Psych CH5 & 6

5A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure? a. Computed tomography (CT) b. Positron emission tomography (PET) c. Brain electrical activity mapping (BEAM) d. Single-photon emission computed tomography (SPECT)

ANS: A CT can image brain structures through a series of radiographs that are computer constructed into "slices" of the brain that can be stacked by the computer, giving the image a three-dimensional appearance. PET and SPECT image brain activity and function through the tracking of radioactive substances as they travel through the brain. BEAM images brain activity and function through recordings of the brain's electrical activity. DIF: Cognitive Level: Comprehension REF: Text Pages: 74-77 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5A patient with a history of depression reports not feeling well rested in recent weeks. Before making the assumption that the complaint is related to depression, a nurse should investigate whether the patient has had any recent changes in: a. work schedule that affect the hours of sleep. b. vacations taken within the same time zone. c. fluid intake with reduced overall intake of water. d. food intake with decreased intake of heavy foods before bedtime.

ANS: A Changes in schedule that affect circadian rhythms, such as work shifts that alter usual sleep patterns, can result in fatigue that is not related to mental health status. Other factors that alter sleep include changes in light and darkness and temperature changes. Vacations in the same time zone should not affect sleep, whereas food and fluid intake should enhance sleep by reducing risk of nocturia or indigestion. DIF: Cognitive Level: Application REF: Text Page: 79 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses? a. Dopamine b. Melatonin c. Serotonin d. Norepinephrine

ANS: A Dopamine is derived from tyrosine, is located mostly in the brainstem, and is involved in control of complex movements, motivation, and cognition. It is involved in movement disorders such as Parkinson disease and in many of the deficits seen in schizophrenia and other forms of psychosis. This is not necessarily true of the other options. DIF: Cognitive Level: Knowledge REF: Text Page: 76 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient visiting from Puerto Rico has become psychotic while staying with family here in the United States. When conducting the mental status examination, the nurse remembers that: a. sociocultural factors may greatly affect the examination. b. liking the patient as a person is important to the outcome. c. an interpreter may help facilitate the verbal portion of the examination. d. biological expressions of psychiatric illness are not relevant to someone from another culture.

ANS: A Dress, eye contact, personal hygiene, speech and use of language, personal space, and body language are a few aspects of the mental status examination that vary with culture and social status. DIF: Cognitive Level: Comprehension REF: Text Page: 88 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

During a mental status examination, a patient shouts angrily at the nurse, "You are too nosy for your own good!" Then, almost immediately, happily says, "Well, let's let bygones be bygones and be buddies." The nurse assesses this emotional display as: a. labile affect. b. hallucinations. c. magical thinking. d. ideas of reference.

ANS: A Lability is identified when the patient's affect shifts rapidly, such as from happy to sad or angry to elated. The remaining options are thought-content descriptors. DIF: Cognitive Level: Application REF: Text Page: 91 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5The spouse of a patient recently diagnosed with cancer asks, "What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they've diagnosed cancer." The answer that best reflects the current thinking about psychoneuroimmunology is: a. "It's thought that the immune system is negatively affected by high stress." b. "The research hasn't been focused directly on the link between cancer and stress." c. "Your spouse's situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness." d. "Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers."

ANS: A Natural killer cells, which are believed to play a role in tumor surveillance and the control of viral infections, seem to decrease with increasing levels of stress. DIF: Cognitive Level: Application REF: Text Page: 81 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5When a patient asks the nurse, "What are neurotransmitters?" The nurse replies that neurotransmitters are: a. "the chemical messengers that cause brain cells to turn on or off." b. "small clumps of cells that alert the other brain cells to receive messages." c. "tiny areas of the brain that are responsible for controlling our emotions." d. "weblike structures that provide connections among various parts of the brain."

ANS: A Neurotransmitters are chemicals manufactured in the brain responsible for exciting or inhibiting brain cells in the production of an action. DIF: Cognitive Level: Comprehension REF: Text Page: 73 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The patient believes that the CIA is "plotting to kill me." The report is given with the patient exhibiting little emotion. The nurse documents the patient's affect as: a. flat. b. elated. c. labile. d. congruent.

ANS: A Reporting significant life events with little emotional response suggests a blunted or flattened affect. Lability refers to swift shifts in affect. Congruent affect is appropriate emotional expression for the current circumstances. Elation is an exaggerated display of happiness. The patient is not showing fear or anxiety, which would be appropriate in this case, nor is the patient displaying exaggerated happiness, which would be inappropriate under the circumstances. DIF: Cognitive Level: Application REF: Text Page: 91 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak? a. A pregnant patient with sickle cell anemia b. A patient who has made a recent suicide attempt c. A patient prescribed the most drugs for the treatment of chronic disorders d. A patient with schizophrenia who had multiple hospital admissions in the last year

ANS: A Several hundred genetic tests are in clinical use for illnesses such as muscular dystrophies, cystic fibrosis, and sickle cell anemia. Although research is being conducted, there is no proof of a definitive genetic cause for schizophrenia. The remaining options do not deal with conditions that have a proven link to a genetic cause. DIF: Cognitive Level: Analysis REF: Text Pages: 81-83 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5A patient tells a nurse, "My doctor says my problem may be with the neurotransmitters in my brain but I don't understand what that means." The nurse responds: a. "Let's begin with exploring what your doctor has told you about your problem." b. "We should start with a discussion about any concerns you have about having a neurotransmitter disorder." c. "First let me say that neurotransmitter problems can usually be treated or cured with medication therapy." d. "What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication."

ANS: A The correct option assesses the patient's understanding of his condition, the initial step in any educationally focused discussion. None of the remaining options—defining the role of a neurotransmitter, exploring the patient's concerns, or providing an explanation of a typical treatment plan—address the patient's question concerning a lack of understanding. DIF: Cognitive Level: Comprehension REF: Text Page: 73 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain's _____ lobe. a. frontal b. parietal c. occipital d. temporal

ANS: A The frontal lobe is responsible primarily for intellectual functioning, including learning, abstracting, reasoning, and inhibition of impulses. DIF: Cognitive Level: Application REF: Text Pages: 71-72 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5A patient tells a nurse, "My doctor thinks my problem is serious but it can be treated with medications. Does that mean I'll always have to be treated with drugs?" The nurse replies: a. "How would you feel about being on medications for a lifetime?" b. "What concerns do you have about having a serious mental disorder?" c. "Did your doctor suggest your problem was related to neurotransmitter problems?" d. "What do you know about this condition that the doctor is preparing to treat with medications?"

ANS: A The initial concern expressed by the patient is being prescribed medications for a lifetime. The correct option explores this concern. DIF: Cognitive Level: Application REF: Text Pages: 83-84 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5The function of the limbic system is to: a. regulate emotional behavior. b. perform abstract reasoning. c. facilitate critical decision making. d. coordinate stress-related responses.

ANS: A The limbic system is concerned with subjective emotional experiences and with changes in body functions associated with emotional states. DIF: Cognitive Level: Comprehension REF: Text Page: 73 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

While being interviewed, a patient expresses the belief that other people can place beliefs in her mind. This statement can be assessed as evidence of: a. thought insertion. b. nihilistic delusions. c. somatic delusions. d. ideas of reference.

ANS: A Thought insertion is the delusion that thoughts are placed into the mind by people or influences outside of the self. DIF: Cognitive Level: Comprehension REF: Text Page: 92 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A nurse managing the care of a depressed patient will use the Beck Depression Inventory Scale at admission and during the course of treatment. The nurse expects to obtain assessment data that would: (Select all that apply.) a. confirm the patient's diagnosis. b. measure the extent of the patient's problem. c. identify co-morbid physiological disorders. d. track the patient's progress over the hospitalization. e. predict the patient's likelihood of experiencing a relapse.

ANS: A, B, D This tool is not designed to predict the possibility/probability of relapse or identify co-morbid physiological disorders. DIF: Cognitive Level: Application REF: Text Page: 97 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A depressed patient scheduled for an MRI asks about the purpose of the test and whether it will hurt. The response would include that the test: (Select all that apply.) a. takes a picture of the brain. b. is used to diagnose mental illness. c. should not produce any physical pain. d. may be uncomfortable if tight spaces bother you. e. machinery produces loud noises while the test is being conducted.

ANS: A, C, D, E The function of an MRI is to visualize brain structure and detect abnormal brain formations. MRIs are not painful but require that the patient lie still in a confined space. The MRI machine produces a loud noise during the test. MRIs are not used in the diagnosis of mental illness. DIF: Cognitive Level: Application REF: Text Page: 77 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A cognitively impaired patient reports to the nurse that, "I had the best time. My husband took me out to dinner and then to a concert. The music was wonderful." Knowing that the patient is a widow, the nurse determines her remarks are an example of: a. tangential thinking. b. confabulation. c. hallucination. d. circumstantiality.

ANS: B Confabulation means covering one's inability to remember by making up a story of something that might have happened. DIF: Cognitive Level: Application REF: Text Page: 93 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A couple tells a nurse that they are concerned about having children because there is bipolar disorder in first-degree relatives of each of them. What advice should the nurse give? a. "Do not have children." b. "Seek genetic counseling." c. "Do as your conscience dictates." d. "Bipolar disorder is not hereditary."

ANS: B Current evidence suggests that there is a significant genetic role in the cause of recurrent depression and bipolar disorder. A genetic counselor is well prepared to discuss the concerns of these individuals. DIF: Cognitive Level: Application REF: Text Page: 82 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5A patient tells a nurse, "My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?" Which response is best? a. "This is not an inherited disorder." b. "You should speak to a genetic counselor." c. "Science has not yet developed gene testing for this disease." d. "There are new treatments for this illness that are readily available."

ANS: B Genetic counselors are trained to diagnose and explain disorders from a genetic perspective. They can review available options for testing and treatment and provide emotional support to individuals or families who have genetic disorders, are at risk for them, or need information about risks to their offspring. DIF: Cognitive Level: Application REF: Text Pages: 81-82 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care

To assess for the presence of hallucinations during the mental status examination, a nurse should ask: a. "Can you tell me what the name of this building is?" b. "Do you ever see or hear things that others don't see or hear?" c. "When did you start believing aliens were controlling your thoughts?" d. "What do I mean when I say, 'Don't count your chickens before they hatch?'"

ANS: B Hallucinations are false sensory perceptions while delusions are non-reality-based beliefs. The remaining options are related to thought or cognitive disorders. DIF: Cognitive Level: Application REF: Text Page: 91 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A patient states, "I'm going to have a positron emission tomography (PET) scan. What are the doctors going to learn from it?" The best reply would be that they focus on: a. "identifying structures like tumors and scars." b. "highlighting activity in various portions of the brain." c. "outlining the structures of the brain more clearly." d. "providing data to support new treatment modalities."

ANS: B PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan. DIF: Cognitive Level: Application REF: Text Pages: 75-77 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Success in obtaining sufficient data in the initial psychiatric interview depends largely on the: a. patient's ability to communicate effectively. b. interviewer's ability to establish good rapport. c. number of psychiatric interviews the nurse has performed. d. interviewer's ability to organize and systematically record data.

ANS: B Patients with whom the nurse has established rapport will feel understood by the examiner and will be more willing to cooperate with the examiner's questions. Although the remaining options have an impact on the success of the interview, they are not the primary factor. DIF: Cognitive Level: Application REF: Text Page: 89 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5Pharmacogenetics will eventually allow researchers to do which of the following? a. Remove the genes that cause illness. b. Allow the design of custom drugs. c. Develop foods that fight disease. d. Splice genes to improve health.

ANS: B Pharmacogenetics is a discipline that blends pharmacology with genomic capabilities and will eventually allow researchers to match DNA variants with individual responses to medical treatments. It will allow for custom drugs based on individual genetic profiles. DIF: Cognitive Level: Comprehension REF: Text Page: 82 TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

During an interview, a patient with mania demonstrates very rapid speech and talks continuously and loudly. The patient's speech pattern is best documented as: a. tangential. b. pressured. c. inappropriate. d. circumlocution.

ANS: B Pressured speech is rapid, forcefully delivered speech that is often loud and excessive. DIF: Cognitive Level: Comprehension REF: Text Page: 90 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A nurse asks a patient to remember the following object, color, and address: pencil, red, and 15 Maple Street. After 15 minutes the nurse asks the patient to repeat the object, color, and address. The nurse is assessing: a. judgment. b. recent memory. c. ability to abstract. d. immediate recall.

ANS: B Recent memory is tested when the patient is asked to recall several words 15 minutes after hearing them for the first time. DIF: Cognitive Level: Application REF: Text Page: 93 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

During a mental status evaluation, a nurse's intuition may indicate: a. clues about the patient's physical well-being. b. subtle emotions being expressed by the patient. c. areas to be explored in the predischarge interview. d. potential nursing diagnoses that relate to a patient knowledge deficit.

ANS: B Subtle emotions are transmitted during the mental status evaluation, but they may register only as suspicions. Examples are subtle hostility that may make the nurse feel threatened or angry and sadness or hopelessness that may make the nurse feel sad. DIF: Cognitive Level: Application REF: Text Page: 89 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

The Mini-Mental State Examination would be used by a nurse who is interested in obtaining information about: a. affect changes. b. cognitive processes. c. thought content and processes. d. abnormal psychological experiences.

ANS: B The Mini-Mental State Examination is a simplified scored form of the cognitive mental status examination. It consists of 11 questions, including "what is today's date?", "what month is it?", and "where are you right now?", and it requires only 10 minutes to administer. DIF: Cognitive Level: Application REF: Text Page: 96 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

When asked what a mental status examination is intended to reveal about the patient, the nurse answers: a. "It gives us a more complete family history." b. "It reflects the patient's current state of function." c. "It reveals a lot about the patient's past experiences." d. "It helps us determine the patient's future prognosis."

ANS: B The mental status examination is designed to give a picture of the patient's current level of functioning. The information provided may be a factor in prognosis, but that is not the primary function of the examination. Family history and general patient information are derived from other sources and the general nursing interview. DIF: Cognitive Level: Comprehension REF: Text Page: 88 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A patient admitted for treatment of uncontrolled diabetes mellitus is withdrawn and tearful. The patient says, "I just want to be normal again." The nurse determines there is a need for a psychiatric evaluation primarily to assist: a. the patient in verbalizing distress about the disease. b. in assessing the emotional factors affecting the patient's present condition. c. in assessing priorities to be set for the patient's overall nursing plan of care. d. the patient in emotionally accepting the chronic nature of the disease.

ANS: B The primary purpose would be to assess emotional factors that may have an effect on the patient's current condition. The patient has given clues to psychological distress. Holistic care requires the assessment of biological, psychological, and sociocultural health status. DIF: Cognitive Level: Application REF: Text Pages: 88-89 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A family member asks a mental health nurse, "I am reading a lot of information about gene therapy in the news lately. Will gene therapy be able to help my spouse, who has schizophrenia?" Which response by the nurse is best? a. "Gene therapy for schizophrenia is common in Europe but has not yet become popular in the United States." b. "Gene therapy for schizophrenia is available, but the high cost prohibits most people from taking advantage of it." c. "Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future." d. "Gene therapy has already shown promise in treating schizophrenia, but not enough large-scale studies have been carried out to date."

ANS: C Gene therapy is still an experimental field. It holds potential for treating or even curing genetic and acquired diseases such as cancer or AIDS, but it is not likely to be clinically applicable in psychiatry in the near future. DIF: Cognitive Level: Application REF: Text Page: 82 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient tells a nurse, "God has given me special powers to heal the sick and raise the dead. I can cast out demons and cure cancer." The nurse assesses the patient's statements as indicating: a. a phobia. b. depersonalization. c. grandiose delusions. d. an idea of reference.

ANS: C Grandiose delusions are beliefs that one possesses greatness or special powers. A phobia is a morbid fear, depersonalization is a loss of self-identity, and idea of reference is the incorrect interpretation of casual events. DIF: Cognitive Level: Application REF: Text Page: 92 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A nurse conducting a mental status examination should plan to: a. compare results with at least one other nurse. b. perform the examination without the patient knowing. c. integrate the examination into the nursing assessment. d. perform the examination as the first communication with the patient.

ANS: C Many observations can be made during other aspects of the nursing assessment, and specific questions can be blended into the general flow of the interview. Planning to compare results requires the assumption that more than one assessment will be conducted. This examination requires input from the patient that is best secured when the patient-nurse relationship has been established. DIF: Cognitive Level: Application REF: Text Page: 88 TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5A patient's spouse asks a nurse, "Why are they wasting money doing all these tests on my spouse? The hallucinations and delusions make the mental illness obvious!" The best reply would be: a. "Don't be upset. We are using the most modern approach to caring for your spouse." b. "I know you must be worried about costs, but having these tests is very necessary." c. "Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating." d. "I think that you are upset about your spouse's illness and not thinking clearly. To avoid harm, physical illness must be ruled out."

ANS: C Only after a patient has been carefully screened can it be determined that the problems are amenable to psychiatric intervention. These symptoms can be a result of a physiological problem and this situation must be assessed appropriately. It is never appropriate to be disrespectful or demeaning to a patient or family members. DIF: Cognitive Level: Application REF: Text Pages: 83-84 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A nurse assessing a patient's emotional intelligence will focus on the patient's: a. linguistic and musical abilities. b. body kinesthetic and spatial abilities. c. interpersonal and intrapersonal skills. d. logical mathematics and linguistic abilities.

ANS: D Interpersonal intelligence and intrapersonal intelligence form one's personal intelligence or "emotional quotient." DIF: Cognitive Level: Comprehension REF: Text Page: 95 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A patient mentions, "My doctor told me I was going to have a PET scan that would show where my brain has bright spots. Does that mean I'm getting an electrical jolt like in electroconvulsive therapy (ECT)?" The best reply would be: a. "PET scans and ECT treatments are entirely different." b. "A PET scan is a diagnostic test, and an ECT treatment is a form of therapy." c. "A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active." d. "PET scans show us the electrical activity of the brain in the form of light bands."

ANS: C PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan. There is no electrical "jolt" involved. Two of the options address an assumption made by the nurse that the patient is referring to ECT, and PET scans do not produce light bands of measurable degrees of brightness. DIF: Cognitive Level: Application REF: Text Pages: 77-78 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A nurse plans to engage in participant observation while conducting a mental status examination. This will require the nurse to: a. increase verbalization with the patient. b. listen attentively to the patient's response. c. engage in communication and observation simultaneously. d. advise the patient on what to do about data obtained during the interview.

ANS: C Participant observation is a clinical approach that allows the nurse to critically observe a patient while structuring the examination in a way that allows for the broad exploration of many areas to screen for potential problems and for the in-depth exploration of obvious symptoms or maladaptive coping responses. Discussing treatment options is not the purpose of this intervention. Verbalization and attentive listening are required but may not need to be increased. DIF: Cognitive Level: Comprehension REF: Text Pages: 89-90 TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment: Management of Care

Generally, a nurse can expect the motor activity of a patient with profound depression and the motor activity of a patient with mania to: a. be similar. b. show many tics and grimaces. c. be at opposite ends of the continuum. d. show unusual bizarre gestures or posturing.

ANS: C Patients with mania show excessive body movement, whereas many patients with depression show little body activity. Tics and grimaces may be medication-related, whereas bizarre gesturing and posturing are not usually associated with mood disorders. DIF: Cognitive Level: Application REF: Text Page: 90 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5A patient diagnosed with depression tells a nurse, "I don't feel rested. It's as though I didn't sleep at all." Comments by night shift staff show that the patient slept through most of the night. How can these two observations be reconciled? a. The patient is considered the more accurate reporter. b. The staff observations are more objective than the patient's statement. c. Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation. d. People with depression characteristically underreport sleep satisfaction because of cognition flaws.

ANS: C Studies show that with depression, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense, leading to patient reports of fatigue, poor concentration, and irritability associated with sleep deprivation. DIF: Cognitive Level: Application REF: Text Pages: 79-80 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

A patient diagnosed with depression tells a nurse, "If I hadn't been admitted, I would have carried out my plan and everyone would have been better off without me." The nurse responds: a. "It's frustrating when plans are interrupted." b. "Things can still turn out all right for you while you're here." c. "What specifically did you plan to do before you were admitted?" d. "I know you're feeling bad now but if you talk, things will be better."

ANS: C Suicidal intent should be openly and directly investigated. The other options either provide false hope or are not directed at the most serious patient issue. DIF: Cognitive Level: Application REF: Text Pages: 90-91 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5Which part of the brain is responsible for fine motor coordination? a. Medulla b. Thalamus c. Cerebellum d. Temporal lobe

ANS: C The cerebellum is responsible for fine motor coordination, posture, balance, and integration of emotional processes. DIF: Cognitive Level: Knowledge REF: Text Pages: 73-74 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

During a mental status examination, a patient sits looking tense and suspicious. The patient has a reddened scar on the left cheek and is wearing a torn, soiled shirt and only one shoe. Which observation about appearance has the greatest significance for the patient's current mental state? a. The patient has a reddened scar on the left cheek. b. The patient is wearing a torn, soiled shirt. c. The patient appears tense and suspicious. d. The patient is wearing only one shoe.

ANS: C The observation of tension and suspicion indicates current stress and possible paranoia. The scar, the condition of the clothing, and the absence of a shoe are not as relevant to the patient's current mental state because they originated in a time other than the present. DIF: Cognitive Level: Analysis REF: Text Page: 92 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

While interviewing a patient, a nurse notes that the patient uses invented words and that the patient's thoughts do not seem to flow logically. These observations are most consistent with a diagnosis of: a. depression. b. panic disorder. c. schizophrenia. d. defensive coping.

ANS: C These symptoms indicate the presence of a thought disorder seen more often in patients with schizophrenia than in those with panic or depression. Defensive coping is not a diagnosis. DIF: Cognitive Level: Application REF: Text Page: 91 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Which clinical skills used to conduct a mental status examination are most relevant to establishing rapport? a. Clarification and restatement b. Information giving and feedback c. Systematic inquiry and organization of data d. Attentive listening, observation, and focused questions

ANS: D Attentive listening, observation, and focused questions allow for the use of empathic statements and make a patient feel understood, which fosters rapport. The other options are broadly related to communication in general. DIF: Cognitive Level: Application REF: Text Page: 88 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care

Asking a patient to give the meaning of the proverb "people who live in glass houses shouldn't throw stones" will assist a nurse in assessing the patient's: a. short-term memory. b. orientation to reality. c. emotional intelligence. d. ability to think abstractly.

ANS: D Interpreting proverbs gives clues to the patient's ability to move from concrete to abstract thinking by stating meaning in terms symbolic of human behavior or events. DIF: Cognitive Level: Application REF: Text Page: 95 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

To gather data about a patient's judgment, which question would be most appropriate? a. "What brought you to the hospital?" b. "On a scale of 1 to 100, what would you consider your stress level to be?" c. "What problem would you like to work on while you are hospitalized?" d. "If you found a stamped, addressed envelope lying in the street, what would you do with it?"

ANS: D Judgment involves making decisions that are constructive and adaptive. The other options relate information but do not require critical thinking to produce a judgment. DIF: Cognitive Level: Application REF: Text Page: 95 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A nurse will perform a mental status examination. The data most pertinent for determining the patient's affective response will be the patient's: a. judgment and insight. b. sensorium and memory. c. appearance and thought content. d. statements of mood and affect.

ANS: D Mood is the patient's self-report of his or her prevailing emotional/affective state. The remaining options are more related to cognition and thought. DIF: Cognitive Level: Application REF: Text Page: 91 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

The health care provider describes a patient as being dressed like a "typical patient with mania." From this statement, the nurse can assume that the patient's mode of dress was: a. drab. b. slovenly. c. seductive. d. flamboyant.

ANS: D Patients with mania often dress in bright colors and mix a variety of patterns. Their attire may give them an eccentric or bizarre look. "Drab" usually reflects more of a personal preference in dress, whereas "slovenly" and "seductive" may be considered indicators of mental illness if seen in combination with other specific assessment observations. DIF: Cognitive Level: Application REF: Text Page: 90 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression? a. Norepinephrine b. Acetylcholine c. Dopamine d. Serotonin

ANS: D Serotonin, also called 5-HT, is derived from tryptophan, a dietary amino acid. It is located only in the brain, particularly in the raphe nuclei of the brainstem. It plays a role in regulation of mood through its mood-elevating capacity. DIF: Cognitive Level: Comprehension REF: Text Page: 76 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Which question would best assess a patient's ability to make judgments? a. "Who is the president of the USA?" b. "How long have you been here?" c. "What is the name of the building we're in?" d. "If you won $10,000, what would you do with it?"

ANS: D The correct option involves judgment since it is asking what the patient would do with $10,000. The remaining options assess the patient's orientation to self, time, and place. DIF: Cognitive Level: Application REF: Text Page: 95 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body's temperature? a. Thalamus b. Cerebellum c. Limbic system d. Hypothalamus

ANS: D The hypothalamus is responsible for regulation of metabolism, temperature, and emotions. DIF: Cognitive Level: Knowledge REF: Text Page: 73 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following? a. Genetic studies b. Patient histories c. Comparisons of blood chemistries d. Magnetic resonance imaging (MRI) studies

ANS: D When results of studies such as MRI are coupled with neuropsychological test results, the deficits in a person's performance, such as language or cognitive or sensory information processing, can be linked to the activity in the region of the brain responsible for those functions. DIF: Cognitive Level: Knowledge REF: Text Pages: 74-77 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation