Model of Care, a philosophical approach to mental health.

20) A Native American patient diagnosed with lung cancer wants to have a shaman come to the hospital to perform a healing ceremony at his bedside. Using Leininger's theory, how should the nurse respond? 1. "I will help arrange the visit for you." 2. "That is not an acceptable part of hospital procedures." 3. "It might interfere with your current course of treatment." 4. "It is not a good idea because it might upset the other patients."

Answer: 1 Explanation: 1. According to Leininger, the role of the nurse is to provide culturally congruent care. The nurse's first obligation is to her patient. She can help mitigate any impact the ceremony may have on the other patients. There is no indication that the shaman's visit would interfere with other treatment. Care procedures should support an individual's values and beliefs.

1) A nurse observes that a patient appears scared during a.m. assessment. Which of the ABCs of psychiatry is the nurse observing? 1. Affect 2. Attitude 3. Behavior 4. Cognition

Answer: 1 Explanation: 1. Affect is an observable emotion expressed in the moment. Attitude describes an interaction, orientation, or state of attention. Behavior describes social relating and psychomotor activity. Cognition addresses several functions including thought processes, content, memory, and judgment.

4) A nurse is preparing a paper for a conference on mental illness nursing throughout history. How does she present the concept of a curative pointas a shift in the treatment of the mentally ill? 1. It envisioned the possibility of recovery in mental illness. 2. It incorporated herbal remedies in the treatment of mental illness. 3. It was the first treatment to provide specific treatment interventions. 4. It was the first treatment focused on the humane treatment of individuals with mental illness.

Answer: 1 Explanation: 1. Although treatment that emphasized a curative point may have had some more humane aspects that were absent from some earlier treatments for mental illness, humane treatment was not the most essential element incorporated in this concept. Belief in a curative point presented the possibility that those with mental illness could actually improve rather than just be maintained. The curative point did not emphasize specific interventions, nor did it advocate specific herbal remedies.

27) The patient with a history of schizophrenia presents in the emergency department with delusions, hallucinations, and unsafe behavior. The nurse learns the patient has completed an advance directive agreeing to hospitalization should decompensation occur. How would the current admission be categorized? 1. Voluntary admission 2. Involuntary commitment 3. Temporary involuntary admission 4. Emergency involuntary admission

Answer: 1 Explanation: 1. Because the patient has a psychiatric advance directive, he is admitted as a voluntary admission. He is currently a danger to himself. If he did not have an advanced directive, he would be eligible to be admitted as an emergency involuntary patient. This case does not describe either temporary involuntary admission or an involuntary commitment.

13) The nurse is caring for a patient with a sleep disorder who tells the nurse that she is considering drinking chamomile tea at night in order to help her sleep. The nurse knows to provide patient education to avoid concurrent use of chamomile with which class of medication? 1. Anticoagulant 2. Anticholinergic 3. Antidepressant 4. Antiemetic

Answer: 1 Explanation: 1. Chamomile may interact with anticoagulants. Chamomile does not interact with anticholinergics, antidepressants, or antiemetics.

16) A nurse manager experiences an increased heart rate, GI discomfort, and perspiration when preparing to give presentations to his staff. He has prepared three presentations, and his charge nurse has given them all. The nurse manager knows he is experiencing which level of anxiety and that which treatment will help? 1. Trait anxiety; Thiamine therapy 2. State anxiety; propranolol (Inderal) 3. Panic anxiety; buspirone (Buspar) 4. Moderate anxiety; alprazalom (Xanax)

Answer: 1 Explanation: 1. Chronic or trait anxiety is a more general and long-lasting personality characteristic in which the patient has difficulty performing at work and/or enjoying relationships. Herbs, vitamins, and other supplements can be used to treat anxiety disorders. B vitamins are important for the production of neurotransmitters and thiamine is important for those prone to panic, anxiety, and depression. The other states of anxiety and medications do not address the characteristics of trait anxiety and its effective treatment.

32) A patient who is taking olanzepine (Zyprexa) also smokes. Which will the nurse include when discussing use of Zyprexa with this patient? 1. Smoking can diminish the effect of Zypreza. 2. Zyprexa will increase the negative effects of smoking. 3. Smoking can increase the possible toxicity of Zyprexa. 4. Smoking is bad for the patient's health but will not interact with Zyprexa.

Answer: 1 Explanation: 1. Cigarette smoking is an inducer of CYP 1A2 and can diminish the effect of Zyprexa. Smoking does not increase the toxicity of Zyprexa, nor does Zyprexa increase the negative effects of smoking. Smoking does interact with Zyprexa.

32) A nurse is making a presentation to her administration on the need for a room that is comfortable, light, and calming that a patient can use during times of stress. What is the best argument for encouraging implementation at this facility? 1. It has been proven effective. 2. It is required for accreditation. 3. It will be liked by the patients. 4. It presents a more up-to-date care image

Answer: 1 Explanation: 1. Evidence-based practice is the best argument for implementing new practices. Image and accreditation requirements are important but should be secondary considerations. Patient preferences should be considered but effective outcomes are most important.

5) When assessing a patient with chronic anxiety, the nurse notes that the patient also suffers from frequent infections. Which is most likely the reason for the patient's frequent infections? 1. Trait anxiety leads to immune system compromise. 2. Trait anxiety is a defense mechanism for psychological illness. 3. Proteins released by immune cells indirectly influence brain activity. 4. Psychological illness occurs due to a lack of interpersonal relationships, resulting in manifestations of physiological illness.

Answer: 1 Explanation: 1. Factors affecting mental illnesses are thought to include a combination of genetic, environmental, psychological, and developmental influences. Chronic anxiety (also known as trait anxiety) leads to immune system compromise. Trait anxiety is not a defense mechanism. Cytokines are proteins released by immune cells that influence brain activity; however, these proteins directly, not indirectly, influence brain activity. Alterations of interpersonal relationships and their connection to psychological illness are not likely to result in infection.

12) What factors influence the metabolic liver enzymes contained in the cytochrome P450 system? 1. Genetics 2. Excretion 3. Drug half-life 4. Acid-base balance in the body

Answer: 1 Explanation: 1. Genetic differences influence the enzymatic process. Excretion is a result of the enzymatic process. The drug's half-life is influenced by the liver's enzymatic process, not the reverse. Acid-base balance is a renal function.

32) The novice nurse is learning about the barriers to communication within the therapeutic nurse-patient relationship and the various types of communication that block the therapeutic relationship. What will the nurse recognize as a barrier to the therapeutic relationship? 1. Giving advice 2. Voicing doubt 3. Giving information 4. Seeking clarification

Answer: 1 Explanation: 1. Giving advice is a barrier to therapeutic communication because it involves the nurse identifying his or her own personal thoughts, experiences, or views and placing them above or projecting them onto the patient's situation or concerns. Giving information, seeking clarification, and voicing doubt are all therapeutic communication techniques.

13) When planning care for patients on the mental health unit, which statement will the nurse consider as using principles associated with the humanistic theory? 1. Emotional stress has a holistic relationship to physical symptoms. 2. Patients rely on providers to develop solutions for their problems. 3. The mind-body relationship focuses on biological explanations of illness. 4. Clinical interventions are most effective when they focus on the current actions, feelings, and concerns of clients.

Answer: 1 Explanation: 1. Humanistic theory views physical and mental factors as interrelated and recognizes that a change in one may result in a change in another. This holistic perspective is the major concept of the humanistic theory. Principles of this theory stress that people have the power or potential to solve their own problems and are not passive recipients of care given by psychiatric professionals. Individuals are influenced by their past and the full range of life experiences, not simply by the present situation.

2) A 54-year-old patient tells the nurse that she is very upset that her son has become involved in demonstrations protesting corporate lobbying. Which of Kohlberg's stages of moral development does the nurse identify as her patient's current stage? 1. Adaptation 2. Assimilation 3. Conventional 4. Pre-conventional

Answer: 1 Explanation: 1. In the conventional stage, the individual focuses on doing his or her duty to keep the social order, which the patient would prefer her son to do. Adaptation and assimilation are concepts of Piaget's cognitive theory, not Kohlberg's stages of moral development. The pre-conventional stage is characterized by avoidance of punishment.

3) A 74-year-old male patient is distressed that he has not accomplished all that he hoped to in his life. Based on Erikson's developmental stages, which conflict does the nurse consider this patient to be experiencing? 1. Integrity vs. despair 2. Generativity vs. stagnation 3. Identity vs. identity confusion 4. Autonomy vs. shame and doubt

Answer: 1 Explanation: 1. Integrity vs. despair occurs during late adulthood and involves finding satisfaction or dissatisfaction from examining one's past. Generativity vs. stagnation happens during middle adulthood and involves accomplishment and concern for future generations. Identity vs. identity confusion is characteristic of an adolescent developing a sense of self. Autonomy vs. shame and doubt is the toddler's developmental stage.

17) The nursing student is preparing a presentation for the class on the relationship of ligands to receptors. Which explanation should the student include in the presentation? 1. "The drug ligand works like a key that fits into a lock, which is the receptor protein in the neuron." 2. "The drug ligand is the door that opens into the house, which is the neuron." 3. "The receptor protein is like a flame that ignites the stove, which is the drug ligand." 4. "The drug ligand works like a comforter, providing a protective cover for the receptor protein."

Answer: 1 Explanation: 1. Like a key (drug ligand molecule) fitting into a lock (receptor protein in the neuron cell), the drug molecule ligand tells the protein receptor in the neuron cell to do something (open the gate). The other images (door into a house, flame on a stove, comforter on a bed) do not convey the interaction of the ligand and receptor that results in specific activity.

25) Which intervention demonstrates the nurse's sensitivity toward the teen who is admitted with a diagnosis of depression? 1. Listening to the patient's feelings 2. Using closed-ended questions with the patient 3. Asking for details to demonstrate interest in the patient 4. Avoiding the use of silence with the patient to decrease anxiety

Answer: 1 Explanation: 1. Listening to the patient's feelings helps to communicate the patient's value and is part of demonstrating sensitivity to the patient. Closed-ended questions limit the quality of the patient's responses, minimizing opportunity for the patient to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

24) What was the treatment model used by Matilda Coskery? 1. Moral therapy 2. Biomedical treatment 3. Interpersonal therapy 4. Brief solution-focused therapy

Answer: 1 Explanation: 1. Matilda Coskery was a practitioner of moral therapy and administered the Mount Hope Retreat. Biomedical therapy reflects the position that nurses are adjuncts to physician directed treatment. Interpersonal therapy was promoted by Hilda Peplau. Brief solution-focused therapy is a modality recently used by some advanced nurse-practitioners.

16) Several nurses are discussing the effect of the medicalization of care on nursing patients with mental illness. What statement indicates that the nurses understand this historical trend? 1. "Medicalization tended to pull care away from its holistic tradition." 2. "Medicalization provided an essential basis for nursing education." 3. "Medicalization reflected a diminished interest in psychopathology." 4. "Medicalization provided a good understanding of the mind-body connection."

Answer: 1 Explanation: 1. Medicalization served to diminish interest in the mind-body connection and pulled nursing away from its traditional interest in caring for the whole person. With medicalization, nursing training lost some of its focus on nursing as a singular discipline. Psychopathology rather than healing was emphasized with medicalization.

20) The nurse is working in a facility that uses music as therapy. What is true regarding this therapy? 1. Music therapy decreases blood pressure and heart rate in patients with coronary heart disease. 2. Music therapy uses high frequency music that is played for an hour at a time. 3. Music therapy decreases cholesterol and homocysteine levels in patients with coronary heart disease. 4. Music therapy uses low frequency music that is played for two hours at a time.

Answer: 1 Explanation: 1. Music therapy is used for reducing anxiety in a variety of clinical settings. Listening to music may help reduce heart rate and blood pressure in patients with coronary heart disease. Music therapy has not been shown to decrease cholesterol and homocysteine levels in patients with coronary heart disease. Even though the music employed is usually calming, it is unclear which specific style or type of music, duration, and frequency are most effective.

21) What is the purpose of the nurse using nonverbal communication in a therapeutic relationship with a patient? 1. Enhance verbal messages. 2. Detract from verbal messages 3. Avoid the use of verbal messages. 4. Terminate the therapeutic relationship.

Answer: 1 Explanation: 1. Nonverbal messages should enhance, not detract from, verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

8) The nurse is caring for a patient who is experiencing dysfunctional grieving following the traumatic death of spouse due to an automobile accident. The nurse also experienced the death of a loved one in the same manner. What statement made by the nurse best exemplifies the nurse using empathy toward the patient? 1. "Many people may feel angry when faced in this situation. How do you feel?" 2. "Many people may feel angry when faced in this situation. I know I felt very angry." 3. "I am so sorry you feel angry about this situation. How do you diffuse your anger?" 4. "I am so sorry you feel angry about this situation. I feel bad you have to experience this."

Answer: 1 Explanation: 1. One way to prevent misinterpretation of the patient's feelings is for nurses to check his or her perceptions with the patient. The nurse stating, "Many people may feel angry when faced in this situation. How do you feel?" is the best way for the nurse to provide empathetic care while remaining perceptive of his or her own feelings. The nurse should not tell the patient how the nurse felt in the similar situation, because this doing so puts the focus on the nurse rather than the patient. By telling the patient that the nurse is sorry for the patient, the nurse is exhibiting sympathy, not empathy.

3) A student nurse tells her mentor that adolescents are too young to be treated for depression. What information should her mentor provide to help the student understand the epidemiology and treatment of mental health disorders? 1. In 2012, more than two million individuals ages 12 to 17 had a major depressive episode (MDE). 2. Adolescents do not usually receive mental health treatment. 3. All depression in adolescents is connected to illicit drug use. 4. Men are the most likely group to experience depression.

Answer: 1 Explanation: 1. Over 50% of the total population of adolescents experience some form of mental illness. The most common reason for adolescents receiving services was feeling depressed. Of those adolescents who had a major depressive episode, 34.0% used illicit drugs in the past year. Women are more likely than men to experience mental illness.

2) Which action by the psychiatric-mental health nurse best indicates use of Hildegard Peplau's nursing theory when caring for a patient with mental illness? 1. Establishing a therapeutic nurse-patient relationship 2. Assessing patient interactions with the environment 3. Intervening to enhance the patient's abilities to perform self-care 4. Evaluating the effectiveness of the patient's coping and adaptation skills

Answer: 1 Explanation: 1. Peplau conceptualized the one-to-one nurse-patient relationship as one in which the patient can accomplish developmental tasks and practice healthy behaviors. This relationship is best known as the therapeutic nurse-patient relationship. While the additional answer choices are appropriate interventions for the psychiatric-mental health nurse, they do not best represent Hildegard Peplau's nursing theory.

13) When taking care of a patient newly diagnosed with panic attacks, the nurse knows that which sign and/or symptom correlates with Peplau's panic level of anxiety? 1. Delusions and withdrawal into self 2. Restlessness and increased motivation 3. Feelings of dread and hyperventilation 4. Increased heart rate and physical discomfort

Answer: 1 Explanation: 1. Peplau identified four levels of anxiety: mild, moderate, severe, and panic. The patient experiencing the panic level of anxiety may present with delusions and hallucinations, diaphoresis, dilated pupils, labored breathing, muscular incoordination or purposeless hyperactivity, palpitations, sense of impending doom, sleeplessness, trembling, unusual behaviors, and withdrawal into self.

15) The nurse taking care of a patient recently diagnosed with anxiety disorder knows that the patient's symptoms of hyperventilation, insomnia, and nausea are at which level according to Peplau? 1. Severe +3 2. Panic +4 3. Mild +1 4. Moderate +2

Answer: 1 Explanation: 1. Peplau identified four levels of anxiety: mild, moderate, severe, and panic. The patient experiencing the severe level of anxiety may present with dizziness, diarrhea, feelings of dread, headaches, hyperventilation, insomnia, nausea, palpitations, trembling, urinary frequency, and total focus of self.

21) A nurse who is considering theories that guide the practice of psychiatric nursing wants to base her interactions with patients on the theory of interpersonal relations. Whose works might she consult in order to learn more? 1. Hilda Peplau 2. Karl Menninger 3. William Stokes 4. Florence Nightingale

Answer: 1 Explanation: 1. Peplau's work on interpersonal relations and anxiety became foundational to nursing practice in general, and psychiatric-mental health nursing in particular. Karl Menninger worked to reform and reorganize psychiatry. William Stokes promoted moral therapy. Nightingale created a model for training nurses.

18) What is the key concept that allows the nurse to maintain professional boundaries when first developing the nurse-patient relationship? 1. Intentional development of the relationship 2. Use of caring in the relationship 3. Shared goals of the relationship 4. Shared knowledge occurring in the relationship

Answer: 1 Explanation: 1. The key to maintaining boundaries is for the nurse to be intentional in developing the therapeutic relationship with a patient. For example, a nurse meeting a patient for the first time introduces himself or herself as a professional involved in the patient's care, rather than informally telling the patient his or her name and making a comment about the weather, the patient's appearance, or a topic unrelated to patient care. The use of caring, shared goals, and shared knowledge do not aid in the nurse's attempt to maintain professional boundaries within the nurse-patient relationship.

1) A nursing assistant tells the psychiatric nurse that normal people do not have mental disorders. What action by the nurse is most appropriate? 1. Instruct the nursing assistant that anyone can have a mental health disorder. 2. Alert the nursing manager of the nursing assistant's remark. 3. Refer the nursing assistant back to the psychiatric orientation materials. 4. Disregard the comment because the nurse has no responsibility in this situation.

Answer: 1 Explanation: 1. The nurse should instruct the nursing assistant that, given the right circumstances, anyone can have a mental health disorder. The nursing assistant's ability to provide therapeutic care to patients may be affected if misinformation is not corrected. Referring the assistant back to the orientation materials, alerting the nursing manager, and ignoring the comment do not address the situation directly. The nurse has an opportunity to be a positive role model and teacher and promote therapeutic care.

26) What is the most important action for the nurse to take when caring for a patient with obsessive-compulsive disorder (OCD) who is performing a ritual? 1. Don't interrupt the ritual. 2. Teach stress reduction strategies. 3. Interrupt the ritual. 4. Teach patient about the disorder.

Answer: 1 Explanation: 1. The nurse should not interrupt the ritual because that may cause the patient to start from the beginning. Patient teaching is not the priority for a patient who is performing a ritual.

35) A nurse is providing services at a shelter established for tornado survivors. The nurse is wondering what she is accomplishing just by listening to the disaster victims. Why is it important for the nurse to use active listening when caring for these patients? 1. It assists patients through suffering. 2. It assists patients to receive therapy. 3. It assists patients on focusing on the present issue. 4. It assists patients to recall events.

Answer: 1 Explanation: 1. The nurse's presence and willingness to listen to patient stories can give meaning to the experience of suffering and assist the patient through suffering. While active listening is a therapeutic communication technique, it is not considered therapy. The nurse's use of active listening does not assist patients on focusing on the present issue or to recall events.

14) During the first interaction with a client, the nurse makes an introduction and identifies the purpose of the interaction. This serves to accomplish which stage of the nurse-patient relationship? 1. Orienting 2. Evaluating 3. Identifying 4. Implementing

Answer: 1 Explanation: 1. The orientation phase of the nurse-patient relationship identifies the purpose of the relationship and its associated structure. Evaluating and implementing are phases of the nursing process, not the nurse-patient relationship. The identification phase of the nurse-patient therapeutic relationship is characterized by interdependence between the nurse and the patient.

2) A patient in the clinic is diagnosed with General Adaptation Syndrome (GAS). Which physiological symptoms would indicate that the patient is in the last stage of this syndrome if the patient is unable to find resolution of the stressor? 1. Infection, migraines, stroke 2. Increased cortisol, stroke, high cholesterol levels 3. Hallucinations, fatigue, decreased immune response 4. Decreased albumin, increased adrenaline, decreased blood pressure

Answer: 1 Explanation: 1. The stage of exhaustion is the last stage of General Adaptation Syndrome. Physical and psychological manifestations of this stage include migraines, delusions, and/or hallucinations. The body is unable to compensate and begins to fail, and the patient exhibits symptoms such as elevated blood pressure, infection, stroke, cardiac arrest, and renal failure. Without resolution death may occur. The other answer choices do not reflect the last stage of General Adaptation Syndrome.

34) While reviewing therapeutic communication techniques, a nursing student reviews statements and actions that are nontherapeutic. Which statement best represents nontherapeutic communication? 1. "Why do you think you will never get well?" 2. "How do you feel about being discharged today?" 3. "What are your concerns about your living situation?" 4. "What happened when you quit taking your medications?"

Answer: 1 Explanation: 1. Therapeutic communication skills are used to foster the nurse-patient relationship in the psychiatric-mental health setting. Asking the patient, "Why do you think you will never get well?" is an example of requesting an explanation, which is not therapeutic and requires the patient to defend his or her actions. Asking how the patient feels about being discharged, what happened when medication was discontinued, or concerns about the patient's living situation are examples of therapeutic communication.

9) What process is used as a tool in developing a therapeutic relationship but is not used in developing a social relationship? 1. Interaction 2. Equal sharing 3. Mutual knowledge 4. The process of intimate disclosures

Answer: 1 Explanation: 1. Therapeutic relationships differ from social relationships; in part, this is because the therapeutic relationship uses the process of interaction as a tool. It is one of the few healthy relationships in which one party helps another or acts in the best interest of another without expectation that the other person will return the action. Equal sharing, mutual knowledge, and intimate disclosures are characteristics of social relationships, not therapeutic relationships.

15) A patient tells her therapist that she is having an affair because she needs more attention and her husband won't give it to her. What component of personality functioning does the patient's statement indicate to the therapist? 1. Id 2. Ego 3. Sensorimotor 4. Self-esteem

Answer: 1 Explanation: 1. When the id dominates in making decisions, impulsive and perhaps reckless behavior may result. When the ego is able to supersede the id's wishes, the individual can delay gratification. Sensorimotor is not a component of personality function; rather, it is a stage in Piaget's cognitive theory development. Self-esteem is not a component of personality function; rather, it is a level in Maslow's hierarchy of needs.

18) According to the Murphy-Moller wellness model, which elements occur within the sociological domain? Select all that apply. 1. Environment 2. Kinship 3. Religious faith 4. Moral development 5. Nutrition

Answer: 1, 2 Explanation: 1. According to the Murphy-Moller wellness model, five major wellness domains are used to approach the understanding and treatment of psychiatric illnesses: biological, psychological, sociological, cultural, and spiritual. Environmental factors, such as living conditions, and kinship (relationships with others) occur within the sociological domain. Religious faith falls within the spiritual domain, moral development within the psychological domain, and nutrition within the biological domain. 2. According to the Murphy-Moller wellness model, five major wellness domains are used to approach the understanding and treatment of psychiatric illnesses: biological, psychological, sociological, cultural, and spiritual. Environmental factors, such as living conditions, and kinship (relationships with others) occur within the sociological domain. Religious faith falls within the spiritual domain, moral development within the psychological domain, and nutrition within the biological domain.

In the 19th century, what factors did practitioners who accepted the theory that mental illness was an excess or deficit in excitability see as contributing to mental illness? Select all that apply. 1. Education 2. Urban life 3. Intemperance 4. Cerebral hyperemia 5. Demonic possession

Answer: 1, 2 Explanation: 1. Following the excitability theory of William Cullen, some thought education to be a major contributing factor in the emergence of insanity. The pace of urban life also contributed to excitability. Intemperance was not related to excitability excesses or deficits. Demonic possession was considered a cause of insanity in earlier eras and, by the 19th century had been replaced by other causative theories. Cerebral hyperemia as a contributing factor was promulgated by 18th century French physicians. 2. Following the excitability theory of William Cullen, some thought education to be a major contributing factor in the emergence of insanity. The pace of urban life also contributed to excitability. Intemperance was not related to excitability excesses or deficits. Demonic possession was considered a cause of insanity in earlier eras and, by the 19th century had been replaced by other causative theories. Cerebral hyperemia as a contributing factor was promulgated by 18th century French physicians

6) A nurse is asked to provide a brief presentation comparing and contrasting the types of biologically based therapies. Which will the nurse include in the presentation? Select all that apply. 1. Supplements 2. Herbal products 3. Naturopathic medicine 4. Homeopathic medicine 5. Ayurveda

Answer: 1, 2 Explanation: 1. Two categories of CAM therapies include biologically based (natural), and mind and body practices. Biologically based therapies include supplements and herbal products. Naturopathic, homeopathic, and Ayurveda are categorized as mind and body practices of CAM. 2. Two categories of CAM therapies include biologically based (natural), and mind and body practices. Biologically based therapies include supplements and herbal products. Naturopathic, homeopathic, and Ayurveda are categorized as mind and body practices of CAM.

2) The nurse is caring for a patient with an anxiety disorder. The patient asks that nurse, "Do you think complementary and alternative medicine (CAM) would help my condition?" Which factors will guide the nurse in helping the patient determine whether a CAM therapy may be beneficial? Select all that apply. 1. Current treatment regimen 2. History of use and success of CAM therapy 3. Assessment of the patient's current level of anxiety 4. History of patient adherence to a treatment regimen 5. Assessment of the patient's beliefs regarding CAM therapy

Answer: 1, 2, 3 Explanation: 1. Assessment of the patient's current level of anxiety, history of use and success with CAM therapies, and current treatment regimen will guide the nurse in helping the patient determine whether a CAM therapy may be beneficial and will decrease the likelihood of any contraindications between CAM therapies and the patient's current treatment regimen. History of the patient's adherence to a treatment regimen is not necessary to guide the nurse in helping the patient determine whether a CAM therapy may be beneficial. The patient is asking the nurse about possible CAM therapy; therefore, it is not necessary to assess the patient's beliefs to determine whether a CAM therapy may be beneficial. 2. Assessment of the patient's current level of anxiety, history of use and success with CAM therapies, and current treatment regimen will guide the nurse in helping the patient determine whether a CAM therapy may be beneficial and will decrease the likelihood of any contraindications between CAM therapies and the patient's current treatment regimen. History of the patient's adherence to a treatment regimen is not necessary to guide the nurse in helping the patient determine whether a CAM therapy may be beneficial. The patient is asking the nurse about possible CAM therapy; therefore, it is not necessary to assess the patient's beliefs to determine whether a CAM therapy may be beneficial. 3. Assessment of the patient's current level of anxiety, history of use and success with CAM therapies, and current treatment regimen will guide the nurse in helping the patient determine whether a CAM therapy may be beneficial and will decrease the likelihood of any contraindications between CAM therapies and the patient's current treatment regimen. History of the patient's adherence to a treatment regimen is not necessary to guide the nurse in helping the patient determine whether a CAM therapy may be beneficial. The patient is asking the nurse about possible CAM therapy; therefore, it is not necessary to assess the patient's beliefs to determine whether a CAM therapy may be beneficial.

6) Which components of Abraham Maslow's humanistic theory support the outcome of a person-centered motivation to grow and develop in a healthy way? Select all that apply. 1. Focus on health 2. Needs and self-actualization 3. Holistic, interactive approach 4. Human potential for goodness 5. Use of empathy and positive regard

Answer: 1, 2, 3 Explanation: 1. Components of Maslow's humanistic theory that support the outcome of person-centered motivation to grow and develop in a healthy way include Maslow's focus on health, needs and self-actualization, and holistic and interactive approach. The human potential for goodness and the use of empathy and positive regard are components of Carl Rogers's humanistic theory. 2. Components of Maslow's humanistic theory that support the outcome of person-centered motivation to grow and develop in a healthy way include Maslow's focus on health, needs and self-actualization, and holistic and interactive approach. The human potential for goodness and the use of empathy and positive regard are components of Carl Rogers's humanistic theory. 3. Components of Maslow's humanistic theory that support the outcome of person-centered motivation to grow and develop in a healthy way include Maslow's focus on health, needs and self-actualization, and holistic and interactive approach. The human potential for goodness and the use of empathy and positive regard are components of Carl Rogers's humanistic theory.

19) A nurse is considering how the Sisters of Charity at Mt. Hope provided treatment for patients with mental illness. What elements of treatment at this facility does she see reflected in modern perspectives and practice? Select all that apply. 1. Conversation with the patient 2. Respectful and kind treatment 3. Provision of recreational activities 4. Control of treatment by the nursing staff 5. Removal from family and former associates

Answer: 1, 2, 3 Explanation: 1. Current treatment often involves elements of treatment essential at Mt. Hope, including recreational and productive activities, frequent conversations with patients, and respectful and kind treatment. At Mt. Hope, unlike in current practice, the nursing staff was in charge of decisions about patient care. Removal from the home, no longer universally recommended, was considered part of providing a healing environment. 2. Current treatment often involves elements of treatment essential at Mt. Hope, including recreational and productive activities, frequent conversations with patients, and respectful and kind treatment. At Mt. Hope, unlike in current practice, the nursing staff was in charge of decisions about patient care. Removal from the home, no longer universally recommended, was considered part of providing a healing environment. 3. Current treatment often involves elements of treatment essential at Mt. Hope, including recreational and productive activities, frequent conversations with patients, and respectful and kind treatment. At Mt. Hope, unlike in current practice, the nursing staff was in charge of decisions about patient care. Removal from the home, no longer universally recommended, was considered part of providing a healing environment.

4) The psychiatric-mental health novice nurse asks "What is mental health?" Which qualities will her superior include when describing mental health? Select all that apply. 1. The ability to give and receive love 2. Having a sense of purpose in life 3. The ability to make important decisions 4. The ability to experience emotions 5. The ability to give and receive criticism

Answer: 1, 2, 3 Explanation: 1. How each nurse views the concepts of healthand mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health. 2. How each nurse views the concepts of healthand mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health. 3. How each nurse views the concepts of healthand mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health.

14) A patient is on life support and unresponsive to stimuli. One of her daughters talks to the nurse about withdrawing life support. The other daughter asks the nurse when the patient is likely to wake up and be able to eat. The nurse talks with her charge nurse and manager about this patient situation. This action demonstrates which ethical skills outlined in the PILLAR mnemonic? Select all that apply. 1. The ability to IDENTIFY ethical issues 2. The ability to find needed RESOURCES 3. The ability to ANTICIPATE ethical issues 4. The ability to work within defined professional LIMITATIONS 5. The ability to understand how PERSONAL experiences impact care

Answer: 1, 2, 3 Explanation: 1. Notifying supervisors of a potential ethical conflict demonstrates the ability to identify and anticipate an ethical issue. It also demonstrates that the nurse can find and utilize her resources when confronted with a situation that may develop into an ethical dilemma. This is not an example of working within defined limitations or how personal experiences may impact patient care. 2. Notifying supervisors of a potential ethical conflict demonstrates the ability to identify and anticipate an ethical issue. It also demonstrates that the nurse can find and utilize her resources when confronted with a situation that may develop into an ethical dilemma. This is not an example of working within defined limitations or how personal experiences may impact patient care. 3. Notifying supervisors of a potential ethical conflict demonstrates the ability to identify and anticipate an ethical issue. It also demonstrates that the nurse can find and utilize her resources when confronted with a situation that may develop into an ethical dilemma. This is not an example of working within defined limitations or how personal experiences may impact patient care.

29) The nurse is caring for a patient with anxiety and depression who tells the nurse, "I am always stressed out." Which factors inform the nurse's understanding of stress? Select all that apply. 1. It relates to an individual's perception of demands being made on him or her. 2. It relates to the individual's perception of his or her ability to meet the demands being made on him or her. 3. It is often a precipitant of anxiety. 4. It is often caused by anxiety. 5. It relates to an individual's perception of others.

Answer: 1, 2, 3 Explanation: 1. Stress relates to an individual's perception of demands being made on him or her, as well as the individual's perception of his or her ability to meet those demands. Stress may be described in numerous ways, including as a precipitant of anxiety. Stress is not caused by anxiety; rather, anxiety is the result of stress. Stress is not related to the individual's perception of others. 2. Stress relates to an individual's perception of demands being made on him or her, as well as the individual's perception of his or her ability to meet those demands. Stress may be described in numerous ways, including as a precipitant of anxiety. Stress is not caused by anxiety; rather, anxiety is the result of stress. Stress is not related to the individual's perception of others. 3. Stress relates to an individual's perception of demands being made on him or her, as well as the individual's perception of his or her ability to meet those demands. Stress may be described in numerous ways, including as a precipitant of anxiety. Stress is not caused by anxiety; rather, anxiety is the result of stress. Stress is not related to the individual's perception of others.

8) A patient is complaining of being unable to get to sleep. There is a PRN order for temazepam. What should the nurse do? Select all that apply. 1. Check the PRN protocol. 2. Assess the patient's need. 3. Assess the patient's safety. 4. Review the patient's diagnosis. 5. Explore the patient's expectations.

Answer: 1, 2, 3 Explanation: 1. The PRN order should specify the signs and symptoms, maximum daily dosage, and any specific instructions. The nurse should check the order and assess the patient's need and safety before administering any PRN medication. Although discussing expectations with the patient may be helpful, this is not a necessary part of PRN administration. Reviewing the patient's diagnosis is not part of the PRN protocol. 2. The PRN order should specify the signs and symptoms, maximum daily dosage, and any specific instructions. The nurse should check the order and assess the patient's need and safety before administering any PRN medication. Although discussing expectations with the patient may be helpful, this is not a necessary part of PRN administration. Reviewing the patient's diagnosis is not part of the PRN protocol. 3. The PRN order should specify the signs and symptoms, maximum daily dosage, and any specific instructions. The nurse should check the order and assess the patient's need and safety before administering any PRN medication. Although discussing expectations with the patient may be helpful, this is not a necessary part of PRN administration. Reviewing the patient's diagnosis is not part of the PRN protocol.

25) Nursing theory provides guidance for a nurse who is expected to perform what activity? Select all that apply. 1. Generate goals 2. Plan interventions 3. Organize assessment data 4. Generate nursing actions 5. Diagnose patient conditions

Answer: 1, 2, 3, 4 Explanation: 1. Nurses use theories to assist them to organize and think about human responses and assessment data in meaningful ways. Nursing theories guide nurses to generate goals that have meaning for patients and reflect desired outcomes to promote health and well-being. Nurses do not diagnose patient conditions; rather, this is the role of the health care provider. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments. Nursing theories also provide guidance in the focus for nursing actions that promote health as defined by each theory. 2. Nurses use theories to assist them to organize and think about human responses and assessment data in meaningful ways. Nursing theories guide nurses to generate goals that have meaning for patients and reflect desired outcomes to promote health and well-being. Nurses do not diagnose patient conditions; rather, this is the role of the health care provider. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments. Nursing theories also provide guidance in the focus for nursing actions that promote health as defined by each theory. 3. Nurses use theories to assist them to organize and think about human responses and assessment data in meaningful ways. Nursing theories guide nurses to generate goals that have meaning for patients and reflect desired outcomes to promote health and well-being. Nurses do not diagnose patient conditions; rather, this is the role of the health care provider. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments. Nursing theories also provide guidance in the focus for nursing actions that promote health as defined by each theory. 4. Nurses use theories to assist them to organize and think about human responses and assessment data in meaningful ways. Nursing theories guide nurses to generate goals that have meaning for patients and reflect desired outcomes to promote health and well-being. Nurses do not diagnose patient conditions; rather, this is the role of the health care provider. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments. Nursing theories also provide guidance in the focus for nursing actions that promote health as defined by each theory.

12) Several nurses were discussing methods of restraint used in the 19th century. What are some of the methods the nurses might have noted? Select all that apply. 1. Mitts 2. Seclusion 3. Strapping 4. Hydrotherapy 5. Straightjacket

Answer: 1, 2, 3, 5 Explanation: 1. A straightjacket has long arms that can be tied together behind an individual's back to achieve restraint. Mitts are a hand device forrestraining the hands of an individual. Hydrotherapy is a form of treatment, not restraint. Seclusion was used with some violent patients. Strapping involves tying patients to a bed or chair. 2. A straightjacket has long arms that can be tied together behind an individual's back to achieve restraint. Mitts are a hand device forrestraining the hands of an individual. Hydrotherapy is a form of treatment, not restraint. Seclusion was used with some violent patients. Strapping involves tying patients to a bed or chair. 3. A straightjacket has long arms that can be tied together behind an individual's back to achieve restraint. Mitts are a hand device forrestraining the hands of an individual. Hydrotherapy is a form of treatment, not restraint. Seclusion was used with some violent patients. Strapping involves tying patients to a bed or chair. 5. A straightjacket has long arms that can be tied together behind an individual's back to achieve restraint. Mitts are a hand device forrestraining the hands of an individual. Hydrotherapy is a form of treatment, not restraint. Seclusion was used with some violent patients. Strapping involves tying patients to a bed or chair.

1) Which aspect of nonverbal communication conveys the nurse's positive attitude toward the patient? Select all that apply. 1. Leaning slightly forward 2. Orienting to face the patient 3. Maintaining physical proximity 4. Formulating a reply while the patient is speaking 5. Maintaining good eye contact while the patient is speaking

Answer: 1, 2, 3, 5 Explanation: 1. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication. 2. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication. 3. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication. 5. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication.

31) A patient has been court-ordered to take his antipsychotic medications due to concerns that he will be a danger to himself. The nurse recognizes such action may be justified in which situations? Select all that apply. 1. To alleviate suffering 2. In an emergency situation 3. When in the patient's best interest 4. To foster the therapeutic relationship 5. To care a patient who cannot care for himself

Answer: 1, 2, 3, 5 Explanation: 1. Ethical dilemmas may arise when patients in psychiatric settings refuse much needed treatment. Coercing treatment may be justified to alleviate suffering, in emergency situations, and when it is in the patient's interest to provide care when the patient cannot care for himself. Coercing treatment is unlikely to foster the therapeutic relationship—in fact, distrust is a likely outcome of forced treatment. 2. Ethical dilemmas may arise when patients in psychiatric settings refuse much needed treatment. Coercing treatment may be justified to alleviate suffering, in emergency situations, and when it is in the patient's interest to provide care when the patient cannot care for himself. Coercing treatment is unlikely to foster the therapeutic relationship—in fact, distrust is a likely outcome of forced treatment. 3. Ethical dilemmas may arise when patients in psychiatric settings refuse much needed treatment. Coercing treatment may be justified to alleviate suffering, in emergency situations, and when it is in the patient's interest to provide care when the patient cannot care for himself. Coercing treatment is unlikely to foster the therapeutic relationship—in fact, distrust is a likely outcome of forced treatment. 5. Ethical dilemmas may arise when patients in psychiatric settings refuse much needed treatment. Coercing treatment may be justified to alleviate suffering, in emergency situations, and when it is in the patient's interest to provide care when the patient cannot care for himself. Coercing treatment is unlikely to foster the therapeutic relationship—in fact, distrust is a likely outcome of forced treatment.

18) What physical changes will the nurse likely observe when assessing a patient during an acute panic attack? Select all that apply. 1. Sweating 2. Trembling 3. Vomiting 4. Impaired cognition 5. Breathing difficulty

Answer: 1, 2, 3, 5 Explanation: 1. Sweating (diaphoresis), breathing difficulties, trembling, and vomiting are physical changes which may occur during a panic attack. Impaired cognition may or may not occur during a panic attack. Impaired cognition is not an acute physical change; it is a cognitive change. 2. Sweating (diaphoresis), breathing difficulties, trembling, and vomiting are physical changes which may occur during a panic attack. Impaired cognition may or may not occur during a panic attack. Impaired cognition is not an acute physical change; it is a cognitive change. 3. Sweating (diaphoresis), breathing difficulties, trembling, and vomiting are physical changes which may occur during a panic attack. Impaired cognition may or may not occur during a panic attack. Impaired cognition is not an acute physical change; it is a cognitive change. 5. Sweating (diaphoresis), breathing difficulties, trembling, and vomiting are physical changes which may occur during a panic attack. Impaired cognition may or may not occur during a panic attack. Impaired cognition is not an acute physical change; it is a cognitive change.

19) A nurse is making a presentation at her facility in order to promote the Tidal Model of care. What does the nurse describe as some of the commitments made between patients and providers in this model? Select all that apply. 1. Provide transparency. 2. Become the apprentice. 3. Develop genuine curiosity. 4. Teach appropriate language. 5. Determine the next steps in recovery.

Answer: 1, 2, 3, 5 Explanation: 1. The Tidal Model represents an interdisciplinary approach to patient care and is informed by the work of Harry Stack Sullivan and Hildegard Peplau. Various commitments are emphasized in this approach, including: providing transparency, becoming the apprentice, developing genuine curiosity, and determining the next steps in recovery. Teaching appropriate language is not a commitment according to this approach. 2. The Tidal Model represents an interdisciplinary approach to patient care and is informed by the work of Harry Stack Sullivan and Hildegard Peplau. Various commitments are emphasized in this approach, including: providing transparency, becoming the apprentice, developing genuine curiosity, and determining the next steps in recovery. Teaching appropriate language is not a commitment according to this approach. 3. The Tidal Model represents an interdisciplinary approach to patient care and is informed by the work of Harry Stack Sullivan and Hildegard Peplau. Various commitments are emphasized in this approach, including: providing transparency, becoming the apprentice, developing genuine curiosity, and determining the next steps in recovery. Teaching appropriate language is not a commitment according to this approach. 5. The Tidal Model represents an interdisciplinary approach to patient care and is informed by the work of Harry Stack Sullivan and Hildegard Peplau. Various commitments are emphasized in this approach, including: providing transparency, becoming the apprentice, developing genuine curiosity, and determining the next steps in recovery. Teaching appropriate language is not a commitment according to this approach.

29) What reactions to medications are influenced by chemical biotransformations in the liver's enzymatic pathways? Select all that apply. 1. Tolerance 2. Toxicity 3. Potency 4. Resistance 5. Therapeutic range

Answer: 1, 2, 4 Explanation: 1. An enzyme system in the liver facilitates chemical biotransformations. Reactions in these enzymatic pathways contribute to drug resistance, drug tolerance, and drug toxicity. The amount (dose) of the drug necessary to produce the desired response is its potency. The therapeutic range is the range at which therapeutic efficacy can be achieved without risking harm to the patient. 2. An enzyme system in the liver facilitates chemical biotransformations. Reactions in these enzymatic pathways contribute to drug resistance, drug tolerance, and drug toxicity. The amount (dose) of the drug necessary to produce the desired response is its potency. The therapeutic range is the range at which therapeutic efficacy can be achieved without risking harm to the patient. 4. An enzyme system in the liver facilitates chemical biotransformations. Reactions in these enzymatic pathways contribute to drug resistance, drug tolerance, and drug toxicity. The amount (dose) of the drug necessary to produce the desired response is its potency. The therapeutic range is the range at which therapeutic efficacy can be achieved without risking harm to the patient.

2) The nurse is planning care for a newly admitted patient. Which concepts are considered essential in establishing a therapeutic nurse-patient relationship? Select all that apply. 1. An emphasis on patient-centered care 2. The nurse's view of health and mental health 3. The nurse's ability to sympathize with the patient 4. Unconditional positive regard for the patient and family 5. The nurse's ability to make judgments regarding the patient's condition

Answer: 1, 2, 4 Explanation: 1. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship. 2. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship. 4. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship.

4) A nurse is preparing a presentation on serious mental illness. Which conditions should be included? Select all that apply. 1. Major depression 2. Schizophrenia 3. Adjustment reaction 4. Bipolar disorder 5. Social phobia

Answer: 1, 2, 4 Explanation: 1. Serious mental illnesses create significant disability in the individual's ability to achieve life goals. Serious mental illnesses include major depression, schizophrenia, and bipolar disorder. Although they can have distressing and disabling effects, adjustment disorders and social phobias do not necessarily interfere with the achievement of life goals. 2. Serious mental illnesses create significant disability in the individual's ability to achieve life goals. Serious mental illnesses include major depression, schizophrenia, and bipolar disorder. Although they can have distressing and disabling effects, adjustment disorders and social phobias do not necessarily interfere with the achievement of life goals. 4. Serious mental illnesses create significant disability in the individual's ability to achieve life goals. Serious mental illnesses include major depression, schizophrenia, and bipolar disorder. Although they can have distressing and disabling effects, adjustment disorders and social phobias do not necessarily interfere with the achievement of life goals.

16) What are some of the professional organizations that contribute to psychiatric-mental health nursing? Select all that apply. 1. The American Nurses Association (ANA) 2. The American Psychiatric Nurses Association (APNA) 3. The American Psychiatric Association (APA) 4. The North American Nursing Diagnosis Association International 5. The American Psychological Association (APA)

Answer: 1, 2, 4 Explanation: 1. The ANA advances the nursing profession by fostering high standards of nursing practice. The APNA is the only professional nursing organization that focuses on all levels of psychiatric nursing. The American Psychiatric Association is an organization of psychiatrists, not nurses. The North American Nursing Diagnosis Association International provides approved nursing diagnoses. The American Psychological Association is an organization of psychologists. 2. The ANA advances the nursing profession by fostering high standards of nursing practice. The APNA is the only professional nursing organization that focuses on all levels of psychiatric nursing. The American Psychiatric Association is an organization of psychiatrists, not nurses. The North American Nursing Diagnosis Association International provides approved nursing diagnoses. The American Psychological Association is an organization of psychologists. 4. The ANA advances the nursing profession by fostering high standards of nursing practice. The APNA is the only professional nursing organization that focuses on all levels of psychiatric nursing. The American Psychiatric Association is an organization of psychiatrists, not nurses. The North American Nursing Diagnosis Association International provides approved nursing diagnoses. The American Psychological Association is an organization of psychologists.

7) The charge nurse is caring for a patient recently diagnosed with an anxiety disorder. The patient has an identical twin. The nurse knows that which condition increases the likelihood that the undiagnosed twin will suffer from the same disorder? Select all that apply. 1. Genetics 2. Environment 3. Shared trauma 4. Psychological influences 5. Developmental influences

Answer: 1, 2, 4, 5 Explanation: 1. Factors affecting mental illnesses include a combination of genetic, environmental, psychological, and developmental influences. Twin studies show that there is both a genetic and environmental component that plays a role in critical developmental phases of neurons that regulate emotions and affect individual resilience toward stress-related disorders. Not all individuals who are exposed to the same trauma will develop an anxiety disorder. 2. Factors affecting mental illnesses include a combination of genetic, environmental, psychological, and developmental influences. Twin studies show that there is both a genetic and environmental component that plays a role in critical developmental phases of neurons that regulate emotions and affect individual resilience toward stress-related disorders. Not all individuals who are exposed to the same trauma will develop an anxiety disorder. 4. Factors affecting mental illnesses include a combination of genetic, environmental, psychological, and developmental influences. Twin studies show that there is both a genetic and environmental component that plays a role in critical developmental phases of neurons that regulate emotions and affect individual resilience toward stress-related disorders. Not all individuals who are exposed to the same trauma will develop an anxiety disorder. 5. Factors affecting mental illnesses include a combination of genetic, environmental, psychological, and developmental influences. Twin studies show that there is both a genetic and environmental component that plays a role in critical developmental phases of neurons that regulate emotions and affect individual resilience toward stress-related disorders. Not all individuals who are exposed to the same trauma will develop an anxiety disorder.

10) Which statement by the nurse reflects the application of deontology to the care of patients admitted to the mental health unit? Select all that apply. 1. "I need to report this error because it is the right thing to do." 2. "I think patients have a right to refuse certain psychotropic medications." 3. "All patients need flu shots so that we can all be healthy during flu season." 4. "All patients should be treated equally whether they have insurance or not." 5. "The doctor needs to obtain informed consent so the patient can make a good decision."

Answer: 1, 2, 4, 5 Explanation: 1. Requiring all patients to have flu shots is an example of utilitarianism, which speaks more to morality as a function of doing the greatest good for the greatest number. All the other statements refer to principles of rule-based ethics, or deontology. This concept reflects the idea of the duty to be honest, regardless of the outcome. It is about "doing the right thing." 2. Requiring all patients to have flu shots is an example of utilitarianism, which speaks more to morality as a function of doing the greatest good for the greatest number. All the other statements refer to principles of rule-based ethics, or deontology. This concept reflects the idea of the duty to be honest, regardless of the outcome. It is about "doing the right thing." 4. Requiring all patients to have flu shots is an example of utilitarianism, which speaks more to morality as a function of doing the greatest good for the greatest number. All the other statements refer to principles of rule-based ethics, or deontology. This concept reflects the idea of the duty to be honest, regardless of the outcome. It is about "doing the right thing." 5. Requiring all patients to have flu shots is an example of utilitarianism, which speaks more to morality as a function of doing the greatest good for the greatest number. All the other statements refer to principles of rule-based ethics, or deontology. This concept reflects the idea of the duty to be honest, regardless of the outcome. It is about "doing the right thing."

2) The nurse is teaching the patient about the concept of mental disorders. When instructing the patient, what areas should be covered when explaining what impacts the determination of a mental disorder? Select all that apply. 1. Social conditions 2. Biochemistry 3. Mother-child interactions 4. Brain structure 5. Culture

Answer: 1, 2, 4, 5 Explanation: 1. Research has shown that brain chemicals and processes (biochemistry) are frequently altered in mental disorders. While mother-child interactions are important in mental health, current theory and research emphasize a more biological and societal definition. Contemporary diagnostic testing has demonstrated some structural differences of the brain in persons who have mental disorders. Behavior may be considered part of a mental disorder in one culture, but perfectly normal and acceptable in another. The appropriateness of behavior is judged against what is considered normal or appropriate to both social conditions as well as laws defining standards for behavior in a given society. 2. Research has shown that brain chemicals and processes (biochemistry) are frequently altered in mental disorders. While mother-child interactions are important in mental health, current theory and research emphasize a more biological and societal definition. Contemporary diagnostic testing has demonstrated some structural differences of the brain in persons who have mental disorders. Behavior may be considered part of a mental disorder in one culture, but perfectly normal and acceptable in another. The appropriateness of behavior is judged against what is considered normal or appropriate to both social conditions as well as laws defining standards for behavior in a given society. 4. Research has shown that brain chemicals and processes (biochemistry) are frequently altered in mental disorders. While mother-child interactions are important in mental health, current theory and research emphasize a more biological and societal definition. Contemporary diagnostic testing has demonstrated some structural differences of the brain in persons who have mental disorders. Behavior may be considered part of a mental disorder in one culture, but perfectly normal and acceptable in another. The appropriateness of behavior is judged against what is considered normal or appropriate to both social conditions as well as laws defining standards for behavior in a given society. 5. Research has shown that brain chemicals and processes (biochemistry) are frequently altered in mental disorders. While mother-child interactions are important in mental health, current theory and research emphasize a more biological and societal definition. Contemporary diagnostic testing has demonstrated some structural differences of the brain in persons who have mental disorders. Behavior may be considered part of a mental disorder in one culture, but perfectly normal and acceptable in another. The appropriateness of behavior is judged against what is considered normal or appropriate to both social conditions as well as laws defining standards for behavior in a given society.

1) The novice nurse is applying the ANA Code of Ethics to the care of individuals with mental illness. Which reflects its appropriate use? Select all that apply. 1. As a framework to help nurses solve ethical dilemmas. 2. As an affirmation of nursing's nonnegotiable ethical standards. 3. As an answer to specific ethical challenges which nurses face in clinical practice. 4. As a reference for how the nursing profession sees itself in terms of its obligation to society. 5. As a brief description of the ethical obligations and duties of all persons who enter the nursing profession.

Answer: 1, 2, 4, 5 Explanation: 1. The Code of Ethics does not exist to provide the answers to specific ethical challenges that nurses face. Rather, it provides a brief description of the ethical obligations and duties of nurses entering the profession, establishes nursing's nonnegotiable ethical standards, and provides a reference for how nurses understand their obligations to society. It also provides a framework to enable nurses to work through ethical challenges and conflicts. 2. The Code of Ethics does not exist to provide the answers to specific ethical challenges that nurses face. Rather, it provides a brief description of the ethical obligations and duties of nurses entering the profession, establishes nursing's nonnegotiable ethical standards, and provides a reference for how nurses understand their obligations to society. It also provides a framework to enable nurses to work through ethical challenges and conflicts. 4. The Code of Ethics does not exist to provide the answers to specific ethical challenges that nurses face. Rather, it provides a brief description of the ethical obligations and duties of nurses entering the profession, establishes nursing's nonnegotiable ethical standards, and provides a reference for how nurses understand their obligations to society. It also provides a framework to enable nurses to work through ethical challenges and conflicts. 5. The Code of Ethics does not exist to provide the answers to specific ethical challenges that nurses face. Rather, it provides a brief description of the ethical obligations and duties of nurses entering the profession, establishes nursing's nonnegotiable ethical standards, and provides a reference for how nurses understand their obligations to society. It also provides a framework to enable nurses to work through ethical challenges and conflicts.

17) A nurse educator is teaching a group of students about the traits of a mentally healthy individual. Which concepts provide information regarding psychological, emotional, and social health? Select all that apply. 1. Behavior 2. Intrapersonal relationships 3. Gender 4. Age 5. Interpersonal relationships

Answer: 1, 2, 5 Explanation: 1. In general, what an individual does (the individual's behavior), how that individual relates to others (the individual's interpersonal relationships between his or her self and others), and how that individual relates to him or herself (the individual's intrapersonal relationships within the mind or the self), provide evidence of psychological, emotional, and social health. There is no evidence that age and gender play a role in defining a mentally healthy individual. 2. In general, what an individual does (the individual's behavior), how that individual relates to others (the individual's interpersonal relationships between his or her self and others), and how that individual relates to him or herself (the individual's intrapersonal relationships within the mind or the self), provide evidence of psychological, emotional, and social health. There is no evidence that age and gender play a role in defining a mentally healthy individual. 5. In general, what an individual does (the individual's behavior), how that individual relates to others (the individual's interpersonal relationships between his or her self and others), and how that individual relates to him or herself (the individual's intrapersonal relationships within the mind or the self), provide evidence of psychological, emotional, and social health. There is no evidence that age and gender play a role in defining a mentally healthy individual.

5) A nursing student is doing a research paper on how to improve psychiatric nursing outcomes for serious mental illness. Which types of research would be most useful? Select all that apply. 1. Nursing 2. Psychosocial 3. Educational 4. Economic 5. Neurobiological

Answer: 1, 2, 5 Explanation: 1. Nursing research can provide information on specific nursing interventions that are most effective. Psychosocial research can provide information on factors that are important in diagnosis and treatment. Educational and historical research may provide important background information but are not necessarily relevant to psychiatric treatment outcomes. Neurobiological research provides important information on both causality and treatment options. 2. Nursing research can provide information on specific nursing interventions that are most effective. Psychosocial research can provide information on factors that are important in diagnosis and treatment. Educational and historical research may provide important background information but are not necessarily relevant to psychiatric treatment outcomes. Neurobiological research provides important information on both causality and treatment options. 5. Nursing research can provide information on specific nursing interventions that are most effective. Psychosocial research can provide information on factors that are important in diagnosis and treatment. Educational and historical research may provide important background information but are not necessarily relevant to psychiatric treatment outcomes. Neurobiological research provides important information on both causality and treatment options.

11) The nurse is caring for a patient with a sleep disorder who tells the nurse that he takes the supplement valerian to sleep at night. What clinical manifestation is most likely to be present due to the effects of this medication? Select all that apply. 1. Headache 2. Dizziness 3. Renal toxicity 4. Hepatotoxicity 5. Gastrointestinal disturbances

Answer: 1, 2, 5 Explanation: 1. Valerian is a natural product that may promote sedation and sleep. Potential adverse effects include headache, dizziness, and gastrointestinal disturbances. Renal toxicity is not associated with valerian. Hepatotoxicity may occur from the natural product Kava. 2. Valerian is a natural product that may promote sedation and sleep. Potential adverse effects include headache, dizziness, and gastrointestinal disturbances. Renal toxicity is not associated with valerian. Hepatotoxicity may occur from the natural product Kava. 5. Valerian is a natural product that may promote sedation and sleep. Potential adverse effects include headache, dizziness, and gastrointestinal disturbances. Renal toxicity is not associated with valerian. Hepatotoxicity may occur from the natural product Kava.

19) A nurse fails to check on her suicidal patient every 15 minutes per hospital policy. When she checks on him next, he has jumped off the bed and broken his ankle. Why could she be charged with negligence? Select all that apply. 1. Failure to properly monitor 2. Failure to communicate risk 3. Failure to assess the risk of suicide 4. Failure to maintain proper boundaries 5. Failure to provide sufficient documentation

Answer: 1, 3 Explanation: 1. A primary nursing duty is to prevent harm. In this case, the nurse failed to assess the risk of suicide because she did not perform the required checks every 15 minutes. She also failed to properly monitor the patient. This case is not about boundaries, documentation, or communicating risk. As a licensed nurse, she is individually accountable for her failure to protect the patient. Because she failed to follow policy, the hospital may choose not to defend the nurse and could even seek damages against her if she is held liable for her actions. 3. A primary nursing duty is to prevent harm. In this case, the nurse failed to assess the risk of suicide because she did not perform the required checks every 15 minutes. She also failed to properly monitor the patient. This case is not about boundaries, documentation, or communicating risk. As a licensed nurse, she is individually accountable for her failure to protect the patient. Because she failed to follow policy, the hospital may choose not to defend the nurse and could even seek damages against her if she is held liable for her actions.

13) Which actions made by the nurse best exemplify the orientation phase of the nurse-patient therapeutic relationship? Select all that apply. 1. Assessing the patient's limitations 2. Clarifying the patient's expectations for care 3. Educating the patient about the patient's health problem 4. Identifying resources that will be used in the first interaction 5. Reviewing the patient's history in the patient's medical record

Answer: 1, 3 Explanation: 1. Assessing the patient's limitations and educating the patient about the patient's health problem are nursing actions performed in the orientation phase of the nurse-patient therapeutic relationship. Clarifying the patient's expectations for care occurs in the identification phase of the nurse-patient therapeutic relationship. Identifying the resources that will be used in the first interaction and reviewing the patient's history in the patient's medical record are actions that occur in the pre-orientation phase of the nurse-patient therapeutic relationship. 3. Assessing the patient's limitations and educating the patient about the patient's health problem are nursing actions performed in the orientation phase of the nurse-patient therapeutic relationship. Clarifying the patient's expectations for care occurs in the identification phase of the nurse-patient therapeutic relationship. Identifying the resources that will be used in the first interaction and reviewing the patient's history in the patient's medical record are actions that occur in the pre-orientation phase of the nurse-patient therapeutic relationship.

20) The novice nurse is learning about the use of boundaries in the therapeutic nurse-patient relationship. What examples will the nurse recognize as boundary violations? Select all that apply. 1. Sexual misconduct 2. Last-minute appointment changes 3. Inappropriate self-disclosure 4. Giving or receiving small gifts 5. Disclosing bits of personal information

Answer: 1, 3 Explanation: 1. The National Council of State Boards of Nursing defines boundary crossings as decisions to deviate from a boundary for a therapeutic purpose, such as appointment changes, disclosing bits of personal information, or the giving or receiving of small gifts. These are small breaches with a likely return to expected limits of the professional relationship. Boundary violations may include inappropriate self-disclosure and sexual misconduct. 3. The National Council of State Boards of Nursing defines boundary crossings as decisions to deviate from a boundary for a therapeutic purpose, such as appointment changes, disclosing bits of personal information, or the giving or receiving of small gifts. These are small breaches with a likely return to expected limits of the professional relationship. Boundary violations may include inappropriate self-disclosure and sexual misconduct.

12) A nurse is working with a patient who needs to change unwanted or undesired behavior. The nurse recognizes that which patient response indicates that patient is at the pre-contemplation stage of the stages of change model? Select all that apply. 1. The patient denies having a problem. 2. The patient acknowledges the problem. 3. The patient has no desire to change the problem. 4. The patient begins to make plans to change the problem. 5. The patient begins to seriously consider changing the problem.

Answer: 1, 3 Explanation: 1. The stages of change model include pre-contemplation, contemplation, preparation, action, and maintenance stages. In the pre-contemplation stage, the patient denies a problem and has no desire to change the problem. In the contemplation stage, the patient acknowledges the problem exists and begins to seriously consider changing the problem. In the preparation stage, the patient begins to make plans to change the problem. 3. The stages of change model include pre-contemplation, contemplation, preparation, action, and maintenance stages. In the pre-contemplation stage, the patient denies a problem and has no desire to change the problem. In the contemplation stage, the patient acknowledges the problem exists and begins to seriously consider changing the problem. In the preparation stage, the patient begins to make plans to change the problem.

9) The nurse will expect to observe which responses in behavior in the patient who is experiencing an episode of anxiety? Select all that apply. 1. Irritability 2. Indulgence 3. Withdrawal 4. Perspiration 5. Constricted pupils

Answer: 1, 3, 4 Explanation: 1. Irritability is a common response to anxiety. Somatic symptoms of anxiety include perspiration and dilated pupils. Withdrawal is also a common response because it allows the individual to avoid dealing with the stressor. Decreased interest, not indulgence, is a common response to distress. 3. Irritability is a common response to anxiety. Somatic symptoms of anxiety include perspiration and dilated pupils. Withdrawal is also a common response because it allows the individual to avoid dealing with the stressor. Decreased interest, not indulgence, is a common response to distress. 4. Irritability is a common response to anxiety. Somatic symptoms of anxiety include perspiration and dilated pupils. Withdrawal is also a common response because it allows the individual to avoid dealing with the stressor. Decreased interest, not indulgence, is a common response to distress.

12) Which tools and guidelines are included in the DSM-5? Select all that apply. 1. Cultural formulation interview 2. Guidelines for forming a multi-axial diagnosis 3. Directions for use of the manual 4. Suggestions for future research 5. Global assessment functioning scale

Answer: 1, 3, 4 Explanation: 1. The DSM-5 includes a cultural formulation interview, directions for use of the manual, and suggestions for future research. Guidelines for forming a multi-axial diagnosis and a global assessment functioning scale were included in prior editions of the manual. 3. The DSM-5 includes a cultural formulation interview, directions for use of the manual, and suggestions for future research. Guidelines for forming a multi-axial diagnosis and a global assessment functioning scale were included in prior editions of the manual. 4. The DSM-5 includes a cultural formulation interview, directions for use of the manual, and suggestions for future research. Guidelines for forming a multi-axial diagnosis and a global assessment functioning scale were included in prior editions of the manual.

4) A nurse is working with a 9-year-old girl who has been diagnosed with leukemia. Using Piaget's cognitive theory of development, what are some specific ways in which the nurse should interact with the child? Select all that apply. 1. Give clear information regarding treatment. 2. Recognize and respect her need for increased privacy. 3. Show the child items or equipment that will be used in treatment. 4. Assess for and encourage the child to participate in favorite activities. 5. Provide opportunity to touch or play with medical equipment prior to assessments and procedures.

Answer: 1, 3, 4 Explanation: 1. The child is at the concrete operational stage when reasoning begins; she should be able to understand when clear information is presented and concrete items are used in explanations. Encouraging participation in favorite activities supports normal developmental processes. The need for privacy is usually typical of adolescence. Touching and playing with equipment is advised at an earlier developmental stage. 3. The child is at the concrete operational stage when reasoning begins; she should be able to understand when clear information is presented and concrete items are used in explanations. Encouraging participation in favorite activities supports normal developmental processes. The need for privacy is usually typical of adolescence. Touching and playing with equipment is advised at an earlier developmental stage. 4. The child is at the concrete operational stage when reasoning begins; she should be able to understand when clear information is presented and concrete items are used in explanations. Encouraging participation in favorite activities supports normal developmental processes. The need for privacy is usually typical of adolescence. Touching and playing with equipment is advised at an earlier developmental stage.

12) A 16-year-old patient is brought into the emergency department (ED) after being attacked in an alley. The patient states that she "can't see," but that she is otherwise "okay." The initial assessment reveals no physiological reason for the blindness, but several bruises, cuts, and abrasions are noted. After a thorough assessment, the patient is diagnosed with posttraumatic stress disorder (PTSD). The nurse knows that the patient is employing which defense mechanisms? Select all that apply. 1. Denial 2. Projection 3. Conversion 4. Suppression 5. Displacement

Answer: 1, 3, 4 Explanation: 1. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person. 3. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person. 4. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person.

31) The nurse is caring for a patient who has been diagnosed with postpartum depression. The patient tells the nurse, "I can't seem to get out of bed and take care of my baby." Which responses by the nurse best demonstrate therapeutic communication? Select all that apply. 1. "It sounds like you are having a hard time." 2. "The baby blues are normal for every woman after birth." 3. "Have you felt like this before, after the birth of your oldest child?" 4. "Would I be correct in saying that you are sleeping more than usual?" 5. "I had this condition after my son's birth. It is best to seek help from family members."

Answer: 1, 3, 4 Explanation: 1. Various techniques are used to demonstrate therapeutic communication. Asking the patient, "Would I be correct in saying that you are sleeping more than usual?" is seeking clarification, and is a therapeutic communication technique. Telling the patient, "It sounds like you are having a hard time" is a statement that uses the therapeutic communication technique of affirming. Asking the patient, "Have you felt like this before, after the birth of your oldest child?" is using the therapeutic communication technique of encouraging comparison. Telling the patient, "The baby blues are normal for every woman after birth" is using social responding, which is nontherapeutic. Telling the patient, "I had this condition after my son's birth. It is best to seek help from family members" is giving advice, which is a barrier to communication. 3. Various techniques are used to demonstrate therapeutic communication. Asking the patient, "Would I be correct in saying that you are sleeping more than usual?" is seeking clarification, and is a therapeutic communication technique. Telling the patient, "It sounds like you are having a hard time" is a statement that uses the therapeutic communication technique of affirming. Asking the patient, "Have you felt like this before, after the birth of your oldest child?" is using the therapeutic communication technique of encouraging comparison. Telling the patient, "The baby blues are normal for every woman after birth" is using social responding, which is nontherapeutic. Telling the patient, "I had this condition after my son's birth. It is best to seek help from family members" is giving advice, which is a barrier to communication. 4. Various techniques are used to demonstrate therapeutic communication. Asking the patient, "Would I be correct in saying that you are sleeping more than usual?" is seeking clarification, and is a therapeutic communication technique. Telling the patient, "It sounds like you are having a hard time" is a statement that uses the therapeutic communication technique of affirming. Asking the patient, "Have you felt like this before, after the birth of your oldest child?" is using the therapeutic communication technique of encouraging comparison. Telling the patient, "The baby blues are normal for every woman after birth" is using social responding, which is nontherapeutic. Telling the patient, "I had this condition after my son's birth. It is best to seek help from family members" is giving advice, which is a barrier to communication.

11) What aspects of medication administration can be influenced by the expected half-life of the drug? Select all that apply. 1. Dosage 2. Acid-base balance 3. Frequency of administration 4. Expected duration of drug in the body 5. Anticipated duration of targeted effects

Answer: 1, 3, 4, 5 Explanation: 1. The expected half-life of a drug and its influence on achieving a steady state (when the amount of a drug being taken into the body equals the amount of the drug being eliminated) can influence decisions on dosage and frequency of administration. It can also provide information on the anticipated duration of targeted effects and the expected duration the drug remains in the body. Acid-base balance is not controlled by drug half-life. 3. The expected half-life of a drug and its influence on achieving a steady state (when the amount of a drug being taken into the body equals the amount of the drug being eliminated) can influence decisions on dosage and frequency of administration. It can also provide information on the anticipated duration of targeted effects and the expected duration the drug remains in the body. Acid-base balance is not controlled by drug half-life. 4. The expected half-life of a drug and its influence on achieving a steady state (when the amount of a drug being taken into the body equals the amount of the drug being eliminated) can influence decisions on dosage and frequency of administration. It can also provide information on the anticipated duration of targeted effects and the expected duration the drug remains in the body. Acid-base balance is not controlled by drug half-life. 5. The expected half-life of a drug and its influence on achieving a steady state (when the amount of a drug being taken into the body equals the amount of the drug being eliminated) can influence decisions on dosage and frequency of administration. It can also provide information on the anticipated duration of targeted effects and the expected duration the drug remains in the body. Acid-base balance is not controlled by drug half-life.

34) What are some of the goals of trauma-informed care? Select all that apply. 1. Understand symptoms as attempts to cope. 2. Provide regular medication education and monitoring. 3. Collaborate between provider and consumer at all phases of service delivery. 4. Protect patients with a history of trauma from physical harm and re-traumatization. 5. Focus on what has happened to the person rather than what is wrong with the person.

Answer: 1, 3, 4, 5 Explanation: 1. Trauma-informed care is designed to inform caregivers about and sensitize them to trauma-related issues present in trauma survivors. A trauma-informed system is one that accommodates vulnerabilities of trauma survivors, avoids re-traumatization and exacerbation of symptoms for those who have been traumatized, and facilitates patient participation in treatment. Medication management is not an essential part of trauma-informed care. 3. Trauma-informed care is designed to inform caregivers about and sensitize them to trauma-related issues present in trauma survivors. A trauma-informed system is one that accommodates vulnerabilities of trauma survivors, avoids re-traumatization and exacerbation of symptoms for those who have been traumatized, and facilitates patient participation in treatment. Medication management is not an essential part of trauma-informed care. 4. Trauma-informed care is designed to inform caregivers about and sensitize them to trauma-related issues present in trauma survivors. A trauma-informed system is one that accommodates vulnerabilities of trauma survivors, avoids re-traumatization and exacerbation of symptoms for those who have been traumatized, and facilitates patient participation in treatment. Medication management is not an essential part of trauma-informed care. 5. Trauma-informed care is designed to inform caregivers about and sensitize them to trauma-related issues present in trauma survivors. A trauma-informed system is one that accommodates vulnerabilities of trauma survivors, avoids re-traumatization and exacerbation of symptoms for those who have been traumatized, and facilitates patient participation in treatment. Medication management is not an essential part of trauma-informed care.

14) In a research paper on moral therapy, a nurse wants to examine how the diagnoses in this method of treating mental illness differ from current diagnoses. What are some of the diagnoses she should consider related to the use of moral therapy? Select all that apply. 1. Ill health 2. Binge eating 3. Pecuniary losses 4. Family affliction 5. Jealousy and pride

Answer: 1, 3, 4, 5 Explanation: 1. William Stokes, a physician who consulted on moral therapy and wrote extensively on its practice, considered major diagnoses to include jealousy and pride, family affliction, pecuniary losses, and ill health. Binge-eating disorder is a diagnosis in the DSM-5. 3. William Stokes, a physician who consulted on moral therapy and wrote extensively on its practice, considered major diagnoses to include jealousy and pride, family affliction, pecuniary losses, and ill health. Binge-eating disorder is a diagnosis in the DSM-5. 4. William Stokes, a physician who consulted on moral therapy and wrote extensively on its practice, considered major diagnoses to include jealousy and pride, family affliction, pecuniary losses, and ill health. Binge-eating disorder is a diagnosis in the DSM-5. 5. William Stokes, a physician who consulted on moral therapy and wrote extensively on its practice, considered major diagnoses to include jealousy and pride, family affliction, pecuniary losses, and ill health. Binge-eating disorder is a diagnosis in the DSM-5.

13) The nurse obtains a new position as a psychiatric-mental health nurse at the generalist level of practice. Based on the Psychiatric-Mental Health Nursing Standards of Practice (ANA, APNA, ISPN), in which areas might the nurse plan programs and intervention to fulfill employment expectations? Select all that apply. 1. Stress management strategies 2. Early diagnosis of psychiatric disorders 3. Parenting classes for new parents 4. Family and group psychotherapy 5. Medication teaching for anti-anxiety medications

Answer: 1, 3, 5 Explanation: 1. Stress management strategies address health, wellness, and care of mental health problems and are appropriate for psychiatric-mental health nursing at the generalist level of practice. Parenting classes for new parents provide teaching that is consistent with the prevention of mental health problems and is consistent with psychiatric-mental health nursing at the generalist level of practice. Family and group psychotherapy is consistent at the advanced practice registered nurse level but not the generalist level. Medication teaching for anti-anxiety medications promotes quality of care for individuals with psychiatric disorders and is vital for psychiatric-mental health nursing practice at the generalist level of practice. Early diagnosis of psychiatric disorders is generally not consistent with the definition or practice of psychiatric-mental health nursing, especially at the generalist level. 3. Stress management strategies address health, wellness, and care of mental health problems and are appropriate for psychiatric-mental health nursing at the generalist level of practice. Parenting classes for new parents provide teaching that is consistent with the prevention of mental health problems and is consistent with psychiatric-mental health nursing at the generalist level of practice. Family and group psychotherapy is consistent at the advanced practice registered nurse level but not the generalist level. Medication teaching for anti-anxiety medications promotes quality of care for individuals with psychiatric disorders and is vital for psychiatric-mental health nursing practice at the generalist level of practice. Early diagnosis of psychiatric disorders is generally not consistent with the definition or practice of psychiatric-mental health nursing, especially at the generalist level. 5. Stress management strategies address health, wellness, and care of mental health problems and are appropriate for psychiatric-mental health nursing at the generalist level of practice. Parenting classes for new parents provide teaching that is consistent with the prevention of mental health problems and is consistent with psychiatric-mental health nursing at the generalist level of practice. Family and group psychotherapy is consistent at the advanced practice registered nurse level but not the generalist level. Medication teaching for anti-anxiety medications promotes quality of care for individuals with psychiatric disorders and is vital for psychiatric-mental health nursing practice at the generalist level of practice. Early diagnosis of psychiatric disorders is generally not consistent with the definition or practice of psychiatric-mental health nursing, especially at the generalist level.

20) A six-year-old has been diagnosed with both reactive attachment and disinhibited social engagement disorders after being found living in the streets. The nurse knows that the patient will exhibit which symptoms? Select all that apply. 1. Wandering from caregivers 2. Engaging in repetitive behaviors 3. Unable to seek comfort when distressed 4. Preoccupation with physical appearance 5. Fearfulness despite the absence of stressors

Answer: 1, 3, 5 Explanation: 1. The patient with reactive attachment disorder displays limited positive affect; experiences periods of irritability, sadness, and fearfulness despite the absence of stressors; and does not seek comfort when distressed or respond to comforting efforts. With disinhibited social engagement disorder, the patient may readily engage with unfamiliar adults and wander from caregivers. Engaging in repetitive behaviors and preoccupation with physical appearance are not associated with reactive attachment or disinhibited social engagement disorder. 3. The patient with reactive attachment disorder displays limited positive affect; experiences periods of irritability, sadness, and fearfulness despite the absence of stressors; and does not seek comfort when distressed or respond to comforting efforts. With disinhibited social engagement disorder, the patient may readily engage with unfamiliar adults and wander from caregivers. Engaging in repetitive behaviors and preoccupation with physical appearance are not associated with reactive attachment or disinhibited social engagement disorder. 5. The patient with reactive attachment disorder displays limited positive affect; experiences periods of irritability, sadness, and fearfulness despite the absence of stressors; and does not seek comfort when distressed or respond to comforting efforts. With disinhibited social engagement disorder, the patient may readily engage with unfamiliar adults and wander from caregivers. Engaging in repetitive behaviors and preoccupation with physical appearance are not associated with reactive attachment or disinhibited social engagement disorder.

7) The nurse is caring for a patient with mental illness who expresses interest in the use of complementary and alternative medicine (CAM). What main categories of CAM will the nurse include when providing education to the patient about CAM? Select all that apply. 1. Natural 2. Non-traditional 3. Alternative 4. Mind and body practices 5. Allopathic and naturopathic practices

Answer: 1, 4 Explanation: 1. The main categories of CAM are natural and mind and body practices. Allopathic is conventional medicine. Some may describe CAM treatments as non-traditional, alternative, and naturopathic; however, these terms are not the main categories of CAM. 4. The main categories of CAM are natural and mind and body practices. Allopathic is conventional medicine. Some may describe CAM treatments as non-traditional, alternative, and naturopathic; however, these terms are not the main categories of CAM.

6) A patient with a history of an anxiety disorder presents at the community health clinic complaining of headache and dizziness. Which additional symptoms would suggest to the nurse that the patient might be experiencing a recurrence of the anxiety disorder? Select all that apply. 1. Dilated pupils 2. Decreased blood pressure 3. Dry skin 4. Tachycardia 5. Diarrhea

Answer: 1, 4, 5 Explanation: 1. Symptoms of severe anxiety include headache, dizziness, dilated pupils, tachycardia, and diarrhea. Elevated, not decreased, blood pressure and sweating, not dry skin, are also symptoms of severe anxiety. 4. Symptoms of severe anxiety include headache, dizziness, dilated pupils, tachycardia, and diarrhea. Elevated, not decreased, blood pressure and sweating, not dry skin, are also symptoms of severe anxiety. 5. Symptoms of severe anxiety include headache, dizziness, dilated pupils, tachycardia, and diarrhea. Elevated, not decreased, blood pressure and sweating, not dry skin, are also symptoms of severe anxiety.

21) A group of nurses is discussing various types of psychotherapy. What do they identify as universal practice principles among the different theories and methodologies? Select all that apply. 1. Establishing goals 2. Using effective medications 3. Establishing a treatment time frame 4. Determining behavioral objectives 5. Establishing a therapeutic alliance

Answer: 1, 5 Explanation: 1. Establishing a therapeutic alliance and establishing treatment goals are an essential part of all psychotherapeutic treatments. Medications may be an adjunctive treatment but are not an essential part of psychotherapy. Time frames are an important part of certain modalities, but some treatments, such as psychoanalysis, may continue open-ended. Behavioral objectives are not critical in all forms of psychotherapy. 5. Establishing a therapeutic alliance and establishing treatment goals are an essential part of all psychotherapeutic treatments. Medications may be an adjunctive treatment but are not an essential part of psychotherapy. Time frames are an important part of certain modalities, but some treatments, such as psychoanalysis, may continue open-ended. Behavioral objectives are not critical in all forms of psychotherapy.

7) What essential treatment elements of moral therapy could be considered as components of some current treatments? Select all that apply. 1. Kindness 2. Medication 3. Nutrition 4. Bloodletting 5. Meaningful activity

Answer: 1, 5 Explanation: 1. Kindness and meaningful activity were critical elements of moral therapy that are important components of some current methods of treatment. Although medication and bloodletting may have been used therapeutically by practitioners of moral therapy, they were secondary modalities. Nutrition was not an important consideration in this treatment. 5. Kindness and meaningful activity were critical elements of moral therapy that are important components of some current methods of treatment. Although medication and bloodletting may have been used therapeutically by practitioners of moral therapy, they were secondary modalities. Nutrition was not an important consideration in this treatment.

5) A patient is extremely agitated and presents a danger to others. The resident orders 5 mg haloperidol IM to be administered immediately in order to calm the patient. What kind of order is this? 1. PRN 2. STAT 3. Single order 4. Standing order

Answer: 2 Explanation: 2. A STAT order is a one-time order for a medication to be given immediately. PRN medications are given on an "as needed" basis for specific signs or symptoms. A single order is for a medication to be given only once and at a specific time. A standing order is given for medications to be administered routinely until the order is cancelled.

25) A patient has been administered a benzodiazepine one hour ago and is now agitated and angry. What does the nurse suspect the patient is demonstrating? 1. A target effect 2. A paradoxical response 3. An anaphylactic reaction 4. An idiosyncratic response

Answer: 2 Explanation: 2. A paradoxical response is the development of a contradictory reaction to the medication. Because the desired effect of a benzodiazepine is to calm the patient, agitation and anger would be paradoxical responses to a benzodiazepine. An idiosyncratic response is a unique and strange response to medication resulting in pain, bleeding, over response or organ failure. Target effect describes the intended or expected response of a medication. An anaphylactic response is a life-threatening severe, whole-body allergic response.

33) A patient taking a selective serotonin-reuptake inhibitor (SSRI) is experiencing a decrease in sexual functioning. What medication might be considered to help restore the patient's sexual functioning? 1. Ativan 2. Wellbutrin 3. Trazadone 4. Propranolol

Answer: 2 Explanation: 2. Adding a noradrenergic medication, such as bupropion (Wellbutrin), to an SSRI can reduce sexual dysfunction. Trazodone may be useful in treating insomnia. A benzodiazepine, such as Ativan, can reduce anxiety. An adrenergic beta antagonist (such as propranolol) can also reduce anxiety.

7) A nurse looks at the patient's wrist tag when she enters the room to administer medication. Which of the five "rights" is she verifying? 1. Right time 2. Right patient 3. Right medication 4. Right documentation

Answer: 2 Explanation: 2. Administering medication to the right patient should be checked by verifying the patient's ID and using any other appropriate method, e.g., verifying the patient's date of birth. The medication type, dosage, and time to be administered should be verified using the medication orders. Documentation should always include all essential information about the patient, the prescriber and the medication.

3) A patient in the emergency department (ED) is pacing the hallway, then sits briefly before getting up and walking again. What would be an appropriate description of this patient's psychomotor activity? 1. Energetic 2. Agitated 3. Retarded 4. Spontaneous

Answer: 2 Explanation: 2. Agitated activity appears nervous and disturbed. Energetic activity is marked by vigor. Retarded activity is slow or limited. Spontaneous activity occurs naturally and without planning.

6) The parents of a 22-year-old male who is hospitalized for depression ask the nurse what they should be doing to help. What is the most appropriate response the nurse can make? 1. Refuse to talk with family members because of confidentiality restrictions. 2. Provide the family with education, information, and referral resources. 3. Tell the family members that their son is too old for them to be involved in his care. 4. Inform the family that only the psychiatrist can discuss their son's care.

Answer: 2 Explanation: 2. Although confidentiality must be observed, there are many aspects of care in which a patient's family can help. An important role of the psychiatric-mental health nurse is to ensure that the family is involved in the provision of care to the fullest extent possible. Family involvement in care is not limited by the patient's age. A psychiatric nurse is qualified to discuss mental health treatment.

3) What quality, emphasized by Vincent dePaul in the 17th century, would a psychiatric nurse find important in her practice today? 1. Spirituality 2. Humility 3. Practicality 4. Obedience

Answer: 2 Explanation: 2. Although spirituality was considered an important quality, it was not the focus of the treatment promoted by Vincent de Paul. According to de Paul, humility provided a lens for the recognition and acknowledgement of both personal talents and limits. Neither practicality nor obedience were qualities emphasized by de Paul.

27) A patient has been brought to the emergency department (ED) with a Stevens-Johnson rash. What might the nurse consider as a possible cause? 1. Target reaction to a drug 2. Allergic reaction to a drug 3. Paradoxical reaction to a drug 4. Idiosyncratic reaction to a drug

Answer: 2 Explanation: 2. An allergic (hypersensitive) reaction occurs when an antibody-antigen response causes an extreme reaction in the body; for example, lamotrigiene (Lamictal) has been observed to cause Stevens-Johnson rash, an allergic response that can be fatal. Idiosyncratic reactions are unexpected and unpredictable. Paradoxical reactions have the opposite of the desired effect. A target effect is the desired reaction to a medication.

21) What drug acts as an inhibitor to activity by the protein receptor? 1. Agonist 2. Antagonist 3. Therapeutic 4. Partial agonist

Answer: 2 Explanation: 2. An antagonist (inhibitor, blocker) causes there to be no chemical action at the cell site. Agonists activate the protein receptor on the cell site. Therapeutic drugs are those that have a positive clinical effect. Partial agonists elicit only a partial biologic response.

8) The student nurse is learning about the various complementary and alternative medicine (CAM) therapies, which may be employed as collaborative treatment for the patient with mental illness. What will the student learn about the core concept of Ayurveda? 1. It uses instruments measuring body functions and providing sensory feedback to train patients to voluntarily control certain bodily processes. 2. It aims to integrate the body, mind, and spirit to prevent and treat illness and may employ herbs, massage, meditation, diet, and lifestyle modifications. 3. A medical system originating in China, its philosophy views the human body as a microcosm of the surrounding universe. 4. It seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances that, in larger doses, would produce symptoms or illness.

Answer: 2 Explanation: 2. Ayurveda is one of the oldest systems of medicine, originating in India. Ayurveda aims to integrate the body, mind, and spirit to prevent and treat illness and may employ herbs, massage, meditation, diet, and lifestyle modifications. Biofeedback uses instruments measuring body functions and providing sensory feedback to train patients to voluntarily control certain bodily processes. Traditional Chinese medicine (TCM) is a medical system originating in China whose philosophy views the human body as a microcosm of the surrounding universe. Homeopathy seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substance that, in larger doses, would produce symptoms or illness.

10) Which theorist is the nurse modeling when encouraging the patient to develop, strengthen, and use self-efficacy to maintain or regain mental health and wellness? 1. B. F. Skinner 2. Albert Bandura 3. Jean Piaget 4. Sigmund Freud

Answer: 2 Explanation: 2. Bandura contended that an individual not only reacts to a stimulus but also has the ability to adapt and reinforce positive, healthier responses to the stimulus. This concept, known as self-efficacy, is best reflected when the nurse encourages the patient to develop, strengthen, and use self-efficacy to maintain or regain mental health and wellness. Skinner examined human responses to stimuli. Piaget's theory involved components that explained children and adolescent behavior according to various ages. Freud's theory focuses on psychoanalysis, not self-efficacy.

14) Which theory does the nurse recognize as the approach that explains how the patient's transformation of information is used? 1. Psychoanalytic theory 2. Cognitive theory 3. Psychosocial theory 4. Humanistic theory

Answer: 2 Explanation: 2. Cognitive theory focuses on the internal knowing and thinking processes of individuals. Cognitive theorists examine cognitive development—how perception, organization, and transformation of information occur. Psychoanalytic theory proposes that personality develops in a progressive manner grounded in psychosexual stages. Psychosocial theory focuses on the achievement and mastery of life challenges that occur within certain time periods. Humanistic theory is a holistic perspective that concentrates on the ability of humans to control their everyday events and determine what they want to accomplish in the future.

36) The psychiatric-mental health nurse is learning about various tools that can be used to help the nurse establish a therapeutic nurse-patient relationship. The nurse learns that taping offers what advantage to establishing a therapeutic relationship? 1. Assists the nurse in memorizing useful habits and mannerisms. 2. Assists the nurse in identifying communication habits and mannerisms. 3. Offers a way for feedback on communication skills and dynamics to be provided when direct observation is not an option. 4. Offers a way for feedback on communication skills and dynamics to be provided when indirect observation is not an option.

Answer: 2 Explanation: 2. Communication habits and mannerism can be identified using the method of taping, offering the nurse greater awareness of both verbal and nonverbal communication skills. The technique of process recording, not taping, offers a way for feedback to be provided on communication skills and dynamics when direct, not indirect, observation is not an option. Taping does not allow communication habits and mannerisms to be memorized.

20) A nurse is caring for an older adult with a mental illness who will be going to surgery for placement of a non-emergent pacemaker in the morning. The patient has been deemed incompetent by a court of law. The nurse understands that which individual will need to sign the patient's surgical consent? 1. Spouse 2. Guardian 3. Oldest child 4. Hospital administrator

Answer: 2 Explanation: 2. Competency is a legal issue. Patients who are deemed incompetent by law are appointed a conservator or guardian, and any consent to procedures must be approved by that individual. If it was an emergent procedure, informed consent could be waived as long as standard of care was followed appropriately. In the case of an incapacitated patient (as opposed to an incompetent one), next of kin may be able to provide consent depending on state law. Nurses should be familiar with the laws in their own states.

1) The nurse is caring for a patient with mental illness who asks the nurse, "I have a friend who tells me that I should look into using complementary and alternative medicine to help treat my disease. What is that?" What is the nurse's best response? 1. "It is a group of diverse medical and health care systems, practices, and products that may be used but are not considered evidence-based medicine." 2. "It is a group of diverse medical and health care systems, practices, and products that are not generally considered part of traditional medicine." 3. "It is a group of diverse medical and health care systems, practices, and products that are not generally considered useful in treating mental illness." 4. "It is a group of diverse medical and health care systems, practices, and products that are used extensively in the treatment of mental illness."

Answer: 2 Explanation: 2. Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of traditional medicine. Some of the treatments used in CAM are considered evidence-based medicine. CAM treatments may be useful in treating mental illness; however, these treatments are generally not used extensively in the treatment of mental illness.

20) A nurse was asked to identify the most preferred location for addressing mental illness during the 19th century. What is the nurse's best response? 1. Home 2. Asylums 3. Hospitals 4. Sanitariums

Answer: 2 Explanation: 2. During the 17th and 18th century, asylums were an attempt to provide humane treatment for the mentally ill, but by the 19th century they were intended more for restraint. Asylums were the preferred means of housing those with mental illness in the 19th century. Prior to the 19th century, the mentally ill were frequently housed in hospitals that treated all illnesses. The mentally ill, particularly those who were violent, were frequently institutionalized and removed from the home. Sanitariums were usually restricted to the wealthy.

5) Which nursing diagnosis does the nurse recognize as the most consistent with the focus of psychiatric nursing care during the 19th century? 1. Anxiety 2. Self-care deficit 3. Altered thought processes 4. Ineffective individual coping

Answer: 2 Explanation: 2. During the 19th century, psychiatric nurses attended mainly to the physical needs of patients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial. Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid-20th century.

5) The nurse is establishing a therapeutic environment with a newly admitted patient with a severe mental illness. Which statement best demonstrates empathetic communication? 1. "I feel really bad that you have this disorder." 2. "You appear upset. Do you want to talk about it?" 3. "You appear upset. Why do you feel this way?" 4. "Many people have this disorder. You will feel better in no time."

Answer: 2 Explanation: 2. Empathy is sensing the perceptions or feelings of an individual and one's relationship to the individual's situations and experiences (feeling what the other person is feeling), and communicating and validating or adjusting them based on feedback from that person. Empathy is an important aspect of therapeutic communication. The statement, "You appear upset. Do you want to talk about it?" is the best example of empathetic communication because the nurse is perceiving and validating the patient's feelings. Telling the patient that the nurse feels bad for the patient is expressing sympathy, not empathy. Asking why the patient feels the way that he or she does is not validating the patient's feelings. The nurse should not tell the patient that many people have the same disorder as the patient, as this does not validate the patient's feelings or experience.

11) A school nurse is explaining to a student that, as a result of an eye exam, it is likely that the student will need to get eyeglasses. The student says, "I guess even though I don't like glasses, I'll get them because they will help me see better." Which of Piaget's intellectual components of development does this statement indicate to the nurse? 1. Schemas 2. Equilibrium 3. Assimilation 4. Accommodation

Answer: 2 Explanation: 2. Equilibrium represents a balance between taking in new information and changing schemas to meet a new reality. A schema is a category of knowledge that helps individuals interpret and understand the world. Assimilation is the process of taking in new information into previously existing schemas; it is a thought process that does not involve behavioral change. Accommodation involves changing behavior to account for new knowledge.

33) Which dimension is notcommonly affected by suffering experienced by cancer patients? 1. Physical 2. Geographical 3. Psychological 4. Social well-being

Answer: 2 Explanation: 2. Fatigue and pain are dimensions of suffering. Commonalities exist in cancer patients from diverse cultures and locations. Psychological pain includes depression. Social well-being is affected by isolation and withdrawal.

5) How might a nurse describe the relationship between mental health treatment and humanism? 1. Science is the core consideration of humanistic philosophy. 2. Caring practices and compassion must be approached holistically. 3. Mental health clients must rely on clinicians for difficult decision-making and care. 4. Limitations of life in today's world have little effect on planning effective interventions.

Answer: 2 Explanation: 2. In humanistic philosophy, healing and caring are approached holistically. The philosophy accounts for well-being within the limitations of life in today's world. Humanism purports that service to benefit humanity is accomplished through reason, science, and democracy. Patients are not passive recipients of care but, rather, have the potential to solve their own problems. Patients need to be supported and empowered to develop new perspectives and make self-directed choices.

24) A new nurse is discouraged because a patient with whom she has been working for four months recently refused to continue group therapy. The nurse tells her supervisor that she doubts the patient will ever have an effective recovery. What is an appropriate response from her supervisor? 1. "Recovery is probably unlikely for this patient." 2. "The patient is experiencing a setback, not an end to recovery." 3. "The patient should be told that group therapy is her only route to recovery." 4. "The patient should be punished for her refusal to participate."

Answer: 2 Explanation: 2. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. Setbacks are a natural, though not inevitable, part of the recovery process. Recovery pathways are highly personalized. Recovery is based on respect; punishment is not appropriate.

4) The nurse is caring for an individual who has been diagnosed with depression. The patient tells the nurse that, in addition to prescription antidepressants, the patient is practicing yoga and meditation. What type of CAM is the patient using? 1. Allopathic medicine 2. Integrative medicine 3. Alternative medicine 4. Complementary medicine

Answer: 2 Explanation: 2. Integrative medicine refers to a practice that combines both conventional and CAM treatments for which there is high-quality scientific evidence of safety and effectiveness. Yoga and meditation have been proven scientifically to help with the treatment of depression. Complementary medicine refers to the use of CAM in conjunction with conventional medicine. Alternative medicine refers to the use of CAM in place of conventional medicine. Allopathic medicine is traditional medicine.

18) A patient who was admitted voluntarily to the hospital verbally refuses his medication. The nurse proceeds to give the medication over the patient's objections. What is the legal significance of the nurse's actions? 1. The nurse cannot be held liable. 2. The nurse could be charged with battery. 3. The nurse could be charged with negligence. 4. The nurse could be charged with malpractice.

Answer: 2 Explanation: 2. Medication can be administered against the patient's wishes only if there is a treatment order from a judge or the patient is a danger to self or others. Unauthorized treatment without consent may constitute medical battery because it is a form of unlawful touching. Malpractice refers to the negligent acts of health care professionals when they fail to act in a responsible and prudent manner. Negligence occurs when a nurse fails to act in a manner in which most reasonable and prudent nurses would act. The nurse is liable for these actions.

19) A nurse is providing mental health services to a 45-year-old homeless man who is diagnosed with bipolar disorder. Based on a wellness model, which services could broaden the patient's base of social supports? 1. Medication monitoring 2. Housing assistance 3. Nutritional counseling 4. Individual psychotherapy

Answer: 2 Explanation: 2. Medication monitoring and nutritional counseling address the biological domain in the wellness model. Housing assistance would strengthen the patient's social support base. Individual psychotherapy addresses the psychological domain.

17) The nurse is caring for a patient with a circadian rhythm sleep disorder. The patient expresses a desire to try complementary and alternative medicine (CAM) and the use of melatonin for the treatment of the condition. How does melatonin work for circadian rhythm sleep disorders? 1. It works by helping the individual stay asleep. 2. It works by helping the individual fall asleep. 3. It works by stimulating the pineal gland to improve sleep. 4. It work by suppressing the pineal gland to improve sleep

Answer: 2 Explanation: 2. Melatonin, a hormone found naturally in the body, is produced by the pineal gland, which regulates circadian rhythm and sleep-wake cycles. As darkness falls, endogenous melatonin levels rise, sending signals to the body to sleep. Light reduces melatonin production and signals the body to awaken. When taken at night, melatonin may decrease the time it takes to fall asleep (sleep latency) in circadian rhythm sleep disorders, but it does not help the individual stay asleep. Though melatonin is produced by the pineal gland, taking a supplement of melatonin does not stimulate or suppress the pineal gland.

22) The nurse is caring for a patient with Alzheimer disease. The patient has been taking donezepil (Aricept), and reports that has been helping but that it does not seem to be working as well as it used to. The health care provider writes an order for memantine (Namenda). Which statement will the nurse include in the education for the patient and caregiver? 1. "Memantine works by increasing activation of glutamine transmission." 2. "Memantine works by reducing activation of glutamine transmission." 3. "Memantine will enhance breakdown of acetylcholine." 4. "Memantine will inhibit breakdown of acetylcholine."

Answer: 2 Explanation: 2. Memantine is an N-methyl d-aspartate glutamate receptor antagonist, which means it works by inhibiting or reducing activation of glutamine transmission. Donezpril reduces the breakdown of acetylcholine. Reducing activation of glutamine transmission and reducing the breakdown of acetylcholine may slow the progress of dementia associated with Alzheimer disease.

26) Which intervention promotes mindful listening in any health care setting? 1. Telling the patient to get off the phone 2. Turning off the television before interviewing the patient 3. Encouraging family to step outside before assessing the patient 4. Offering the patient a choice of drink when taking a medication

Answer: 2 Explanation: 2. Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a patient. Offering patients a choice to drink when taking medication and encouraging the family to step outside before assessing the patient are examples of conveying respect, not mindful listening. Telling the patient to get off the phone is not a therapeutic intervention.

27) A nurse, newly assigned to a 55-year-old Native American patient diagnosed with major depression, is concerned about the patient's reliance on certain totemic objects for comfort. What should the nurse do in order to address her concern? 1. Tell the patient that he needs to learn to rely upon himself. 2. Ask the patient to explain the significance of these objects. 3. Inform the patient that superstitions will interfere with his recovery. 4. Request a psychiatric consult to help determine if the patient is delusional.

Answer: 2 Explanation: 2. Nurses should be deliberative in determining with patients what their needs are rather than assuming on their own that they know or understand their patients' needs. Asking the patient to explain the significance of these objects will help the nurse better understand the patient's beliefs and needs. The nurse who is more objective and more accepting of patients can improve the quality of nurse-patient interactions. The nurse should be aware of her culturally based judgments. The situation, as described, requires collaboration with the patient rather than a consultation about the patient.

23) Based on the work of Florence Nightingale, what distinguishes nurses from nursing attendants? 1. Kindness 2. Training and education 3. Ability to use herbal remedies 4. Belief in the bio-medical model

Answer: 2 Explanation: 2. Nursing traditionally uses a holistic model of care. Nightingale emphasized training and education as the foundation of professional nursing. Kindness is an element of many models of nursing care but does not distinguish nurses from other care providers. Herbal remedies are not a specialty particular to nurses.

17) What was a common response during the eras when patients with mental illness were believed to be victims of demonic possession? 1. Punishment by stoning 2. Shackling in chains 3. Burning at the stake 4. Treatment with exorcism

Answer: 2 Explanation: 2. Patients with mental illness were often placed in chains as restraints. Stoning was frequently used as a punishment for adultery. Burning at the stake was a punishment for heresy and witchcraft. The Catholic Church distinguishes behavior that indicates the need for exorcism from behavior indicating mental illness.

18) The nurse is caring for a patient who is prescribed an antidepressant. The patient asks the nurse how the drug works. Which is the best response by the nurse? 1. "The medication will target neurotransmitters in the stomach." 2. "The medication will target specific cells in the central nervous system." 3. "The medication will enter your bloodstream and find the targeted area." 4. "The medication will target your central nervous system as a whole."

Answer: 2 Explanation: 2. Psychiatric medications work by targeting specific neuronal cells and synapses in the central nervous system. Although some psychotropic medications may affect neurotransmitters in the stomach, this is not a target effect. To say that the medication will target the entire central nervous system is incorrect. To say that the medication will enter the bloodstream and find the targeted area is vague and misleading.

13) What does the novice nurse identify as a characteristic that assists psychotropic medications in penetrating the blood-brain barrier (BBB)? 1. They are acidic. 2. They are lipophilic. 3. They are water soluble. 4. They have large molecules.

Answer: 2 Explanation: 2. Psychotropic medications gain entrance and leave the protected brain environment by being lipophilic (preferring fat-soluble molecules). Acidity does not affect BBB penetration. Water solubility affects absorption, not BBB penetration. Large molecules prevent BBB penetration.

23) Which is a fundamental principle of mental health recovery? 1. Recovery is culturally unrelated. 2. Recovery is holistic. 3. Recovery begins with despair. 4. Recovery is solitary.

Answer: 2 Explanation: 2. Recovery is culturally based and influenced. Recovery encompasses an individual's whole life, including mind, body, spirit, and community. Recovery emerges from hope. Recovery is supported through relationship and social networks.

30) A 72-year-old patient tells the nurse that she is unable to take her antidepressant medication regularly because her granddaughter forgets to go to the drugstore for her. What perception of life events does this explanation demonstrate? 1. Resilience 2. External locus of control 3. Internal locus of control 4. Primary appraisal

Answer: 2 Explanation: 2. Resilience is the capacity to adapt constructively to difficulty. External locus of control places control of one's life on other people and on circumstances outside the self. Internal locus of control places control within the self. Primary appraisal occurs when an individual determines whether or not the event or stressor will impact his or her well-being.

35) In order to minimize neuromuscular side effects, which medication is likely to be prescribed for psychotic symptoms? 1. Lithium 2. Olanzapine 3. Galantamine 4. Haldoperidol

Answer: 2 Explanation: 2. Second generation antipsychotics such as olanzapine have fewer neuromuscular side effects than first generation antipsychotics such as haloperidol. Lithium is a salt ion used in the treatment of bipolar disorder. Galantamine is a cholinesterase inhibitor.

34) A patient who has been prescribed sertraline (Zoloft) reports to the nurse that she uses St. John's Wort. What danger does the nurse recognize? 1. Tardive dyskinesia 2. Serotonin syndrome 3. Stevens-Johnson rash 4. Anaphylactic reaction

Answer: 2 Explanation: 2. Serotonin syndrome, a sometimes fatal condition, typically occurs when two or more medications that increase serotonin levels are used concurrently. St.John's Wort and Zoloft are two such substances. An anaphylactic reaction is a severe, whole-body allergic response to a medication. Stevens-Johnson rash is a severe hypersensitivity reaction to a medication or infection. Tardive dyskenesia is a condition characterized by extrapyramidal symptoms that result from certain anti-psychotic medications.

8) What evaluative tool is most important in assessing a patient's mental condition? 1. Beck Depression Inventory 2. Mental Status Exam 3. CAT scan 4. WAIS

Answer: 2 Explanation: 2. The Beck Depression Inventory is important only if the nurse suspects that the patient is depressed. The mental status exam provides an overall picture of the patient's mental condition. A CAT scan is not part of an initial assessment. The WAIS (Wechsler Adult Intelligence Scale) primarily tests intellectual functioning.

11) What is the standardized source for classifying psychiatric diagnoses? 1. DSM-III 2. DSM-5 3. ICD-9 4. WHO Disability Schedule

Answer: 2 Explanation: 2. The DSM-III provided a psychiatric classification system using a multiaxial approach that has recently been replaced. The DSM-5 is the official manual approved by the APA and the NIMH for use by all clinicians to diagnose psychiatric and mental health disorders in patients. The ICD-9 provides a set of codes for classifying diseases, injuries, health encounters and inpatient procedures. The WHO Disability Schedule is a generic assessment instrument for health and disability.

10) Which religious group of women instituted asylum-based treatment in the United States in order to provide peaceful surroundings for those with mental illness? 1. Quakers 2. Sisters of Charity 3. Daughters of Charity 4. Little Sisters of the Sick Poor

Answer: 2 Explanation: 2. The Mount Hope Retreat, where people could live in secluded, peaceful natural surroundings, was created and administered by the American Sisters of Charity nurses. The Quakers are not a group of religious women. The Daughters of Charity pioneered asylum-based psychiatric nursing at French hospitals. The Little Sisters of the Sick Poor did not focus on treating the insane.

19) A nurse asks her mentor to identify the term describing a drug's ability to bind to a particular receptor site. The mentor knows that which is the most appropriate response? 1. Affinity 2. Selectivity 3. Intrinsic activity 4. Hyperosmolarity

Answer: 2 Explanation: 2. The drug's ability to bind to a particular receptor site is referred to as its selectivity.Affinity refers to how strong an interest or attraction a drug might have for a particular receptor. The drug's ability to produce a response once it has been bound or attached itself to the receptor is called its intrinsic activity.Hyperosmolarity refers to particularly high concentrations of a substance.

23) The nurse is caring for a patient who is scheduled to undergo a total knee replacement in two weeks. The nurse notes that the patient takes herbal supplements for the treatment of the patient's mental illness. What is the correct pre-surgical instruction the nurse will provide to the patient? 1. "You should continue the herbal supplements regardless of your surgery." 2. "You should discontinue the herbal supplements 2 weeks prior to your surgery." 3. "You should continue the herbal supplements if they do not interfere with your surgery." 4. "You should discontinue the herbal supplements 1 week prior to your surgery."

Answer: 2 Explanation: 2. The nurse should advise the patient to discontinue the herbal supplements 2 weeks, not 1 week, prior to the surgery. It is incorrect to advise the patient to continue the herbal supplements regardless of the surgery, or to continue the supplements if they do not interfere with the surgery. The nurse must assume that the patient does not know whether the supplements will interfere with the patient's surgery.

12) The nurse is caring for a patient with depression. When obtaining the patient's current medication list, the nurse notes that the patient is taking St. John's wort. What additional class of medication would most concern the nurse if the patient reports taking a medication in that class? 1. MAOI 2. SSRI 3. Antipsychotics 4. Barbiturate

Answer: 2 Explanation: 2. The nurse would be most concerned about the patient taking an SSRI in conjunction with St. John's wort. Serotonin syndrome, a potentially life-threatening condition, may occur if St. John's wort is used concomitantly with SSRIs. MAOIs, antipsychotics, and barbiturates do not cause potentially life-threatening conditions if taken concomitantly with SSRIs.

18) What specific condition was considered an indication for bloodletting when patients were diagnosed with mental illness? 1. Melancholy 2. Excess excitability 3. Cerebral dysfunction 4. Hereditary weakness

Answer: 2 Explanation: 2. The treatment for melancholy often included stimulants. Excess excitability was often treated with bloodletting or emetics. Symptoms that were attributed to cerebral dysfunction or hereditary predisposition were not usually treated with bloodletting.

11) The nurse is caring for the patient complaining of acute pain. The physician tells the nurse that the patient is not really in pain and orders a placebo instead. The nurse disagrees with this idea and tells the physician he will not administer a placebo, even though he does not know whether the patient is experiencing pain or not. He suggests to the physician that they have an honest discussion with the patient rather than administering a placebo. This is an example of which element of ethical decision- making? 1. Utilitarianism 2. Virtue ethics 3. Paternalism 4. Rule-based ethics

Answer: 2 Explanation: 2. There are many different guidelines for ethical decision making. Nurses often face threats to their personal and/or professional integrity and must choose to adhere (or not) to their own set of values. In this example, the nurse offered the physician an integrity-preserving compromise. Even though the nurse refused to carry out the order, he acknowledged the physician's opinion and sought to work with the individual patient. The nurse had already clarified his values and had identified the biggest stakeholder as the patient. He had also made it clear that in the moral hierarchy, his biggest duty was to the patient.

6) Which dimension would the nurse most likely focus on if assessing the patient from primarily a 19th century perspective? 1. Spiritual 2. Physical 3. Social 4. Emotional

Answer: 2 Explanation: 2. Until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment. More holistic care (including emotional-social-spiritual dimensions) is a product of more recent history.

11) What documentation was required for hospital admission to the Maryland Hospital for the Insane? 1. No documentation 2. Certificate of Insanity 3. Order of the patient's physician 4. Written request of the patient's family

Answer: 2 Explanation: 2. Upon a patient's admission, the admitting nurse had to collect from the patient the certificate of insanity issued by the Court of Competent Jurisdiction or two physicians. Patients could not be admitted without documentation. The order of an individual physician or a family request was not sufficient for admission.

17) A patient tells the nurse, "Everything makes me anxious now." The nurse suspects the patient is suffering from which condition? 1. Phobia 2. Chronic anxiety 3. Dissociative identity disorder 4. Obsessive-compulsive disorder

Answer: 2 Explanation: 2. Usually, patients with chronic anxiety have anxiety that is more general and long-lasting, and which has become part of their personality over time. Patients with phobias, dissociative identity disorders, and obsessive-compulsive disorders have anxiety related to a stimulus.

9) A nurse in the emergency department is working triage. Although a patient with hypomania has been waiting for 2 hours, the nurse sends a suicidal patient to be evaluated immediately. This decision is most likely based upon which ethical principle? 1. Deontology 2. Utilitarianism 3. Ethics of care 4. Virtue ethics

Answer: 2 Explanation: 2. Utilitarianism focuses on the consequences of an action and promoting the greater good. By choosing to treat a suicidal patient who may be in immediate jeopardy over a patient with perhaps a more chronic condition, the nurse is focused on the potential outcome of her decision. Deontology focuses on moral duty and that all persons are of equal value. If the nurse used this principle, she might have shown preference to the patient with who had been waiting longer. The ethics of care has most to do with being empathetic and having an emotional connection. It would be hard for the nurse to use this principle for a triage decision as she is likely empathetic to both patients but doesn't necessarily have an emotional connection to either one. Virtue ethics is how the nurse applies her values to a particular case, and is not the primary principle for this situation.

15) The nurse is caring for a patient with schizophrenia who is admitted to the hospital after being found incoherent and combative at a local grocery store. The patient tells the nurse that he has not taken his medications for over two weeks. The nurse is assessing the patient's needs, symptoms, and strengths. What stage of the nurse-patient relationship is being demonstrated? 1. Working 2. Orientation 3. Identification 4. Pre-orientation

Answer: 2 Explanation:2. During the orientation phase of the nurse-patient relationship, the nurse assesses needs, symptoms, strengths, and limitations. In the pre-orientation phase, the nurse identifies and collects materials and resources likely to be used at the initial meeting. In the working phase, the "work" of treatment occurs. In the identification phase, the nurse clarifies the patient's expectations for care

31) A group of student nurses were discussing how to promote resilience in their patients and realized that it is a concept they also want to promote in themselves. How might student nurses foster their own resilience? 1. By avoiding challenges 2. By using reflection 3. Through self-reliance 4. Through expecting the worst

Answer: 2 Explanation:2. Promoting the capacity to adapt constructively to difficulty requires facing challenges. Reflection can help the individual to learn and adapt. Resilience requires a balanced approach to life. Positive emotions promote resilience

4) The psychiatric nurse faces a patient care ethical dilemma and uses the ANA's Code of Ethics for Nurses as a reference. What will the ANA's Code of Ethics provide to the nurse's situation? 1. The answer to the ethical dilemma 2. A framework for addressing the ethical dilemma 3. A choice for various decisions regarding the ethical dilemma 4. The evaluation of the decision made regarding the ethical dilemma

Answer: 2 Explanation:2. The Code of Ethics does not provide nurses with the "right" answers to the ethical challenges faced in practice. Rather, it is intended to provide a framework to guide nurses in solving ethical conflicts. The Code of Ethics does evaluate or provide options for solving ethical dilemmas

2) A nurse assessing a patient's cognition will include which elements as part of the assessment? Select all that apply. 1. Humor 2. Insight 3. Memory 4. Judgment 5. Fund of knowledge

Answer: 2, 3, 4, 5 Explanation: 2. Assessing cognition includes evaluating patients' ability to recall information (memory), their development of normal information (fund of knowledge), their ability to understand problems and consequences (insight) and their ability to make good choices (judgment). Evaluating humor is not a part of a cognitive assessment. 3. Assessing cognition includes evaluating patients' ability to recall information (memory), their development of normal information (fund of knowledge), their ability to understand problems and consequences (insight) and their ability to make good choices (judgment). Evaluating humor is not a part of a cognitive assessment. 4. Assessing cognition includes evaluating patients' ability to recall information (memory), their development of normal information (fund of knowledge), their ability to understand problems and consequences (insight) and their ability to make good choices (judgment). Evaluating humor is not a part of a cognitive assessment. 5. Assessing cognition includes evaluating patients' ability to recall information (memory), their development of normal information (fund of knowledge), their ability to understand problems and consequences (insight) and their ability to make good choices (judgment). Evaluating humor is not a part of a cognitive assessment.

16) Which condition can contribute to a vulnerability of the blood-brain barrier (BBB)? Select all that apply. 1. Anxiety 2. Infection 3. Radiation 4. Dementia 5. High blood pressure

Answer: 2, 3, 4, 5 Explanation: 2. High blood pressure can open the BBB. Radiation, infection, and brain injury also can open the BBB. The progression of dementia causes a weakening of the BBB. Anxiety has not been associated with BBB vulnerability. 3. High blood pressure can open the BBB. Radiation, infection, and brain injury also can open the BBB. The progression of dementia causes a weakening of the BBB. Anxiety has not been associated with BBB vulnerability. 4. High blood pressure can open the BBB. Radiation, infection, and brain injury also can open the BBB. The progression of dementia causes a weakening of the BBB. Anxiety has not been associated with BBB vulnerability. 5. High blood pressure can open the BBB. Radiation, infection, and brain injury also can open the BBB. The progression of dementia causes a weakening of the BBB. Anxiety has not been associated with BBB vulnerability.

20) What are some of the drug types whose primary action is to target the transporters in the presynaptic portion on the neuronal cell? Select all that apply. 1. Opioid receptor agonists 2. Serotonin-reuptake inhibitors 3. Norepinephrine-reuptake inhibitors 4. Selective serotonin-reuptake inhibitors 5. Norepinephrine-dopamine-reuptake inhibitors.

Answer: 2, 3, 4, 5 Explanation: 2. Some examples of drugs that target the transporters in the presynaptic portion on the neuronal cell, thereby making more neurotransmitter available for the receptors on the postsynaptic neuron, include selective serotonin-reuptake inhibitors, serotonin-reuptake inhibitors, norepinephrine-reuptake inhibitors, and norepinephrine- dopamine-reuptake inhibitors. Opioid agonists have chemical properties that mimic the body's own drug-to-receptor process and will produce the same response in the cell. 3. Some examples of drugs that target the transporters in the presynaptic portion on the neuronal cell, thereby making more neurotransmitter available for the receptors on the postsynaptic neuron, include selective serotonin-reuptake inhibitors, serotonin-reuptake inhibitors, norepinephrine-reuptake inhibitors, and norepinephrine- dopamine-reuptake inhibitors. Opioid agonists have chemical properties that mimic the body's own drug-to-receptor process and will produce the same response in the cell. 4. Some examples of drugs that target the transporters in the presynaptic portion on the neuronal cell, thereby making more neurotransmitter available for the receptors on the postsynaptic neuron, include selective serotonin-reuptake inhibitors, serotonin-reuptake inhibitors, norepinephrine-reuptake inhibitors, and norepinephrine- dopamine-reuptake inhibitors. Opioid agonists have chemical properties that mimic the body's own drug-to-receptor process and will produce the same response in the cell. 5. Some examples of drugs that target the transporters in the presynaptic portion on the neuronal cell, thereby making more neurotransmitter available for the receptors on the postsynaptic neuron, include selective serotonin-reuptake inhibitors, serotonin-reuptake inhibitors, norepinephrine-reuptake inhibitors, and norepinephrine- dopamine-reuptake inhibitors. Opioid agonists have chemical properties that mimic the body's own drug-to-receptor process and will produce the same response in the cell.

4) The nurse who is caring for an Asian patient who is newly diagnosed with an anxiety disorder considers what factors when developing the plan of care? Select all that apply. 1. Adherence to treatment 2. The patient's cultural beliefs 3. The spiritual component of treatment 4. Clarification of stressors and resources 5. Medical history

Answer: 2, 3, 4, 5 Explanation: 2. When caring for patients, it is important to consider their cultural and spiritual beliefs in developing the plan of care. Clarifying stressors and resources is important, as different people view these differently—what may be a stressor to one patient may not cause distress for another. Because co-existing medical conditions can be a source of distress, the nurse should consider this when developing the plan of care. The patient is newly diagnosed, so information about the patient's adherence to treatment is not yet available. 3. When caring for patients, it is important to consider their cultural and spiritual beliefs in developing the plan of care. Clarifying stressors and resources is important, as different people view these differently—what may be a stressor to one patient may not cause distress for another. Because co-existing medical conditions can be a source of distress, the nurse should consider this when developing the plan of care. The patient is newly diagnosed, so information about the patient's adherence to treatment is not yet available. 4. When caring for patients, it is important to consider their cultural and spiritual beliefs in developing the plan of care. Clarifying stressors and resources is important, as different people view these differently—what may be a stressor to one patient may not cause distress for another. Because co-existing medical conditions can be a source of distress, the nurse should consider this when developing the plan of care. The patient is newly diagnosed, so information about the patient's adherence to treatment is not yet available. 5. When caring for patients, it is important to consider their cultural and spiritual beliefs in developing the plan of care. Clarifying stressors and resources is important, as different people view these differently—what may be a stressor to one patient may not cause distress for another. Because co-existing medical conditions can be a source of distress, the nurse should consider this when developing the plan of care. The patient is newly diagnosed, so information about the patient's adherence to treatment is not yet available.

22) A 20-year-old college student recently diagnosed with schizophrenia is taking antipsychotic medication to control his hallucinations. Which are appropriate activities for level 2 of wellness that could be included in this patient's treatment? Select all that apply. 1. Referral to a job training program 2. Medication management education 3. Group therapy 4. Inpatient admission 5. Family support group

Answer: 2, 3, 5 Explanation: 2. At level 2 of wellness, the patient is stable but is not yet ready to focus on activities related to the future. Psychoeducational activities, such as providing medication education, are important at this stage. Mutual support groups, including the sharing of experiential knowledge and skills, play an invaluable role in recovery. Inpatient admission might be appropriate in the level 1 phase. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. 3. At level 2 of wellness, the patient is stable but is not yet ready to focus on activities related to the future. Psychoeducational activities, such as providing medication education, are important at this stage. Mutual support groups, including the sharing of experiential knowledge and skills, play an invaluable role in recovery. Inpatient admission might be appropriate in the level 1 phase. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. 5. At level 2 of wellness, the patient is stable but is not yet ready to focus on activities related to the future. Psychoeducational activities, such as providing medication education, are important at this stage. Mutual support groups, including the sharing of experiential knowledge and skills, play an invaluable role in recovery. Inpatient admission might be appropriate in the level 1 phase. Family members, peers, providers, faith groups, community members, and other allies form vital support networks.

9) According to Piaget's cognitive theory of development, which nursing considerations are most appropriate when caring for a 6-year-old child? Select all that apply. 1. Promote interaction with peers. 2. Offer explanations of assessments and procedures. 3. Provide consistency of caregiver; address stranger anxiety. 4. Provide clear and complete information, in both verbal and written form. 5. Provide opportunities to touch or play with medical equipment prior to assessments and procedures.

Answer: 2, 5 Explanation: 2. According to Piaget, the 6-year-old child is in the preoperational stage of cognitive development. Children in this stage benefit from the nurse offering explanations of assessments and procedures and providing opportunities to touch or play with medical equipment prior to assessments and procedures. Promoting interaction with peers and providing information in both verbal and written form are interventions best used for children ages 11 and older, who are at the formal operational stage. Providing consistency of caregiver as well as addressing stranger anxiety are interventions best provided for children up to age two, who are in the sensorimotor stage of cognitive development. 5. According to Piaget, the 6-year-old child is in the preoperational stage of cognitive development. Children in this stage benefit from the nurse offering explanations of assessments and procedures and providing opportunities to touch or play with medical equipment prior to assessments and procedures. Promoting interaction with peers and providing information in both verbal and written form are interventions best used for children ages 11 and older, who are at the formal operational stage. Providing consistency of caregiver as well as addressing stranger anxiety are interventions best provided for children up to age two, who are in the sensorimotor stage of cognitive development.

26) A patient has been taking sertraline (Zoloft) for one month. What can the nurse anticipate as the patient's target reaction? 1. Weight gain 2. Decreased sexual interest 3. A remission of depression 4. A remission of hallucinations

Answer: 3 Explanation: 3. A target effect is an intended or expected response of a medication. Sertraline (Zoloft), an SSRI, is generally prescribed for depression. Antipsychotic drugs are prescribed to address hallucinations. Weight gain and decreased sexual interest may be side effects of the medication; they are not target effects.

28) The nurse is learning about active listening techniques that will improve nurse-patient relationships. What is active listening's influence on communication? 1. It acknowledges the nurse's interest in a nonjudgmental attitude. 2. It facilitates spontaneous responses and interactive conversation. 3. It offers a way to hear, observe, and understand what patients communicate. 4. It offers a way to seek information or clarification of the patient's thoughts or ideas.

Answer: 3 Explanation: 3. Active listening offers a way to hear, observe, and understand what patients communicate. Seeking clarification, another therapeutic communication technique, offers a way to seek information or clarification of the patient's thoughts or ideas. Showing acceptance, another therapeutic communication technique, acknowledges the nurse's interest in a nonjudgmental attitude. Open-ended questioning, also a therapeutic communication technique, facilitates spontaneous responses and interactive conversation.

26) The relative of a woman with severe mental illness requests that the woman be involuntarily committed because of her history of numerous hospitalizations and because she is refusing to get dressed. Based on which factor does the nurse recognize that the woman likely does not qualify for involuntary commitment? 1. The woman has used up her hospital coverage. 2. The woman has not voluntarily requested hospitalization. 3. There is no evidence that woman is a danger to self or others. 4. It is less than two weeks since the woman's most recent hospital discharge.

Answer: 3 Explanation: 3. Although regulations vary by state, a common criterion for involuntary admission is that the patient poses a danger to self or others. There is no evidence that the woman described is threatening herself or others. If the patient met the criteria for hospitalization, she could be admitted even if she did not have hospital coverage under her health insurance plan or had recently been hospitalized. By definition, patients who are involuntarily hospitalized do not want or voluntarily request hospitalization.

23) The novice nurse is attempting to incorporate both verbal and nonverbal communication to her practice. What does the nurse recognize as the best definition of the purpose of verbal communication? 1. To establish and maintain relationships 2. To establish and maintain interactions 3. To communicate information about external events 4. To communicate information about internal events

Answer: 3 Explanation: 3. Argyle hypothesized that verbal communication or spoken words communicate information about external events, whereas nonverbal communication functions to establish and maintain relationships. Interactions and internal events are not part of the definition of the purpose of verbal communication.

24) The nurse is performing an admission assessment on a patient with mental illness. Which question is best when inquiring about the patient's current and past complementary and alternative medicine (CAM) use? 1. "How frequently do you have acupuncture?" 2. "What is the name of the supplement you take?" 3. "What types of therapy do you participate in?" 4. "How frequently do you take the herbal supplement?"

Answer: 3 Explanation: 3. Asking the patient, "What therapy do you participate in?" is an open-ended question that prompts the patient to explain the types of CAM he or she is using. The other questions are appropriate assessment questions; however, they may not elicit information about all the therapies the patient is using.

10) A patient with bipolar disorder has been prescribed valproate. What precautions should the nurse explain to the patient as a result of possible drug interactions? 1. Taking valproate with clozapine decreases the effect of valproate. 2. Taking valproate with antacids can result in toxic levels of valproate. 3. Taking valproate with aspirin can result in toxic levels of valproate. 4. Taking valproate with lithium decreases the effectiveness of lithium.

Answer: 3 Explanation: 3. Aspirin can increase the free concentration of valproate and result in toxic drug levels. Antacids, lithium, and clozapine have not been noted to have any significant interactive effect with valproate.

16) The patient, who is in recovery for alcohol addiction and is a heavy smoker, tells his nurse that he can never stop smoking because it is the only way he can relieve stress. He thinks his other problems are much more serious than his smoking. Having assessed that the patient is at the pre-contemplation stage of change, what would be an appropriate action for the nurse to take? 1. Help the patient make a plan to stop smoking. 2. Offer information regarding therapies and treatment options. 3. Help the patient identify specific stressors and some alternative ways to manage them. 4. Tell the patient that he is risking his life by smoking and must find a way to stop soon.

Answer: 3 Explanation: 3. At the pre-contemplation stage, without directly addressing or confronting behaviors that require change, nurses can help patients identify helpful techniques to reduce stress. At the contemplation stage, nurses and other clinicians may begin offering treatment options. In the preparation stage, individuals may plan to make changes.

15) What is the role of blood-brain barrier (BBB) transporters in neurotransmission? 1. Facilitate medication absorption. 2. Increase neurotransmission activity. 3. Shuttle neurotransmitters away from the brain. 4. Maintain a steady state of available medication molecules.

Answer: 3 Explanation: 3. BBB transporters shuttle away neurotransmitters and their metabolites to prevent them from entering the brain. BBB transporters are not involved in increasing neurotransmission, facilitating absorption, or maintaining a steady state of available medication levels in the blood.

28) A 14-year-old female patient tells the school nurse that she frequently cuts herself. The nurse is very upset by this information. What is the best action by the nurse? 1. Report the problem to the principal. 2. Call the girl's parents and suggest a psychiatric evaluation. 3. Reflect on her own reactions and focus on responding to the patient's needs. 4. Shift the conversation to the girl's academic performance.

Answer: 3 Explanation: 3. Because the patient is not in imminent danger, the desire to involve others, whether it is the principle or the girl's parents, must be guided by the patient's choices and the need to respect confidentiality. While developing the nurse-patient relationship, the nurse must learn to respond to the patient rather than react to the patient. Ignoring the issue does not address the patient's needs.

6) The nurse is participating in a team meeting to determine the disposition of a patient with severe mental illness. The nurse speaks up to ensure that the placement is appropriate to the patient's needs and interests. Which ethical principle is the nurse demonstrating? 1. Justice 2. Veracity 3. Fidelity 4. Beneficence

Answer: 3 Explanation: 3. Fidelity is loyalty and commitment to patients. The nurse demonstrates fidelity when advocating for the best interests of the patient. Justice is the principle of treating others fairly and equally. Veracity is the intention to tell the truth. Beneficence is the principle of attempting to do things that promote the good of others.

21) The nurse is caring for a patient who fears being in social settings. What will the nurse recommend to the client as an intervention strategy aimed at helping this patient face the fear? 1. Meditation 2. Physical exercise 3. Group therapy 4. Eye-movement desensitization

Answer: 3 Explanation: 3. Group therapy can be helpful to individuals with social phobia. Eye-movement desensitization and reprocessing (EMDR) is typically used for patients with posttraumatic stress disorder (PTSD). While meditation and exercise may help lower anxiety levels generally, they are not specific treatments for social phobia.

23) The nurse notes cigarette burns on the back of an adolescent patient while providing routine care. After initial hesitation, the patient tells the nurse that her mother burns her when she is "bad." The patient then begs the nurse not to tell anyone. What is the appropriate statement by the nurse? 1. "Don't worry, I won't break your confidence." 2. "I have to tell or I'll get in big trouble myself." 3. "I'm sorry, but it is my responsibility to report that your mother is burning you with a cigarette." 4. "OK, but can I get your permission to tell your doctor this is happening?"

Answer: 3 Explanation: 3. In most states, nurses are mandated reporters for cases of abuse of both children and older adults. There are substantial penalties for failing to report. Therefore, the nurse cannot assure the patient that she won't report the abuse. It is not sufficient to tell the doctor only, and the nurse does not need to get the adolescent's consent in this case. Telling the patient that the nurse will get in trouble is not the best way to foster a therapeutic relationship with the child, in part because it puts the focus on the nurse and not the patient. Gently letting the patient know that the nurse will need to report the abuse and following protocol early is the best response.

14) The nurse is caring for a patient with major depressive disorder (MDD) who is taking DHEA in addition to antidepressant medications. Which potential adverse effect will the nurse be most concerned about the patient developing? 1. Suicidal ideation 2. Hypertension 3. Mania 4. Hypoglycemia

Answer: 3 Explanation: 3. In patients with mood disorders, large doses of DHEA may increase the risk of mania. DHEA has not been linked to suicidal ideation. Hypertension and hypoglycemia are not adverse effects of DHEA.

5) The nurse is caring for a patient with mental illness who expresses an interest in complementary and alternative medicine (CAM). When explaining the principles behind integrative medicine, what will the nurse tell the patient? 1. "Integrative medicine uses CAM as experimental treatment for conditions which are unknown." 2. "Integrative medicine uses CAM in place of conventional medicine." 3. "Integrative medicine combines both conventional and CAM treatments for which there is high-quality scientific evidence of safety and effectiveness." 4. "Integrative medicine uses CAM in conjunction with conventional medicine."

Answer: 3 Explanation: 3. Integrative medicine is a practice that combines both conventional and CAM treatments for which there is high-quality scientific evidence of safety and effectiveness. Integrative medicine is not considered an experimental treatment. Alternative medicine uses CAM in place of conventional medicine. Complementary medicine uses CAM in conjunction with conventional medicine.

25) Which patient situation does the mental health nurse recognize may support the need for involuntary commitment? 1. History of incarceration 2. Self-medication with marijuana 3. Threats made against family members 4. Presence of auditory hallucinations

Answer: 3 Explanation: 3. Involuntary commitment is reserved for those individuals who are dangerous to themselves or others, or who are unable to meet their own basic needs. Making threats against family members constitute a danger to others and may support the need for involuntary commitment. The patient's history of incarceration, reports of auditory hallucinations, or the use of marijuana are not factors that support involuntary commitment.

8) The nurse is caring for the patient with a history of addiction. The nurse notes that although the patient is in severe pain, the patient's requests for pain medication have been ignored. Which ethical principle is the nurse exercising when advocating for appropriate pain relief? 1. Justice 2. Autonomy 3. Beneficence 4. Nonmaleficence

Answer: 3 Explanation: 3. It is a nurse's ethical obligation to practice beneficence, or "doing good." In this case, the nurse is advocating on behalf of a patient who may not be receiving appropriate care. Generally, beneficence implies that the nurse is acting in the autonomous interest of the patient. Justice refers to treating all patients fairly and equally. Autonomy refers to a person's right to self-determination. Nonmaleficence is the principle of "doing no harm."

19) The nurse is caring for a patient who expresses an interest in the use of complementary and alternative medicine (CAM) for the treatment of anxiety. The patient asks the nurse about using Kava to treat his anxiety. What is the nurse's best response? 1. "Kava may be effective for long-term treatment of mild anxiety symptoms." 2. "Kava may be effective for the treatment of anxiety symptoms." 3. "Kava may be effective for short-term treatment of mild anxiety symptoms." 4. "Kava may be effective for short-term treatment of severe anxiety symptoms."

Answer: 3 Explanation: 3. Kava is a plant indigenous to the Pacific Islands, where it is used as a social beverage. Kava has anxiolytic properties and has been shown effective for short-term treatment of mild anxiety symptoms. Short-term treatment is indicated, in part because there is some evidence that prolonged use increases risk for hepatotoxicity.

1) Which theory or concept does a psychiatric nurse consider to be most closely aligned with Erikson's developmental theory? 1. Freud's psychosexual stages 2. Freud's behaviorist concepts 3. Sullivan's stages of interpersonal development 4. Maslow's theory of self-actualization and hierarchy of needs

Answer: 3 Explanation: 3. Like Erikson, Sullivan believed that learning and development occur across the life span and that individuals can relearn tasks previously unaccomplished at earlier stages of life. Freud believed all developmental tasks were accomplished by a certain age, and tasks that remained unaccomplished resulted in fixation and caused lifelong psychiatric problems. Freud did not develop behaviorist concepts; furthermore, behaviorist concepts do not account for developmental tasks. Maslow proposed an order of basic human needs that were not linked to developmental stages or tasks. According to Maslow, physiologic needs must be met before higher-level needs such as self-esteem and self-actualization.

30) A patient tells the nurse, "My therapist touched my face and asked me to come to his house for a romantic evening." The nurse recognizes that the therapist has engaged in which unethical behavior? 1. Invasion of privacy 2. Inappropriate self-disclosure 3. Failure to maintain boundaries 4. False imprisonment

Answer: 3 Explanation: 3. Making sexual advances to a patient constitutes a serious boundary violation, not inappropriate self-disclosure, invasion of privacy, or false imprisonment. The nurse should report the patient's claims following agency protocols.

9) The mental health nursing student is preparing to attend a meeting of the mental health care team to discuss possible updates to clients' diagnoses. When preparing for this meeting, the nursing student will consult which reference? 1. Standards of Psychiatric Nursing Practice 2. Psychiatric nursing care plan manual 3. Diagnostic and Statistical Manual of Mental Disorders 4. Dictionary of common mental disorders

Answer: 3 Explanation: 3. Mental disorders are identified, standardized, and categorized in the Diagnostic and Statistical Manual of Mental Disorderspublished by the American Psychiatric Association (APA). All members of the health care team use this reference. A psychiatric nursing care plan manual is a reference for nursing care. A dictionary will offer only a general definition. Standards of Psychiatric Nursing Practice outlines nursing responsibilities but does not apply to clients or other members of the multidisciplinary health care team.

29) The nurse is working with a patient who has revealed to the nurse that she hits her toddler with a wooden paddle when she is angry. When the child visits, the nurse sees bruises and welts on the child's legs. The patient asks the nurse not to tell anyone because she is ashamed and afraid the child will be taken away from her. What is the most appropriate response by the nurse? 1. "I won't tell anyone. HIPAA protects this information." 2. "I will not report this if you sign a contract stating that you won't hit the child again." 3. "I will have to report this because it is my legal obligation to do so as a nurse." 4. "I will refer you to social services so they can discuss it with you."

Answer: 3 Explanation: 3. Nurses are legally obligated to report suspected child abuse to the proper government authorities. This is part of the duty to protect. The information may also be communicated to the nursing supervisor, the physician, and others, but the priority notification is to the government authorities. Child abuse is not protected by HIPAA or privacy/confidentiality laws. Nurses who learn of or suspect child abuse or elder abuse are mandated to report it.

25) What is the priority action by the nurse for a patient having a severe panic attack? 1. Explaining about anxiety 2. Teaching about ways to decrease anxiety 3. Reassuring and protecting until the episode subsides 4. Providing a physical activity to redirect patient focus

Answer: 3 Explanation: 3. Offering firm reassurance and protection until the episode subsides provides safety for the patient. Teaching about anxiety and ways to decrease anxiety are not appropriate because a patient who is having a severe panic attack cannot learn at this level of anxiety. The patient is unable to focus on a physical activity at this level of anxiety.

9) The nurse is caring for a patient with mental illness who expresses a desire to learn more about complementary and alternative medicine (CAM). What will the nurse tell the patient about the difference between osteopathic and naturopathic medicine? 1. "Osteopathy is a hands-on therapy that focuses on the health and function of the spine and other body structures and their effect on health; naturopathy stimulates the body's ability to heal itself by giving very small doses of highly diluted substances that, in larger doses, would produce symptoms or illness." 2. "Osteopathy aims to support the body's inherent ability to maintain and restore health, and prefers to use treatment approaches considered to be the least invasive; naturopathy is a system of medicine that emphasizes the relationship between structure and function of the body." 3. "Osteopathy is a system of medicine that emphasizes the relationship between structure and function of the body; naturopathy aims to support the body's inherent ability to maintain and restore health, and prefers to use treatment approaches considered to be the least invasive." 4. "Osteopathy stimulates the body's ability to heal itself by giving very small doses of highly diluted substances that, in larger doses, would produce symptoms or illness; naturopathy is a hands-on therapy that focuses on the health and function of the spine and other body structures and their effect on health."

Answer: 3 Explanation: 3. Osteopathy is a system of medicine that emphasizes the relationship between structure and function of the body; naturopathy aims to support the body's inherent ability to maintain and restore health, and prefers to use treatment approaches considered to be natural and the least invasive. Chiropractic is a hands-on therapy that focuses on the health and function of the spine and other body structures and their effect on health. Homeopathy stimulates the body's ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce symptoms or illness.

2) What concepts create the framework for the American Nurses Association's Code of Ethics for Nurses? 1. Patient care and a commitment to learning 2. Patient rights and a commitment to compassion 3. Patient advocacy and a commitment to society 4. Patient education and a commitment to professionalism

Answer: 3 Explanation: 3. Patient advocacy and a commitment to society are the framework for the American Nurses Association's Code of Ethics for Nurses. Nurses have an obligation to provide clinically competent, patient-centered care in accordance with ethical and legal principles. It is this patient-centered advocacy that creates a commitment to society. Patient education, rights, and compassion are all vital aspects of the nursing profession; however, these do not create the framework for the American Nurses Association's Code of Ethics for Nurses.

23) The nurse is providing medication education to a patient who has been prescribed ramelteon (Rozerem). The patient asks how it will improve his sleep. Which is the best response by the nurse? 1. "By inhibiting the work of melatonin in the body." 2. "It acts as an off switch to deactivate melatonin that your body produces." 3. "It produces the same response in the body as melatonin." 4. "It will prevent you from building up a tolerance to melatonin."

Answer: 3 Explanation: 3. Ramelteon (Rozerem) is a melatonin receptor agonist, so it will act to produce the same response in the body as melatonin, a sleep-inducing hormone. An antagonist medication would act to inhibit or deactivate the work of a hormone or neurotransmitter in the body. Tolerance describes the need to take increasing doses of a drug to achieve the same effect.

9) A patient tells the nurse that he is experiencing gastrointestinal problems since he began taking a selective serotonin-reuptake inhibitor (SSRI) for depression. Which response by the nurse would be most appropriate? 1. "Try taking the medication will a full glass of water." 2. "Try taking the medication at bedtime." 3. "Try taking the medication with food." 4. "Try taking the medication at least an hour before eating."

Answer: 3 Explanation: 3. SSRIs attaching to serotonin receptors in the digestive tract can cause digestive problems. Taking a small amount of food with the SSRI can alleviate these symptoms if they occur. Taking the medication on an empty stomach or taking it at bedtime will not help resolve the patient's symptoms. Although water soluble medications should be taken with water to assist in absorption, taking the medication with food will be more likely to alleviate GI distress.

7) A nurse is providing counseling services to flood victims who are staying in a shelter. According to Maslow's hierarchy of needs, on what category should the nurse focus in order to provide effective assistance? 1. Physiological 2. Self-actualization 3. Safety and security 4. Love and belonging

Answer: 3 Explanation: 3. Safety and security include emotional and physical security in home, neighboring, and work environments. Until these needs are met, higher order needs cannot be addressed. The services at the shelter provide for the physiological needs of food and housing. The needs of love and belonging and self-actualization must follow meeting more basic needs.

4) A nurse tells a patient a list of five objects to remember and, after five minutes, asks the patient to repeat the list. What is the nurse evaluating? 1. IQ 2. Thought content 3. Short-term memory 4. Long-term memory

Answer: 3 Explanation: 3. Short-term, or active, memory holds information available for a brief period. Long-term memory is the brain's continuing system for storing and retrieving information over time. IQ is a measure of many elements of cognitive functioning. Thought content involves what an individual thinks about.

15) A psychiatric nurse wants to comply with the recommendation of the Institute of Medicine (IOM) Future of Nursingreport that nurses take part in expanded opportunities to lead and share in collaborative improvement efforts. What activity would accomplish this? 1. Taking a course on nursing diagnoses 2. Becoming a nurse-mentor 3. Leading an interdisciplinary team focused on improving patient outcomes 4. Volunteering for extra shifts

Answer: 3 Explanation: 3. Taking a course does not focus on collaborative efforts. Although nurse-mentoring is a leadership activity, it does not necessarily contribute to collaboration. Leading an interdisciplinary team demonstrates both leadership and collaboration. Volunteering for extra shifts does not comply with the IOM recommendation.

29) A nurse tells the patient that meeting new people sometimes makes the nurse feel anxious. What is the nurse demonstrating by acknowledging feelings to the patient? 1. Empathy 2. Sympathy 3. Genuineness 4. Superficiality

Answer: 3 Explanation: 3. The active component of genuineness requires an individual to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client. Sympathy is a feeling of care or concern toward the patient, not an acknowledgment of how one feels. Empathy is the ability to feel the experience of others, not an acknowledgment of feelings. Superficiality indicates concern for one's self only and is not apparent in this scenario.

26) A novice nurse is working with a preceptor on a medical-surgical unit. After assessment of a patient, the novice nurse states to the preceptor, "This patient has many odd ideas about several common health practices. He seems like a deviant to me." What concept will guide the preceptor's response? 1. A definition of deviance that covers all clinical situations. 2. The knowledge that beliefs and behaviors are only deviant if the patient thinks there is a problem. 3. The knowledge that beliefs and behaviors vary according to cultural and social considerations. 4. The need for further assessment to determine the duration of the beliefs and actions.

Answer: 3 Explanation: 3. The appropriateness of beliefs and behaviors are judged according to cultural, social, ethical, and legal rules that define the limits of appropriate behavior and reality. Given the cultural, social, ethical, and legal considerations, there is no definition of deviance that covers all clinical situations. The duration of the beliefs and actions in this situation may be irrelevant. Given the lack of a definitive definition of deviant behavior, the statement that beliefs and behaviors are only deviant if the patient thinks they are a problem is an incorrect statement.

10) A staff nurse notices that her co-worker has been checking the mirror constantly and asking several times during their shift if her uniform "looks okay." The co-worker has become increasingly preoccupied with any perceived flaws in her personal appearance. The staff nurse is concerned and suspects which disorder? 1. Obsessive-compulsive disorder 2. Posttraumatic stress disorder 3. Body dysmorphic disorder 4. Reactive attachment disorder

Answer: 3 Explanation: 3. The co-worker is exhibiting body dysmorphic disorder; individuals engage in repetitive behaviors or mental acts in response to physical appearance preoccupations not readily observed by others. The other answer choices do not describe the symptoms exhibited.

26) Which nursing action is priority if the nurse is using the nursing theory that has shaped psychiatric-mental health most directly? 1. Teaching effective coping skills 2. Assessing the patient's abilities in areas of self-care 3. Establishing a therapeutic nurse-patient relationship 4. Encouraging the patient's sensitivity and caring for self

Answer: 3 Explanation: 3. The interpersonal theory of psychiatric-mental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatric-mental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills, are important areas for nursing action, all efforts are supported by the therapeutic nurse-patient relationship.

19) A new nurse has just taken his state board exams and passed, but he has not yet found a job. He also married the month after graduation, and his new wife just announced that she is pregnant. He has recently been experiencing sleep disturbances, difficulty concentrating, and irritability. The nurse at the clinic suspects which disorder? 1. Obsessive-compulsive disorder 2. Generalized anxiety disorder 3. Adjustment disorder 4. Reactive attachment disorder

Answer: 3 Explanation: 3. The new nurse is likely experiencing adjustment disorder in response to the stressful events in his life. Symptoms occur within 3 months of onset of the disorder and will continue for no more than 6 months after the termination of the stressor.

33) A patient tells the nurse, "I don't think I can deal with feeling so sad much longer." What is the nurse's best response? 1. "We all have times of sadness." 2. "Are you saying you feel sad?" 3. "Tell me about your feelings of sadness." 4. "Is there a history of depression in your family?"

Answer: 3 Explanation: 3. The nurse is using the therapeutic communication technique of encouraging the patient to explore feelings when asking the patient to talk about the feelings of sadness. Asking the patient if he is sad is therapeutic; however, the better response is to encourage the patient to explore his feelings about being sad to facilitate developing insight. Restating would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the patient's history provides the patient with an opportunity to shift the focus from the feelings to providing information about the patient's family and is not the best response. Suggesting that everyone has sad times discounts the patient's feelings.

25) During the shift report, a nurse describes a patient as "crazy." Which approach by the charge nurse would be best? 1. Ask the staff what terminology they wish to use. 2. Disregard the staff member's comment. 3. Suggest that staff use the term "mentally ill." 4. Role model using the term "nervous breakdown."

Answer: 3 Explanation: 3. The nurse should suggest that staff use the term "mentally ill," thus, reinforcing that the patient has an illness. The term "nervous breakdown" is too general and nonspecific for clinical use. Disregarding the comment or asking staff what terminology to use is not implementing the patient advocate role of the professional nurse.

22) During a group session, a patient expresses anger at the nurse. The nurse sits tensely with arms and legs crossed while verbally agreeing that the patient's point of view is correct. What message is being sent by the nurse? 1. Tolerance 2. Empathy 3. Incongruence 4. Compassion

Answer: 3 Explanation: 3. The nurse's nonverbal communication is incongruent with the verbal message; the nurse's closed body position conflicts with the open verbal statements. Because nonverbal cues help individuals judge the reliability of verbal messages, any incongruence between the nurse's verbal and nonverbal communication may confuse the patient. Tolerance, compassion, and empathy are positive messages that are typically expressed by using open body language.

24) The nurse is meeting with a patient and says, "I would love to hear how you are feeling today." While the patient speaks, the nurse yawns, looks at her watch, and folds her arms over her chest. What do the nurse's words and actions best indicate? 1. Disinterest in the patient's answers 2. Boredom with the therapy session 3. Incongruence of verbal and nonverbal communication 4. Incongruence of nonverbal communication and meta-communication

Answer: 3 Explanation: 3. The nurse's verbal message is incongruent with her nonverbal communication because her statement indicates interest while her nonverbal communication indicates disinterest. Meta-communication refers to those involved in the communication and the context of the communication, but not the content of the communication. There is insufficient information to determine if the nurse is bored, in part because of the mixed message she is sending.

36) A patient ready to leave a substance abuse rehabilitation facility tells the nurse that he understands that he must avoid his former associates and join Nar-Anon in order to find new connections. What stage of hope is this patient exhibiting? 1. Bracing for negative outcomes 2. Continuously evaluating signs to reinforce selected goals and the revision of these goals 3. Developing a realistic appraisal of personal resources and external conditions and resources 4. Making a realistic appraisal of an event and the threat to self

Answer: 3 Explanation: 3. The patient's stated plan does not include bracing for negative consequences. Although it may be part of his plan, this statement does not indicate continuous evaluation. The patient is making a realistic appraisal of his needs and resources. He has already made a realistic appraisal of events.

20) A nurse institutes an exercise program at an inpatient mental health facility. Which wellness domain does this type of program address? 1. Psychological 2. Sociological 3. Biological 4. Cultural

Answer: 3 Explanation: 3. The psychological domain consists of understanding our attitudes and behaviors. The sociological domain focuses on all aspects of the environment, including interpersonal relationships. The biological domain refers to the ability of all body systems to function in a manner compatible with life and social function and includes exercise. The cultural domain includes customs, and beliefs that are rooted in the patients' cultural background.

22) A patient tells his nurse during the initial assessment that he is angry with his girlfriend and plans to kill her with a gun as soon as he is released from the hospital. The nurse confirms that he does have a gun and ammunition. Which statement best describes the nurse's legal and ethical obligation? 1. The nurse may not break confidentiality because of HIPAA. 2. The nurse cannot disclose the information because it is considered privileged. 3. The nurse has a duty to warn the girlfriend and law enforcement of the patient's plans. 4. The nurse may not discuss the assessment with anyone except those caring for the patient.

Answer: 3 Explanation: 3. The right to privacy and confidentiality are very important aspects of care of the psychiatric-mental health patient. However, knowledge of a threat against a person's life is an exception to any confidentiality law and must be reported to avert danger to others. Privilege is a legal term and is only recognized in nurse-patient communications in a small number of states and would not apply in this case.

7) A nurse is teaching a class on psychiatric-mental health nursing. She asks her class to identify the most challenging part of this practice. What response would let her know that a student understands the difficulties in providing psychiatric-mental health nursing? 1. "The most difficult part is making correct diagnoses." 2. "The most difficult part is providing advocacy." 3. "The most difficult part is development of the therapeutic relationship and the corresponding therapeutic use of self." 4. "The most difficult part is involving the patient in treatment planning."

Answer: 3 Explanation: 3. The skill set for psychiatric nursing involves all the skills important in all nursing practice, such as making accurate nursing diagnoses, providing advocacy, and involving the patient in treatment planning. However, psychiatric-mental health nursing further emphasizes the importance of self-awareness, empathy, and personal integrity in the development of therapeutic relationships.

19) The nurse manager is meeting with a staff nurse on the inpatient mental health unit for an annual employee review. When discussing the nurse's current concerns, the nurse tells the manager, "I am having trouble sleeping at night thinking about that patient we had who was hospitalized for several weeks. I got so close to that patient and I wonder how she is doing." What is the manager most concerned about regarding the nurse's statement? 1. The nurse is experiencing burnout. 2. The nurse is experiencing insomnia. 3. The nurse has crossed professional boundaries. 4. The nurse has compromised his or her professional license.

Answer: 3 Explanation: 3. The staff nurse has crossed professional boundaries, perhaps without realizing it, by getting too close to the patient. Setting and maintaining nurse-patient boundaries are essential skills for the psychiatric-mental health nurse. However, these skills are not easy to learn and these boundaries may be crossed at times. There is not enough information to determine if the nurse is experiencing burnout. Although the nurse appears to be experiencing insomnia, this would not cause the manager as much concern as a possible boundary crossing or violation. Though the staff nurse has inadvertently crossed professional nurse-patient boundaries, there is not enough information in the question to determine if the nurse has compromised his or her professional license.

21) The nurse is caring for a patient with mental illness who desires the use of natural products or supplements for the treatment of the disorder. What symbol of safety will the nurse instruct the patient to look for when purchasing these products? 1. USDA 2. FDA 3. NSF 4. SMP

Answer: 3 Explanation: 3. The symbols GMP (Good Manufacturing Practices), NSF (National Safety Foundation), or USP (United States Pharmacopoeia) on product labels indicate safety of the products. The other answer choices are incorrect.

8) A patient tells the nurse that she is extremely unhappy at her job and she doesn't know what to do. Using Rogerian therapeutic techniques, how might the nurse respond? 1. "Let's make a plan for how you can handle this situation." 2. "This situation sounds really awful. I think you should quit." 3. "Tell me more about what is happening and how it makes you feel." 4. "You really need to think about whether you are contributing to the difficulties you are having."

Answer: 3 Explanation: 3. Using the Rogerian approach, the clinician should focus on clarifying the client's experience and feelings. Rogers's theory stresses unconditional positive regard, so the clinician should not be critical. Using the Rogerian approach, the clinician should avoid giving advice. This nondirective approach doesn't facilitate changes that clients may need to make to alleviate stress.

7) A nurse makes a medication error and, even though it does not cause any adverse reaction, she tells the patient about this error and apologizes. This is an example of which ethical principle? 1. Justice 2. Fidelity 3. Veracity 4. Beneficence

Answer: 3 Explanation: 3. Veracity describes the nurse's ethical obligation to tell the truth and be transparent. As the most trusted professionals, nurses have a duty to be honest when dealing with patients, families, other health care professionals, and the general public. Veracity is essential in creating a therapeutic relationship and creating trust with the patient. Justice refers to treating all patients fairly and equally. Fidelity describes the nurse's requirement to be dedicated to her patients. Beneficence speaks to the nurse's obligation to "do good."

8) A patient presents to the clinic with an exacerbation of eczema. During the assessment phase, the nurse determines that the 18-year-old was recently diagnosed with panic disorder after being thrown out of her parent's house. The nurse knows that which domain is an important factor in this patient's condition? 1. Cultural 2. Biological 3. Sociological 4. Psychological

Answer: 3 Explanation: 3. While the domains can overlap, the patient's lack of social connections and threat to her environment that result from being thrown out of the house are sociological factors that increase her risk for higher anxiety levels and physiological responses. Sociological considerations affect patient function, hope, and healing.

27) The psychiatric-mental health nurse wishes to build upon the professional skill of using therapeutic communication during the nurse-patient relationship. Using the acronym RULE, which action by the nurse will best demonstrate active listening? 1. Conveying sympathy 2. Accepting the patient 3. Conveying empathy 4. Validating the patient

Answer: 3 Explanation: 3. With the acronym RULE, 'L' means listen. The best way the nurse can actively listen to the patient is by conveying empathy, or the ability to feel another person's feelings. Conveying sympathy is conveying pity for an individual, which is not active listening. While accepting and validating the patient are both important tasks for the nurse to achieve, these are therapeutic techniques themselves, not examples of active listening.

30) A patient is taking sertraline (Zoloft). Because of the danger of toxicity, the nurse advises the patient to avoid which food? 1. Milk 2. Peanuts 3. Grapefruit 4. Orange juice

Answer: 3 Explanation:3. Grapefruit is an inhibitor of CYP450-3A4, which affects the metabolism of a sertraline (Zoloft), which could potentially build up to toxic levels. Although certain individuals may be sensitive to peanuts or dairy products, these foods have not been associated with increasing the toxicity of Zoloft. Orange juice may be taken as a citrus alternative to grapefruit juice

16) The nurse refers a patient for acupuncture. What conditions has acupuncture been shown effective in treating? Select all that apply. 1. Personality disorder 2. Insomnia 3. Anxiety 4. Depression 5. Schizophrenia

Answer: 3, 4 Explanation: 3. Acupuncture has been proven beneficial in the treatment of anxiety and depression. While acupuncture may help a patient with insomnia relax, it has not been proven effective in treating the disorder. Acupuncture has not been shown effective in the treatment of personality disorder or schizophrenia. 4. Acupuncture has been proven beneficial in the treatment of anxiety and depression. While acupuncture may help a patient with insomnia relax, it has not been proven effective in treating the disorder. Acupuncture has not been shown effective in the treatment of personality disorder or schizophrenia.

31) What drug interactions in the liver are of primary importance? Select all that apply. 1. Excretion 2. Dependence 3. Induction 4. Inhibition 5. Tolerance

Answer: 3, 4 Explanation: 3. Two interactions that occur when one substance competes with another at sites of enzymatic activity are of particular importance: induction and inhibition. The inhibitive competition of one substance interferes with the ability of the enzyme to breakdown the other substance, while induction hastens the speed of enzymatic action. Excretion is a pharmokinetic process that is not necessarily associated with drug interactions. Dependence refers to a developed compulsive need to use a substance to function normally. Tolerance results when the presentation of a medication to a receptor leads to a diminished effect of the drug over time. 4. Two interactions that occur when one substance competes with another at sites of enzymatic activity are of particular importance: induction and inhibition. The inhibitive competition of one substance interferes with the ability of the enzyme to breakdown the other substance, while induction hastens the speed of enzymatic action. Excretion is a pharmokinetic process that is not necessarily associated with drug interactions. Dependence refers to a developed compulsive need to use a substance to function normally. Tolerance results when the presentation of a medication to a receptor leads to a diminished effect of the drug over time.

18) The nurse is caring for an older adult patient with an anxiety disorder who expresses a desire to learn about the various complementary and alternative medicine (CAM) therapies that may help treat the disorder. Which mind and body practices will be most likely to benefit this patient? Select all that apply. 1. Kava 2. DHEA 3. Meditation 4. Biofeedback 5. Progressive muscle relaxation

Answer: 3, 4, 5 Explanation: 3. Meditation, biofeedback, and progressive muscle relaxation are mind and body practices that have been shown effective in the treatment of anxiety disorders. Kava and DHEA are natural supplements, not mind and body practices. 4. Meditation, biofeedback, and progressive muscle relaxation are mind and body practices that have been shown effective in the treatment of anxiety disorders. Kava and DHEA are natural supplements, not mind and body practices. 5. Meditation, biofeedback, and progressive muscle relaxation are mind and body practices that have been shown effective in the treatment of anxiety disorders. Kava and DHEA are natural supplements, not mind and body practices.

12) A novice nurse is learning how to effectively communicate within a therapeutic nurse-patient relationship. What struggle is most harmful when the nurse is new to therapeutic relationships? 1. Feeling uncomfortable with the relationship 2. Feeling anxious about developing the relationship 3. Falling back on knowledge learned from nursing school and not accounting for practical knowledge 4. Falling back on relationship skills learned in friendships, family relationships, or other personal relationships

Answer: 4 Explanation: 4. A difficulty that commonly occurs in therapeutic relationships is that newcomers to this type of relationship do not know how to respond, and they often fall back on relationship skills learned in friendships, family relationships, or other personal relationships. This may be most harmful because by relying on these skills, the nurse is not developing the necessary skills for developing the therapeutic relationship. The novice nurse will likely feel uncomfortable and anxious, and fall back on knowledge learned from nursing school; however, these are not most harmful.

3) The nurse caring for a patient recently diagnosed with an anxiety disorder knows that which physiological disturbance is thought to result in pathologic anxiety? 1. Increased pituitary response 2. Increased cortisol production 3. Decreased epinephrine response 4. Increased limbic system response

Answer: 4 Explanation: 4. A heightened response to catecholamine levels is a normal physiological response of the body to stress. Tefera, Shah, & Hsu (2012) posit that pathologic anxiety results in cerebral cortex disturbances, especially in the limbic system. Increased pituitary response, increased cortisol production and decreased epinephrine response are not associated with pathologic anxiety.

17) A patient becomes upset when touched by a staff member who is attempting to obtain the patient's blood pressure. What has the staff member overlooked? 1. Privacy 2. Confidentiality 3. Duty to protect 4. Informed consent

Answer: 4 Explanation: 4. A patient has the right to understand the treatment process prior to consenting to any intervention or treatment. This is called informed consent and is required by all states. Staff members do not control patients. A duty to protect is a safeguard that is an exception to confidentiality and privilege. The scenario does not describe any violation of privacy or confidentiality.

6) The nurse working on an inpatient psychiatric unit is caring for a patient with depression and substance use disorder. The nurse administers the patient's medication as ordered. Which patient response will the nurse report immediately to the health care provider? 1. Increased appetite 2. Dry mouth 3. Drowsiness 4. Decreased level of consciousness

Answer: 4 Explanation: 4. All side effects must be recorded and reported, but those that the nurse should report immediately include altered mental status (such as decreased level of consciousness or delirium), hypersensitivity responses, changes in gastrointestinal function, and changes in personality or behavior.

15) What practice, implemented by the Sisters of Charity at Mount Hope, served as a resource providing historical information about the treatment provided there? 1. Daily notes 2. Patient charts 3. Treatment plans 4. Log of patient outcomes

Answer: 4 Explanation: 4. Although there were no charts in which the Sisters recorded daily notes, or treatment plans, they did keep a log that included the name and age of each patient admitted to a facility, the diagnosis, when the patient was discharged, and the outcome of care.

30) A psychiatric-mental health nurse is learning about effective ways to clarify patient's responses. What is the best example of clarifying a patient's verbal response? 1. "See, the medicine does work." 2. "Everything seems to work out eventually." 3. "I knew it would work for you; it just takes time." 4. "Are you saying you feel the medicine is helping you?"

Answer: 4 Explanation: 4. Asking if the patient thinks the medicine is helping is an example of clarifying, which is therapeutic. "See, the medicine does work" communicates a lack of trust and is not therapeutic. "I knew it would work for you; it just takes time" and "Everything seems to work out eventually" are examples of making stereotypical comments and do not provide the patient with a sense that the nurse is listening.

5) Which statement would indicate that a novice nurse understands the concept of autonomy? 1. "All patients should be given their due." 2. "We must always be honest with patients." 3. "Part of our profession is doing good things for others." 4. "After I provide information, I will respect my patient's right to make a decision."

Answer: 4 Explanation: 4. Autonomy is the freedom to choose a course of action, to act on that choice, and to live with the consequences of that choice. Nurses help patients by providing patients with the information that they need to make informed choices regarding their treatment options, helping patients to understand and sort through the information, and supporting patients' choices. The statement "All patients should be given their due" demonstrates justice, or a mandate for fair and equal treatment. The statement "Part of our profession is doing good things for others" demonstrates beneficence, or the nurse's moral obligation to "do what is good." The statement "We must always be honest with patients" demonstrates veracity, or the nurse's obligation to be truthful and forthcoming.

22) The mental health nurse is speaking with primary care providers about treatment options for anxiety disorders, including pharmacologic options. Why are selective serotonin-reuptake inhibitors (SSRIs) the choice class of medications for treating anxiety disorders? 1. They have a short half-life. 2. They are metabolized by the liver. 3. They are adrenergic blocking agents. 4. They have fewer side effects than other anti-anxiety medications.

Answer: 4 Explanation: 4. Because SSRIs have fewer side effects than other anti-anxiety medications, this makes them the medications of choice. SSRIs are not adrenergic blocking agents and are not metabolized in the liver. SSRIs do not have a short half-life.

1) The nurse is taking care of a patient newly diagnosed with an anxiety disorder. Which process is most important in providing care to patients with anxiety disorders? 1. Review of the health care professional's orders for the patient 2. Acquisition of information from the patient's high school counselor 3. Assessment of the patient's response during the initial phase of treatment 4. Awareness of the nurse's own anxiety and how it may affect the patient's treatment

Answer: 4 Explanation: 4. Because nurses encounter anxiety in patients, families, staff, and themselves on a daily basis, it is important that nurses be aware of their own anxiety and how it affects others. It is important to acquire information about the patient's condition through review of orders, assessment, and peers/family, however, becoming comfortable with how anxiety affects the nurse is important in learning what it represents for patients in order to promote healing and alleviate suffering.

16) A nurse is a member of an ethics committee. The committee has been asked to help make a decision regarding end-of-life care for an unresponsive patient who has no advanced directives or next of kin. The nurse asks the committee to meet with the patient's friends to learn more about his life. This action corresponds with which guideline from the DILEMMA mnemonic? 1. Moral hierarchy 2. Make decisions 3. Describe the conflict 4. Learn background information

Answer: 4 Explanation: 4. By learning more about the individual's background from his friends, it may be possible to learn how the patient might view issues surrounding end-of-life care. Additional background information may also include evidence-based information regarding the particular diagnosis of the patient. Moral hierarchy, making a decision, and describing the conflict are not the elements described by this scenario.

24) A nurse is working with a group of patients who have been identified as at risk for psychosis. Which therapeutic modality might be the most effective to help this population? 1. Hypnosis 2. Psychoanalysis 3. Brief solution focused therapy 4. Cognitive-behavioral therapy (CBT)

Answer: 4 Explanation: 4. CBT has shown much success with this at-risk patient population Psychoanalysis has usually been used to address neurotic disorders rather than psychosis. Brief-solution focused therapy helps clients to establish goals and clarify solutions.. Hypnosis is a technique used in several types of therapy, including psychoanalysis and relaxation training.

11) The nurse caring for a 5-year-old diagnosed with posttraumatic stress disorder (PTSD) knows that which coping mechanisms and/or symptoms may manifest during treatment? 1. Crying and pacing 2. Hoarding and migraines 3. Nausea and separation anxiety 4. Repetitive play and temper tantrums

Answer: 4 Explanation: 4. Children with PTSD will experience many of the same symptoms as adults; however, children ages 6 or younger may also exhibit headaches, stomachaches, temper tantrums in absence of provocation, repetitive play, reenactment of the event, or nightmares.

3) The nurse is caring for a patient with schizophrenia who takes herbal supplements along with prescribed medication to treat the condition. What type of CAM is the patient utilizing? 1. Allopathic medicine 2. Integrative medicine 3. Alternative medicine 4. Complementary medicine

Answer: 4 Explanation: 4. Complementary medicine refers to the use of CAM in conjunction with conventional medicine. Alternative medicine refers to the use of CAM in place of conventional medicine. Allopathic medicine is traditional medicine. Integrative medicine refers to a practice that combines both conventional and CAM treatments for which there is high-quality scientific evidence of safety and effectiveness.

24) A nurse flying home is called to the front of the airplane by the flight attendant because a woman in the first row is having a panic attack and stating, "I have got to get off of this plane!" The nurse knows that which treatment is best at this time? 1. Ask the woman to focus on the nurse's voice. 2. Ask the other patrons if someone has any alprazalom (Xanax) available. 3. Administer an emergency epinephrine shot to counteract the panic symptoms. 4. Instruct the woman to breathe in through the nose and blow out through the mouth.

Answer: 4 Explanation: 4. Controlling breathing will help ease a panic attack or for anyone in distress. Guide patients to control breathing by breathing in slowly through the nose for 4 counts; hold breath for 2 counts; and blow air through the mouth as if blowing up a balloon slowly for 4 counts.

16) The psychiatric-mental health nurse is receiving a report on a patient who is being transferred to the hospital from a local emergency department (ED) after expressing suicidal ideations. The ED nurse tells the psychiatric-mental health nurse that the patient is "crazy, just like my aunt!" Which quality that commonly occurs in the pre-interaction stage of the nurse-patient relationship does the ED nurse's statement demonstrate? 1. Transference 2. Ethnocentrism 3. Cultural relativism 4. Countertransference

Answer: 4 Explanation: 4. Countertransference occurs when the nurse's previous experiences trigger reactions that have nothing to do with the current patient. In this case, the emergency department nurse labels the patient with depression as "crazy," and identifies the patient with her own family member. Transference is similar to countertransference; however, this occurs in patients, not nurses. Ethnocentrism occurs when an individual judges another individual's values, culture, and beliefs based solely on the judging individual's own culture. Cultural relativism is the concept that beliefs, customs, and ethics of an individual must be considered within that individual's own culture, to evaluate whether the individual deviates from his or her own culture.

28) The nurse is preparing to discharge a patient diagnosed with anxiety and depression. During evaluation, the nurse determines that which of the patient's outcomes indicate an improvement? 1. The patient reports a decrease in physical symptoms. 2. The patient is able to verbalize anxiety-causing activities. 3. The patient is able to stay focused for a limited amount of time. 4. The patient is sleeping six hours 5 days/week.

Answer: 4 Explanation: 4. During an evaluation, the nurse determines if the patient's goals and objectives have been fully, partially, or not met at all. Improvement is evaluated by attainment of specific, realistic, and measurable goals. The only answer choice that meets the criteria is the patient sleeping six hours 5 days/week (specific, realistic, and measurable), because patients with depression typically sleep more than 10 hours/day. Reporting a decrease in physical symptoms does not provide a realistic determination of symptoms, nor a measurable time-frame by which the patient should report this decrease. Verbalizing anxiety-causing activities and staying focused for a limited amount of time are not specific, realistic, or measurable goals.

17) The psychiatric-mental health nurse uses an eclectic clinical approach with newly admitted patients who are diagnosed with schizophrenia. Which statement most accurately reflects the therapeutic value of an eclectic approach? 1. Nurses do not need a philosophy of care to direct their practice. 2. It is difficult to determine a final plan of care for new patients with psychotic disorders. 3. There is limited scientific evidence about treatment for schizophrenia, so a variety of medications and interventions must be tried over time. 4. Strategies from one or a combination of psychiatric theories and therapies are used to determine interventions and evaluation criteria for working with each patient.

Answer: 4 Explanation: 4. Eclectic approaches various features from several psychiatric theories and therapies to determine what assessment information, interventions, approaches, and evaluation criteria are needed for any given patient. An eclectic approach does not indicate indecision or use of interventions that are unsupported by evidence. An eclectic approach does not indicate a nurse is non-philosophical; rather, this demonstrates that a range of theories are used to understand the best way to approach assessing and planning care for different patients.

28) What important development in nursing is attributed to Effie Taylor? 1. Reforming the asylum system 2. Introducing the use of activity therapy 3. Pioneering the development of nursing training 4. Incorporating a reintegration of the mind and body in nursing training

Answer: 4 Explanation: 4. Effie Taylor, a nurse educator at the Phipps Clinic at Johns Hopkins Hospital and later professor of psychiatric nursing at Yale University, sought to integrate mind and body in her nurses' training program involving both general and mental health nursing. Reform of the asylum system is associated with Dorothea Dix. Activity therapy was a central part of moral therapy. Nursing training was pioneered by Florence Nightingale.

7) A novice nurse caring for patients with mental illness wants to use empathy as a therapeutic tool. How is empathy used as a therapeutic tool for nurses? 1. To validate the nurse's expertise 2. To validate the nurse's perceptions 3. To validate the nurse-patient relationship 4. To validate the experiences of the patient

Answer: 4 Explanation: 4. Empathy has components of both perception and interaction; it is more than a quality or characteristic, it is also a communication tool that validates the experience of the patient. Empathy does not validate the nurse's expertise or perceptions, nor does it validate the nurse-patient relationship.

10) A patient is taking fluoxetine (Prozac) and wonders if adding St. John's wort would help the patient's depression symptoms. The nurse provides the patient with information regarding which adverse effect that occurs when taking fluoxetine and St. John's wort in combination? 1. Gastrointestinal distress 2. Increased depressive symptoms 3. Mania 4. Serotonin syndrome

Answer: 4 Explanation: 4. Fluoxetine (Prozac) is a selective serotonin-reuptake inhibitor (SSRI) used in the treatment of depression. SSRIs should not be combined with St. John's wort because too much serotonin presents a risk for serotonin syndrome, a potentially life-threatening condition. Combining fluoxetine and St. John's wort does not necessarily cause gastrointestinal distress, mania, or worsen depressive symptoms.

15) The nurses on a medical-surgical floor disagree with the care being provided to a patient by a particular physician. They contact the ethics committee at the hospital. Which action should they expect the committee to take? 1. Assume primary care of the patient. 2. Censure the physician for inappropriate care. 3. Turn the information over to a judge. 4. Make recommendations to resolve conflict.

Answer: 4 Explanation: 4. Hospital ethics committees are a good resource for nurses. They serve as a neutral forum in which to discuss ethical issues. They do not make decisions for other clinicians or assume care of a particular patient. Rather, they serve to assist with conflict management and provide advocacy for patients.

3) The nurse understands that health is typically defined as the state of being without illness. What is wrong with this definition? 1. It suggests that being healthy is difficult to achieve. 2. It suggests that all who are without illness are healthy. 3. It suggests that health and illness correlate with one another. 4. It suggests that individuals diagnosed with illness cannot possibly be healthy.

Answer: 4 Explanation: 4. How each nurse views the concepts of healthand mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Typically, health is defined as the state of being without illness. This definition is problematic in that it suggests that those with a diagnosed illness, such as heart disease or depression, cannot possibly be healthy. In reality, though, many individuals with a variety of illnesses adapt in such a way that they would be considered healthier than some individuals without any illness. This definition does not suggest that being healthy is difficult to achieve or that all without illness are healthy. While the definition may suggest that health and illness correlate with one another, this is not a problem with this definition.

27) What does a nurse realize is the most important thing in order to become an effective psychiatric nurse? 1. Develop good diagnostic skills. 2. Understand how to use medications effectively. 3. Understand the history of mental health treatment. 4. Learn how to guide a patient through their illness towards recovery.

Answer: 4 Explanation: 4. It is important to understand medications use and appropriate diagnoses but these are not the most important skills to learn. The ability to guide a patient towards recovery, using effective interpersonal skills, is critical to the holistic practice of psychiatric nursing. Understanding the history of mental health nursing can provide perspective but not necessarily practical skills.

8) Several nurses are discussing the medicalization of mental health treatment. Which historical figure do they identify as claiming that the physician should be the ultimate authority over moral as well as medical therapy, and that no one should be exempt from the physician's decision? 1. Tuke 2. Stokes 3. de Paul 4. Esquirol

Answer: 4 Explanation: 4. Jean-Étienne Esquirol, who created one of the most successful private asylums in Paris, believed that physicians should be the undisputed authority in all forms of mental health treatment. Stokes believed that the care of the insane necessitated a consulting rather than a resident physician. Tuke was one of the leaders of the York retreat, which was under the control of lay therapists rather than physicians. Vincent de Paul helped establish a nursing ministry for the insane.

36) A nurse is working with a patient who is taking lithium for bipolar disorder. In addition to performing regular monitoring of lithium levels, what should the nurse tell the patient to educate them about using lithium. 1. "Avoid grapefruit juice." 2. "Never take the medication with food or milk." 3. "Lithium may interfere with your birth control medications." 4. "It is important to drink plenty of water and avoid overheating."

Answer: 4 Explanation: 4. Lithium can also interfere with sodium and water regulation in the body so it is important that the patient drink plenty of water and avoid overheating. Grapefruit juice does not interact with lithium. Taking lithium with food or milk will reduce possible digestive side effects like nausea, vomiting, diarrhea, and abdominal pain. Some of the other medicines used to treat bipolar disorder, including carbamazepine, interact with birth control pills, but here is no known interaction with lithium.

23) A patient who lost his job as a result of his habitual lateness tells his therapist that he thinks his boss was making a big deal about nothing. What type of cognitive distortion does the therapist consider the patient to be exhibiting? 1. Arbitrary inference 2. Selective abstraction 3. Overgeneralization 4. Magnification/minimization

Answer: 4 Explanation: 4. Magnification/minimization involves an exaggeration of the importance of something or the diminishment of something that is obviously important, such as a pattern of lateness on the job. Arbitrary inference is making a judgment with no supporting evidence. In selective abstraction, details are taken out of context. Overgeneralization is using a small amount of data to make an incorrect assumption.

15) The nurse is caring for a patient with insomnia who asks the nurse about possible complementary and alternative (CAM) practices which may help with the patient's disorder. What is the nurse's best response? 1. "DHEA has been shown to be effective in sleep-wake disorders." 2. "Acupuncture has been shown to be effective in all sleep-wake disorders." 3. "Natural products have been shown more effective in sleep-wake disorders than mind and body practices." 4. "Mindfulness-based meditation has been shown to be effective in sleep-interfering cognitive processes."

Answer: 4 Explanation: 4. Mindfulness-based meditation has been shown to be effective in sleep-interfering cognitive processes. DHEA is a natural product used in the collaborative treatment of depression, not sleep-wake disorders. While acupuncture may relax the patient who is suffering from a sleep-wake disorder, this therapy has not been proven to be effective in the treatment of insomnia. While natural products are used in the collaborative treatment of sleep-wake disorders, these products are not proven to be more effective than mind and body therapies.

1) What would the nurse recognize as the impact that Florence Nightingale has had on the role of the nurse in psychiatric-mental health nursing? 1. Nightingale emphasized the cultural environment for healing. 2. Nightingale developed the idea of the therapeutic relationship. 3. Nightingale focused her ideas on nursing education rather than direct patient care. 4. Nightingale was among the first to note the influence of nurses has psychological components.

Answer: 4 Explanation: 4. Nightingale was among the first to note that the influence of nurses on their patients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. In addition to being the first to note the influence of nurses on psychological components, Nightingale emphasize the physical, not cultural, environment for healing. Nightingale focused her ideas on both direct patient care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurse-patient relationship.

10) A patient experiencing psychosis tells the nurse, "I am in charge. Who are you and why are you here?" What is the most therapeutic response by the nurse? 1. "You know who I am." 2. "You don't know who I am?" 3. "You are not in charge; you are a patient in the hospital." 4. "I am your nurse and I will be here to help you until dinner."

Answer: 4 Explanation: 4. Responding with "I am your nurse" is an example of giving information; the nurse responds to the patient's request without getting into a confrontation and conveys respect. Asking if the patient knows who the nurse is or stating that the patient knows the nurse are not therapeutic responses and may be perceived as challenging to the patient. Stating that the patient is not in charge and reminding the patient of his or her inpatient status provide the patient with information and presents reality but do not provide the patient with a response to the question asked.

14) A patient who has been prescribed a selective serotonin-reuptake inhibitor (SSRI) asks the nurse how it works. What is the best response by the nurse? 1. "SSRIs maintain the drug in its bound form, allowing more of the drug to attach to the neurotransmitter." 2. "SSRIs increase enzymatic action in the blood-brain barrier." 3. "SSRIs improve acid-base balance, enhancing the penetration of the blood-brain barrier." 4. "SSRIs target blood-brain barrier transporters and prevent the reuptake of the neurotransmitter."

Answer: 4 Explanation: 4. Selective serotonin reuptake inhibitors (SSRIs) stop the reuptake of the neurotransmitter, making more neurotransmitter available for the receptors on the postsynaptic neuron. SSRIs are not involved in enhancing enzymatic activity, maintaining drugs in their bound form, or improving acid-base balance.

23) The nurse taking care of an older adult patient recently diagnosed with anxiety disorder. The patient asks why the primary care provider is reluctant to prescribe an antianxiety medication. The nurse educates that patient about which possible adverse effect of antianxiety medications commonly seen in older adults? 1. Dizziness 2. Decreased libido 3. Gastrointestinal distress 4. Paradoxical reaction

Answer: 4 Explanation: 4. Special considerations should be given when administering antianxiety medication to older adults due to the slower rate of clearance secondary to a slow metabolism rate, increased accumulation, and/or greater sensitivity to central nervous system depressants. Older adults may exhibit a paradoxical effect in which the medication gives an opposite effect than the expected outcome. Dizziness, decreased libido, and gastrointestinal side effects may also be seen, but these are not side effects specific to older adults.

22) A patient whose new job requires travel to Europe requests the nurse's assistance with fear of flying. What treatment method might the nurse select as likely to be the most effective? 1. Psychoanalysis 2. Aversion therapy 3. Cognitive therapy 4. Systematic desensitization

Answer: 4 Explanation: 4. Systematic desensitization, involving exposure to the feared activity along with an anxiety reducing technique, is a standard treatment for fear of flying. Psychoanalysis explores psychodynamic patterns whose roots are in childhood experiences. Aversion therapy is not a standard treatment for phobias. Cognitive therapy involves addressing negative assumptions.

3) The novice nurse is reviewing the ANA's Code of Ethics for Nurses and its influence on providing patient care. What concept is correct regarding ethical and legal standards? 1. Ethical standards outweigh legal standards. 2. Legal standards outweigh ethical standards. 3. Ethical and legal standards are separate, yet similar. 4. Ethical and legal standards are intertwined, yet distinct.

Answer: 4 Explanation: 4. The ANA Code of Ethics outlines the nurse's obligation to provide clinically competent, patient-centered care in accordance with ethical and legal principles. In clinical practice, ethical and legal standards are intertwined, yet distinct. In general, ethics dictate what nurses "should" do, whereas laws mandate what nurses "must" do. Neither type of standards outweighs the other.

10) A nurse is caring for a patient who likely has obsessive-compulsive disorder. The nurse is not familiar with the assessment data and behaviors associated this disorder. What action would be most appropriate for the nurse to take? 1. Document all subjective and objective data provided by the client. 2. Ask the primary health provider to identify needed subjective and objective assessment data. 3. Research obsessive-compulsive disorder in the medical dictionary. 4. Consult the Diagnostic and Statistical Manual of Mental Disordersfor diagnostic criteria.

Answer: 4 Explanation: 4. The Diagnostic and Statistical Manual of Mental Disorders provides diagnostic criteria that all members of the health care team will use in the diagnosis process and will serve as a resource for assessment and analysis of data. While communication with the primary care provider is appropriate, knowledge of the DSM is expected in a graduate nurse and this choice does not reflect an application of basic knowledge. A medical dictionary is not specific enough for diagnostic purposes. Documentation of subjective and objective data is appropriate; however, this action is not the most appropriate action to assist the nurse in determining the appropriate assessment and behaviors associated with obsessive-compulsive disorder.

14) A nurse is a member of a committee assigned to review the roles and responsibilities of the nurses on the psychiatric unit. Which publication will the nurse bring to the first meeting? 1. Diagnostic and Statistical Manual of Mental Disorders 2. American Nurses Credentialing Center certification requirements 3. American Nurses Association,Code of Ethics 4. Psychiatric-Mental Health Nursing Standards of Practice

Answer: 4 Explanation: 4. The Psychiatric-Mental Health Nursing Standards of Practicedelineates psychiatric-mental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders andis not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but they do not delineate roles and responsibilities.

12) The nurse who is operating with the ethics of care in mind believes which statement? 1. "We should always tell the truth." 2. "We are expected to always do the right thing." 3. "We should do whatever provides the best benefit." 4. "We are all interconnected and part of the same global family."

Answer: 4 Explanation: 4. The ethics of care is grounded in relationships and the interconnectedness and interdependence that humans share. It is strong in empathy. Telling the truth and "doing the right thing" are deontological principles. Operating on the premise of providing the best benefit for all is a utilitarian principle.

14) An ICU nurse diagnosed with acute anxiety is scheduled to take the CCRN exam for the second time in 2 weeks after being unsuccessful the first time. The nurse knows that which medication may be prescribed to help him with his anxiety? 1. Buspirone (Buspar) 2. Citalopram (Celexa) 3. Alprazolam (Xanax) 4. Propranolol (Inderal)

Answer: 4 Explanation: 4. The nurse is experiencing Peplau's moderate level of anxiety or situational anxiety. Benzodiazepines such as alprazolam (Xanax) are effective for anxiety at low doses and insomnia at higher doses. SSRIs such as citalopram (Celexa) take at least 2-4 weeks to become fully effective. Buspirone, a nonbenzodiazepine anxiolytic, can take up to 4 weeks to achieve effect. The beta-blocker propranolol (Inderal) can prevent physical symptoms of anxiety and may be prescribed to control symptoms of performance anxiety only.

21) The patient admitted to the mental health unit is concerned that health information given to the nurse remains confidential. What is the nurse's best response? 1. "We can keep the information just between the two of us if you prefer." 2. "I will share the information with staff members only with your approval." 3. "You can choose whether your physician needs this information for your care." 4. "If the information is important to your care, I will need to share it with the staff."

Answer: 4 Explanation: 4. The nurse is obligated to share with the patient the limits of confidentiality in nurse-patient exchanges. Information gathering and sharing are part of the mental health nurse's role, and the expectation is that the nurse will accurately portray and convey data about the patient. The nurse would not keep information from the rest of the mental health team.

22) The nurse is performing an admission assessment on a patient with depression. The patient takes a prescription antidepressant and tells the nurse that she also takes herbal supplements. The nurse is unsure of whether the medication and herbal supplements interact with one another. What is the nurse's best action? 1. Ask the health care provider about potential interactions. 2. Consult a pharmacological reference text. 3. Consult a homeopathic reference text. 4. Ask the pharmacist about potential interactions.

Answer: 4 Explanation: 4. The nurse's best action is to consult the pharmacist about any potential interactions. The pharmacist is considered the expert on medications and herbal supplements. The health care provider and reference texts are not the best resource for this information.

28) A patient holds a knife to his throat and tells a family member that voices in his head are telling him to kill himself. The patient may be admitted to the psychiatric unit under which type of admission? 1. Commitment 2. Temporary admission 3. Observational admission 4. Emergency involuntary admission

Answer: 4 Explanation: 4. The patient is a danger to himself at this time and may be admitted as an emergency involuntary admission. A temporary or observational admission is indicated for diagnosis and treatment in non-emergent situations. Commitment is a long involuntary admission that requires higher procedural safeguards.

32) A patient who is agitated and aggressive has threatened two staff members. After other less invasive interventions fail, the nurse calls the physician and obtains an order to physically restrain the patient. Which statement regarding restraint use is correct? 1. The patient must be assessed every 6 hours. 2. The order must be written as "PRN confusion." 3. The doctor must assess the patient every other day. 4. The patient must be educated about the use of restraints.

Answer: 4 Explanation: 4. The patient should be educated about the restraints and the criteria for their removal. A restraint order should never be written as PRN or used for staff convenience or to punish a patient. The patient who is restrained must be assessed constantly, not every 6 hours. The doctor must assess the patient daily.

28) A patient reports that she is going to stop taking Zyprexa because she always feels tired. What is an appropriate response for the nurse to make? 1. "If you just keep taking the medication, after a while you will not feel so tired." 2. "If you are so tired, this drug is probably not working the way it is supposed to work." 3. "You will have to learn to live with it because you cannot stop taking your medication." 4. "We can check with your doctor and see if a lower dose might be OK, but it is important not to stop taking your medications until this can be resolved."

Answer: 4 Explanation: 4. The patient should be informed that adjusting medication dosages sometimes helps with side effects and about possible consequences of suddenly discontinuing the medication. Problems with side effects do not mean that the medication is ineffective. Telling the patient to live with a problem does not address that problem. Some side effects may remit in time, but it is always useful to examine additional solutions.

35) A novice nurse is learning about various tools that nurses may use to aid in therapeutic communication in the nurse-patient relationship. What does the nurse recognize as true regarding the concept of process recording? 1. The purpose is to record the nurse-patient interaction and provide a guideline for therapeutic care. 2. The purpose is to allow the patient to actually hear what the nurse stated in the nurse-patient interaction. 3. The purpose is to allow the nurse to actually hear what the patient heard in the nurse-patient interaction. 4. The purpose is to reflect on and evaluate the dynamics of a specific interaction and to provide a sample of interaction for consideration in supervision or consultation with others.

Answer: 4 Explanation: 4. The process recording is a written record, not audio record, of an interaction between two or more individuals. The purpose of the process recording is to reflect on and evaluate the dynamics of a specific interaction and to provide a sample of interaction for consideration in supervision or consultation with others. The process recording does not provide a guideline for therapeutic care.

13) What term was acceptable in the 19th century when talking about mental illness that a nurse would not find acceptable today? 1. The same terminology is still in use today. 2. The term "mentally ill" was used regularly. 3. The term "mentally disabled" was frequently used in the 19th century. 4. In the 19th century, using the term "insane" was considered acceptable.

Answer: 4 Explanation: 4. The term "insane" was considered acceptable to identify people with a variety of disabilities including learning and developmental disabilities, as well as mental health problems. The terms "mentally ill" and "mentally disabled" were not regularly used until the 20th century.

24) A nurse is monitoring a patient who is taking lithium to make certain that the lithium levels are between 0.8 and 1.1 mmol/L. The nurse documents that the patient's levels comply with what criteria? 1. Potency 2. Target effect 3. Drug dependence 4. Therapeutic range

Answer: 4 Explanation: 4. Therapeutic range is the range at which therapeutic efficacy can be achieved without risking harm to the patient. Drug dependence refers to a developed compulsive need to use a substance to function normally. The amount (dose) of the drug necessary to produce the desired response is its potency. Target effects occur when a medication reaches the target site and produces the desired effect or the expected or intended response.

11) The novice nurse is learning about the various types of relationships and how these affect the role of the nurse when providing care to patients with mental illness. What tool do therapeutic relationships use that is not used in social relationships? 1. Shared interest 2. Shared power 3. The process of communication 4. The process of interaction

Answer: 4 Explanation: 4. Therapeutic relationships differ from social relationships; in part, this is because the therapeutic relationship uses the process of interaction as a tool. Communication occurs with all relationships and is not unique to therapeutic ones. Shared power and interest occur in social, not therapeutic, relationships.

13) A physician orders a nurse to give a patient a placebo instead of her scheduled opiate medication because he doesn't believe that the patient is really experiencing pain. The nurse refuses to do so but tells the physician he is happy to talk with the patient about her pain and whether they could try decreasing the dosage of her pain medication. This is an example of which element of ethical decision making? 1. Values clarification 2. Stakeholder identification 3. Moral hierarchy exploration 4. Integrity-preserving compromise

Answer: 4 Explanation: 4. There are many different guidelines for ethical decision making, although no one 'right' way. Nurses often receive threats to their personal and/or professional integrity and must choose to adhere (or not) to their own set of values. In this example, the nurse offered the physician an integrity-preserving compromise. Even though he refused to carry out the order, he acknowledged the physician's opinion and sought to work with the individual patient. The nurse had already clarified his values and had identified the biggest stakeholder as the patient. He had also made it clear that in the moral hierarchy, his biggest duty was to the patient.

21) A patient presents to the emergency department. Her husband, who drove her, explains that the patient has a history of depression and told him she intends to take sleeping pills and "just end it all." What stage in the Murphy-Moller wellness model is the patient demonstrating? 1. Recovery 2. Restoration 3. Rehabilitation 4. Relapse

Answer: 4 Explanation: 4. This patient presents at level 1, relapse or initial onset, with a level of wellness that is unstable and acute. In level 2, recovery, symptoms have stabilized. In level 3, rehabilitation, symptoms no longer interfere with normal activities of daily living or regular conversation. Restoration is not an identified part of the wellness model.

17) The nurse is developing a plan of care for a patient. Which intervention must the nurse be careful to avoid? 1. Discussing expectations with the patient 2. Identifying the patient's perception of the problem 3. Addressing issues related to the patient's past experiences 4. Performing actions that conflict with the patient's value system

Answer: 4 Explanation: 4. When developing a plan of care, the nurse must avoid actions that conflict with the patient's value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the patient's perception of the problem. The nurse involves the patient in the planning process by discussing issues related to the patient's experiences and discussing expectations for performance.

24) The nurse is subpoenaed to provide information about a patient's injuries sustained in a criminal case. The hospital's attorney tells her she must comply. Which statement best describes how the nurse should respond? 1. Plead the Fifth Amendment in this case. 2. Refuse to give any information about the patient. 3. Disclose any information she knows about the patient. 4. Answer questions with the minimum information needed.

Answer: 4 Explanation: 4. When disclosing any patient information, the nurse should only disclose the minimum amount and nothing additional. This protects the nurse. In this case, it is in the nurse's best interest to comply with a subpoena and not refuse to give information. It is not appropriate to plead the Fifth Amendment, which is a protection against self-incrimination.

6) The nurse validates the patient's response to an intervention prior to documenting in the progress note. What does validation ensure? 1. The patient's request is clarified. 2. The patient's affect is appropriate to the situation. 3. The patient's need for further intervention is understood. 4. The patient's perception of the response is communicated.

Answer: 4 Explanation: 4. When evaluating the patient's response to an intervention, the nurse validates to ensure the patient's perception of the response is communicated. Affect refers to a patient's emotional tone, not a method of validation. The patient's need for further intervention will be determined when the response is evaluated, not during validation of the patient's response. Clarification is used when a message is not clear.

27) The nurse taking care of a patient with panic disorder understands that which nursing interventions are important at this anxiety level? 1. Speak in a low voice and help patient identify triggers. 2. Encourage the patient to explore alternative coping strategies. 3. Remain calm and assist patient with problem-solving techniques. 4. Administer medications as prescribed and respect the need for personal space without leaving the patient unattended.

Answer: 4 Explanation:4. When taking care of a patient at the panic level of anxiety nursing interventions will include: remaining calm; staying with the patient; using clear, simple, and direct communication; helping the patient regain a sense of control; ensuring the safety of the patient and others; respecting the need for personal space, but not leaving the patient unattended; administering medications as prescribed; reinforcing reality; and getting assistance as needed