Psych study guide

9. The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? A) A white blood cell count B) Liver function studies C) Serum potassium level D) Serum sodium level

A) A white blood cell count

5. The nurse is caring for a patient who has been under severe stress while caring for her elderly mother who is in the advanced stages of Alzheimer's disease. The nurse explains that the patient is adapting to the stress is she is experiencing because of which of the following? A) Ability to survive in the midst of severe stress B) Acceptance of others' help in caring for her mother C) Success at being able to solve problems D) Capability in setting reasonable personal goals

A) Ability to survive in the midst of severe stress

11. A nurse is performing a biopsychosocial assessment of a patient with depression. Which of the following would the nurse assess as part of the psychological domain? Select all that apply. A) Abstract reasoning B) Medication use C) Mood D) Orientation E) Self-care

A) Abstract reasoning C) Mood D) Orientation

8. A nurse is working on developing ways to meet the challenge of knowledge development. Which of the following would be most appropriate? A) Access new information through continuing education programs. B) Improve access to community psychiatric care for all populations. C) Reduce the burden of mental illness by fighting stigma. D) Provide culturally competent, high-quality nursing care.

A) Access new information through continuing education programs.

21. A nurse is developing a plan of care integrating Maslow's hierarchy of needs. Which of the following would the nurse identify as the priority? A) Activity level B) Predictable social environment C) Acceptance from family D) Positive self-image

A) Activity level

18. A nurse is reading a journal article about cognitive behavior therapy techniques used in various settings. In which setting would the nurse expect to find solution-focused therapy being used? A) Acute inpatient setting B) Community setting C) Clinic setting D) Home care setting

A) Acute inpatient setting

19. A group of nursing students is reviewing the factors associated with group psychotherapy through which therapeutic changes occur. The student's demonstrate understanding when they identify which of the following as a factor? Select all that apply. A) Altruism B) Catharsis C) Repressed behavior D) Universality E) Hopelessness

A) Altruism B) Catharsis D) Universality

11. A nursing instructor is preparing a class presentation for a group of nursing students about cognitive behavioral therapy. Which of the following would the instructor be least likely to include? A) An event is the underlying issue causing the disturbance. B) An individual has a belief regardless of how it developed. C) Practice can help to alter the belief causing the problem. D) Negative inaccurate thoughts can be replaced.

A) An event is the underlying issue causing the disturbance.

4. The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe? A) Anticholinergic B) Anxiolytic C) Benzodiazepine D) Beta-blocker

A) Anticholinergic

5. In an initial group therapy session, the nurse observes that one group member continually tries to monopolize the conversation. The nurse interprets this behavior as reflecting which of the following in the patient? A) Anxiety B) Anger C) Rebellion D) Fear

A) Anxiety

4. A female patient was admitted to the hospital with pneumonia, and in the course of her treatment, it was determined that she was experiencing alcohol dependence because she began experiencing alcohol withdrawal while she was in the hospital. When the psychiatrist who was called in as a consultant documented the patient's mental disorder, he identified her alcohol dependence on which axis? A) Axis I B) Axis II C) Axis III D) Axis IV

A) Axis I

7. A nurse engaged in an interaction with a patient recognizes body space zones. Which of the following would the nurse identify as the individual's personal zone? A) Beginning at the boundary of the intimate zone and ending at the social zone B) Extending outward from the border to the public zone C) Surrounding and protecting an individual from others, especially outsiders D) The most distant boundary that can be used for recognizing intruders

A) Beginning at the boundary of the intimate zone and ending at the social zone

1. When applying the biopsychosocial model to client care, the nurse integrates the psychological domain when involved with which of the following? A) Behavior therapy B) Family support C) Nutritional therapy D) Sleep hygiene measures

A) Behavior therapy

13. A psychiatric mental health nurse is working on an inpatient unit that uses a privilege system. The nurse understands that this intervention integrates which group of theories? A) Behavioral B) Developmental C) Humanistic D) Cognitive

A) Behavioral

18. A group of nursing students are reviewing information about psychodynamic theories. The students demonstrate a need for additional study when they identify which of the following as a humanistic theorist? A) Carl Jung B) Carl Rogers C) Abraham Maslow D) Frederick Perls

A) Carl Jung

7. A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level practice? A) Case management B) Program development C) Clinical supervision D) Community interventions

A) Case management

13. The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following? A) Clang association B) Stilted language C) Verbigeration D) Neologisms

A) Clang association

9. A home health nurse is making a home visit to a psychiatric patient who was recently discharged from a mental health unit. During the visit, the nurse plans on clarifying with the patient when she will return for the next home visit. During which stage would the nurse discuss the next home visit with the patient? A) Closure stage B) Service implementation C) Greeting stage D) Focus establishment

A) Closure stage

20. A psychiatric mental health nurse is preparing to lead a medication group. Which of the following would be most important for the nurse to assess? Select all that apply. A) Cognitive abilities B) Medication knowledge C) Reading skills D) Writing abilities E) Use of a specific medication

A) Cognitive abilities B) Medication knowledge C) Reading skills D) Writing abilities

16. A group of nursing students are preparing a class presentation on therapeutic and nontherapeutic techniques of communication. The students demonstrate understanding of the information when they select which techniques to demonstrate as therapeutic? Select all that apply. A) Confrontation B) Open-ended statements C) Reflection D) Reassurance E) Agreement F) Challenges

A) Confrontation B) Open-ended statements C) Reflection

24. A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal? A) Continuity of care B) Shorter in-patient stays C) Immediate crisis stabilization D) Social engagement

A) Continuity of care

14. During assessment, a patient tells the nurse that he follows Buddhist beliefs. The nurse would integrate understanding of which of the following when developing the patient's plan of care? A) Desire is the cause of all human suffering and misery. B) Self-indulgence is necessary to reach nirvana. C) Present behavior is based on current unhappiness. D) Salvation is achieved through faith and humility.

A) Desire is the cause of all human suffering and misery.

14. A nurse is acting as the leader of a newly formed group that is in the beginning stage of development. Which of the following would the nurse expect to do? Select all that apply. A) Develop rapport with the group members B) Anticipate members testing one another C) Work with members to develop norms D) Promote sharing of feelings E) Facilitate verbal and nonverbal communication

A) Develop rapport with the group members B) Anticipate members testing one another

6. A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? A) Diphenhydramine (Benadryl) B) Propranolol (Inderal) C) Risperidone (Risperdal) D) Aripiprazole (Abilify)

A) Diphenhydramine (Benadryl)

15. A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-amino butyric acid (GABA)

A) Dopamine

17. A group of students are preparing a class presentation about negligence. Which of the following would the group include as an element required for proving negligence? Select all that apply. A) Duty to provide care B) Proximate cause C) Resultant damages D) Breach of duty E) Cause in fact F) Evidence of mistake

A) Duty to provide care B) Proximate cause C) Resultant damages D) Breach of duty E) Cause in fact

10. A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? A) Elevated temperature B) Tremor C) Decreased blood pressure D) Weight gain

A) Elevated temperature

21. A nurse is preparing a patient for electroconvulsive therapy. Which of the following would the nurse include in the patient's plan of care? Select all that apply. A) Ensuring that there is a signed informed consent on the patient's chart B) Telling the patient he can have fluids but no food before the procedure C) Alerting the patient to the possibility of confusion after the treatment D) Informing the patient that he can leave his dentures in place for the treatment E) Ensuring that the patient is closely supervised for at least the first 12 hours afterward

A) Ensuring that there is a signed informed consent on the patient's chart C) Alerting the patient to the possibility of confusion after the treatment E) Ensuring that the patient is closely supervised for at least the first 12 hours afterward

6. As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders. B) Epidemiology helps explain research findings about the neurophysiology that causes mental disorders. C) Epidemiology provides a thorough theoretical explanation of why specific mental disorders occur. D) Epidemiology predicts when a specific psychiatric client will recover from a specific mental disorder.

A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders.

6. When reviewing the evolution of mental health and illness care, which event is associated with mental disorders beginning to be viewed as illnesses requiring treatment? A) Establishment of Pennsylvania Hospital in Philadelphia Test Bank - Psychiatric Nursing: Contemporary Practice (6th Edition by Boyd) 2 B) Quaker establishment of asylums C) Creation of the state hospital system D) Freud's views on the causes of mental illnesses

A) Establishment of Pennsylvania Hospital in Philadelphia

11. When engaged in a nontherapeutic relationship, which of the following would the nurse identify as occurring first? A) Failure to recognize the patient as a person with a need B) Patient avoiding the nurse C) The nurse being perceived as rude D) Patient feeling hopeless and frustrated

A) Failure to recognize the patient as a person with a need

17. A nurse is preparing a continuing education presentation for a group of psychiatric mental health nurses about various psychopharmacologic agents. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply. A) Fluoxetine B) Duloxetine C) Sertraline D) Venlafaxine E) Bupropion F) Amoxapine

A) Fluoxetine C) Sertraline

16. A group of nursing students is preparing a class presentation comparing the different types of cognitive therapies. When describing solution-focused brief therapy, which of the following would the students identify as being different from the other therapies? A) Focus on functional aspects of the patient B) Challenge about the existence of problems C) Assumption that change is not constant D) View of the past rather than the present

A) Focus on functional aspects of the patient

14. A group of students are reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which of the following as the first component of process? A) Formulation of an idea B) Message encoding C) Transmission of message D) Message reception

A) Formulation of an idea

3. A nurse is caring for a psychiatric patient who is receiving an antacid that contains aluminum salts. Which action by the nurse would be most appropriate? A) Give the antacid 1 hour before the antipsychotic medication. B) Give the antacid at the same time as the antipsychotic medication. C) Administer the antacid 1 hour after the antipsychotic medication. D) Administer the antacid just before the patient goes to sleep.

A) Give the antacid 1 hour before the antipsychotic medication.

11. A group of nursing students is reviewing information about the types of crisis. The students demonstrate understanding of the information when they identify which of the following as a developmental crisis? A) Going away to college B) Obtaining a job promotion C) Loss of a pet D) Earthquake

A) Going away to college

3. While leading a small group, the nurse sets up the ground rules at the beginning of the group's first meeting. One of the rules established is that the group will always start at the specified time rather than waiting to start until after everyone has arrived. This rule reflects which of the following? A) Group norms B) Group cohesion C) Group think D) Group process

A) Group norms

4. A patient who is hospitalized with depression tells the nurse, I don't want to take the medication because I'm afraid I'll become suicidal. Which response by the nurse would be most appropriate? A) Have you ever thought about hurting yourself? B) It's important that you take this medication. C) I agree with you. I wouldn't want to take this medication either. D) Another patient took that medication, and he really felt better.

A) Have you ever thought about hurting yourself?

10. The nurse is reviewing the assessment data of a patient diagnosed with a mental illness. The patient is to be prescribed medication to treat the illness. The nurse would identify changes in which laboratory values as being the least significant? A) Hemoglobin B) Alanine aminotransferase (ALT) C) Blood urea nitrogen (BUN) level D) Serum creatinine

A) Hemoglobin

4. The nurse is caring for a patient with chronic stress for the past month because of job loss and financial difficulties. When evaluating the patient's assessment findings, the nurse would anticipate finding an elevated antibody titer to which of the following? A) Herpes simplex viruses B) Herpes zoster viruses C) Acquired immune deficiency viruses D) Influenza viruses

A) Herpes simplex viruses

17. When providing care to a patient, the psychiatric mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? A) Hildegarde Peplau B) Florence Nightingale C) Dorothea Dix D) Sigmund Freud

A) Hildegarde Peplau

16. A nurse is conducting an assessment of a patient's social network. Which of the following would the nurse assess? Select all that apply. A) How big is your network of contacts? B) What benefits do you receive from these people? C) Who is responsible for providing the support? D) Do any of the members know one another? E) What services do you think might be helpful?

A) How big is your network of contacts? B) What benefits do you receive from these people? C) Who is responsible for providing the support? D) Do any of the members know one another?

3. A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which of the following would the student include as key to interpersonal theories? A) Human relationships B) Instincts C) Drives D) Potential for goodness

A) Human relationships

1. A nurse is assessing a patient with a psychiatric illness. The nurse interprets which patient statement as reflecting the concept of cognitive triad? A) I always mess things up. No matter what I do, my whole world is a mess, and my future will be a big mess, too. B) My sister is always the pretty one, her world is free of problems, and she'll have a perfect future. C) My bosses think they know it all, that they can control the world's future, and that the entire planet is dependent on them. D) My mother used to always tell me bad things happen in threes like when someone you know dies, you just know two other people you know will die.

A) I always mess things up. No matter what I do, my whole world is a mess, and my future will be a big mess, too.

6. A Red Cross nurse is working with tornado victims. The nurse is interviewing a woman whose house was totally destroyed during the night by the tornado; the woman's pet poodle died as a result of the tornado. Which of following would the nurse most likely expect to hear from the woman? A) I don't know. I can't feel anything right now. Nothing seems real. B) Devastated. . . . I just feel totally devastated. I don't know how I can go on living. C) I just want my insurance man to get here so I can file a claim. Everything I had is gone. D) I always thought my dog would die peacefully in my arms. Now I'll never be able to hold her again.

A) I don't know. I can't feel anything right now. Nothing seems real.

19. After teaching a patient who is prescribed imipramine about the drug, the nurse determines that the teaching was effective when the patient states which of the following? A) I need to be careful because the drug can make me sleepy. B) I don't have to worry about getting dizzy when I get up from lying down. C) I might notice some excess saliva in my mouth at different times. D) I need to avoid foods with fiber because diarrhea can occur.

A) I need to be careful because the drug can make me sleepy.

10. After interviewing a patient about social supports, the nurse determines that the patient is experiencing emotional support from these social supports based on which statement? A) I'm glad I have someone that I can talk to. B) The person who cut my lawn was great! C) I received a small community grant for groceries. D) The senior center gave me a booklet about my medications.

A) I'm glad I have someone that I can talk to.

5. A person was supposed to meet a friend at a local theatre to see a movie. The friend never showed up. The person's initial thought was, My friend didn't come because she doesn't like me. This automatic thought was most likely inferred from which irrational belief? A) I'm worthless, so no one could really want to be my friend. B) Movies are a waste of time and money anyway. C) I'm sure she just got confused and thought we were going to a different movie. D) I'm so forgetful and confused sometimes; I probably wrote down the wrong time.

A) I'm worthless, so no one could really want to be my friend.

39. As part of an interdisciplinary team, a nurse is assisting in developing the plan of care for a client with a delusional disorder. Which of the following would the team be least likely to include in the plan? A) Insight-oriented therapy B) Psychoeducation C) Cognitive therapy D) Support therapy

A) Insight-oriented therapy

2. When describing the influence of Harry Stack Sullivan on psychiatric mental health nursing, which of the following would the instructor address as a major concept? A) Interpersonal relations B) Harmony between the individual and society C) Collective unconscious D) Unconditional positive regard

A) Interpersonal relations

17. A patient is scheduled for a challenge test. Which of the following would the nurse include when explaining this test to the patient? A) Intravenous administration of a substance to induce symptoms B) Application of electrodes to the scalp for monitoring C) Evaluation electrical impulses recorded on graph paper D) Exposure to a flashing strobe light to elicit abnormal activity

A) Intravenous administration of a substance to induce symptoms

3. A patient receives a court order for commitment. Which of the following best exemplifies the concept of least restrictive environment? A) Involuntary commitment to an outpatient community mental health center B) Medication administration for sedation so the patient cannot get out of bed C) Placing the patient in a locked padded room in response to threats of self-harm D) Allowing the patient to make the decision about whether treatment is necessary

A) Involuntary commitment to an outpatient community mental health center

27. A nursing instructor is developing a class lecture that compares and contrasts schizoaffective disorder with schizophrenia. When describing one of the differences between these two diagnoses, which of the following would the instructor include as reflecting schizoaffective disorder? A) It is episodic in nature. B) It involves difficulties with self-care. C) It has less severe hallucinations. D) It is associated with a lower suicide risk.

A) It is episodic in nature.

6. The nurse is preparing to care for a patient under severe stress resulting from caring for her elderly aunt diagnosed with leukemia. When assessing the patient's psychological domain, which question would the nurse ask first? A) Let's talk about what you have been feeling. B) Tell me about your depressed moods. C) How long have you been caring for your aunt? D) Are you feeling overwhelmed by caring for your aunt?

A) Let's talk about what you have been feeling.

2. A nurse is providing care to a patient with a mental disorder classified by the DSM-IV-TR. The nurse understands that although the first three axes appear to contain all the diagnostic information about a patient, a truly accurate picture of the client is incomplete without considering other factors such as an estimate of current functioning and: A) Life stressors B) Cultural background C) Marital status D) Genetic history

A) Life stressors

12. A nursing instructor is preparing a class about rural cultures and the influence on mental health problems. Which of the following would the instructor include as impacting the use of mental health services for this group? Select all that apply. A) Limited access to care B) Lack of available resources C) Geographical similarities D) Diverse cultural groups E) Consistency in treatment approaches

A) Limited access to care B) Lack of available resources D) Diverse cultural groups

5. A staff nurse on a psychiatric unit knows that patients often have trouble sleeping because of their psychiatric conditions. Which of the following would reflect a psychiatric nursing intervention to appropriately address this problem? A) Limiting amounts of evening snacks and beverages B) Involving patients in a volleyball game immediately before bedtime C) Enforcing the rule that all patients be in bed with lights out by 10:30 PM D) Encouraging patients to take short naps in the afternoons

A) Limiting amounts of evening snacks and beverages

9. A group of nursing students are reviewing information about the various nursing theorists and their application to psychiatric mental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory of cultural care diversity and universality? A) Madeleine Leininger B) Sister Calista Roy C) Hildegard Peplau D) Dorothea Orem

A) Madeleine Leininger

2. A nursing instructor is describing the impact of technology and electronic health records on psychiatric mental health care. Which of the following would the instructor identify as a major challenge associated with it? A) Maintaining confidentiality B) Establishing educational models C) Decreasing fragmented care D) Defining professional standards more clearly

A) Maintaining confidentiality

11. A group of nursing students are reviewing the various neurotransmitters. The students demonstrate understanding when they identify which of the following as a neuropeptide? A) Melatonin B) Serotonin C) Glutamate D) Gamma-aminobutyric acid

A) Melatonin

12. The following are important legislative and policy efforts influencing current mental health care. Which of the following is the most recent? A) Mental Health: A Report of the Surgeon General B) New Freedom Commission on Mental Health C) Action for Mental Health D) Mental Retardation Facilities and Community Mental Health Centers Construction Act

A) Mental Health: A Report of the Surgeon General

13. During an interview, a patient states, I feel so guilty, and I'm so ashamed of what I did. The nurse interprets this as which of the following? A) Negative emotion B) Positive emotion C) Borderline emotion D) Nonemotion

A) Negative emotion

16. A nurse is reading a journal article about psychoneuroimmunology. Which information would the nurse most likely find? Select all that apply. A) Neurotoxin's role in receptor site damage B) Hypothalamic pituitary thyroid axis disruption C) Static activity of natural killer cells in response to stress D) Hypothalamic damage leading to immune dysfunction E) Interruption in the typical circadian rhythm cycle

A) Neurotoxin's role in receptor site damage B) Hypothalamic pituitary thyroid axis disruption D) Hypothalamic damage leading to immune dysfunction

5. A psychiatric mental health nurse working in a Veteran's Administration Medical Center is meeting with a military wife who is an Asian American. The woman is to be joining a support group for wives of veterans who have posttraumatic stress syndrome. When asking her to describe her husband's mental health problems, which response would the nurse most likely expect? A) Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his family. B) I know the war messed his mind up. He'll never be the same. C) Sometimes he hallucinates that he is back in Vietnam. D) He just stays to himself; he never talks to me about what is bothering him.

A) Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his family.

15. A nurse is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? A) Part of personal life not governed by society's laws B) Ethical duty for nondisclosure C) Involvement of two individuals D) Knowledge of treatment costs and benefits

A) Part of personal life not governed by society's laws

4. A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding of these types when identifying which of the following as involved in providing the most intensive outpatient nursing care? A) Partial hospitalization programs B) Crisis intervention programs C) Outpatient detoxification programs D) Rehabilitation programs

A) Partial hospitalization programs

3. A nursing instructor is preparing a presentation about key events and people that influenced the development of contemporary mental health and illness care. When describing the effects of World War II, which of the following would the instructor include? A) People began to view mental illness as more commonplace and acceptable. B) The biologic understanding of mental illness was almost fully developed. C) Deinstitutionalization occurred in response to the community health movement. D) Mental illnesses became categorized as psychoses or neuroses.

A) People began to view mental illness as more commonplace and acceptable.

10. A nurse is working as part of a community disaster response team. When responding to a community disaster, the nurse integrates understanding of individuals' responses, anticipating which of the following? A) People can become aggressive and violent when their basic needs are threatened. B) People involved in the disaster will always put the welfare of others before their own. C) Losses incurred during the disaster have little, if any, long-term effect on victims. D) The psychological distress associated with disasters is felt immediately.

A) People can become aggressive and violent when their basic needs are threatened.

11. A nursing instructor is preparing a class discussion on the topic of self-determinism. Which of the following would the instructor expect to include? Select all that apply. A) Personal autonomy as a key value B) Choices based on pleasing others C) Activities reflect personal goals D) Right to refuse treatment E) Lack of empowerment

A) Personal autonomy as a key value C) Activities reflect personal goals D) Right to refuse treatment

12. As part of a community program on crisis prevention, a nurse is describing the phases of crisis. Which of the following would the nurse identify as occurring first? A) Problem stimulating usual problem solving B) Trial and error attempts to alleviate problem C) Automatic relief behaviors take over D) Serious personality disorganization

A) Problem stimulating usual problem solving

1. A nursing instructor is describing the DSM-IV-TR to a group of nursing students. Which of the following would the instructor include as the primary purpose of this classification? A) Provide a commonly understood diagnostic category for clinical practice. B) Describe treatment modalities for psychiatric disorders and mental illnesses. C) Identify various etiologies for mental disorders based on family histories. D) Provide optimal outcomes for treatment for individuals with mental illnesses.

A) Provide a commonly understood diagnostic category for clinical practice.

8. A nursing instructor is describing the concept of evidence-based practice in psychiatric mental health nursing. Which of the following would the instructor include as being important? Select all that apply. A) Research findings B) Expert opinion C) Clinical experiences D) Patient data E) Established routines

A) Research findings B) Expert opinion C) Clinical experiences D) Patient data

18. When leading a group, the nurse determines that several of the group members have assumed roles that may be interfering with the group's function. Which roles might be involved? Select all that apply. A) Self-confessor B) Follower C) Dominator D) Elaborator E) Playboy F) Compromiser

A) Self-confessor C) Dominator E) Playboy

9. A patient's psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect the patient's right to request a second opinion before agreeing to this suggestion? A) Self-determinism B) Least restrictive environment C) Confidentiality D) Mandates to inform

A) Self-determinism

3. A hospitalized patient diagnosed with depression asks the nurse, Should I go home this weekend? Which response by the nurse uses the technique of reflection? A) Should you go home for the weekend? B) Home means what to you? C) It sounds as if you don't want to go home this weekend. D) I doubt that you really should go home this weekend.

A) Should you go home for the weekend?

7. A psychiatric mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders as identified in Healthy People 2020. Which type of program would be least appropriate? A) Single substance abuse treatment programs B) Depression screening programs for primary care providers C) Mental health programs for the homeless population D) Employment programs for those with serious mental illness

A) Single substance abuse treatment programs

7. The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patient's plan of care, in which of the following areas would the nurse anticipate a problem? A) Sleep B) Constipation C) Speech D) Motor activity

A) Sleep

40. When assessing a client with delusional disorder, the nurse would most likely expect to find impairment in which of the following? Select all that apply. A) Social functioning B) Marital functioning C) Intellectual functioning D) Occupational functioning E) Mental status functioning

A) Social functioning B) Marital functioning

28. The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurse's understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority? A) Suicide B) Aggression C) Substance abuse D) Eating disorder

A) Suicide

1. A nurse is explaining advance care directives, or living wills, to a patient and the patient's spouse. Which of the following would the nurse include in the description? A) The document tells what treatment is to be omitted if the patient is unable to make the decision. B) It requires that the patient sign the living will document while an attorney is present. C) The patient's physician must act as a witness when the patient signs the document. D) An attorney draws up the papers to be given to the patient and his or her family.

A) The document tells what treatment is to be omitted if the patient is unable to make the decision.

5. Two nursing students are discussing psychiatric mental health nursing and the role it has played in nursing's overall history. Which statement is most accurate? A) The importance of using therapeutic communication was stressed by Nightingale. B) The use of self-care to enhance the immune system was taught by Dorothea Dix. C) The moral treatment of mental illness was a primary focus of deinstitutionalization. D) Peplau was the first nurse to stress the importance of therapeutic communication.

A) The importance of using therapeutic communication was stressed by Nightingale.

6. A patient is talking to the nurse about the recent death of her grandmother. She is obviously very sad, and a tear rolls down her cheek as she talks. The nurse remembers how she felt when her own grandmother died the previous summer. The nurse puts her hand on the patient's shoulder and says, This must be very difficult for you. The nurse is demonstrating empathy based on which of the following? A) The response comment reflects an attempt to communicate understanding of patient's feelings. B) The nurse's response and use of reassuring touch reinforce the nurse's concern for the patient. C) The nurse demonstrates understanding of how the patient feels because of her own grandmother's death. D) The nurse's statement expresses compassion and kindness toward the patient.

A) The response comment reflects an attempt to communicate understanding of patient's feelings.

16. A nurse is applying King's model to a nurse patient interaction by identifying the outcome as which of the following? A) Transaction B) Adaptation C) Transpersonal caring D) Self-system

A) Transaction

4. The nurse has begun group counseling sessions for several hospitalized patients in the psychiatric facility. Which of the following would be most effective for the nurse to do to promote group cohesiveness? A) Use team-building exercises. B) Encourage task completion by members. C) Spend time with each member individually. D) Be consistent with the group themes.

A) Use team-building exercises.

3. A patient visits the clinic and tells the nurse about being under a great deal of stress on the job for the past month. Applying the factors that determine the stress response, which question would be most appropriate for the nurse to ask? A) What effect is the stress having on your job performance? B) How would you describe the social network within your family? C) What is the specific event that you find most stressful? D) When did you first become aware of experiencing this stress?

A) What effect is the stress having on your job performance?

14. A patient is involuntarily committed without a court order. The nurse understands that the emergency short-term hospitalization can occur for which time frame? A) A maximum of 24 hours B) 48 to 92 hours C) 3 to 5 days D) One week

B) 48 to 92 hours

3. A patient's global assessment functioning reveals that he has minimal symptoms with good functioning in all areas. Which score would the nurse correlate with these findings? A) 94 B) 82 C) 75 D) 63

B) 82

18. After teaching a class to a group of nursing students about the historical perspectives of mental health care, the instructor determines that the group has understood the information when they identify which of the following as a common belief about mental illness during the medieval period? A) Mental illness in an individual was the result of being possessed by demons. B) A person was removed from a contaminated environment to protect him or her. C) Exorcisms were used as primary mode of treatment to cleanse the person of his or her sins. D) The focus was on moral treatment to promote the individual's safety and comfort.

B) A person was removed from a contaminated environment to protect him or her.

10. When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter? A) Dopamine B) Acetylcholine C) Norepinephrine D) Serotonin

B) Acetylcholine

18. A psychiatric mental health nurse is documenting information in a patient's medical record. Which of the following would be least likely to increase the nurse's legal liability? A) Patient reported that he was feeling better today than yesterday. B) Administered haloperidol 10 mg IM stat as ordered for agitation. C) Patient was talking with another staff member and started screaming. D) Applied restraints to all four patient extremities.

B) Administered haloperidol 10 mg IM stat as ordered for agitation.

8. A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an understanding of this test, which of the following would the nurse avoid? A) Explaining in depth what to expect during the upcoming procedure B) Administering a benzodiazepine medication prescribed for anxiety C) Taking a thorough history of her use of prescribed and illicit drugs D) Giving her a noncaffeinated beverage of her choice

B) Administering a benzodiazepine medication prescribed for anxiety

5. A nurse is demonstrating behaviors that the treatment team is attempting to get the patient to develop. The nurse is integrating which theory? A) Erikson's model of psychosocial development B) Albert Bandura's social cognitive theory C) Skinner's operant conditioning D) Freud's psychoanalytic model

B) Albert Bandura's social cognitive theory

23. A patient is experiencing hallucinations and delusions. The nurse would expect the physician to order which class of drug? A) Mood stabilizer B) Antipsychotic C) Antianxiety agent D) Stimulant

B) Antipsychotic

8. The nurse is integrating Peplau's model when providing care to a patient with a mental illness. Which of the following would the nurse identify as a key component? A) Suffering B) Anxiety C) Self-care D) Nonverbal behaviors

B) Anxiety

37. A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe? A) Lithium B) Aripiprazole C) Clozapine D) Olanzapine

B) Aripiprazole

15. When engaged in rational emotive behavior therapy, which of the following would be addressed during the activating event sequence? A) Teaching the connection between beliefs and consequences B) Assessing the consequences of the problem C) Facilitating the working-through process D) Preparing patient to deepen conviction in rational beliefs

B) Assessing the consequences of the problem

9. A patient is a successful insurance salesman; however, because of market changes, his level of sales has dropped. His boss tells him he will consequently be receiving a $2,000 per year cut in his salary. When the patient arrives home from work, the family dog runs to greet him as he always does, barking and jumping up and down and begging for attention. The patient yells at the dog, Get away from me; I can't take your barking right now. The patient's response reflects a defense mechanism because it was which of the following? A) An intentional behavior performed to let the dog know his behavior was inappropriate B) Automatic, protecting the patient from the anxiety related to his upcoming pay cut C) Implemented to keep the patient from having to cope with his upcoming pay cut D) Implemented so the patient could rationalize his upcoming pay cut

B) Automatic, protecting the patient from the anxiety related to his upcoming pay cut

20. A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they identify which of the following? A) Grief and bereavement are used interchangeably as responses to loss. B) Bereavement is the process of mourning and grief is the emotional reaction. C) Grief involves confronting the stress, but bereavement helps avoid the stresses. D) Bereavement is influenced by culture, but grief is not.

B) Bereavement is the process of mourning and grief is the emotional reaction.

13. A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse identifies this as which of the following? A) First-pass effect B) Bioavailability C) Solubility D) Biotransformation

B) Bioavailability

25. After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. A) Dilated reactive pupils B) Blurred vision C) Ataxia D) Coherent speech E) Facial pallor F) Disorientation

B) Blurred vision C) Ataxia F) Disorientation

20. A college-aged student and his friend arrive at the student health center. The friend reports that the patient has been having difficulties concentrating, remembering, and thinking. He's had quite a few research papers due this past week. After ruling out other problems, the nurse determines that the patient is experiencing a culture-bound syndrome. Which of the following would the nurse most likely suspect? A) Ataque de nervios B) Brain fog C) Mal de ojo D) Shenjing shuairo

B) Brain fog

3. A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which of the following? A) The postcentral gyrus B) Broca's area C) Basal ganglia D) The hippocampus

B) Broca's area

5. The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following? A) Perceiving sensory input B) Calculating a math problem C) Seeing objects in front of him D) Speaking fluently

B) Calculating a math problem

18. A patient is engaged in bibliotherapy and begins to express his feelings because he closely associates his experience with that provided by the reading material. The nurse interprets this as which of the following? A) Insight B) Catharsis C) Anxiety reduction D) Problem solving

B) Catharsis

2. A psychiatric mental health nurse determines that a patient is competent when he is able to do which of the following? A) Speak coherent English. B) Communicate his or her choices. C) Write a living will. D) Comply with the medical regimen.

B) Communicate his or her choices.

6. The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in the patient's medical record? A) Patient states that he had a good night with no complaints. B) Complained of being unable to sleep because he heard voices throughout the night. C) Had a typical night without incidence of insomnia or nightmares. D) Acted crazily throughout the night; kept hearing voices and noises.

B) Complained of being unable to sleep because he heard voices throughout the night.

4. The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty with which of the following? A) Smell B) Concept formation C) Receptive speech D) Hearing

B) Concept formation

16. While leading a group, a nurse leader says to a patient, This is the fourth time that you've changed the subject when we have talked about child abuse. Is something going on? The nurse is using which technique? A) Support B) Confrontation C) Summarizing D) Clarification

B) Confrontation

20. A nurse is providing an in-service presentation on coping and adaptation. Which of the following would the nurse most likely include? Select all that apply. A) Most coping strategies are similar in their approach. B) Coping when effective leads to adaptation. C) Reappraisal occurs simultaneously with coping. D) The same coping strategy is used in each situation. E) Coping is a deliberate and planned effort to mange stress.

B) Coping when effective leads to adaptation. E) Coping is a deliberate and planned effort to mange stress.

17. After teaching a group of nursing students about crisis, the instructor determines that the teaching was successful when the students state which of the following? A) Crisis triggers maladaptive responses. B) Crisis is a time-limited event. C) Chronic crisis is a real situation. D) Events causing a crisis are similar for everyone.

B) Crisis is a time-limited event.

5. In a postclinical conference, a group of students are engaged in a discussion with their instructor. The instructor repeatedly has the students analyze and evaluate the nursing interventions implemented throughout the clinical experience. The students are engaged in which of the following? A) Therapeutic use of self B) Critical thinking C) Interdisciplinary care D) Planning care

B) Critical thinking

9. During an assessment, the patient states, We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of him. The nurse interprets this as indicating which of the following? A) Acculturation B) Cultural identity C) Cultural competence D) Linguistic competence

B) Cultural identity

14. A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the client's room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following? A) Diabetes mellitus B) Disordered water balance C) Tardive dyskinesia D) Orthostatic hypotension

B) Disordered water balance

13. A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved? A) Acetylcholine B) Dopamine C) Norepinephrine D) Serotonin

B) Dopamine

6. The nurse is determining the success of a patient's plan of care by evaluating outcome indicators. The nurse understands that these indicators are usually determined initially at which time? A) On the day of discharge B) During the assessment process C) At the initial interview D) With goal-setting process

B) During the assessment process

16. A psychiatric mental health nurse is providing care for a patient with a mental disorder. The patient is participating in the decision-making process. The nurse interprets this as which component of recovery? A) Self-direction B) Empowerment C) Person-centered D) Holistic

B) Empowerment

15. When applying the biopsychosocial model for a patient with a mental health problem, the nurse addresses the psychological domain when assessing which of the following? A) Sleep patterns B) Feelings C) Family functioning D) Cultural groups

B) Feelings

2. A nurse is reviewing the American Nurses Association's Statement on Psychiatric Nursing Practice published in 1967, which sanctioned the involvement of psychiatric mental health nurses in the provision of holistic nursing care. Integrating knowledge of the various theories and views of mental health and illness, the nurse identifies which of the following as most strongly linked to this holistic approach? A) Sigmund Freud's psychoanalytic theory B) Florence Nightingale's Notes on Nursing C) Hildegarde D) Clifford Beers' A Mind That Found Itself E) Peplau's Interpersonal Relations in Nursing

B) Florence Nightingale's Notes on Nursing

9. A nursing instructor who is lecturing to students about how to respond to individuals who are in the midst of a disaster. Which statement would be most appropriate to include about initial nursing interventions for such individuals? A) You should ask them to give you a brief medical history so their physical needs can be met. B) Focus on safety needs and provide simple, clear instructions to help them function effectively. C) Help them determine what their long-term goals will be so they can maintain a sense of hope. D) Try to redirect their attention away from the problems at hand so you can decrease their anxiety.

B) Focus on safety needs and provide simple, clear instructions to help them function effectively.

20. The nurse is watching a video that depicts a patient and therapist interacting. The patient is asked to say whatever comes to his mind. The nurse identifies this as which of the following? A) Dream work B) Free associations C) Gestalt therapy D) Classical conditioning

B) Free associations

17. During a group session, one of the members states, Let's keep this discussion going so that everyone can participate, but let's keep the time each person speaks to about 3 minutes. The leader interprets this member as acting in which role? A) Group observer B) Gatekeeper C) Encourager D) Energizer

B) Gatekeeper

14. A group of nursing students are reviewing the various theories that form the basis for psychiatric mental health nursing. The students demonstrate understanding of these theories when they identify which theorist as addressing female development? Select all that apply. A) Maslow B) Gilligan C) Bandura D) Miller E) Thorndike

B) Gilligan D) Miller

22. A nurse is developing a teaching plan for a client with schizophrenia. Which method would the nurse use to be most effective? A) Engaging the client the trial and error learning B) Having the client write down information after directly being given the correct information C) Asking the client questions that encourage the client to guess at the correct answer D) Using visual aids that are very colorful and full of descriptive graphic images

B) Having the client write down information after directly being given the correct information

13. As part of a career day presentation to a group of nursing students, a psychiatric mental health nurse plans to describe how this specialty developed. Which individual would the nurse describe as playing a major role in the development of specialty training programs for psychiatric nurses? A) Mary Adelaide Nutting B) Hildegarde Peplau C) Harriet Bailey D) Linda Richards

B) Hildegarde Peplau

15. Assessment of a patient indicates complicated grief. Which statements would the nurse identify as supporting this reaction? Select all that apply. A) It's been 2 months, and I still want my son back. B) I still wait for him to come right through the door every day. C) I'm really struggling with trusting anybody anymore. D) I wish I could go back to the days before he died. E) Life seems so empty now that he's gone. What will I do?

B) I still wait for him to come right through the door every day. C) I'm really struggling with trusting anybody anymore. D) I wish I could go back to the days before he died. E) Life seems so empty now that he's gone. What will I do?

18. The nurse is assessing an Asian American patient. During the interview, the nurse determines that the patient likely follows Taoism based on which statement? A) Purity and balance guide all of my actions. B) I strive to be in happy harmony with nature. C) Nature's powers must be respected in life. D) God is worshipped out of love, not fear.

B) I strive to be in happy harmony with nature.

15. A psychiatric mental health nurse is implementing evidence-based practice. The nurse understands that this approach is developed by doing which of the following first? A) Conducting research B) Identifying a clinical question C) Determining outcomes D) Collaborating with the patient

B) Identifying a clinical question

18. During an interview, a patient tells the nurse that he was recently let go from his job. As the interaction continues, the patient states, I was really overqualified for that position anyway. It was definitely below my area of expertise. The nurse interprets this information as reflecting which of the following? A) Denial B) Intellectualization C) Projection D) Passive aggression

B) Intellectualization

36. After teaching a group of students about the epidemiology of schizoaffective disorder, the instructor determines that the teaching was successful when the students state which of the following? A) The disorder occurs often in children. B) It is more likely to occur in women. C) Most persons are African Americans. D) The disorder is rare in family relatives.

B) It is more likely to occur in women.

18. A client with schizophrenia tells the nurse, I'm being watched constantly by the FBI because of my job. Which response by the nurse would be most appropriate? A) Tell me more about how you are being watched. B) It must be frightening to feel like you're always been watched. C) You're not being watched; it's all in your mind. D) You are experiencing a delusion because of your illness.

B) It must be frightening to feel like you're always been watched.

10. A nurse is preparing to administer an as-needed (PRN) medication. Which of the following would the nurse need to keep in mind when documenting administration? A) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a patient. B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient. C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a patient. D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a patient.

B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient.

11. A nurse is preparing to lead an older adult group. Which of the following would the nurse need to keep in mind when leading this group? A) Focusing the group to promote learning of new information B) Keeping the pace of the group meetings slow C) Discouraging the use of life review strategies D) Teaching entirely new methods for coping

B) Keeping the pace of the group meetings slow

19. When describing the concept of allostatic load to a group of students, which of the following would the instructor identify as abnormalities of which of the following as indicative of the overall changes? A) Nuclear imaging studies B) Laboratory test results C) Bone radiographs D) Cardiac studies

B) Laboratory test results

15. After teaching a class about formal and informal roles of group members, the instructor determines that the teaching was successful when the class identifies which of the following as a formal role? Select all that apply. A) Coordinator B) Leader C) Member D) Harmonizer E) Information seeker

B) Leader C) Member

15. A group of nursing students are reviewing information related to drug therapy for mood disorders. The students demonstrate understanding of the information when they identify which agent as the gold standard for treating bipolar disorder? A) Carbamazepine B) Lithium C) Valproate D) Lamotrigine

B) Lithium

25. A group of nursing students are reviewing the various drug classes used to treat psychiatric disorders. The students demonstrate understanding when they identify which of the following as examples of antianxiety medications? Select all that apply. A) Selegiline B) Lorazepam C) Buspirone D) Zolpidem E) Methylphenidate

B) Lorazepam C) Buspirone

13. After teaching a group of students about the service and patient variables used when determining settings along the continuum of behavioral care, the instructor determines that the teaching was successful when the students identify which of the following as a service variable? A) Signs and symptoms B) Milieu C) Risk D) Social support

B) Milieu

10. During a solution-focused behavior therapy session, the therapist asks a patient to use his imagination based on a scenario in which a patient awakens and all his problems have disappeared. The therapist then asks the patient, How would your life be different? Which type of question is the therapist using? A) Exception question B) Miracle question C) Relationship question D) Scaling question

B) Miracle question

14. A nursing instructor is describing uncomplicated grief to a class. Which of the following would the instructor most likely include in the discussion? A) Uncomplicated grief differs from normal grief because it lasts longer. B) Most bereaved persons experience uncomplicated grief. C) Uncomplicated grief is primarily loss associated with death D) This type of grief is less painful and disruptive than normal grief.

B) Most bereaved persons experience uncomplicated grief.

12. The nurse is assessing a patient experiencing anxiety and observes increased sweating and gooseflesh. The nurse understands that these are the result of which substance? A) Acetylcholine B) Norepinephrine C) Serotonin D) Histamine

B) Norepinephrine

33. The nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect? A) Cognitive impairment B) Normal behavior C) Labile affect D) Evidence of motor symptoms

B) Normal behavior

11. A psychiatric mental health nurse is adhering to the standards of practice. When engaging in clinical decision making, the nurse is integrating which of the following as the foundation? A) Developmental issues B) Nursing process C) Commitment D) Accountability

B) Nursing process

5. The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A) Akathisia B) Oculogyric crisis C) Retrocollis D) Tardive dyskinesia

B) Oculogyric crisis

15. After teaching a group of students about the beliefs associated with the major religions, the instructor determines that additional teaching is needed when the students identify which belief as associated with Confucianism? A) People are born good. B) People are assigned to castes. C) Authority figures are respected. D) Self-responsibility leads to improvement.

B) People are assigned to castes.

15. A nurse responds to a patient's statement with silence based on the rationale that this technique is used primarily to do which of the following? A) Allow the nurse to determine an appropriate response B) Permit the patient to gather his or her thoughts C) Encourage self-reflection by the nurse D) Demonstrate passive listening

B) Permit the patient to gather his or her thoughts

18. A patient with depression tells the nurse that he is to have a test that involves the recording of an electroencephalogram (EEG) throughout the night. The nurse most likely identifies this testing as which of the following? A) Sleep deprivation EEG B) Polysomnography C) Evoked potentials D) Functional magnetic resonance imaging

B) Polysomnography

15. Which of the following would a nurse identify as being categorized as Axis I in the DSM-IV-TR? Select all that apply. A) Paranoid personality disorder B) Posttraumatic stress disorder C) Anorexia nervosa D) Mental retardation E) Unemployment F) Coronary artery disease

B) Posttraumatic stress disorder C) Anorexia nervosa

13. The nurse is reviewing the drawing that a patient completed as a self-portrait. The nurse observes that the drawing lacks arms and feet. The nurse interprets this as indicating which of the following? Select all that apply. A) Low self-esteem B) Powerlessness C) Insecurity D) Inadequacy

B) Powerlessness D) Inadequacy

12. While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the patients is really psycho. Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) Lack of knowledge B) Public stigma C) Label avoidance D) Self-stigma

B) Public stigma

9. A patient is talking to the nurse about her friendship with another person. She comments, That person is always there for me, and I am always there for her. We help each other out; sometimes she's helping me, and sometimes I am helping her. The nurse interprets the patient's statements about her social network as reflecting which of the following? A) Denseness B) Reciprocity C) Social support D) Constraints

B) Reciprocity

18. A nurse is engaged in exercises to develop self-awareness. The nurse is using which tool? A) Interdisciplinary care B) Reflection C) Plan of care D) Clinical reasoning

B) Reflection

19. The nurse is assessing a patient with anxiety and observes the patient yelling and screaming. The nurse, integrating Peplau's theory, interprets this behavior as which of the following? A) Panic behaviors B) Relief behaviors C) Empathetic linkage D) Social distance

B) Relief behaviors

7. Based on assessment data, the nurse formulates the nursing diagnosis for a patient as sleep pattern disturbance. After teaching the patient how to relax before bedtime, the nurse determines that the teaching was effective by which outcome? A) Discusses feelings about not being able to fall asleep B) Reports feeling rested on awakening in the morning within 3 days C) Requests sleeping medication each night before bedtime D) Is able to sleep for short intervals throughout the night

B) Reports feeling rested on awakening in the morning within 3 days

29. A family member of a client diagnosed with schizoaffective disorder asks a nurse what causes the disorder. Which response by the nurse would be most appropriate? A) Dysfunctional family dynamics has been identified as a strong link. B) Research has suggested that the cause is predominately genetic. C) Dopamine, a substance in the brain, appears to be underactive. D) Studies have indicated that birth order is strongly associated with this disorder.

B) Research has suggested that the cause is predominately genetic.

20. A nurse is engaged in active listening. Which of the following would the nurse use? Select all that apply. A) Changing the subject to gather more information B) Responding indirectly to statements C) Using open-ended statements D) Concentrating on what patient says E) Allowing the patient to talk as he wishes

B) Responding indirectly to statements C) Using open-ended statements D) Concentrating on what patient says

16. A patient is experiencing traumatic grief resulting from the suicide of a family member. In addition to the usual emotions experienced with bereavement and grief, which of the following would the person most likely exhibit? Select all that apply. A) Acceptance of the loss B) Sense of rejection C) Disgust D) Stigmatization E) Self-blame

B) Sense of rejection D) Stigmatization E) Self-blame

15. A patient is referred to a psychosocial rehabilitation program. When explaining this type of care to the patient, the nurse would emphasize which of the following? A) Intensive treatment that prepares the patient to live in the community B) Services that promote the patient's reintegration into the community C) Detoxification services for alcohol and drugs in an outpatient setting D) Frequent monitoring within a therapeutic milieu for relapse prevention

B) Services that promote the patient's reintegration into the community

2. A patient's 5-year-old poodle ran in front of a car and was killed. The patient continues to be upset by her pet's death, and she explains to a community counseling center nurse that she can't stop crying because, My Precious meant the world to me, and now my world will never be the same! If the nurse were to determine that the patient was experiencing a crisis, which of the following types of crisis would it most likely be? A) Maturational B) Situational C) Traumatic D) Developmental

B) Situational

20. A patient with depression asks the nurse about possible herbal supplements. Which of the following would the nurse identify as being commonly used? A) Valerian B) St. John's wort C) Kava D) Melatonin

B) St. John's wort

20. When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which of the following? A) Soma B) Synaptic cleft C) Terminal D) Receptor site

B) Synaptic cleft

12. A group of students are reviewing the events associated with the fight-or-flight response. They demonstrate understanding of the information when they identify which of the following results from sympathetic nervous stimulation? A) Hypoglycemia B) Tachycardia C) Hypotension D) Hypercoagulability

B) Tachycardia

5. An individual is seeking employment as a nurse in a crisis center. The interviewer asks the person what he would ask someone who called the crisis hotline to determine whether the caller was experiencing a crisis. Which response would be most appropriate? A) To what extent are you involved in a crisis situation? B) Tell me about what you are experiencing and what it means to you. C) How would you rate your level of functioning on a scale from 1 to 10? D) Why do you think you are in a crisis situation?

B) Tell me about what you are experiencing and what it means to you.

19. The nurse is engaged in a therapeutic nurse patient relationship. The relationship is in the working phase. With which of the following would the patient be involved? Select all that apply. A) Beginning to identify a need B) Testing new ways for problem solving C) Testing the relationship D) Discussing problems related to needs E) Examining personal issues

B) Testing new ways for problem solving D) Discussing problems related to needs E) Examining personal issues

5. Which patient would the nurse determine to be the most likely a candidate for involuntary commitment? A) The client who refuses to take the prescribed medication B) The client who is screaming in the street disturbing neighbors C) The client who refuses to participate in the planned therapy D) The client with a mental disorder who is homeless

B) The client who is screaming in the street disturbing neighbors

11. A group of students are reviewing the goals identified by the New Freedom Commission on Mental Health. The students demonstrate understanding of this report when they identify which of the following as a goal? A) Mental health is viewed as one component of overall health. B) The consumer and family are the driving forces for mental health care. C) Screening is of greater importance than assessment and referral for services. D) Disparities in mental health services are decreased.

B) The consumer and family are the driving forces for mental health care.

10. A group of nursing students is reviewing information about the different types of group. The students demonstrate understanding of the information when they identify which of the following as a characteristic of a self-help group that differentiates it from a supportive therapy group? A) The group is led by a professional. B) The group is led by a consumer. C) There is no identified leader. D) The group is focused on a specific problem.

B) The group is led by a consumer.

2. When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the nurse to keep in mind? A) The nurse should self-disclose when indicated. B) The patient is the primary focus of the interaction. C) The nurse should have an empathetic relationship with the patient. D) The patient's conversations should be recorded.

B) The patient is the primary focus of the interaction.

1. A nurse is performing an admission assessment. The patient complains that it has been taking larger and larger amounts of medication to get the desired effect. Based on this information, the nurse interprets this as suggesting which of the following? A) Desensitization B) Tolerance C) Therapeutic index D) Toxicity

B) Tolerance

1. A nurse is performing an assessment interview with a patient. The patient tells the nurse that he has a type A personality. Based on the nurse's interpretation, the nurse would expect which behavior by the patient? A) Appearing relaxed and easygoing throughout the interview B) Wanting the interview to be over as quickly as possible C) Being pleased with the overall pace of the interview D) Speaking slowly, requiring time to consider his answers

B) Wanting the interview to be over as quickly as possible

20. A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? A) He needs to have an electrocardiogram periodically when taking this drug. B) We'll need to make sure that he has his blood count checked at least weekly. C) He might develop toxic levels of the drug if he smokes cigarettes. D) We need to watch to make sure that he doesn't lose too much weight.

B) We'll need to make sure that he has his blood count checked at least weekly.

7. A nurse is part of team working with hurricane victims. One of the hurricane victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with his situation and how much support he needs, which question would be most appropriate for the nurse to ask? A) What kind of help do you need from us? B) What are your thoughts about what you will do during the next few days? C) How are you feeling about all that you have gone through? D) Are you feeling guilty because you survived and some of your neighbors did not?

B) What are your thoughts about what you will do during the next few days?

1. Which of the following questions would be most helpful in beginning an initial assessment interview for a patient who has just been admitted to a psychiatric inpatient unit? A) Have you had any previous psychiatric admissions? B) What brings you into the hospital today? C) Have you had any thoughts about trying to harm yourself? D) How would you describe your relationship with your spouse?

B) What brings you into the hospital today?

8. A nurse who is working with a patient being treated for depression is using solution-focused brief therapy (SFBT) during the patient's brief psychiatric hospitalization. The nurse decides to use an exception question. Which question would the nurse most likely use? A) When did you first feel depressed? B) When do you not feel depressed? C) What feelings contribute to your depression? D) What has to happen for you to feel depressed?

B) When do you not feel depressed?

10. A patient is being discharged from the psychiatric unit this afternoon, and the nurse needs to teach the patient about discharge medications. The patient is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the teaching plan at which time? A) When his anxiety stabilizes at its current level B) When his anxiety decreases to a mild level C) When he is completely free of anxiety D) When his anxiety escalates to the panic level

B) When his anxiety decreases to a mild level

4. A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells the nurse that he or she has been constipated. Which instruction would the nurse give the patient? A) You need to eat more high-protein foods such as meat and peanut butter. B) You need to eat more fruits and vegetables and drink more water. C) Ask your psychiatrist to prescribe a stool softener for you. D) This side effect should disappear within a week or so.

B) You need to eat more fruits and vegetables and drink more water.

8. A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be seeing on an outpatient basis. Which response by the nurse would be most appropriate? A) Sure, we'll have that information sent out in today's mail. B) You will need to sign written authorization for us before we can do this. C) I think it would just be best if you just told your psychologist everything he needs to know. D) How are you feeling about being discharged this afternoon?

B) You will need to sign written authorization for us before we can do this.

3. A nurse is working as part of an interdisciplinary treatment team caring for patients with psychiatric disorders. Based on the nurse's understanding of cognitive behavioral therapy (CBT) and its limitations cited by critics, the nurse would identify which patient as an inappropriate candidate for CBT? A) A client diagnosed with substance abuse B) A client diagnosed with depression C) A client diagnosed with schizophrenia D) A client diagnosed with an eating disorder

C) A client diagnosed with schizophrenia

7. A nurse is providing in-home mental health care and determines that the care was effective when the patient demonstrated which of the following? A) A need for continued intensive monitoring in the home B) A need for crisis intervention services on an ongoing basis C) A decrease in admission frequency to inpatient psychiatric hospitals D) A dependence on parents to participate in the patient's care

C) A decrease in admission frequency to inpatient psychiatric hospitals

8. A group of students are reviewing the multiaxial diagnostic system of the DSM-IV-TR. The students demonstrate understanding of the axes when they identify that each axis represents which of the following? A) An evidence-based research finding B) An experimental design to guide care C) A domain of information D) A laboratory test finding

C) A domain of information

3. A patient has threatened to kill his wife, and it is not anticipated that this crisis will resolve itself. The patient is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which of the following as the focus of care? A) Long-term therapy B) Rehabilitative services C) Acute symptom stabilization D) 24-hour supervision

C) Acute symptom stabilization

9. A group of nursing students is reviewing the history of the development of cognitive therapies over the years. The students demonstrate understanding of the information when they identify which individual as being responsible for first developing cognitive therapy interventions? A) Aaron Beck B) Sigmund Freud C) Albert Ellis D) de Shazer and Berg

C) Albert Ellis

13. After teaching a group of students about mental health and mental illness, the instructor determines that the teaching was successful when the group identifies which of the following as reflecting mental disorders? A) Capacity to interact with others B) Ability to deal with ordinary stress C) Alteration in mood or thinking D) Lack of impaired functioning

C) Alteration in mood or thinking

12. A nurse who is working as part of an interdisciplinary team is looking at potential outpatient services for a patient. The patient requires a setting that provides a program of about 4 hours per day, three times per week with a 24-hour crisis and consultation service. The nurse would identify which of the following as appropriate? A) Primary care setting B) Ambulatory level one C) Ambulatory level two D) Multimodal outpatient setting

C) Ambulatory level two

11. When working within the continuum of care, which of the following occurs first? A) Referral B) Transfer C) Assessment D) Discharge planning

C) Assessment

16. During an interview, a patient states, God does not exist for me. The nurse interprets this statement as reflecting which of the following? A) Animism B) Agnosticism C) Atheism D) Polytheism

C) Atheism

5. A 25-year-old woman who recently had abdominal surgery was admitted to the psychiatric unit, where it was determined that she had a borderline personality disorder. During the first week on the unit, it was determined that she also has diabetes. Her diabetes mellitus would be listed in which axis of her DSM-IV-TR diagnosis? A) Axis I B) Axis II C) Axis III D) Axis IV

C) Axis III

5. The nurse is caring for a 70-year-old psychiatric patient who has been prescribed a number of medications. When teaching the patient about the medications, which explanation would be most appropriate? A) Your stomach empties more quickly as you age; therefore, you may feel the effect of your medications almost immediately. B) Your entire GI system speeds up, so your medications are digested much more quickly. Therefore, it is important that you not drive after you take your medications. C) Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic. D) Because of age-related circulation changes, your body will be able to deliver therapeutic doses of your medication to select body sites more quickly.

C) Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic.

17. After reviewing the major beliefs of Hinduism, a nursing student identifies the following castes. The student demonstrates understanding by identifying which of the following as the highest caste? A) Kshatriyas B) Vaisyas C) Brahmans D) Untouchables

C) Brahmans

15. When describing the major concepts of Jean Watson's theory to a group of nursing students, which ofthe following would the nurse expect to include? Select all that apply. A) Freedom B) Paradox C) Carative factors D) Rhythmicity E) Caritas field F) Mystery

C) Carative factors E) Caritas field

4. A student does poorly on the first class exam of the semester. Although there are three more tests plus a final exam that will be given during the rest of the semester, the student believes that he will fail the course because of doing so poorly on the one exam. The student's belief reflects which type of irrational belief? A) Low frustration tolerance B) Absolute thinking C) Catastrophizing D) A demand

C) Catastrophizing

1. A nurse has engaged in self-awareness and has come to understand his own personal beliefs and attitudes and has recognized some prejudicial ideas. Based on this understanding, which of the following would the nurse now be able to accomplish? A) Have a therapeutic relationship with a patient. B) Influence patients with certain biases. C) Change learned behaviors. D) Formulate values and morals.

C) Change learned behaviors.

10. Within the context of the culture of poverty, which of the following most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral? A) Unemployment causes poverty; a lack of willpower and motivation can, in turn, cause unemployment in people who do not have a strong work ethic. B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications. C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty. D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty.

C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty.

19. The nurse is reviewing the medical record of a patient and notes the information below. Which of the following would be found on Axis III? Select all that apply. A) Cocaine dependence B) Bipolar I disorder C) Chronic obstructive pulmonary disorder D) Cellulitis E) Homelessness F) Arrest for cocaine possession with intent to sell

C) Chronic obstructive pulmonary disorder D) Cellulitis

1. A group of nursing students are reviewing information about the evolution of mental health care and are discussing the recommendations of the final report of the Joint Commission on Mental Illness and Health. The students demonstrate understanding of this information when they identify that the report recommended an increase in which of the following? A) Numbers of mental health hospitals B) State funding for mental health care C) Clinics supplemented by general hospital units D) Use of psychotherapy by psychiatrists

C) Clinics supplemented by general hospital units

14. A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) Mental disorders are defined by an underlying biological pathology. B) Numerous laboratory tests are used to aid in the diagnosis of mental disorders. C) Cluster of behaviors, thoughts, and feelings characterize mental disorders. D) Manifestations of mental disorders are within normal, expected parameters.

C) Cluster of behaviors, thoughts, and feelings characterize mental disorders.

14. A group of nursing students is reviewing information about emotional responses to stress and the themes associated with them. The students demonstrate understanding of the information when they identify which emotion as associated with being moved by another's suffering and wanting to help? A) Relief B) Hope C) Compassion D) Love

C) Compassion

9. A nurse is leading a group on an adolescent psychiatric unit. A new member in the group is from out of state; his accent and his way of dressing set him apart from the other patients; and it is obvious that the group, for the most part, dislikes this patient. During the group session, the nurse has the members draw the emotion they are feeling and then has them present their drawings and explain them to the group. Which of the following would be the most effective way to address the group's dislike for the new member? A) Skip him when it is his turn to present his drawing. B) Let the patient talk last so the others will not have time to make fun of him. C) Compliment the patient when he presents his drawing. D) Demand that each member of the group tell the patient why they dislike him.

C) Compliment the patient when he presents his drawing.

12. While working with an older male patient, the nurse begins to think that the patient reminds the nurse of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following? A) Empathy B) Transference C) Countertransference D) Modeling

C) Countertransference

8. A patient was brought to the emergency department for an injury he received while working as a migrant worker. It soon becomes evident that the patient cannot speak English. A nurse on duty offers to find an interpreter so the patient can communicate with the medical staff. The nurse's offer is an example of which type of nursing intervention? A) Milieu therapy B) Conflict resolution C) Cultural brokering D) Structured interaction

C) Cultural brokering

17. The nurse is assessing a young adult and determines that the individual has achieved successful resolution of the previous stage of growth and development, evidenced by demonstrating which of the following? A) Drive and hope B) Direction and purpose C) Devotion and fidelity D) Production and care

C) Devotion and fidelity

23. Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate? A) Disturbed thought processes B) Risk for self-directed violence C) Disturbed sensory perception D) Ineffective coping

C) Disturbed sensory perception

10. The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. The patient is smacking her lips and blinking her eyes rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate? A) Ask if the patient has been experiencing side effects. B) Contact the patient's physician for a different medication order. C) Document the patient's symptoms of tardive dyskinesia. D) Instruct the patient to begin tapering off the medication.

C) Document the patient's symptoms of tardive dyskinesia.

16. A nurse is assisting a patient in using simple relaxation techniques. Which of the following would the nurse do first? A) Have the patient assume a relaxed position. B) Advise the patient to let the sensations happen. C) Ensure a quiet, nondisrupting environment. D) Instruct the patient to take an initial slow, deep breath.

C) Ensure a quiet, nondisrupting environment.

16. A group of students are reviewing information about mental health care after World War II. The students demonstrate understanding of this information when they identify which of the following as a result of the National Mental Health Act? A) Discovery of psychopharmacology B) Passage of the Hill-Burton Act C) Establishment of the National Institute of Mental Health D) Development of community mental health centers

C) Establishment of the National Institute of Mental Health

4. A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The student's decision reflects which ethical principle? A) Autonomy B) Beneficence C) Fidelity D) Veracity

C) Fidelity

11. A nursing instructor is integrating Piaget's theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in which stage? A) Concrete operations B) Preoperational C) Formal operations D) Sensorimotor

C) Formal operations

20. The nurse is assessing a patient's immediate and short-term memory. Which of the following would be most appropriate? A) Questioning the patient about an event that has occurred within the past several months B) Giving the patient a simple scenario and having him identify what would be the best response C) Giving the patient three words and asking him to recite them now and then in 5 minutes D) Asking the patient to tell the nurse the date, time, and current location

C) Giving the patient three words and asking him to recite them now and then in 5 minutes

17. A group of nursing students are reviewing information about counseling interventions. The students demonstrate a need for additional review when they identify counseling interventions as involving which of the following? A) Specific, time-limited intervention B) Focus on coping improvement C) Goal of regaining functional abilities D) Prevention of disability

C) Goal of regaining functional abilities

22. The nurse is reviewing the medical records of several patients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a patient at greater risk for tardive dyskinesia? A) Male gender B) Age 30 to 45 years C) History of depression D) Short duration of treatment

C) History of depression

7. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murray's latest laboratory work and psychological testing results so Mr. Murray's medical records in employee health can be kept up to date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? A) I'm sorry; we're not allowed to give out that information about our patient. B) I'll have to get the patient's signed consent before we can send that information to you. C) I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit. D) Sure, give me your address, and I will see that the information is sent to you.

C) I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit.

1. The nurse is assessing a 35-year-old woman who is seeking assistance at a local community counseling center. Which of the following statements made by the woman would indicate that she is experiencing a crisis? A) I'm so upset; my husband has never left me like this before. B) I'm confused and hurt; I have lost my best friend and my lover. C) I don't understand; I can't seem to function like I usually do. D) No matter what I do, I am still overcome by these sad feelings.

C) I don't understand; I can't seem to function like I usually do.

6. A psychiatric mental health nurse is working with a patient who is being treated for depression. Which patient statement would indicate that her spirituality is intact? A) My church friends came to visit me this past Sunday afternoon. B) Nothing will ever be the same again; my life is not worth living. C) I know I am as well off as I can be under the circumstances. D) I know God must be punishing me for all my sins.

C) I know I am as well off as I can be under the circumstances.

7. A patient has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as the worst thing that has ever happened to me, and she stated, "There is absolutely nothing I can do to pass this course now. In response to the nurse's questions, the nurse finds out there are three more equally weighted exams scheduled for the course in question. The nurse and patient collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the patient would the nurse identify as providing support for this decision? A) You've got to figure out something for me to do to get me out of this situation! B) This is a waste of time because absolutely nothing you or I can do will make it any better. C) I overreacted; surely together we can figure out something for me to do. D) This is the worst thing that could ever happen to me. I'm nothing but a failure.

C) I overreacted; surely together we can figure out something for me to do.

13. A patient is being treated in an interdisciplinary clinic. During interactions with a patient who is receiving cognitive behavior therapy, which of the following would the nurse concentrate on first? A) Identifying alternative explanations of an event B) Exploring evidence to support or refute the beliefs C) Identifying the underlying beliefs D) Examining the real implications if the beliefs are true

C) Identifying the underlying beliefs

10. A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which of the following would the nurse include as the main focus? A) Cost savings B) Consistent third-party reimbursement C) Improved access to less costly services D) Individualized care for additional inpatient stays

C) Improved access to less costly services

16. A nurse had developed a plan of care for a patient with depression. Which nursing diagnosis would reflect the social domain? A) Imbalanced Nutrition, Less Than Body Requirements related to lack of appetite. B) Powerlessness related to feelings of lack of control over the situation. C) Ineffective Role Performance related to inability to participate as family provider D) Risk for Suicide related to depressed mood and feelings of oneself as a failure

C) Ineffective Role Performance related to inability to participate as family provider

2. While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets this behavior as reflecting which group role? A) Coordinator B) Recorder C) Information seeker D) Standard setter

C) Information seeker

5. A patient who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The patient continues to need routine psychiatric services. The nurse anticipates that this patient will most likely be referred to which of the following? A) Partial hospitalization program B) In-home mental health care C) Intensive outpatient program D) Crisis center in the community

C) Intensive outpatient program

5. A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, Should I break up with my partner? Which response by the nurse would be most effective in building rapport between the patient and nurse? A) Of course you should; being a lesbian is just not natural. B) Yes, I think you should pursue building a relationship with a man. C) It sounds like you're beginning to be uncomfortable in this relationship. D) You need to focus on yourself rather than the relationship right now.

C) It sounds like you're beginning to be uncomfortable in this relationship.

35. A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? A) Keep a record of how often and how long you experience the side effect of dry mouth. B) Monitor your urinary output and notify your doctor if your urine changes color. C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. D) If you experience any drowsiness, discontinue taking this medication.

C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor.

7. A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address? A) Public stigma B) Self-stigma C) Label avoidance D) Negative life events

C) Label avoidance

19. A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority? A) Improving the quality of life B) Instilling hope C) Managing psychosis D) Preventing relapse

C) Managing psychosis

16. A psychiatric mental health patient has an advance care directive on his medical record. A clinician provides treatment that disregards the patient's directive. The clinician would be liable for which of the following? A) Assault B) Battery C) Medical battery D) False imprisonment

C) Medical battery

17. The plan of care for a patient with schizophrenia identifies the following outcomes. Which of the following would the nurse identify as addressing the biologic domain? Select all that apply. A) Improving problem-solving skills B) Promoting economic stability C) Minimizing adverse effects of drug therapy D) Improving nutritional status E) Providing family education

C) Minimizing adverse effects of drug therapy D) Improving nutritional status

3. A 62-year-old man experienced the loss of his 87-year-old father a week ago. The hospice nurse is making a follow-up visit to determine how he is handling his father's death. Which of the following statements made indicates to the hospice nurse that patient is in the acute mourning stage of bereavement? A) I keep thinking about my father; I have trouble believing he's dead. I feel guilty because I didn't go to the nursing home to visit him last week! B) I've been grieving my father; losing him is a tremendous loss, but I have to get on with my life. C) My father was a saint. I am so angry at God for taking him away! I'm crying all the time; I haven't been able to work for days. D) I'm going to spend the weekend with my children; they understand what I've been going through, and I can relax around them.

C) My father was a saint. I am so angry at God for taking him away! I'm crying all the time; I haven't

1. A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when he's in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the response? A) The extrapyramidal motor system B) The amygdala C) Neuroplasticity D) Psychoneuroimmunology

C) Neuroplasticity

12. A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the students identify which of the following as a site of action? A) Receptor B) Ion channels C) Neurotransmitters D) Enzymes

C) Neurotransmitters

11. A nurse is preparing an in-service program for a group of psychiatric mental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? A) Lack of family support B) Accessibility to community resources C) Non-adherence to prescribed medications D) Stigmatization of mental illness

C) Non-adherence to prescribed medications

8. The nurse is in the orientation phase of the nurse patient relationship with a patient diagnosed with a mental disorder. When interviewing the patient during this first encounter, which information would be most important for the nurse to obtain about the patient? A) Known allergies B) Recent hospitalizations C) Perception of the problem D) Family history

C) Perception of the problem

12. While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion? A) Grandiose B) Nihilistic C) Persecutory D) Somatic

C) Persecutory

11. A nurse is working as part of a team involved with the testing of a new psychiatric medication. The drug is currently being used in multiple clinical trials at various different sites. The nurse is engaged in which phase of testing? A) Phase I B) Phase II C) Phase III D) Phase IV

C) Phase III

19. A nurse is working with a patient who is in crisis. Which of the following would be least appropriate for the nurse to do? A) Support the patient's cultural beliefs about expressing feelings. B) Encourage the patient to focus on one aspect at a time. C) Provide the patient with an understanding that everything will be okay. D) Explain information clearly to clarify any misconceptions or myths.

C) Provide the patient with an understanding that everything will be okay.

7. A patient has been placed in an anger management group because he has trouble controlling his angry outbursts. The nurse interprets this type group as an example of which of the following? A) Psychotherapy B) Self-help C) Psychoeducation D) Supportive therapy

C) Psychoeducation

6. A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following as an advanced practice level function? A) Milieu therapy B) Promotion of self-care C) Psychopharmacology interventions D) Health promotion activities

C) Psychopharmacology interventions

16. After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent? A) Fluphenazine (Prolixin) B) Thiothixene (Navane) C) Quetiapine (Seroquel) D) Chlorpromazine (Thorazine)

C) Quetiapine (Seroquel)

2. A nurse is assessing a patient and the patient's social networks. When evaluating this area, the nurse integrates knowledge that which of the following is an important component? A) Blood relationships B) Bonding with one another C) Reciprocity D) Emotional support

C) Reciprocity

14. A psychiatric mental health nurse is asked to be a guest speaker at a community fund-raising event for mental health services. Which of the following would the nurse emphasize as the primary goal of mental health services? A) Access to affordable mental health care B) Removal of exclusions because of preexisting conditions C) Recovery from mental illness D) Effective treatment for mental health care needs

C) Recovery from mental illness

2. While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following? A) Autistic thinking B) Concrete thinking C) Referential thinking D) Illusional thinking

C) Referential thinking

13. A psychiatric mental health nurse is providing care to patients with a mental illness and is investigating factors related to the patient safety, delivery of care services, and cost effectiveness. The nurse is involved with which area of professional performance? A) Education B) Quality of practice C) Resource utilization D) Collaboration

C) Resource utilization

14. The parents of a young adult diagnosed with schizophrenia are providing care for the patient in their home. During a home visit, the parents state, It's been so difficult taking care of our son. We need a break. But he needs constant supervision. Which of the following would be appropriate for the nurse to suggest? A) Partial hospitalization B) Acute inpatient care C) Respite residential care D) Intensive outpatient program

C) Respite residential care

15. A nurse is involved in gathering information about the inheritance of mental disorders using population genetics. Which of the following would the nurse be least likely to be evaluating? A) Concordance rates B) Occurrence in first-degree relatives C) Risk factor analysis D) Adoptions studies

C) Risk factor analysis

4. After assessing a patient, the nurse noted the following: he was tearful, he tried to kill himself before coming into the hospital, he had no immediate plan for another suicide attempt, he was unable to concentrate, and he reported having trouble sleeping and having little or no appetite. The nurse also noted that the patient's appearance was unkempt, that he spoke in a low monotone, and that he was unable to establish and maintain eye contact. Based on this information, which nursing diagnoses would be the most appropriate? A) Ineffective Role Performance B) Risk for Infection C) Risk for Suicide D) Risk for Self-Mutilation

C) Risk for Suicide

17. During a therapy session, a patient is asked to rate the intensity of his current issue from 1 to 10 with 1 being complete absence of the issue and 10 being the most intense. The patient is being asked which type of question? A) Relationship B) Miracle C) Scaling D) Exception

C) Scaling

13. A nursing instructor is describing the nurse patient relationship to a group of nursing students. Which of the following would the instructor emphasize as crucial for establishing and maintaining the relationship? A) Rapport B) Empathy C) Self-awareness D) Values

C) Self-awareness

18. A patient is brought to the emergency department by her brother, who reports that the patient became very agitated and started hallucinating. Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The brother states that the patient is taking paroxetine for depression. Which of the following would the nurse most likely suspect? A) Neuroleptic malignant syndrome B) Acute dystonic reaction C) Serotonin syndrome D) Hypothyroidism

C) Serotonin syndrome

1. The nurse is preparing to form a group in an inpatient psychiatric setting for patients who have experienced trauma. In addition to the group leader, the nurse would anticipate including how many patients? A) Three or four B) Five or six C) Seven or eight D) Nine or 10

C) Seven or eight

42. A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate understanding of this information when they identify which disorder as involving an inducer? A) Brief psychotic disorder B) Schizophreniform disorder C) Shared psychotic disorder D) Psychotic disorder attributable to a substance

C) Shared psychotic disorder

21. Which of the following would be most important for the nurse to keep in mind when establishing the nurse patient relationship with a client with schizophrenia to promote recovery? A) The relationship typically develops over a short period of time. B) Decisions about care are the responsibility of interdisciplinary team. C) Short, time-limited interactions are best for the client experiencing psychosis. D) Typically, clients with schizophrenia readily engage in a therapeutic relationship.

C) Short, time-limited interactions are best for the client experiencing psychosis.

17. When communicating with a patient, which of the following would the nurse use to convey positive body language? A) Sitting erect with back against the chair B) Crossing the arms over the chest C) Sitting at the patient's eye level D) Keeping the feet flat on the floor with the legs crossed

C) Sitting at the patient's eye level

38. While interviewing a client diagnosed with a delusional disorder, the client states, I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong. The nurse interprets the client's statement as reflecting which type of delusion? A) Erotomanic B) Grandiose C) Somatic D) Jealous

C) Somatic

4. A psychiatric mental health nurse is providing care to a patient who has recently emigrated to the United States from Eastern Europe. Which of the following would be least effective in providing culturally competent care? A) Demonstrating a genuine interest in the patient B) Avoiding assumptions about the patient's culture C) Speaking to the patient in his native language. D) Acquiring information about the patient's country.

C) Speaking to the patient in his native language.

3. The nurse is doing an assessment interview of a patient. During the interview, the patient comments, Our people are connected with nature. Our world, our seasons, and our weather they all have many lessons to teach us. The nurse interprets the patient's statement as an expression of which of the following? A) Religiousness B) Tribal law C) Spirituality D) Ecological values

C) Spirituality

12. A group of nursing students are reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify which of the following as an example? A) American Hospital Association B) American Public Health Association C) State mental health provider D) The Joint Commission

C) State mental health provider

24. After teaching a patient who is receiving phenelzine, the nurse determines that the teaching was successful when the patient states the need to avoid which of the following? A) Fresh cottage cheese B) Cooked sliced ham C) Tap beers D) Soy milk

C) Tap beers

6. The nurse is caring for a group of patients in a partial hospitalization program. The nurse would most likely be involved in which of the following activities? A) Facilitating a drug abuse prevention group B) Providing spiritual assessment and related interventions C) Teaching patients how to plan a menu and to shop for groceries D) Providing an educational group about the nutritional content of canned foods

C) Teaching patients how to plan a menu and to shop for groceries

17. A nurse is explaining recovery to the family of a patient diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this process? A) It is a step-by-step process from being ill to being well. B) The patient focuses mainly on the emotional aspects of his condition. C) The patient is helped to live a meaningful life to his fullest potential. D) Although peer support is important, the self-acceptance is essential.

C) The patient is helped to live a meaningful life to his fullest potential

16. As part of an interdisciplinary team, a nurse is assisting with a patient assessment to determine the most appropriate setting for treatment. The team decides that an acute ambulatory setting would be most appropriate. Which of the following would support the team's decision? A) The patient exhibits moderate to severe symptoms. B) The patient demonstrates marked impairment in two areas of daily life C) The patient is unable to contract for treatment beyond initial care. D) The patient demonstrates a limited ability to seek support.

C) The patient is unable to contract for treatment beyond initial care.

6. An instructor is preparing a class discussion on the various theoretical models used in psychiatric mental health nursing. When describing cognitive theories, which statement would the instructor include? A) The theories attempt to explain the mental processes development and effects on behavior. B) The theories attempt to describe how people learn and act. C) The theories attempt to link internal thought processes with behavior. D) The theories attempt to explain normal human growth and development.

C) The theories attempt to link internal thought processes with behavior.

4. A nursing student is presenting a discussion of the history of psychiatric mental health nursing and its place within nursing history. Which of the following would be most appropriate to include? A) Certification for the psychiatric mental health nursing specialty was first emphasized by Mary Adelaide Nutting. B) Psychiatric nurses played a part in seeing that all deinstitutionalized patients got treatment at community mental health centers. C) There is a historical link between the first nursing program to admit male students and the first training school for psychiatric nursing. D) The first graduate program in psychiatric nurses was established in response to the publication of psychiatric nursing specialty journals.

C) There is a historical link between the first nursing program to admit male students and the first training school for psychiatric nursing.

14. A patient receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate? A) These symptoms are not real; the medication makes your brain think they are real. B) You have developed an allergy to the medication, so we need to change it. C) These are the results of the drug that can be treated; your illness is not getting worse. D) The sunlight together with the medication has caused these symptoms; just stay indoors.

C) These are the results of the drug that can be treated; your illness is not getting worse.

2. A patient is being admitted to the psychiatric unit. While explaining his reason for seeking admission, he describes how his 32-year-old son recently died of a heart attack. Which response by the nurse would enhance the effectiveness of this interview? A) How is your wife handling your son's death? B) Do you have any other living children that can help you cope with this loss? C) This must be a very difficult time for you. D) I know exactly how you're feeling; my 23-year-old son died unexpectedly last year.

C) This must be a very difficult time for you.

31. The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client's level of anxiety and reactions to stressful situations, obtaining this information for which reason? A) To help determine the client's outcomes after treatment B) To help identify whether or not the client's mental competency is intact C) To act as a predictor of the client's risk for a suicide attempt D) To provide a basis for evaluating the client's social skills

C) To act as a predictor of the client's risk for a suicide attempt

18. The nurse is providing follow up care to victims of a disaster that occurred several months ago. Assessment of which of the following would lead the nurse to suspect that the victims are experiencing possible aftereffects of the disaster? A) Tachycardia B) Profuse perspiration C) Unexplained gastrointestinal disturbance D) Tremors

C) Unexplained gastrointestinal disturbance

12. A nurse is preparing to reinforce the use of cognitive behavior therapy with a patient. When interacting with the patient, which of the following would be appropriate? A) Having the nurse establish the agenda B) Focusing primarily on behavior C) Using a future-oriented goal focus D) Identifying the problem from the nurse's perspective

C) Using a future-oriented goal focus

10. A nurse is faced with an ethical dilemma involving a patient. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision making? A) What are my own feelings about the situation? B) What assumptions am I making that need more data? C) What do I know about the situation? D) What do I know about the patient's values?

C) What do I know about the situation?

12. While providing care to a patient with a mental disorder, the patient asks the nurse, Does mental illness run in your family? Which response by the nurse would be most inappropriate? A) Mental illnesses do run in families, and I've had a lot of experience caring for people with mental illness. B) It sounds like you are concerned that there may be a family connection to your current problem? C) Yes, it does. I have a sister who was diagnosed several years ago with severe major depression. D) Mental illness can be family related. Let's focus the discussion on you and how you're doing today.

C) Yes, it does. I have a sister who was diagnosed several years ago with severe major depression.

17. When assessing a client for possible disordered water balance, the nurse checks the client's urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance? A) 1.020 B) 1.011 C) 1.005 D) 1.002

D) 1.002

11. A nurse is assessing a patient and uses the Recent Life Changes Questionnaire as part of the assessment. The nurse determines that the patient has experienced major life crisis with which score on the questionnaire? A) 150 B) 250 C) 350 D) 450

D) 450

16. A nurse administers a prescribed dose of lithium at 8 PM. The nurse would schedule a specimen to be obtained for a blood level at which time? A) 10 PM B) 12 AM C) 4 AM D) 8 AM

D) 8 AM

8. A nurse is reviewing the assessment findings of several patients. Which patient would the nurse identify as having a type D personality? A) A man who threatens the receptionist in the emergency department with bodily harm if a doctor does not see him right away B) A woman who sits quietly reading in a waiting room before seeing her doctor for her annual physical examination C) A quiet teen who drinks a six pack of beer against his better judgment because of peer pressure D) A man who reacts negatively to almost everything but never discusses his feelings with anyone

D) A man who reacts negatively to almost everything but never discusses his feelings with anyone

12. During assessment, the nurse asks a patient to explain what the following means: A penny saved is a penny earned. The nurse is assessing which of the following? A) Affect B) Attention C) Concentration D) Abstract reasoning

D) Abstract reasoning

14. A group of students are reviewing information about neurotransmitter subtypes. The group demonstrates understanding of the information when they identify which neurotransmitter as having muscarinic and nicotinic receptors? A) Serotonin B) Gamma-aminobutyric acid (GABA) C) Dopamine D) Acetylcholine

D) Acetylcholine

8. A patient who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the patient's physician because the nurse suspects which of the following? A) Severe anemia B) Neuroleptic malignant syndrome C) Encephalitis D) Agranulocytosis

D) Agranulocytosis

9. A hospitalized patient who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he cannot sit still. The nurse documents this finding as which of the following? A) Akinesia B) Dystonia C) Pseudoparkinsonism D) Akathisia

D) Akathisia

8. A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic event. Which of the following would the nurse identify as the priority for this family? A) Arranging for follow-up therapy to deal with the crisis B) Completing a family genogram to determine family patterns C) Assessing the impact of the loss on their lifestyle D) Arranging for emergency shelter and food supplies

D) Arranging for emergency shelter and food supplies

6. During the stabilization phase of drug therapy for a patient who is hospitalized with a psychiatric disorder, which action would be most appropriate? A) Discussing the timing of tapering the medication B) Instructing the patient about relapse prevention C) Determining if the medication is losing its effect D) Assessing the patient for target symptoms and side effects

D) Assessing the patient for target symptoms and side effects

9. A 22-year-old patient with schizophrenia is refusing his antipsychotic medication. He states, I don't like the dopey way it makes me feel. I feel like I'm walking under water when I take it. The nurse explains to him, Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better. This conversation reflects a conflict between which two types of ethical principles? A) Autonomy and justice B) Paternalism and veracity C) Justice and nonmaleficence D) Autonomy and beneficence

D) Autonomy and beneficence

10. Mrs. Green is a patient on a psychiatric unit. At the time of her admission, her dog was killed when a car accidentally ran over it; in addition to that, she just found out that her mother has been diagnosed with colon cancer. This information would be addressed in which DSM-IV axis? A) Axis I B) Axis II C) Axis III D) Axis IV

D) Axis IV

3. A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the client's family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? A) Ineffective Role Performance related to symptoms of schizophrenia. B) Social Isolation related to auditory hallucinations. C) Dysfunctional Family Processes related to psychosis. D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

34. The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document? A) Disorientation B) Reduced attention span C) Above average intelligence D) Body complaints

D) Body complaints

7. A nurse is working with an adolescent girl who describes herself as a compulsive overeater and presents with a history of using food to cope with stress. The nurse decides to use journaling as an intervention for this patient based on the rationale that journaling will help the patient identify which of the following? A) How often she eats compulsively in response to stress she encounters on a daily basis B) Patterns in her daily schedule that may be contributing to her compulsive eating C) Behaviors in others that trigger her compulsion to eat in when she experiences stress D) Changes in her self-perception and responses to stress that she might otherwise not notice

D) Changes in her self-perception and responses to stress that she might otherwise not notice

30. The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? A) Lithium B) Haloperidol C) Chlorpromazine D) Clozapine

D) Clozapine

12. A group of nursing students are reviewing the standards of professional performance. The students demonstrate understanding when they identify which as a standard of professional performance? A) Prescriptive authority B) Consultation C) Planning D) Collegiality

D) Collegiality

11. A group of nursing students are reviewing information about spirituality and religiousness. The group demonstrates understanding of these concepts when they identify religiousness as which of the following? A) Feeling of connectedness B) Way of interpreting life events C) Relationship with a unifying force D) Community participation in common worship

D) Community participation in common worship

14. A group of nursing students is reviewing information about cognitive processes and the development of mental disorders. The students demonstrate a need for additional review when they identify which of the following as being involved? A) Cognitive triad B) Cognitive distortions C) Schema D) Compliments

D) Compliments

19. After teaching a group of nursing students about milieu therapy, the instructor determines that additional teaching is needed when the students identify which of the following as a key concept of milieu therapy? A) Structure interaction B) Open communication C) Validation D) De-escalation

D) De-escalation

13. A psychiatric mental health nurse is working on developing cultural competence. Which of the following would be most appropriate for the nurse to do? A) Research information about the cultures of the population being served after assessing the patients. B) Recognize that one's own culture is the predominant way of addressing a patient's health care needs. C) Assume that any individual of a racial or ethnic group is the same as another individual in that group. D) Demonstrate an appreciation of and a genuine interest in the individual and his or her cultural beliefs.

D) Demonstrate an appreciation of and a genuine interest in the individual and his or her cultural beliefs.

4. A psychiatric mental health nurse is integrating Carl Rogers' theory into the plan of care for a patient with a mental illness. The nurse incorporates understanding of this theory by acknowledging that the therapist accomplishes which of the following? A) Provide validation of the terminology used during the session. B) Focus on the client's instinctual drives. C) Recognize an understanding of the client's basic needs. D) Develop unconditional positive regard for the client.

D) Develop unconditional positive regard for the client.

8. A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? A) Weight loss B) Hypertension C) Diarrhea D) Diabetes

D) Diabetes

13. After teaching a class about competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated? A) Communication of choices B) Understanding of relevant information C) Appreciation for situation and consequences D) Discussion of what is right and wrong

D) Discussion of what is right and wrong

1. When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the nurse identify as a reason for this belief about many mental health facilities? A) Require periods of hospitalization B) Do not provide 24-hour emergency services C) Are not reimbursed by third party payers D) Do not accommodate their cultural needs

D) Do not accommodate their cultural needs

1. The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following? A) Echopraxia B) Neologisms C) Tangentiality D) Echolalia

D) Echolalia

2. The nurse is employed by a long-term residential treatment center that provides care to a variety of patients with chronic mental disorders. Which role would the nurse primarily assume when working with these patients? A) Therapist B) Medication administrator C) Mediator D) Educator

D) Educator

1. A group of nursing students are reviewing information about Freud's personality structure. The studentsdemonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of which of the following? A) Defense mechanisms B) Unconscious C) Id D) Ego

D) Ego

8. A nurse is leading a group in which members are encouraged to discuss their feelings and emotions. The group session is just starting when a patient stomps into the room, slams his notebook down on a table, and sits down. His affect is one of anger and hostility. Which response by the nurse would be most appropriate? A) Keep the focus off the patient so his anger has time to de-escalate. B) Suggest the patient make a private counseling appointment to address his anger issues. C) Ask the patient to leave the group until he is calmer. D) Encourage the patient to discuss his anger with the group.

D) Encourage the patient to discuss his anger with the group.

18. While leading a student class presentation about general adaptation syndrome and its stages, which of the following would the student describe as the final stage? A) Perception of a threat B) Use of coping mechanisms C) Physiologic response D) Exhaustion

D) Exhaustion

6. A patient has been diagnosed with memory dysfunction associated with Alzheimer's disease. The nurse determines that damage to the patient's brain includes deterioration of temporal lobe structures and the nerves of which of the following? A) Basal ganglia B) Limbic system C) Frontal lobe D) Hippocampus

D) Hippocampus

8. A psychiatric mental health nurse is teaching a class about social factors associated with mental illness at a community health center. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk? A) Older adults B) Individuals with physical disabilities C) Single-parent families D) Homeless individuals

D) Homeless individuals

18. A psychiatric mental health nurse is preparing a presentation about recovery for a group of newly hired nurses for the mental health facility. Which of the following would the nurse identify as one of the most important concepts? A) Self-direction B) Peer support C) Respect D) Hope

D) Hope

4. A 25-year-old legal secretary is seeking counseling because she recently lost her job unexpectedly. Which question would be most appropriate for the nurse to use in assessing the patient's response to losing her job? A) What happened to cause you to lose your job? B) How did you feel immediately after being told you no longer had a job? C) How do you expect yourself to be able to handle this situation? D) How have you responded to previous stressful situations?

D) How have you responded to previous stressful situations?

14. A nurse identifies a nursing diagnosis of chronic low self-esteem. Which statement by a patient would support this nursing diagnosis? A) I feel so ugly.' B) No one wants to date me. C) I'm so fat, like a cow. D) I never do anything right.

D) I never do anything right.

11. A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The student interprets this as which of the following? A) Rate B) Prevalence C) Point prevalence D) Incidence

D) Incidence

15. A nurse has completed an assessment of a patient who is experiencing significant stress. The assessment revealed intense anger and acting out behaviors along with statements of negative emotions. Which nursing diagnosis would be most appropriate? A) Disturbed though processes B) Low self-esteem C) Hopelessness D) Ineffective coping

D) Ineffective coping

12. A group of nursing students is reviewing information about open and closed groups. The students demonstrate understanding of the information when they identify which of the following as an example of an open group? A) Outpatient smoking cessation group B) Community clinic psychoeducation group C) Ambulatory psychotherapy group D) Inpatient anger management group

D) Inpatient anger management group

1. A nursing instructor is explaining the concept of the continuum of care to a group of students. Which of the following would the nurse include in this description? A) Care provided in episodic intervals B) System of care that focuses primarily on wellness C) A single organization as responsible for care delivery D) Integrated system spanning illness to wellness states

D) Integrated system spanning illness to wellness states

9. A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding? A) The exact location of genes leads to identifying the gene responsible for causing depression. B) A break in the corpus coliseum blocks information exchange between the right and left hemispheres. C) Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function. D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression.

D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression.

6. During a staff meeting, a therapist mentions planning to use bibliotherapy with a patient. Later that morning, the patient approaches the nurse and says his therapist just talked to him but that he is having trouble understanding what his therapist wants him to do. When the nurse asks him to clarify his concern, he asks what bibliotherapy really means. Which response by the nurse would be most appropriate? A) It entails listing books about your diagnosis alphabetically in a reference list in case you ever want to read about your diagnosis. B) It is a new form of coping technique associated with shopping in a bookstore that works to help lift your depression. C) It is a form of therapy based on your therapist teaching you knowledge that is crucial to your recovery that he has collected from a variety of books. D) It is a form of therapy that entails you reading books about ways of perceiving and responding to life events in a different way.

D) It is a form of therapy that entails you reading books about ways of perceiving and responding to life events in a different way.

3. A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle? A) Nonmaleficence B) Paternalism C) Veracity D) Justice

D) Justice

2. Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and expressive speech? A) Right hemisphere B) Parietal lobe C) Occipital lobe D) Left hemisphere

D) Left hemisphere

32. The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find? A) History of chronic major depression B) Consistently disrupting behavior patterns C) Verbalization of bizarre delusions D) Living with one or more delusions for a period of time

D) Living with one or more delusions for a period of time

10. A nurse is preparing a presentation about the current status of mental health services in the United States. Which statement would the nurse include as the most reflective of this status? A) Mental health care in the United States is equally accessible to individuals. B) Mental illness ranks second in terms of causing disability in comparison. C) Mental health care primarily focuses on the cure of mental illness. D) Mental health care services are inadequate and fragmented.

D) Mental health care services are inadequate and fragmented.

17. After teaching a group of students about appraisal and the stress response, the instructor determines that additional teaching is needed when the students identify which of the following as part of the primary appraisal? A) Relevance of the goal B) Consistency of goal with values C) Personal commitment D) Outcome explanation

D) Outcome explanation

9. A nursing student is assigned to care for a patient diagnosed with schizophrenia. When talking about this patient in a clinical postconference, the student would use which terminology when referring to the patient? A) Committed patient B) Schizophrenic C) Schizophrenic patient D) Person with schizophrenia

D) Person with schizophrenia

14. An instructor is preparing a class for a group of students about professional organizations and the leadership provided. Which of the following would the instructor include as an important function of the International Society of Psychiatric-Mental Health Nurses? A) Advocating for mental health nursing practice through liaison activities B) Advancing psychiatric mental health nursing practice C) Improving mental health care for culturally diverse individuals D) Providing a strong voice for psychiatric mental health nurses

D) Providing a strong voice for psychiatric mental health nurses

9. The following events are important in the development of psychiatric mental health nursing practice. Which event occurred first? A) Publication of Standards of Psychiatric-Mental Health Nursing by the ANA B) Publication of Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice C) Establishment of the first graduate program in psychiatric nursing at Rutgers University D) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey

D) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey

19. After teaching a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which of the following as a right? A) Freedom from restraints or seclusion B) Access to one's own mental health records on request C) An individualized written treatment plan D) Refuse treatment during an emergency situation

D) Refuse treatment during an emergency situation

26. A client who has a major depressive episode tells the nurse that for the past 2 weeks, he has been hearing voices and at times thinks that someone is following him. History reveals that he had these alternating symptoms before along with times when he has experienced neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following? A) Paranoid schizophrenia B) Undifferentiated schizophrenia C) Brief psychotic disorder D) Schizoaffective disorder

D) Schizoaffective disorder

19. A group of nursing students are reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder as being associated with its dysfunction? A) Depression B) Obsessive-compulsive disorder C) Panic disorder D) Schizophrenia

D) Schizophrenia

41. When obtaining a client's history, the nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in his ability to function on a daily basis at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following? A) Schizophrenia B) Schizoaffective disorder C) Brief Psychotic disorder D) Schizophreniform disorder

D) Schizophreniform disorder

7. When integrating the Neuman systems model while caring for a patient with a mood disorder, the nurse would focus on which of the following about the patient? A) Behaviors B) Relationships C) Self-care activities D) Stressors

D) Stressors

2. A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Asian Americans, Polynesians, and Pacific Islanders, the nurse would address high rates of which of the following? A) Schizophrenia B) Manic disorders C) Dementia D) Suicide

D) Suicide

7. The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? A) Weight loss B) Torticollis C) Hypoglycemia D) Tardive dyskinesia

D) Tardive dyskinesia

13. A nurse is deciding about the size of the group. The nurse determines that a large group would be best based on which of the following? A) Transference and countertransference issues will be moderate to minimal. B) Group cohesiveness will be strong with greater interpersonal experiences. C) The number of potential interactions and relationships is limited. D) The group is effective for dealing with a specific issue.

D) The group is effective for dealing with a specific issue.

10. Termination takes place during the resolution phase of a nurse patient relationship. During the termination process, a patient brings up resolved problems and presents them as new issues to work toward. The nurse interprets the patient's action as indicating which of the following? A) The patient is angry that the nurse is abandoning him. B) The patient requires additional therapy. C) The patient is unhappy that the therapy was ineffective D) The patient is attempting to prolong the nurse patient relationship.

D) The patient is attempting to prolong the nurse patient relationship.

8. A patient with a psychiatric disorder is considering joining a clubhouse with other patients who have mental disorders. The patient asks the nurse to explain what services the clubhouses provide. Which response by the nurse would be most accurate? A) They are open 24 hours a day to provide care and support for the clubhouse members. B) They are run entirely by psychiatric mental health nurses. C) Their primary focus is on providing ongoing intensive psychotherapy for patients in a group setting. D) They are predominately run by psychiatric patients with minimal assistance from mental health staff.

D) They are predominately run by psychiatric patients with minimal assistance from mental health staff.

13. A nurse is assessing the parents of a 6-year-old child who has died from leukemia. The nurse is integrating the dual process model for the assessment. Which of the following would the nurse identify as reflecting the parents loss-oriented coping? A) Engaging in new activities B) Denying the grief C) Developing new relationships D) Thinking about the lost child

D) Thinking about the lost child

7. A patient is being treated for prostate cancer; his prognosis is very poor. The patient has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for the patient? A) I'll take you to visit my church if you can get a pass. B) You have to belong to the same church I do if you're going to go to heaven. C) Would you like me to bring you a guided imagery audiotape? D) We can pray together if you'd like.

D) We can pray together if you'd like.

15. A nurse is assessing a patient's spirituality. Which question would be most appropriate to ask? A) Have you ever tried to harm yourself? B) How important is your family to you? C) How do you define good and evil? D) What gives your life meaning?

D) What gives your life meaning?

6. The nurse is leading a small group of hospitalized patients diagnosed with psychiatric disorders. One group member has asked for advice and often agrees with suggestions by other group members but then adds, Yes, but . . . to every suggestion offered. Which response by the nurse would be most appropriate? A) Things would probably work out better if you joined a different group. B) Do you realize you say, 'Yes, but . . .' to every suggestion the group has for you? C) I suggest you stop and think about why you always respond to suggestions with 'Yes, but . . .' D) What solution do you think would work best for you?

D) What solution do you think would work best for you?

4. A nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patient's confidentiality if the patient states which of the following? A) I think that the federal government is spying on me. B) I get really 'turned on' by your appearance. C) That doctor I had today really made me angry. D) When I get out of here, I'm going to kill my neighbor.

D) When I get out of here, I'm going to kill my neighbor

2. A nursing instructor is preparing a class lecture about cognitive behavioral therapy (CBT). Which of the following would the instructor use to best describe this process? A) Solving patients' problems for them by determining how they need to change their thoughts and actions and developing a plan that will help them do so. B) Using techniques to modify a patient's behavior shaping it into behavior that is appropriate in order to help the patient experience a more positive future. C) Reinforcing distorted beliefs so they can play a major part in changing a patient's behavior for the better and improving his or her quality of life. D) Working in a trusting and collaborative relationship to help patients focus on solving their own problems by changing the way they think and behave.

D) Working in a trusting and collaborative relationship to help patients focus on solving their own problems by changing the way they think and behave.

3. A patient was admitted to the hospital after a suicide attempt made after his daughter was killed in an automobile accident during which he had been driving and survived with only minor injuries. Even though the accident was unavoidable, he feels responsible. During the assessment interview, the patient begins to describe the last conversation he had with his daughter before he lost control of the automobile. As he speaks about his daughter, his voice trembles, and a silent tear rolls down his face. He makes a visible attempt to straighten up and smiles superficially at the nurse, stating, I'll get over this. I just need to keep a stiff upper lip. I think all I need to do is stay overnight. I'll be as good as new by tomorrow. Which response by the nurse would be most appropriate? A) Tell me about your daughter. How would you describe the relationship you had with her? B) I'm sure you are right; a good night's rest should make a big difference. C) As good as new? D) You made a serious attempt on your life; you will not be ready go home by tomorrow.

D) You made a serious attempt on your life; you will not be ready go home by tomorrow.

7. A patient has been prescribed clozapine for treatment of schizophrenia. Which of the following would the nurse include in the teaching plan for this patient and family? A) You may experience hypertension while taking this medication. B) One of the side effects of this medication is breast engorgement. C) People taking this medication often experience dermatitis. D) You may experience noticeable weight gain while taking this medication.

D) You may experience noticeable weight gain while taking this medication.

2. An older adult is complaining of anxiety is prescribed diazepam (Valium) by a family physician. The physician asks the office nurse to explain the problematic side effects of this medication to the patient. Which instruction would be most important for the nurse to emphasize about this drug? A) You may experience minor urine incontinence from time to time. B) You may find that you have temporary memory disturbances. C) You need to use this medication cautiously because it can cause dependence. D) You may feel dizzy and be prone to falls after taking this medication.

D) You may feel dizzy and be prone to falls after taking this medication.

9. The nurse is working as part of the interdisciplinary staff of a psychiatric inpatient facility who are developing discharge plans for a patient who requires alternative housing arrangements. The patient will be referred to a personal care home. When explaining this housing arrangement to the patient, which of the following would the nurse include? A) You'll be living with a family in their home, and the family will help supervise and support you. B) You'll be living in an apartment with a roommate, and a staff member will come by to check on you. C) You'll be living in a house with about 50 other people and receive 24-hour supervision and assistance. D) You'll be living in a house with about six to 10 other people, and a health care attendant will provide 24-hour supervision.

D) You'll be living in a house with about six to 10 other people, and a health care attendant will provide 24-hour supervision.