FSCJ Psych Evolve Practice Questions – Exam 1

The quantitative study of the distribution of mental disorders in human populations is called

A mortality.
B prevalence.
C epidemiology.
D clinical epidemiology.

Correct Answer – C

Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.

Which statement best describes the DSM-5?

A It is a medical psychiatric assessment system.
B It is a compendium of treatment modalities.
C It offers a complete list of nursing diagnoses.
D It suggests common interventions for mental disorders

Correct Answer – A

The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.

Current information suggests that the most disabling mental disorders are the result of

A biological influences.
B psychological trauma.
C learned ways of behaving.
D faulty patterns of early nurturance.

Correct Answer – A

The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.

A nurse’s identification badge includes the term, “Psychiatric Mental Health Nurse.” A client with a history of paranoia asks, “What does that title mean?” The nurse responds best by answering:

A “Don’t be afraid; it means I’m here to help, not hurt, you.”
B “Psychiatric mental health nurses care for people with mental illnesses.”
C “We have the specialized skills needed to care for those with mental illnesses.”
D “The nurses who work in mental health facilities have that title.”

Correct Answer – C

A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client’s question or assume that the question is the result of the client’s paranoia.

Which statement about diagnosis of a mental disorder is true?

A The symptoms of each disorder are common among all cultures.
B Culture may cause variations in symptoms for each clinical disorder.
C All mental disorders listed in the DSM-5 are seen in all other cultures.
D Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.

Correct Answer – B

Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five axes system was abandoned in this edition of the DSM-5.

The prevalence rate over a 12-month period for major depressive disorder is

A lower than the prevalence rate for panic disorders.
B greater than the prevalence rate for psychotic disorders.
C equal to the prevalence rate for psychotic disorders.
D greater than the prevalence rate for generalized anxiety.

Correct Answer – D

Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.

These severe mental illnesses are recognized across cultures:

A antisocial and borderline personality disorders.
B schizophrenia and bipolar disorder.
C bulimia and anorexia nervosa.
D amok and social phobia.

Correct Answer – B

Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)?

A experimental
B descriptive
C clinical
D analytic

Correct Answer – C

Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms.

A client tells the mental health nurse “I am terribly frightened! I hear whispering that someone is going to kill me.” Which criterion of mental health can the nurse assess as lacking?

A Control over behavior
B Appraisal of reality
C Effectiveness in work
D Healthy self-concept

Correct Answer – B

The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.

A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don’t understand her. The assessment data supports that the client

A is displaying deviant behavior.
B cannot accurately appraise reality.
C is seriously and persistently mentally ill.
D should be considered for group home placement.

Correct Answer – A

This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.

The nurse planning care for a mentally ill client bases interventions on the concept that the client

A has areas of strength on which to build.
B has right that must be respected.
C comes with experiences that contribute to their problem.
D share fears that are similar to those of all mentally healthy individuals.

Correct Answer – A

Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged.

In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to

A ask the client whether he views himself as being depressed.
B identify his culture’s view regarding suicide.
C explain to him that suicide is often regarded as a desperate act.
D assess the client for other examples of depressive behaviors.

Correct Answer – B

One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor, and Middle Eastern “suicide bombers” are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.

An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is

A demonstrating symptoms of bipolar disorder.
B socially deviant.
C egocentric.
D not demonstrating any definitive signs of mental illness.

Correct Answer – D

One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams “irrational” dreams at night, and “irrational” emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.

A nursing diagnosis for a client with a psychiatric disorder serves the purpose of

A justifying the use of certain psychotropic medication.
B providing data essential for insurance reimbursement.
C providing a framework for selecting appropriate interventions.
D completing the medical diagnostic statement.

Correct Answer – C

Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.

Which of the following best demonstrates parity related to mental health care?

A The client is admitted for a 72-hour mental hygiene evaluation.
B Advance practice nurse can be certified as psychiatric nurse specialist.
C A client’s mental health coverage is equal to his medical/surgical coverage.
D A client who has attempted suicide is hospitalized for a mental health evaluation.

Correct Answer – C

Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage.

he mental health status of a particular client can best be assessed by considering

A the degree of conformity of the individual to society’s norms.
B the degree to which an individual is logical and rational.
C placement on a continuum from health to illness.
D the rate of intellectual and emotional growth.

Correct Answer – C

Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as “diseases.” Visualizing these disorders along the mental health continuum is helpful.

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by:

A cultural and ethnic factors.
B occupation and status.
C birth order.
D sexual preference.

Correct Answer – A

The DSM-5 states there is evidence to suggest that mental illness is influenced by cultural and ethnic factors. The DSM-5 does not state that there is evidence that occupation, birth order, or sexual preference affect mental illness.

One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is:

A dependence.
B resilience.
C pessimism.
D altruism.

Correct Answer – B

Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as being dependent on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.

You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy?

A “Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed.”
B “Dr. Raye, during her admissions interview Kiley stated that she has had three other suicide attempts in the past.”
C “Kiley, can you tell me more about your depression and your suicide attempt?”
D “Kiley, I will take you on a tour of the unit and orient you to the rules.”

Correct Answer – A

By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy.

You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a licensed Registered Nurse. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement?
A “You will participate in unit activities and groups daily.”
B “You will be given a schedule daily of the groups we would like you to attend.”
C “You will attend a psychotherapy group that I lead.”
D “You will see your provider daily in a one-to-one session.”

Correct Answer – C

Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient’s schedule on a psychiatric unit.

A nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by:
A becoming active in politics leading to a potential political career.
B reducing the stigma of mental illness and advocating for equality in treatment.
C encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons.
D advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions.

Correct Answer – B

Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.

What statement about mental illness is true?

A Mental illness is a matter of individual nonconformity with societal norms
B Mental illness is present when individual irrational and illogical behavior occurs
C Mental illness changes with culture, time in history, political systems and the groups defining it
D Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality

Correct Answer – C

A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be:

A Nursing Interventions Classification (NIC)
B Nursing Outcomes Classification (NOC)
C NANDA-1 nursing diagnoses

Correct Answer – D

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

A Providing information about effective nursing techniques
B Identifying risk factors that contribute to the development of a disorder
C Identifying who in the general population will develop a specific disorder
D Identifying which individuals will respond favorably to a specific treatment

Correct Answer – C

Which statement best describes a major difference between DSM-5 diagnosis and a nursing diagnosis?

A There is no functional difference between the two; both serve to identify a human deviance
B The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account
C The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present and potential responses to actual mental health problems
D The DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying multidisciplinary interventions

Correct Answer – C

The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is:

A Advocacy
B Psychotherapy
C Coordination of care
D Community-based care

Correct Answer – B

The basic functional unit of the nervous system is called a

A neuron.
B synapse.
C receptor.
D neurotransmitter.

Correct Answer – A

Neurons are nerve cells. Cells are the basic unit of function. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron’s surface.

Treatment of mental illnesses with psychotropic drugs is directed at

A altering brain neurochemistry.
B correcting brain anatomical defects.
C regulating social behaviors.
D activating the body’s normal response to stress.

Correct Answer – A

Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.

Which of the following is classified as a circadian rhythm?

A Sex drive
B Sleep cycle
C Skeletal muscle contraction
D Maintenance of a focused stream of consciousness

Correct Answer – B

Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.

The incoherent thought and speech patterns of the client with schizophrenia are related to the brain’s inability to
A regulate conscious mental activity.
B retain and recall past experience.
C regulate social behavior.
D maintain homeostasis.

Correct Answer – A

When the brain cannot regulate conscious mental activity, the individual’s speech patterns demonstrate incoherence and lack of reality orientation.

Homeostasis is promoted by interaction between the brain and internal organs mediated by

A conscious behavior.
B the autonomic nervous system.
C the sympathetic nervous system.
D the parasympathetic nervous system.

Correct Answer – B

The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.

Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called
A neurons.
B synapses.
C dendrites.
D receptors.

Correct Answer – A

Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.

Which imaging technique can provide information about brain function?

A Computed tomography (CT) scan
B Positron emission tomography (PET) scan
C Magnetic resonance imaging (MRI) scan
D Skull radiograph

Correct Answer – B

The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate

A disequilibrium.
B abnormal eye movement.
C impaired social judgment.
D blood pressure irregularities.

Correct Answer – A

The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance.

Which organs secrete hormones that are a normal component of the body’s general response to stress?

A Brain, thyroid gland, pancreas
B Brain, pituitary gland, adrenal glands
C Pituitary gland, pancreas, thyroid gland
D Adrenal glands, parathyroid glands

Correct Answer – B

The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The three hormones secreted—corticotropin-releasing hormone, corticotropin, and cortisol—influence the function of nerve cells of the brain.

The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates laws and lies demonstrates problems related to the brain’s inability to

A regulate conscious mental activity.
B retain and recall past experience.
C regulate social behavior.
D maintain homeostasis.

Correct Answer – C

The inability to regulate social behavior usually results in antisocial behaviors such as lying, cheating, taking advantage of others, and breaking laws.

A client being medicated for both hallucinations and delusions reports being drowsy. The nurse will correctly interpret this symptom as related to the drug’s effect on the brain’s ability to regulate

A mood.
B thought.
C memory.
D sleep.

Correct Answer – D

A number of psychotropic drugs have side effects that interfere with the brain’s ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the client’s body becomes accustomed to the drug, the drowsiness should dissipate.

A client’s communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms?

A Cerebrum
B Cerebellum
C Brainstem
D Basal ganglia

Correct Answer – A

The ability to think and speak logically is controlled by the cerebrum.

On the basis of the current understanding of neurotransmitters, the nurse can view a client’s symptoms of profound depression as likely related in part to

A increased dopamine level.
B decreased serotonin level.
C increased norepinephrine level.
D decreased acetylcholine level

Correct Answer – B

A lowered serotonin level is highly supported as being related to depression; however, depression is more probably influenced by a number of neurotransmitter abnormalities.

A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as “someone with Alzheimer’s.” The nurse offers the following advice:

A “Try talking to him early in the day to get the best results. Fatigue disorganizes his thinking.”
B “Schizophrenia and Alzheimer’s disease both cause irreversible brain damage, so keep your conversations short when you talk to a client with either disorder.”
C “His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support.”
D “Make sure he eats the comfort foods he is served because they increase serotonin production and will help normalize his thoughts and speech.”

Correct Answer – C

This response will help the nursing assistant understand that improvement can be expected in the client’s condition and that this improvement can be maximized by therapeutic interactions with staff. It establishes the expectation that the nursing assistant will interact in a therapeutic manner.

The nurse caring for a client taking risperidone (Risperidal) observes the client carefully for

A napping during the day, a weight gain, and reports of dizziness.
B reports of falls, heartburn, and nausea.
C a rapid heartbeat, red rash, and hives.
D dry mouth, poor urinary output, and constipation.

Correct Answer – A

H1 blockade has the potential to produce sedation, weight gain, and hypotension.

The nurse caring for a client prescribed an antipsychotic medication that produces anticholinergic side effects will assess for

A sedation, drowsiness, hypotension, and weight gain.
B orthostatic hypotension and memory dysfunction.
C blurred vision, dry mouth, and constipation.
D tremors, tachycardia, and ejaculatory dysfunction.

Correct Answer – C

Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention.

The nurse responsible for the care of a client prescribed clonazepam (Klonopin) would evaluate treatment as being successful when the client demonstrates

A less anxiety.
B normal appetite.
C improved sleep pattern.
D reduced auditory hallucinations.

Correct Answer – A

γ-Aminobutyric acid is thought to modulate neuronal excitability and anxiety. A drug that increases the effectiveness of γ-aminobutyric acid would result in anxiety reduction.

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing

A laughing at a joke
B exercising a sore shoulder.
C writing down his telephone number.
D going to his room to “calm down.”

Correct Answer – A

Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation.

The physician tells a client suspected of experiencing obessive-complusive disorder that “We want to do an imaging study that will tell us which parts of your brain are particularly active.” From this explanation, the nurse can determine that the physician will order a(n)

A computed tomography scan.
B positron emission tomography scan.
C ventriculogram.
D electroencephalogram.

Correct Answer – B

A positron emission tomography scan detects brain activity. The other imaging studies are limited to visualization of structures.

A client is admitted to the hospital experiencing severe depression. The nurse recognizes the possibility that depression may be related to a stress-induced hormonal imbalance associated with

A luteinizing hormone.
B cortisol.
C gronadotropin.
D clomipramine.

Correct Answer – B

Cortisol is a hormone released during periods of stress.

You are caring for Vanessa, a 38-year-old patient with major depression. She has just met with her provider. She states to you, “my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?” Your best response is:

A “Neurotransmitters are chemical messengers in the brain that help regulate specific functions.”
B “Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood.”
C “Neurotransmitters are the reason you are depressed.”
D “I will ask your provider to give you a more in-depth explanation.”

Correct Answer – A

Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.

Vanessa’s provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?

A dopamine
C serotonin/norepinephrine
D Acetylcholine

Correct Answer – C

Antidepressant medication targets serotonin and norepinephrine. Dopamine is implicated in schizophrenia (increase) and Parkinson’s disease (decrease). GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer’s disease as well as Huntington’s disease and Parkinson’s disease.

The term pharmacodynamics refers to the effect of the drug on the body, while pharmacokinetics refers to:
A the effect of the drug specifically on the brain and movement.
B the effect of the person on the drug
C the effect of the drug on children and adolescents.
D the effect of the drug on the half-life and ability of the liver to excrete.

Correct Answer – B

Pharmacokinetics refers to the effect of the person on the drug and helps to guide dosing. The other options are incorrect.

Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?

A Janelle, who is taking Prozac
B Travis, who is taking Depakote
C Shelly, who is taking lithium
D Anna, who is taking Risperdal

Correct Answer – C

Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use do not cause hypothyroidism.

Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone (Risperdal). Which of the following nursing assessments is the priority assessment with Julie?

A Monitoring blood levels to avoid toxicity
B Monitoring for abnormal involuntary movements
C Observing for secondary mania
D Observing for memory changes

Correct Answer – B

Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.

A nurse administering a benzodiazepine should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter:

B Dopamine
C Serotonin
D Acetylcholine
E A & C

Correct Answer – A

Venlafaxine (Effexor) exerts its antidepressant effect by selectively blocking the reuptake of:

B Dopamine
C Serotonin
D Norepinephrine
E C & D

Correct Answer – E

The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:

A Lithium
B Clozapine
C Diazepam
D Amitriptyline

Correct Answer – A

Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?

B Antipsychotics
C Benzodiazepines
D Tricyclic antidepressants

Correct Answer – B

Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in:

A dry mouth
B amenorrhea
C increased production of testosterone
D blurred vision

Correct Answer – B

The primary advantage of using a case manager is to

A increase collaborative practice.
B enhance resource management.
C increase client satisfaction with care.
D promote evidence-based psychiatric nursing.

Correct Answer – B

Case management coordinates and monitors the effectiveness of services appropriate for the client. In the community setting, for example, close monitoring permits rapid assessment of the need for crisis intervention to avoid costly readmission.

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by

A private insurance.
B Medicare.
C Medicaid.
D Social Security.

Correct Answer – A

Because most health insurance is employer based, few chronically ill clients have private insurance.

Which statement regarding clients’ rights after being voluntarily admitted to a behavioral health unit is true?

A All rights remain intact.
B Only rights that do not involve decision making remain intact.
C The right to refuse treatment is no longer guaranteed.
D All rights are temporarily suspended.

Correct Answer – A

The hospitalized client is not a convicted criminal. All civil rights remain intact. Patients’ rights are clearly posted in all inpatient units.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to

A refuse treatment.
B send and receive mail.
C seek legal counsel.
D access all personal possessions.

Correct Answer – D

A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client’s possession and kept in a locked area to be used by the client under supervision or returned at discharge.

For the psychiatric client, the greatest negative aspect of the multidisciplinary treatment team approach to care is that it

A is an expensive treatment model.
B can increase anxiety in the newly admitted client.
C requires the client to answer the same questions repeatedly.
D puts demands on the client’s time and energy.

Correct Answer – B

Newly admitted clients can find the interaction with numerous team members stressful or even threatening.

An ongoing, crucial responsibility of nurses working on an inpatient psychiatric unit is

A fostering research.
B maintaining a therapeutic milieu.
C sympathetic listening.
D providing constructive negative feedback.

Correct Answer – B

Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital.

Which is a characteristic of a therapeutic inpatient milieu?

A It provides for the client’s safety and comfort.
B Voluntarily admitted clients are generally allowed additional privileges.
C Rules and behavioral limits are flexibly enforced.
D Staff provide frequent and ongoing negative feedback to clients.

Correct Answer – A

Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.

In an attempt to provide both safety and client comfort, psychiatric units generally have

A a varied client menu served on nonbreakable plastic dinnerware.
B comfortable seating that is well padded but secured to the floor.
C bedrooms that resemble hotel rooms but with specific safety features.
D a dayroom that has audiovisual equipment and is visible from the nurses’ station.

Correct Answer – C

One of the most important safety features of a psychiatric unit is the noninstitutional bedroom, which is equipped with many safety-specific features.

Which would NOT be considered a crisis on a psychiatric unit?

A Mr. R reports chest pain after eating a spicy lunch.
B Ms. T cannot speak and is holding her hands up to her neck.
C Mr. S demonstrates anger that escalates to physical assault.
D Mr. U reports hearing voices telling him to hit others.

Correct Answer – D

Crises on a psychiatric unit can be either medical in nature or behavioral. Medical crises include shock, cardiopulmonary arrest, hemorrhage, and status epilepticus, whereas behavioral crises include actual or potential violence against self, others, or the environment. Option D is not considered a crisis, but rather a potential crisis that was averted.

The community mental health movement was least influenced by

A the advent of antipsychotic medications.
B increasing public awareness of the poor care given in some large psychiatric hospitals.
C the proliferation of federal entitlement programs, making it possible to move the mentally ill out of hospitals.
D the increasingly larger numbers of advanced practice nurses prepared to care for the mentally ill in the community.

Correct Answer – D

At the time the community mental health movement began, relatively few advanced practice psychiatric nurses were practicing, and fewer still were prepared to care for the mentally ill in the community.

Which attribute would be least helpful for a community mental health nurse to have?

A Flexibility
B Reactive manner
C Nonjudgmental attitude
D Ability to cross service systems

Correct Answer – B

Community mental health nurses need to have a calm, nonreactive, nonjudgmental manner. Reactivity often gives clues to the nurse’s inner feelings, producing situations in which the nurse does not appear to be objective.

Which assessment information is uniquely important to the mental health client receiving outpatient care?

A Mental status examination results
B The client’s strengths and deficits
C Housing adequacy and stability
D The presenting problem and referring party

Correct Answer – C

For hospitalized clients, the treatment team does not have to worry about whether the client has a clean, safe place to stay and adequate food to eat. For the client receiving care in the community, these are legitimate planning concerns.

The major difference between the psychiatric nursing assessment performed for a client who is hospitalized and for a client who will be treated in the community is

A for the latter, the general assessment must be expanded.
B for the latter, the nursing focus is primarily on the mental status examination.
C for the former, the general assessment must be reimbursement based.
D for the former, the nursing focus is limited to the client’s willingness to accept treatment.

Correct Answer – A

General assessment of clients in the community is expanded to include community living challenges and resources, the client’s ability to cope with the demands of living in the community, and the client’s willingness to accept community support.

Which need is the highest priority for a seriously and persistently ill client living in the community?

A Access to medication
B Socialization and diversion
C Independent decision making
D Engaging in meaningful work

Correct Answer – A

After basic life necessities have been met, maintenance of the medication regimen is critical to preventing relapse and recurrence of the client’s illness. If the client does not have access to medication, he or she will be unable to be compliant.

A function shared by advanced practice and general practice psychiatric nurses is

A prescriptive authority.
B hospital privileges.
C provision of consultation services.
D collaboration with a multidisciplinary team.

Correct Answer – D

Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care?

A Nurses
B Social workers
C Clinical psychologists
D Chemical dependency counselors

Correct Answer – A

Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.

Although mental illness still carries a stigma, acceptance has improved over the past 40 years, partly due to

A better control of symptoms through drug therapy.
B public screenings that are well advertized in the community.
C community psychiatric nursing programs that provide in-home care.
D acknowledgment of personal mental health issues by well-known people.

Correct Answer – D

Public discussion of mental illness by famous political, entertainment, and sports figures has proven helpful in minimizing the stigma attached to problems such as depression, anxiety, and eating disorders.

Which criterion must be met to refer a client to a partial hospitalization program?

A The client is hospitalized at night in an inpatient setting.
B The client must be able to provide his or her own transportation daily.
C The client is able to return home each day.
D The client is able to care for his or her own physical and psychological needs.

Correct Answer – C

Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society

A nurse says, “I work with a mobile mental health unit.” The listener can assume that the nurse

A works with patients who are incarcerated.
B sees clients in unconventional settings.
C is a preferred provider for a large HMO.
D is a clinical specialist with the visiting nurse service.

Correct Answer – B

Mobile mental health units travel throughout the community, seeing clients on their own “turf,” such as in shelters, on street corners, in homes, and at factories.

Which activity best exemplifies the focus for a case manager?

A Arranging for rapid assessment of a newly hospitalized client
B Providing a comprehensive client social history to the treatment team
C Writing a report describing best practices in care for clients with depression
D Gathering data for a research study concerning side effects of a new medication

Correct Answer – A

Psychiatric case management fosters success in all aspects of community living by supporting recovery from acute symptoms, reducing recidivism, and enhancing the quality of life for the client with long-term illness.

Which situation demonstrates the nurse functioning in the role of advocate?

A Providing one-to-one supervision for a client on suicide precautions
B Co-leading a medication education group for clients and families
C Attending an inservice education program to obtain recertification in cardiopulmonary resuscitation
D Negotiating with the client’s HMO for extension of a 3-day hospitalization to 5 days

Correct Answer – D

In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client’s insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.

The case manager is demonstrating an understanding of the primary goals of managed care when

A arranging for the client to have a screening for prostate cancer.
B notifying the family that the client will require a wheelchair when discharged.
C providing the client with organizations that help defray the cost of prescribed drug.
D arranging for respite care when the client’s family needs to attend an out-of-state affair.

Correct Answer – A

The goal of managed care is to provide coordination of all health services with an emphasis on preventive care.

A client admitted to the behavioral health unit with a diagnosis of schizophrenia tells the nurse that she does not wish to see her husband if he visits. The nurse tells the client’s husband that

A his wife has the right to refuse visitors if she wishes.
B he is welcome to visit but may receive a cool reception.
C the client’s plan of care calls for limiting visitors for 2 days.
D the client is acutely psychotic and not responsible for her present behavior.

Correct Answer – A

The client has the right to choose or refuse visitors.

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client’s constitutional rights are violated when the nurse states:

A “We will help you make decisions that will keep you safe.”
B “I am going to help you shower, so you will not smell so bad.”
C “Your pocket knife and nail clippers will be kept in the nurses’ station.”
D “You will be having a number of tests to help us learn about your condition.”

Correct Answer – B

Every client has the right to be treated with dignity. This statement is demeaning.

Which symptomatology has priority for admission to an inpatient behavioral health unit?

A Severe anxiety and feeling as though one is suffocating
B Profound grieving over the recent death of one’s identical twin
C Hearing voices that proclaim one to be “the exalted ruler of the universe”
D History of seizures and an elevated lithium level

Correct Answer – D

This modification requires careful titration and observation that would be difficult to provide on an outpatient basis. (Lithium toxicity can proceed to death.)

A novice nurse is assigned to manage the milieu when there is a behavioral crisis with a client in the dining room. The nurse shows a lack of understanding of crisis management when

A requiring that all clients go in their rooms.
B moving clients from the dining room to the day room/solarium.
C encouraging the clients to express their reactions to the incident.
D reassuring clients that staff will handle the agitated client.

Correct Answer – A

Other clients are usually taken to a safe area away from the scene of the crisis. The nurse should allow clients to express their fears, which often include fear of bodily harm from the acting-out client, fear that they, too, could lose control, and fear for the other client’s safety. The nurse should provide realistic reassurance for expressed concerns.

The nurse who provides therapeutic milieu management supports the clients best by

A allowing them to act out their fears and frustrations.
B providing a safe place for them to practice coping skills.
C meeting their physical as well as emotional needs
D encouraging them to talk about their problems with others.

Correct Answer – B

A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community.

A chronically ill client was readmitted when symptoms of the illness exacerbated. The client lives alone and has few outside activities. To best prepare the client for discharge, the nurse will focus on

A improving client-family relationships.
B placing the client in a sheltered workshop.
C psychoeducation to promote medication compliance.
D involving the client in daily visits to a psychosocial club.

Correct Answer – C

To prepare clients for discharge, nurses should focus on precipitants of the crisis that led to hospital admission.

On a hospital inpatient unit, the nurse manager primary responsible is to

A assure the safety of both clients and staff on the unit.
B assist the client to prepare a support system by the time of discharge.
C provide medication therapy for the patients on the unit.
D help the inpatient community remain supportive of each other.

Correct Answer – A

The nurse manager is responsible for an awareness of the safety of the unit, its effectiveness in the delivery of services, and how well the components of the health care team integrate their services.

When preparing an education program focused on the history of the community mental health movement in the United States, the nurse includes the fact that

A use of community settings began after World War II with the discharge of large numbers of veterans with mental illness.
B the shift from care in psychiatric hospitals to community mental health centers began in the 1960s.
C movement of services out of hospitals and into the community is a baby-boomer phenomenon that began in the 1980s.
D the community mental health movement is an outgrowth of managed care’s response to rising health care costs beginning in the 1990s.

Correct Answer – B

The community mental health movement began as a result of legislation passed during the Kennedy administration.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess

A knowledge of both national and local political activism.
B the ability to cross service systems.
C an awareness of own cultural and personal values
D creative problem-solving and intervention skills.

Correct Answer – D

Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.

When asked to explain what a psychosocial rehabilitation program is, the nurse responds best when sharing

A “The concept started in the 1960s and provides psychiatric care for those without private insurance.”
B “The individual program can provide medication, therapies, and social services for the mentally ill.”
C “Referrals from inpatient and intensive outpatient facilities are provided with long-term care that focuses on desired goals.”
D “It is a multidisciplinary team approach that is composed of nurses, psychiatrics, social workers, and psychologists.”

Correct Answer – C

Clients are referred to the clinic program for long-term follow-up from inpatient units or other providers or outpatient care. The treatment can last for years, and discharge is achieved when improvement is shown or desired outcomes are reached.

When mental health care is provided for in a community setting, goal setting is

A client-directed and focused on the individual’s expressed wishes.
B society-driven and focused on returning the client into the social community.
C determined by the care provider and focused on cost-effective measures.
D negotiated by both client and staff and focused on long-term functioning.

Correct Answer – D

In the community setting treatment goals and interventions directed at long-term function within the community are negotiated rather than imposed on the client.

The psychiatric community health nurse engages in primary prevention when

A visiting a homeless shelter to provide crisis intervention for its clients.
B discussing the need for proper nutrition with a depressed new mother.
C providing stress reduction seminars at the local senior center.
D visiting the home of a client currently displaying manic behavior.

Correct Answer – C

Primary prevention is directed at healthy individuals with the purpose of preventing mental illness.

In 1963 the Community Mental Health Centers Act was signed with the primary purpose of

A having mental health care services funded by the federal government while provided by state government.
B providing mental health care to the uninsured in an economical reasonable manner.
C providing mental health care on an outpatient basis in order to maintain the client as a member of an established community.
D assuring all Americans of the mental health care services they need and/or desire.

Correct Answer – C

Community mental health centers were created as a result of the 1963 Community Mental Health Centers Act for the purpose of providing mental health services while maintaining the client in his own community.

A community mental health nurse is assigned to a mobile mental health care unit in a locale where the majority of the population are newly immigrated Vietnamese. The measure that will best help the nurse initially plan and implement culturally sensitive care for clients is

A arranging for the services of an interpreter and cultural consultant.
B reading about the predominant health beliefs held by members of Asian cultures.
C attempting to place self in the position of being an unassimilated member of a culture.
D treating clients in the same manner that clients of any culture would find satisfying.

Correct Answer – A

Use of a translator is helpful with language and with gaining explanations of culture as it might affect health care.

An example of deinstitutionalization would include

A providing a recovering alcoholic with transportation to nightly AA meetings.
B discharging a stabilized psychotic client to a transitional halfway house.
C psychiatric in-home visits for a new mother experiencing post-partum depression.
D conducting regular depression screening at a local homeless shelter.

Correct Answer – B

Deinstitutionalization involves interventions that move a hospitalized mental health client into community-based outpatient services.

The community mental health nurse recognizes that the mentally ill population will require

A frequent assessment for physical illness both acute and chronic in nature.
B continuous supervision in order to assure that their physical needs are met.
C government assistance in the form of health insurance and housing.
D legal assistance to ensure they retain their civic rights.

Correct Answer – A

Repeated studies have shown that people with mental illnesses also have a higher risk for medical disorder than the general population.

A community mental health nurse is responsible for medication management for clients. Which general approach can be anticipated to yield the best results?

A Empowering clients to be responsible for medication compliance
B Providing frequent oversight by nurse of daily medication ingestion
C Establishing a system in which client support figures oversee medications
D Scheduling monthly blood tests to determine serum levels of prescribed medications

Correct Answer – A

Empowerment implies supporting the client to act on his or her own behalf. A client who is empowered takes responsibility for aspects of his or her own care, such as medication compliance. Having the client function at the highest level at which he or she is capable is always a goal of care; the more autonomous the client can be, the better.

There is one bed on a locked psychiatric unit. Which of the following patients is appropriate for involuntary admission?

A Jill, aged 23 years, a college student who has developed symptoms of anxiety and is missing classes and work
B Michael, aged 30 years, an accountant who has developed symptoms of depression
C Mia, aged 26 years, a kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road
D Rose, aged 76 years, a retired librarian who is experiencing memory loss and some confusion at times

Correct Answer – C

Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don’t meet criteria (risk of harm to self and/or others) for admission.

Which of the following structural safety precautions is most important to prevent the most common type of inpatient suicides?

A Break-away closet bars to prevent hanging
B Bedroom and dining areas with locked windows to prevent jumping
C Double-locked doors to prevent escaping from the unit
D Platform beds to prevent crush injuries

Correct Answer – A

Hangings are the most common method of inpatient suicide. The other options are important safety measures but don’t directly address the suicide method of hanging.

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)?

A Ramon, who is suicidal with a plan
B Marty, a substance abuser who is being discharged from an inpatient alcohol rehabilitation unit
C Ellen, who stopped taking her antipsychotic medication and is decompensated and not caring for herself
D Jeff, who has mild depression symptoms and is starting outpatient therapy

Correct Answer – B

PHP is for patients who may need a “step-down” environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.

George W. Bush’s New Freedom Commission on Mental Health’s report emphasized that mental illness is not a hopeless life sentence but a condition from which people can recover. Recovery, which is still the number 1 goal, could be described as:

A the ability to work, live, and participate in the community.
B never having to visit a mental health provider again.
C a short-term journey that leaves people better able to cope with symptoms.
D a long-term journey over the individual’s life span.

Correct Answer – A

Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. Recovery is usually not a short-term journey but rather a long-term journey. While recovery may be a long-term journey over months or even years, it would not cover an entire life span.

One primary goal and benefit of Assertive Community Treatment (ACT) is:
A forming closer relationships with the patient’s family.
B more flexible work schedule for staff.
C more reimbursement to staff for services provided.
D preventing rehospitalization.

Correct Answer – D

A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.

Which of the following factors contribute to the movement of patients out of large state institutions and into community-based mental health treatment? *Select all that apply*

A States desire to save money by moving the patients into the community, where the federal government would pick up more of the cost
B The growing availability of generous mental health insurance coverage gave more patients the ability to seek private care in the community
C A system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment
D The Community Mental Health Centers Act of 1963 required states to develop and offer care in community-based treatment programs
E Patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive settings
F New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.

Correct Answers – A C D E F
Levels of prevention strategies prominent in outpatient psychiatric care consist of primary prevention, secondary prevention & _________________ prevention.
Correct Answer – tertiary

Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications?

A Help Anna to understand her illness and share in decisions about her care.
B Advise Anna that if she stops taking her medications, her doctor will hospitalize her
C Arrange for Anna to receive daily home care so that her use of medications is monitored
D Discourage Anna from focusing on side effects and other excuses for stopping her pills

Correct Answer – A

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has?

A Provide emotional support and encourage him to contact his family to see if they can help him arrange and pay for inpatient care.
B Advise him that hospitals serve all persons regardless of their ability to pay, and immediately contact a Mobile Crisis team or accompany him to the nearest hospital emergency department.
C Help him apply for Medicaid coverage, arrange for him to be monitored by family and friends, and once Medicaid coverage is in place, take him to an emergency room for evaluation
D Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

Correct Answer – D

Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? *Select all that apply*

A Interact frequently with both individuals and groups on the unit
B Attempt to introduce patients with similar backgrounds to each other to form social bonds for after discharge
C Initiate and support group interactions via therapeutic groups and activities
D Provide and encourage opportunities to practice social and other life skills
E Collaborate with housekeeping to provide a safe, pleasant environment
F Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.

Correct Answer – A C D F

The criteria for admission to an inpatient psychiatric unit is that the patient:

A refuses to comply with the treatment team in regard to medication, counseling, living situation or substance abuse abstinence
B is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm
C refuses all psychotropic medication
D is court-ordered by a judge specializing in mental health

Correct Answer – B

Which statement best explains the term “worldview”?

A Beliefs and values held by people of a given culture about what is good, right, and normal.
B Ideas derived from the major health care system of the culture about what causes illness.
C Cultural norms about how, when, and to whom illness symptoms may be displayed.
D Valuing one’s beliefs and customs over those of another group.

Correct Answer – A

A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

When members of a group are introduced to the culture’s worldview, beliefs, values, and practices, it is called

A acculturation.
B ethnocentrism.
C enculturation.
D cultural encounters.

Correct Answer – C

Members of a group are introduced to the culture’s worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact

According to the Western scientific view of health, illness is the result of

A pathogens.
B energy blockage.
C spirit invasion.
D soul loss.

Correct Answer – A

Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured.

Which healing practice is least used in the Western health system of healing practices?

A Antibiotic medication
B Surgery
C Targeted cellular destruction
D Restoring lost balance or harmony

Correct Answer – D

The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

Exclusive use of Western psychological theories by nurses making client assessments will result in

A a high level of care for all clients.
B standardization of nomenclature for psychiatric disorders.
C inadequate assessment of clients of diverse cultures.
D greater ease in selecting appropriate treatment interventions.

Correct Answer – C

Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client’s cultural beliefs as to what will provide a cure are better.

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of

A biased assessment tools.
B insensitive practitioners.
C insensitive interviewing techniques.
D lack of the availability of cultural translators.

Correct Answer – C

Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

People who have an indigenous worldview

A see themselves as spiritual and believe that they are linked with all other living things.
B focus on the articulation of individual needs and ideas.
C view the self as an extension of cosmic energy that is repeatedly reborn.
D are concerned with being part of a harmonious community.

Correct Answer – D

Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

In the Eastern tradition, disease is believed to be caused by

A fluctuations in opposing forces.
B outside influences.
C members’ disobedience.
D adoption of Western beliefs.

Correct Answer – A

In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies.

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of

A hostility.
B lack of self-will.
C variation from tradition.
D illness.

Correct Answer – D

Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as “illness.”

A client reporting gastric pain, tells the nurse, “I think my symptoms started when a neighbor cast a spell on me.” The assessment the nurse can make is that the client

A has a major mental illness.
B is expressing a culture-bound illness.
C requires hospitalization to protect the neighbor.
D will probably not respond to Western medical treatment.

Correct Answer – B

Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness.

The Eastern world view can be identified by the belief that

A one’s identity is found in individuality.
B holds responsibility to family as central.
C time waits for no one.
D disease is a lack of harmony with the environment.

Correct Answer – B

The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

Which idea held by the nurse would best promote the provision of culturally competent care?

A Western biomedicine is one of several established healing systems.
B Some individuals will profit from use of both Western and folk healing practices.
C Use of cultural translators will provide valuable information into health-seeking behaviors.
D Need for spiritual healing is a concept that crosses cultural boundaries.

Correct Answer – A

A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client’s explanatory model for his illness reflects

A supernatural causes.
B negative forces.
C inheritance.
D imbalance.

Correct Answer – D

Many Eastern cultures explain illness as a function of imbalance.

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces?

A Acupuncture
B Dietary change
C Cleansings
D Herbal medicine

Correct Answer – C

Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports

A increased somatic expressions of distress.
B disruption of energy balance.
C appeasement of the spirits.
D increased anxiety.

Correct Answer – C

Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.

The nurse assesses the wellness beliefs and values of a client from another culture best when asking

A “What do you think is making you ill?”
B “When did you first feel ill?”
C “How can I help you get better?”
D “Did you do something to cause the illness?”

Correct Answer – A

Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture?

A “Is there someone in your community who usually cures your illness?”
B “What usually helps people who have the same type of illness you have?”
C “What questions would you like to ask about your condition?”
D “What sorts of stress are you presently experiencing?”

Correct Answer – B

Asking about typical treatment seeks information about the “usual” cultural treatment of the disorder experienced by the client.

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to

A health practices
B power and control
C psychological stability.
D assimilation and conformity.

Correct Answer – B

Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.

The psychiatric nurse planning and implementing care for culturally diverse clients should understand

A holistic theory.
B systems theory.
C adaptation theory.
D political power theory.

Correct Answer – A

In most cultures a holistic perspective prevails, one without separation of mind and body.

The question that would give data of least value to the assessment of family dynamics is
A “What changes have occurred recently at work?”
B “Are your wife and children conforming to your expectations?”
C “Are you experiencing stress associated with conforming to family expectations?”
D “Do you expect others to shun or avoid you because you are seeing a therapist?”

Correct Answer – D

The question about others’ reaction to seeking help from a psychotherapist will not provide data about family dynamics.

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms?

A “So, ethnicity refers to having the same life goals whereas culture refers to race.”
B “So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes.”
C “So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values.”
D “So, ethnicity refers to race, and culture refers to having the same worldview.”

Correct Answer – C

Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group’s members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong’s aged parents live with her. Ms. Wong states, “I am a failure.” Which of the following statements may accurately assess the basis for Ms. Wong’s anxiety and feelings of failure?

A Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace.
B Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them.
C Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance.
D Ms. Wong may be feeling anxiety because in her family’s traditions her failure may result in a changed fate.

Correct Answer – B

Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one’s identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

Which of the following best explains the concept of cultural competence?

A Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care.
B Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States.
C Nurses adjust their own practices to meet their patients’ cultural preferences, beliefs, and practices.
D Nurses must take continuing education classes on culture in the process of becoming culturally competent.

Correct Answer – C

Cultural competence means that nurses adjust and conform to their patients’ cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches “almost every day” and “can’t sleep at night.” She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting:

A regression.
B somatization.
C enculturation.
D assimilation.

Correct Answer – B

Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, “I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!” Which of the following responses you could make promotes culturally competent care? *select all that apply*

A “You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply.”
B “I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English.”
C “Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English.”
D “What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture.”
E “Mr. Tran’s ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known.”

Correct Answer – D & E

Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

In the DSM-5, a major change in how culture is viewed within each disorder is that:

A issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes
B issues related to culture and mental illness are markedly absent in the discussion of each disorder
C it is noted that it is impossible for health practitioners to be expected to be culturally aware with the increasing diversity of the US
D issues related to culture and mental illness are less important than previously thought in diagnostic criteria.

Correct Answer – A

Julio is a 31 year old patient who comes to your mental health outpatient clinic. Which of the following would alert you to the potential for somatization?

A. Julio states, “I have been feeling sad for weeks.”
B Julio shows you bottles of medication he has been prescribed for anxiety.
C Julio presents with concerns involving headaches, dizziness and fatigue.
D Julio states, “I have been sleeping all the time.”

Correct Answer – C

You are caring for Maria, a patient who states that she has “ghost sickness.” Which is the appropriate nursing response?

A “I have no idea what ‘ghost sickness’ is.”
B “How does ‘ghost sickness’ make you feel?”
C “‘Ghost sickness’ is not listed in the manual of psychiatric disorders.”
D “Let’s talk about why you believe in evil spirits.”

Correct Answer – B

Which nursing actions demonstrate cultural competence? *Select all that apply*

A Planning mealtime around the patient’s prayer schedule.
B Advising a patient to visit with the hospital chaplain
C Researching foods that a lacto-ovo-vegetarian patient will eat
D Providing time for a patient’s spiritual healer to visit
E Ordering standard meal trays to be delivered 3 times a day

Correct Answer – A B C & D

The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate?

A Patient will visit with spiritual healer once weekly
B Patient will experience rebalance of yin-yang by discharge
C Patient will identify sources that increase “cold wind” within 24 hours of admission
D Patient will contact “singer” to provide healing ritual within 3 days of admission

Correct Answer – A

The intervention that will be most effective in preventing a nurse from making decisions that will lead to legal difficulties is

A asking a peer to review nursing intervention related decisions.
B balancing the rights of the client and the rights of society.
C maintaining currency in state laws affecting nursing practice.
D seeking value clarification about fundamental ethical principles.

Correct Answer – C

Each nurse’s practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions.

Which ethical principle refers to the individual’s right to make his or her own decisions?

A Beneficence
B Autonomy
C Veracity
D Fidelity

Correct Answer – B

Autonomy refers to self-determination, or the right to make one’s own decisions.

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse’s behavior has violated the ethical principle of

A autonomy.
B veracity.
C fidelity.
D justice.

Correct Answer – C

Fidelity refers to being “true” or faithful to one’s obligations to the client. Client abandonment would be a violation of fidelity.

In the course of providing best psychiatric care for a client, the nurse must place greatest reliance on

A legal principles
B ethical principles
C independent judgment.
D institutional standards.

Correct Answer – A

Legal principles are fundamental to nursing practice. They supersede all other principles, standards, and judgments. All students are encouraged to become familiar with the important provisions of the laws in their own states regarding admissions, discharges, clients’ rights, and informed consent.

The civil rights of persons with mental illness who are hospitalized for treatment are

A the same as those for any other citizen.
B altered to prevent use of poor judgment.
C always ensured by appointment of a guardian.
D limited to provision of humane treatment.

Correct Answer – A

Civil rights are not lost because of hospitalization for mental illness.

If a client with psychiatric illness is determined to be incompetent to make decisions affecting his care

A Staff members are required to use their best judgment when defining care.
B No treatment other than custodial care can be provided.
C The court appoints a guardian to make decisions on his behalf.
D The doctrine of least restrictive alternative is null and void.

Correct Answer – C

An incompetent client is unable to make legal decisions that would affect his care, such as consenting to surgery. A court-appointed guardian functions on behalf of the client.

Which statement is true regarding mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit?

A The client can receive mail from only family and legal sources.
B Mail must first be opened and inspected by staff.
C Receipt of mail is considered a privilege accorded the client for compliance.
D Mail is a form of social interaction and so receiving mail is a client’s civil right.

Correct Answer – D

The client’s civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured.

Which right of the client has been violated if he is medicated without being asked for his permission?

A Right to dignity and respect
B Right to treatment
C Right to informed consent
D Right to refuse treatment

Correct Answer – C

Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents

A assault.
B battery.
C defamation.
D invasion of privacy.

Correct Answer – B

Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual?

A Confidentiality is now reserved to the immediate family.
B Only HIV status continues to be protected and privileged.
C Nothing may be disclosed that would have been kept confidential before death.
D The nurse must confer with the next of kin before divulging confidential, sensitive information.

Correct Answer – C

Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

A nurse is adequately representing the stated bioethical principle when valuing

A autonomy by respecting a client’s right to decide to refuse cancer treatment.
B justice by staying with a client who is suicidal.
C fidelity by informing the client about the negative side effects of a proposed treatment.
D beneficence when advocating for a client’s right to enter into a clinical trial for a new medication.

Correct Answer – A

Autonomy refers to self-determination. Self-determination can be exercised when one makes his or her own decisions without interference from others.

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced

A battery.
B defamation of character.
C false imprisonment.
D assault.

Correct Answer – C

False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons.

A client reports to the nurse that once he’s released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take?

A None, because no explicit threat has been made.
B Ask the client if he is threatening his wife.
C Call the client’s wife and report the threat.
D Report the incident to the client’s therapist and document.

Correct Answer – D

The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.

A client is released from involuntary commitment by the judge, who orders that a caseworker supervise him for the next 6 months. This is an example of

A conditional discharge.
B outpatient commitment.
C voluntary follow-up.
D discretionary treatment.

Correct Answer – A

An unconditional discharge gives the client complete freedom to choose or reject follow-up care. A conditional discharge imposes a legal requirement for the client to submit to follow-up supervision.

When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rules, the correct assumption is that the client was admitted

A per legal requirements.
B for a non-emergency.
C voluntarily.
D involuntarily.

Correct Answer – C

Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.

What assumption can be made about the client who has been admitted on an involuntary basis?

A The client can be discharged from the unit on demand.
B For the first 48 hours, the client can be given medication over objection.
C The client has agreed to fully participate in treatment and care planning.
D The client is a danger to self or others or unable to meet basic needs.

Correct Answer – D

Involuntary admission implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently.

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of

A autonomy and beneficence.
B advocacy and confidentiality.
C veracity and fidelity.
D justice and humanism.

Correct Answer – A

Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client’s autonomy.

Which statement concerning the right to treatment in public psychiatric hospitals is accurate?

A Hospitalization without treatment violates the client’s rights.
B Right to treatment extends only to provision of food, shelter, and safety.
C All clients have the right to choose a primary therapist and case manager.
D The right to treatment for hallucinations has priority over treatment for anxiety.

Correct Answer – A

Many years ago psychiatric clients were warehoused in large mental institutions, given custodial care, and rarely released into the community. As enlightenment occurred, it was determined that each client who is hospitalized has the right to receive treatment.

What ethical principle is supported when a nurse witnesses the informed consent for electroconvulsive therapy from a depressed client?

A Beneficence
B Autonomy
C Justice
D Fidelity

Correct Answer – B

Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one’s care.

The charge nurse shares with the psychiatric technician that negligence of a patient

A is an act or failure to act in a way that a responsible employee would act.
B applies only when the client is abandoned or mistreated.
C is an action that puts the client in fear of being harmed by the employee.
D means the employee has given malicious false information about the client.

Correct Answer – A

Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent clients from striking each other.

You are working on an inpatient psychiatric unit and caring for Elizabeth, who is becoming agitated. You speak with Elizabeth one to one in a private setting, find out the reason for the agitation, and then assist Elizabeth with ways to calm down, possibly including prn medication to prevent further escalation of Elizabeth’s agitation, which could lead to seclusion and/or restraints. You are making care decisions based on:

A writ of habeas corpus.
B least restrictive alternative doctrine.
C veracity.
D bioethics.

Correct Answer – B

Least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described you are possibly preventing the more restrictive setting of seclusion and/or restraints. Writ of habeas corpus is a legal term meaning a written order “to free the person.” Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.

Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)?

A 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn’t agree and wishes to be discharged
B 75-year-old patient with dementia who demands to be allowed to go back to his own home
C 21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home and do outpatient counseling
D 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

Correct Answer – A

Against medical advice discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member’s opinion doesn’t impact an AMA discharge.

Sophie, aged 27 years, has a diagnosis of paranoid schizophrenia. She stopped taking her medications and believes that she is to be taken by the aliens to live with them on another planet. She was observed walking through traffic on a busy road, and then was found climbing the railing on a bridge, to “be ready for them to take me in their ship.” Sophie is hospitalized. During your shift she begins running up and down the halls, banging her head on the walls, and yelling, “Get them out of my head!” On what basis can Sophie be medicated against her will?

A If Sophie has taken the medication in the past and has had no adverse effects
B If Sophie may cause imminent harm to herself or others
C If Sophie still has the capacity to make an informed decision regarding medication
D If Sophie is provided education regarding the medication before administration of the medication

Correct Answer – B

A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient’s will.

Jonas is a 29-year-old patient with anxiety and a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry and aggressive, strikes another patient, and then attacks a staff member. He is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered:

A a restraint.
B a medication time-out.
C false imprisonment.
D malpractice.

Correct Answer – A

Chemical restraints are defined by those medications or doses of medication that are not being used for the patient’s condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.

Which of the following scenarios describe a HIPAA violation?

A Janie, the ED nurse, gives report to Amanda, a nurse on the intensive care unit, regarding Joel, who is being admitted.
B Mark, a nurse on the medical-surgical floor, calls his patient’s primary care provider to obtain a list of current medications.
C Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway.
D Tony, a nurse on the psychiatric unit, gives discharge information to the counseling office where his patient will be going to outpatient treatment after discharge.

Correct Answer – C

Discussing a patient’s information in public places where it may be overheard is a violation of a patient’s confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.

A nurse makes a post on a social media page about his peer taking care of a patient with a crime-related gunshot wound during his shift in the emergency department. He does not use the name of the patient. It can be concluded that:

A the nurse has not violated confidentiality laws because he did not use the patient’s name
B the nurse cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient
C the nurse has violated confidentiality laws and can be held liable
D the nurse cannot be held liable because postings on a social media site are excluded from confidentiality laws

Correct Answer – C

Brian, a patient with schizophrenia, has been ordered an antipsychotic medication. The medication will likely benefit him, but there are side effects; in a small percentage of patients, it may cause a dangerous side effect. After medication teaching, Brian is unable to identify side effects and responds, “I won’t have any side effects because I am iron and cannot be killed.” Which response would be most appropriate under these circumstances?

A Administer the medication because Brian has made a decision to take the medication, and care should be patient-centered
B Petition the court to appoint a guardian as a substitute for Brian, as he is unable to comprehend the proposed treatment
C Administer the treatment because Brian’s need for treatment is the clear priority
D Withhold the medication until Brian is able to identify the benefits and risks of both consenting and refusing consent to the medications

Correct Answer – B

A family who is worried that an adult female might hurt herself asks for her to be admitted to the hospital. An assessment indicates moderate depression with no risk factors for suicide other than a depressed mood. The patient denies any intent or thoughts about self-harm. The family agrees that the patient has not done or said anything to suggest that she might be a danger to herself. Which of the following responses is consistent with the concept of “least restrictive alternative” doctrine?

A Admit the patient as a temporary inpatient admission
B Persuade the patient to agree to a voluntary inpatient admission
C Admit the patient involuntarily to an inpatient mental health treatment unit
D Arrange for an outpatient counseling appointment the next day

Correct Answer – D

David has an overnight pass, and he plans to spend this time with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother and needs him to babysit. You notice that the patient becomes visibly agitated when she says this. How do you balance safety and the patient’s right to confidentiality?

A Cancel the pass without explanation to the sister and reschedule it for a time when babysitting would not be required of the patient
B Suggest that the sister make other arrangements for child care, but withhold the information the patient just shared regarding his concerns about harming children
C Speak with the patient about the safety risk involved in babysitting, seeking his permission to share this information and advising against the pass if he declines to share the information
D Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger toward children and the resultant risk that his babysitting would present.

Correct Answer – D

Gina is admitted for treatment of depression with suicidal ideation triggered by marital discord. Her spouse visits one night and informs Gina that he has decided to file for divorce. The staff are aware of the visit and the husband’s intentions regarding divorce but take no further action, feeling that the q15-minute suicide checks Gina is already on are sufficient. Thirty minutes after the visit ends, staff make rounds and discover Gina has hanged herself in her bathroom, using hospital pajamas she had tied together into a rope. Which of the following statements best describes this situation? *Select all that apply*

A The nurses have created liability for themselves and their employer by failing in their duty to protect Gina.
B The nurses have breached their duty to reassess Gina for increased suicide risk after her husband’s visit.
C Given Gina’s history, the nurses should have expected an increased risk of suicide after her husband’s announcement.
D The nurses correctly reasoned that suicides cannot always be prevented and did their best to keep Gina safe through checks every 15 minutes.
E The nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina’s increased risk.
F Had the nurses restricted Gina’s movements or increased their checks on her, they would have been liable for false imprisonment and invasion of privacy, respectively.

Correct Answer – A B C E

Of the following environments, which would be most conducive to a therapeutic session?

A The nurses’ station
B A table in the coffee shop
C A quiet section of the day room
D The utility room

Correct Answer – C

Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings?

A Using emotionally charged words and gestures
B Offering opinions and avoiding periods of silence
C Asking closed-ended questions requiring “yes” or “no” answers
D Asking open-ended questions and seeking clarification

Correct Answer – D

Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, “Can you tell me what was happening to you that led to your being hospitalized here?”

A Using a minimal encourager
B Using an open-ended question
C Paraphrasing
D Reflecting

Correct Answer – B

Open-ended questions require more than one-word answers.

The content and direction of the clinical interview is determined by the

A nurse.
B client.
C physician.
D health care team.

Correct Answer – B

The client always takes the lead and determines the content and direction of the clinical interview, although the nurse may discourage social conversation or intrusive personal questioning.

The preferred seating arrangement for a nurse-client interview is with

A the nurse behind a desk and the client in a chair in front of the desk.
B the nurse and client sitting at a 90-degree angle to each other
C the client sitting in a chair and the nurse standing a few feet away.
D the nurse and client sitting facing each other.

Correct Answer – B

This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

What is the focus during clinical supervision?

A The nurse’s behavior in the nurse-client relationship
B Analysis of the client’s motivation for transferences
C Devising alternative strategies for client growth
D Assisting the client to develop increased independence

Correct Answer – A

Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients.

Two main principles that can guide the communication process during the nurse-client interview are

A clarity and giving recognition.
B personal and environmental factors.
C passive listening and cultural caution.
D interpreting and speculating on the client’s meaning.

Correct Answer – A

Clarity refers to mutual understanding of communication, and giving recognition indicates awareness of change and personal efforts. Both are desirable.

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy: Verbal communication relates to content as nonverbal communication relates to
A touch.
B conflict.
C process.
D double messages.

Correct Answer – C

The verbal message is sometimes referred to as the content of the message, and the nonverbal behavior is called the process of the message.

A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is

A African American.
B Hispanic American.
C Asian American.
D British American.

Correct Answer – B

Highly emotional verbal communication accompanied by dramatic body language when describing emotional problems is a style associated with persons of Hispanic culture. French and Italian Americans also demonstrate animated facial expressions and expressive hand gestures during communication.

When determining the appropriateness of touching a psychiatric client, the nurse should

A follow his or her instincts concerning touching individual clients.
B touch the elderly but avoid touching the young.
C check the facility’s policy on the acceptability of touch.
D perceive touch as a gesture of warmth and friendship that fosters a relationship.

Correct Answer – C

Students are urged to check the policy manual of their facilities, because some facilities have a no-touch policy, particularly with adolescents and children who may have experienced inappropriate touch and would not know how to interpret the touch of the health care worker.

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a

A safe person to interact with.
B new friend.
C stranger.
D peer.

Correct Answer – C

Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client’s perception of staff during the initial phase of relationship-building.

When discussing her husband, a client shares that “I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time.” What therapeutic communication technique is the nurse using when responding, “Are you saying that things would be better if you left your husband?”

A Focusing
B Restating
C Reflection
D Clarification

Correct Answer – D

Clarification verifies the nurse’s interpretation of the client’s message.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this?

A The mental image of a word may not be the same for both nurse and client.
B One statement may simultaneously convey conflicting messages.
C Many of the client’s remarks are no more than social phrases.
D Content of messages may be contradicted by process.

Correct Answer – D

Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client’s feelings than the verbal message.

During a therapeutic encounter the nurse remarks to a client, “I noticed anger in your voice when you spoke of your father. Tell me about that.” What communication techniques is the nurse using?

A Giving information and encouraging evaluation
B Presenting reality and encouraging planning
C Clarifying and suggesting collaboration
D Reflecting and exploring

Correct Answer – D

Reflecting conveys the nurse’s observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully

After a client discusses her relationship with her father, the nurse asks, “Tell me if I’m correct that you feel dominated and controlled by him?” The nurse’s purpose is to

A elicit more information.
B encourage evaluation.
C verbalize the implied.
D clarify message.

Correct Answer – D

Clarification helps the nurse understand and correctly interpret the client’s message. It gives the client the opportunity to correct misconceptions.

Which statement by the nurse reflects the process occurring in the clinical interview?

A “Give me an example of something your wife does that ‘drives you nuts.'”
B “What makes you think your doctor will give you a pass?”
C “When is your child custody hearing going to be held?”
D “You are frowning. What are you feeling?”

Correct Answer – D

Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of client feelings than what is being verbalized.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful?

A “Don’t let them beat you! Fight back!”
B “School is stressful. What do you find most stressful?”
C “I know just what you are going through. The stress is terrible.”
D “You have only two more semesters. You will be glad if you stick it out.”

Correct Answer – B

This response acknowledges the speaker’s perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique?

A Korea
B Mexico
C Japan
D Germany

Correct Answer – D

Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

With which client should the nurse make the assessment that not using touch would probably be in the client’s best interests?

A A recent immigrant from Russia
B A deeply depressed client
C A Chinese American client
D A tearful client reporting pain

Correct Answer – C

Chinese Americans may not like to be touched by strangers.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should

A quickly break the silence and encourage the client to continue.
B reassure the client that the abuse was not her fault.
C reach out and gently touch the client’s arm.
D allow the client to break the silence.

Correct Answer – D

Silence is not a “bad” thing. It gives the speaker time to think through a point or collect his or her thoughts

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, “I’m fine! Everything’s great.” Which of the following is true regarding verbal and nonverbal communication?

A Verbal communication is always more accurate than nonverbal communication.
B Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking.
C Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.
D Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

Correct Answer – C

Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, “I’m fine! Everything’s great.” Which of the following responses would be therapeutic?

A “Okay, but we are all here to help you, so come get one of the staff if you need to talk.”
B “I’m glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going.”
C “I don’t believe you. You are not being truthful with me.”
D “It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?”

Correct Answer – D

This response uses the therapeutic technique of clarifying; it addresses the difference between the patient’s verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient’s obvious distress or are confrontational and judgmental.

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife’s death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible?

A William did not love his wife.
B William’s response may reflect cultural norms.
C William’s response may reflect guilt.
D William may have an antisocial personality, which would explain his lack of feeling.

Correct Answer – B

Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient did not love his wife, and this would be jumping to conclusions. There is also nothing in the scenario to suggest guilt and there is no evidence in the scenario to suggest antisocial personality disorder.

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa’s behavior?

A You have violated Louisa’s personal space by physically being too close.
B Louisa has issues with sharing personal information.
C You have not made the patient feel comfortable by explaining the purpose of the admission interview.
D Louisa is responding to the voices in her head telling her to leave.

Correct Answer – A

By sitting and leaning in so closely, you have entered into intimate space (0 to 18 inches), rather than social distance and the patient may feel uncomfortable with being so close to someone she does not know. All the other options lack evidence and jump to conclusions regarding the patient’s behavior.

Which of the following statements indicate a nontherapeutic communication technique? (select all that apply):

A “Why didn’t you attend group this morning?”
B “From what you have said, you have great difficulty sleeping at night.”
C “What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?”
D “If I were you, I would quit the stressful job and find something else.”
E “I’m really proud of you for the way you stood up to your brother when he visited today.”
F “You mentioned that you have never had friends. Tell me more about that.”
G “It sounds like you have been having a very hard time at home lately.”

Correct Answer – A C D E

All these options reflect the nontherapeutic techniques of (in order) asking “why” questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

A “A new psychiatrist is a chance to start fresh; I’m sure it will go well for you.”
B “You say you look forward to the meeting, but you appear anxious or unhappy.”
C “I notice that you frowned and avoided eye contact just now; don’t you feel well?”
D “I get the impression you don’t really want to see your psychiatrist–can you tell me why?”

Correct Answer – B

Which student behavior is consistent with therapeutic communication?

A Offering your opinion when asked in order to convey support
B Summarizing the essence of the patient’s comments in your own words.
C Interrupting periods of silence before they become awkward for the patient
D Telling the patient he did well when you approve of his statements or actions

Correct Answer – B

Which statement about nonverbal behavior is accurate?

A A calm expression means that the patient is experiencing low levels of anxiety
B Patients respond more consistently to therapeutic touch than to verbal interventions
C The meaning of nonverbal behaviors varies with cultural and individual differences
D Eye contact is a reliable measure of the patient’s degree of attentiveness and engagement

Correct Answer – C

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction? *Select all that apply*

A Apologize for the differential in height and proceed while standing to avoid delay
B If permitted, raise the head of the bed and, with the patient’s permission, sit on the bed
C If permitted, raise the head of the bed to approximate the nurse’s height while standing
D Sit in whatever chair is available in the room to convey informality and increase comfort
E Locate a chair or stool that would place the nurse at approximately the level of the patient
F Remain standing and proceed so as not to create distraction by altering the arrangements

Correct Answer – E

James is a 42-year old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?

A “There are no such things as demons; what you saw were hallucinations.”
B “It is not possible for anyone to enter your room at night; you are safe here.”
C “You seem very upset; please tell me more about what you experienced last night.”
D “That must have been very frightening, but we’ll check on you at night and you’ll be safe.”

Correct Answer – C
Schizophrenia is best characterized as
A split personality.
B multiple personalities.
C ambivalent personality.
D deteriorating personality.

Correct Answer – D

The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

Which of the following would be assessed as a negative symptom of schizophrenia?
A Anhedonia
B Hostility
C Agitation
D Hallucinations

Correct Answer – A

Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

The type of altered perception most commonly experienced by clients with schizophrenia is

A delusions.
B illusions.
C tactile hallucinations.
D auditory hallucinations.

Correct Answer – D

Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

The most common course of schizophrenia is an initial episode followed by

A recurrent acute exacerbations and deterioration.
B recurrent acute exacerbations.
C continuous deterioration.
D complete recovery.

Correct Answer – A

Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

The causation of schizophrenia is currently understood to be

A a combination of inherited and non-genetic factors.
B deficient amounts of the neurotransmitter dopamine
C excessive amounts of the neurotransmitter serotonin
D stress related and ineffective stress management skills

Correct Answer – A

Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme non-genetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

Which symptom would NOT be assessed as a positive symptom of schizophrenia?

A Delusion of persecution
B Auditory hallucinations
C Affective flattening
D Idea of reference

Correct Answer – C

Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination

A is a projection of the client’s own feelings.
B derives from neuronal impulse misfiring.
C is a retained memory fragment.
D may signal seizure onset.

Correct Answer – A

One theory about derogatory hallucinations is that the content is a projection of the individual’s feelings about himself or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

Which side effect of antipsychotic medication is generally nonreversible?

A Anticholinergic effects
B Pseudoparkinsonism
C Dystonic reaction
D Tardive dyskinesia

Correct Answer – D

Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in A, B, and C often appear early in therapy and can be minimized with treatment.

A client diagnosed with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by
A chronic uncooperativeness.
B personality conflict.
C neural dysfunction.
D dependency needs.

Correct Answer – C

Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be

A “You are safe here in the hospital; nothing bad will happen to you.”
B “The voices are wrong about the hospital food. It is not contaminated.”
C “I understand that the voices are very real to you, but I do not hear them.”
D “Other people are eating the food, and nothing is happening to them.”

Correct Answer – C

This reply acknowledges the client’s reality but offers the nurse’s perception that he or she is not experiencing the same thing.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nurse

A interacting with a neutral attitude.
B using concrete language.
C giving multistep directions.
D providing nutritional supplements.

Correct Answer – C

The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

A nursing intervention designed to help a schizophrenic client manage relapse is to

A schedule the client to attend group therapy that includes those who have relapsed.
B teach the client and family about behaviors associated with relapse.
C remind the client of the need to return for periodic blood draws to minimize the risk for relapse.
D help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

Correct Answer – B

By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

A client diagnosed with paranoid schizophrenia tells the nurse, “I have to get away. The volmers are coming to execute me.” The term “volmers” can be assessed as

A a neologism.
B clang association.
C blocking.
D a delusion.

Correct Answer – A

A neologism is a newly coined word that has meaning only for the client.

When a client diagnosed with paranoid schizophrenia tells the nurse, “I have to get away. The volmers are coming to execute me,” an appropriate response for the nurse would be

A “You are safe here. This is a locked unit, and no one can get in.”
B “I do not believe I understand the word volmers. Tell me more about them.”
C “Why do you think someone or something is going to harm you?”
D “It must be frightening to think something is going to harm you.”

Correct Answer – D

This response focuses on the client’s feelings and neither directly supports the delusion nor denies the client’s experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer.

A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will

A ask for validation of reality.
B describe content of hallucinations.
C demonstrate a cool, aloof demeanor.
D identify prodromal symptoms of disorder.

Correct Answer – A

Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be

A safety and crisis intervention.
B acute symptom stabilization.
C stress and vulnerability assessment.
D social, vocational, and self-care skills.

Correct Answer – D

During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.

A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should

A suggest that the client take something for her fever and get extra rest.
B advise the physician that the client should be admitted to the hospital.
C arrange for the client to have blood drawn for a white blood cell count.
D consider recommending a change of antipsychotic medication.

Correct Answer – C

Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of

A acute dystonia.
B tardive dyskinesia.
C cholestatic jaundice.
D pseudoparkinsonism.

Correct Answer – B

An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia?

A Excessive sleeping with disturbing dreams
B Hearing voices telling him to hurt his roommate
C Withdrawal from college because of failing grades
D Chaotic and dysfunctional relationships with his family and peers

Correct Answer – B

People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true?

A Tara and Aaron have the same expectation of a poor long-term prognosis.
B Tara will experience more positive signs of schizophrenia such as hallucinations.
C Aaron will be more likely to hold a job and live a productive life.
D Tara has a better chance for positive outcomes because of later onset.

Correct Answer – D

Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis.

Which of the following is true regarding schizophrenia treatment and outcomes?
A If treated quickly following diagnosis, schizophrenia can be cured.
B Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations.
C Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.
D If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Correct Answer – C

Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

Declan is a 26-year-old patient with schizophrenia. He states to you, “My, oh my. My mother is brother. Anytime now it can happen to my mother.” Your best response would be:

A “You are having problems with your speech. You need to try harder to be clear.”
B “You are confused. I will take you to your room to rest a while.”
C “I will get you a prn medication for agitation.”
D “I’m sorry, I didn’t understand that. Do you want to talk more about your mother as we did yesterday?”

Correct Answer – D

The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on yourself, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes.

Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan’s mother’s question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone?

A All antipsychotic medications have an equal chance of producing EPSs.
B Newer antipsychotic medications have a higher risk for EPSs.
C Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics.
D Advise Declan’s mother to ask the provider to change the medication to clozapine instead of risperidone.

Correct Answer – C

Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

Mark, a 32 year old patient with schizophrenia, is found in a closet with an empty 2L bottle of cola taken from the staff refrigerator. The bottle had been full. The patient has also been drinking more form the hallway water cooler and taking drinks from his peers’ dinner trays. Recently, staff has noticed an increase in auditory hallucinations and the onset of confusion. Which response is most appropriate?

A Place Mark on every 15 minute checks to identify any further deterioration.
B Restrict his access to fluids and evaluate for water intoxication via daily weights
C Attempt to distract the patient for excess fluid intake and other bizarre behavior
D Request an increase in antipsychotic medication owing to the worsening of his psychosis

Correct Answer – B

Jordan is a 21 year old who was recently diagnosed with schizophrenia. He has had to drop out of college as the positive symptoms of his disease have made it impossible for him to pursue his dream of being an architect. He presents to the emergency room with flat affect, depressed mood and having auditory hallucinations telling him he is “no good to anyone anymore.” Which of the following statements is true regarding depression and schizophrenia?

A Anxiety and substance abuse are comorbid with schizophrenia, but not depression or dysphoria
B It is important to assess for depression in patients with schizophrenia, but suicide rarely occurs in this population of clients
C Assessing for depression and suicidal ideation in patients with schizophrenia is important since almost half of people with schizophrenia will attempt suicide
D The medications that will be given to control the positive symptoms of schizophrenia, such as auditory hallucinations, will alleviate any depressive symptoms a patient may have

Correct Answer – C

Tony, a 45 year old patient with schizophrenia, sometimes moves his lips silently or murmurs to himself when he does not realize others are watching. Sometimes when talking to others, he suddenly stops, appears distracted for a moment and then resumes. Based on these observations, Tony is likely experiencing:

A Illusions
B Delusional thinking
C Auditory hallucinations
D Impaired reality testing

Correct Answer – C

Julia, a 28 year old diagnosed with schizophrenia, is encouraged to attend groups but stays in her room instead. Staff and peers encourage her participation, but without success. Her hygiene is poor despite encouragement to shower and brush her teeth. She does not seem concerned that others wish she would behave differently. Which is the most likely explanation for Julia’s failure to respond to others’ efforts to help her behave in a more adaptive fashion? *Select all that apply*

A She is displaying avolition
B She is displaying anergia
C She is displaying negativism
D She is exhibiting paranoid delusions
E She is being resistant or oppositional
F She is apathetic due to her schizophrenia

Correct Answer – A, B & F

Kyle, a 23 year old patient diagnosed with schizophrenia, has been admitted to the psychiatric unit for one week. He has begun to take the first-generation antipsychotic haloperidol (Haldol). One day you find him sitting very stiffly and not moving. He is diaphoretic and when you ask if he is okay he seems unable to turn towards you or to respond verbally. You obtain his vital signs, which are as follows: BP 170/100, P 110, T 103. What are the priority nursing interventions? *Select all that apply*

A Begin to wipe him with a washcloth wet with cold water or alcohol
B Hold his medication and contact his provider stat
C Administer a medication such as benzotropine IM to correct his dystonic reaction
D Reassure him that although there is no treatment for his tardive dyskinesia, it will pass
E Explain that he has anticholinergic toxicity, hold his meds and give IM physostigmine
F Hold his medication tonight and consult his provider after completing medication rounds

Correct Answer – A & B
Crises that occur as an individual moves from one developmental level to another are called
A reactive crises.
B recurring crises.
C situational crises.
D maturational crises.

Correct Answer – D

Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective.

When a person becomes unemployed, he is likely to experience a(n)

A reactive crisis.
B situational crisis.
C adventitious crisis.
D substance abuse crisis.

Correct Answer – B

Situational crises arise from external sources. Examples are death of a loved one, divorce, marriage, or a change in health status.

When a tornado results in the loss of homes, businesses, and life, the town residents are likely to experience a(n)

A maturational crisis.
B situational crisis.
C adventitious crisis.
D endogenous crisis.

Correct Answer – C

An adventitious crisis is unplanned, accidental, and not part of everyday life. Examples are disasters and crimes of violence.

A crisis is so acutely uncomfortable to the individual that it is likely to self-resolve in

A 1 to 10 days.
B 1 to 3 weeks.
C 4 to 6 weeks.
D 3 to 4 months.

Correct Answer – C

At 4 to 6 weeks, the individual is making accommodations and adjustments to relieve anxiety, and the crisis is no longer a crisis.

The expected outcome at the conclusion of crisis intervention therapy is that the client will function

A at a higher level than before the crisis.
B at the precrisis level.
C only marginally below the precrisis level.
D without aid from identified support systems.

Correct Answer – B

The intent of crisis intervention is to return the individual to the precrisis level of functioning.

In the event of an adventitious crisis, which age group would be least in need of crisis intervention?

A Children
B Such crises seldom require intervention
C The elderly
D A distinction cannot be made

Correct Answer – D

The need for psychological first aid (crisis intervention) and debriefing after any crisis situation cannot be overstressed for all age groups (children, adolescents, adults, and the elderly).

The nurse caring for a client in crisis shows signs of a problematic nurse-client relationship by

A offering to change the time of the counseling session for the second time in 3 weeks.
B experiencing frustration about the decisions the client is making.
C giving the client permission to call him or her at home when the client “needs to talk.”
D suggesting that the client attend an extra counseling session each month.

Correct Answer – C

The behavior in option C is a reaction to the nurse’s need to be needed and undermines the client’s sense of self-reliance.

When a stressful event occurs and the individual is unable to resolve the situation by using his or her usual coping strategies, the individual

A becomes disorganized and uses trial-and-error problem solving.
B withdraws and acts as though the problem does not exist.
C develops severe personality disorganization.
D resorts to planning suicide.

Correct Answer – A

This is the second stage of crisis, according to accepted crisis theory.

A client is treated in the emergency department for injuries sustained while vacationing hundreds of miles away from home. To best meet the client’s emotional needs, the nurse should

A arrange to hospitalize the client.
B refer the client for traditional psychotherapy for posttraumatic stress disorder.
C provide temporary support by arranging shelter and contacting the client’s friends.
D suggest that contacting a victim support group would be more appropriate than crisis intervention.

Correct Answer – C

When a client has no support system, the nurse may assume that role for a short time.

Which statement would suggest to the crisis intervention nurse the need to arrange for hospitalization of a client?

A “I’m feeling overwhelmed by all that has happened, and I need help sorting it out.”
B “I see no solution for this situation if nothing changes by tomorrow.”
C “There are three possibilities that might help, but I can’t decide what to do.”
D “I feel a little calmer than yesterday at this time, but things are still very difficult.”

Correct Answer – B

Whenever the client presents a danger to himself or herself or others, hospitalization must be considered.

To assess the client’s perception of the event precipitating a crisis, the nurse would initially ask

A “What was happening just before you began feeling this way?”
B “During difficult times in the past, what has helped you?”
C “Can you give me the name of someone you trust?”
D “Who is available to help you?”

Correct Answer – A

Option A is the only query that is directed at the client’s perception of the precipitating event. The other options ask important questions but are not related to perception of the precipitating event.

Which assumption serves as a foundation for the use of crisis intervention?

A The individual is mentally healthy but in a state of disequilibrium.
B Long-term dysfunctional adjustment can be addressed by crisis intervention.
C An anxious person is unlikely to be willing to try new problem-solving strategies.
D Crisis intervention nurses need to remain passive as the client deals with the crisis.

Correct Answer – A

Only statement A is true.

The priority concern of the crisis intervention nurse is

A client safety.
B setting up future contacts.
C brainstorming possible solutions.
D working through termination issues.

Correct Answer – A

Client safety is always the priority concern in crisis intervention therapy. The disequilibrium of crisis predisposes the client to suicidal thinking.

Which situation has the potential for early crisis intervention to occur?

A Mrs. R tells the nurse in the well-baby clinic that she’s feeling uptight and has arranged to see a primary care therapist.
B Ms. T is hospitalized after an unsuccessful suicide attempt that she states, “was a mistake.”
C Mr. W asks for reassurance that he will be welcome at the day hospital after his hospital discharge.
D Ms. G enters the emergency department with a strong smell of alcohol on his person, stating he is anxious and depressed.

Correct Answer – A

Phase I intervention is when a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety. Option B indicates a phase 4 response to a crisis; option C would be a phase 3 response. In option D the client is using inappropriate coping mechanisms, which are not effective to treat depression and anxiety.

A 12-year-old finds herself feeling anxious and overwhelmed and seeks out the school nurse to report that “Everything is changing . . . my body, the way the boys who were my friends are treating me, everything is so different.” It is likely the child is

A describing personal identity disorder.
B experiencing a maturational crisis.
C potentially suicidal.
D mildly neurotic.

Correct Answer – B

The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary.

The nurse working with a client in crisis must initially assess for the client’s

A self-report of feeling depressed.
B unrealistic report of a crisis-precipitating event.
C report of a high level of anxiety.
D admission that he or she is abusing drugs.

Correct Answer – B

A person’s equilibrium may be adversely affected by one or more of the following: an unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms. These factors must be assessed when a crisis situation is evaluated because data gained from the assessment are used as guides for both the nurse and the client to set realistic and meaningful goals as well as to plan possible solutions to the problem situation.

A woman comes to the crisis intervention clinic and reports that her 16-year-old son uses drugs in the home and often assaults her. The nurse tells the client,

A “This is not an uncommon problem. Don’t worry.”
B “Together we will be able to work on this problem.”
C “Now that you are asking for help, everything will be all right.”
D “I have friends in law enforcement who can help us choose a solution.”

Correct Answer – B

The nurse takes an active collaborative role in problem resolution beginning with telling the client that a solution will be found.

A woman comes to the crisis intervention clinic expressing concern that her 16-year-old is using illegal drugs in their home.The nurse will

A encourage the mother to call the police when her son brings drugs home.
B inform her of the obligation to report this information to the police.
C work with the client to set goals that are mutually acceptable.
D refer the client to the police for consultation.

Correct Answer – C

Goal setting is a collaborative task. Goals must be acceptable to the client and seen by the nurse as safe and appropriate.

A client comes to the crisis intervention clinic and tearfully tells the nurse, “It is so painful! I have thought about it, and I cannot see how I can go on without my partner.” The nurse states, “You have resilience and will look back on this as a crisis you were able to manage.” Analysis of this interaction reveals that the nurse

A has a good understanding of the effect of time on perception of a crisis.
B is offering a statement of positive outcome based on client coping ability.
C has not followed up on the client’s verbal clues to suicidal thoughts.
D has stepped into the territory of traditional psychotherapy.

Correct Answer – C

Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client’s clues. This client clearly was open to discussing her suicidal thoughts, or she would not have said, “I cannot see how I can go on.”

When the client begins to sob uncontrollably and her speech becomes so incoherent that she is unable to give the nurse any information, the immediate interventions will focus on

A securing hospital admission.
B contacting a family member or close friend.
C lowering her anxiety level from severe to moderate.
D assisting the client to identify new effective coping strategies.

Correct Answer – C

Individuals with severe anxiety are not able to collaborate in problem solving. The nurse must assist the client to lower anxiety from severe to moderate or lower.

Mason and Charlie, both 16 years old, were involved in a bad car accident in which they were both passengers. Mason spoke with a counselor about the incident once and has been able to move forward with little dysfunction. Charlie has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained by:

A perception of the event.
B Mason’s more laid-back personality.
C the possibility that Charlie may have experienced previous trauma from which he did not fully recover.
D the possibility that counseling Charlie received may have been inadequate.

Correct Answer – A

People vary in the way they absorb, process, and use information from the environment. Some people may respond to a minor event as if it were life-threatening. Conversely, others may experience a major event and look at it in a calmer fashion. The other options may be true but are not the primary reason two people respond differently to the same event.

Carter, aged 36 years, comes to the crisis clinic for his first visit with complaints of not sleeping, anxiety, and excessive crying. He recently was fired suddenly from his job and 3 days later lost his home to a tornado that devastated the town he lives in. Which of the following statements regarding crisis accurately describes Carter’s situation?

A He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home.
B He is experiencing both a situational and an adventitious crisis.
C He is experiencing ineffective coping and should be hospitalized for intensive therapy.
D He is experiencing a situational crisis with the added stress of financial burden.

Correct Answer – B

It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. Carter lost his job (situational crisis) and also experienced the devastating effects of a tornado (adventitious crisis). The first option may be true but doesn’t accurately describe the crisis criteria. There is nothing in the scenario suggesting he needs acute hospitalization at this time. He is experiencing not only a situational crisis, but an adventitious one as well, which makes coping more difficult.

Tori is the nurse working with Carter and other members of the community after the tornado. As the weeks go by, she begins to feel anxious and distressed. She speaks to her nurse mentor about her feelings. Which of the following may Tori be experiencing?

A Reactionary grief
B Maturational crisis
C Vicarious traumatization
D Transference

Correct Answer – C

Even experienced nurses working in disaster situations can become overwhelmed when witnessing catastrophes such as loss of human life or mass destruction of people’s homes and belongings (e.g., floods, fires, tornadoes). Researchers have found that mental health care providers may experience psychological distress from working with traumatized populations, a phenomenon of secondary traumatic stress or “vicarious traumatization.” Reactionary grief does not describe secondary stress from working with such populations. A maturational crisis arises from disruption of a developmental stage. Transference describes feelings displaced onto the nurse or therapist by the patient.

Tori knows that Carter needs assistance with many aspects of getting through the crisis. Tori’s highest priority in Carter’s care is:

A reduction of Carter’s anxiety.
B development of new coping skills.
C prevention of boundary blurring.
D keeping Carter safe.

Correct Answer – D

The nurse’s initial task is to promote safety by assessing the patient’s potential for suicide or homicide. The other options are all important components of the care plan, but safety of the patient takes the highest priority.

Carter experiences each of the following during his crisis. Which of the following describes phase IV of Caplan’s phases of crisis?

A Carter experiences increased anxiety and feelings of extreme discomfort the day after the tornado.
B Carter comes to the crisis clinic complaining of depression and expresses that he does not want to go on living.
C Carter experiences a panic attack at his mother’s home in a nearby town where he is staying after the tornado.
D Carter experiences anxiety symptoms the day after he was fired.

Correct Answer – B

This describes phase IV, which, if coping is ineffective, may lead to depression, confusion, violence, or suicidality. The other options describe phase II, phase III, and phase I in Caplan’s phases of crisis.

Which statement about crisis theory will provide a basis for nursing intervention?

A A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable.
B A person in crisis has always had adjustment problems and has coped inadequately in his or her usual life situations
C Crisis is precipitated by an event that enhances a person’s self-concept and self-esteem
D Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis

Correct Answer – A

Lilly, a single mother of four, comes to the crisis center 24 hours after an apartment fire in which all the family’s household goods and clothing were lost. Lilly has no other family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. You assess the situation as:

A A maturational crisis
B A situational crisis
C An adventitious crisis
D An existential crisis

Correct Answer – C

When responding to the patient in question 2, the intervention that takes priority is to:

A Reduce anxiety
B Arrange shelther
C Contact out-of-area family
D Hospitalize and place the patient on suicide precautions

Correct Answer – A

Which belief would be least helpful for a nurse working in crisis intervention?

A A person in crisis is incapable of making decisions
B The crisis counseling relationship is one between partners
C Crisis counseling helps the patient refocus to gain new perspectives on situations
D Anxiety-reduction techniques are used so the patient’s inner resources can be accessed

Correct Answer – A
The highest-priority goal of crisis intervention is:
A Patient safety
B Anxiety reduction
C Identification of situational supports
D Teaching specific coping skills that are lacking
Correct Answer – A

Anger can best be defined as

A an unhealthy way of releasing anxiety.
B doing intentional harm to others.
C an expression of conflict with others.
D a normal response to a perceived threat.

Correct Answer – D

Anger is one of the primary emotions and is not in itself a disorder.

The factor most likely to contribute to a client’s escalating anger is

A watching violence on television.
B another client’s depressed mood.
C a staff member telling him that he is inappropriate.
D a staff member asking him to help another client.

Correct Answer – C

Punitive, threatening, accusatory, or challenging statements to the client should be avoided; rather, the nurse should determine what is behind the client’s feelings and behaviors.

Which assessment finding is the best predictor of violence in a newly admitted client?

A A recent assault on a drinking companion.
B A family history of bipolar disorder
C The nurse’s subjective feeling that the client is uncooperative.
D A childhood history of being bullied at school

Correct Answer – A

The best predictor of violence is past episodes of violent behavior.

Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression?

A Social isolation
B Risk for other-directed violence
C Ineffective coping: overwhelmed
D Ineffective coping: maladaptive

Correct Answer – B

Risk for other-directed violence is the priority diagnosis. The nurse then must determine which of two other diagnoses—ineffective coping: overwhelmed or ineffective coping: maladaptive—is appropriate. Social isolation is not an initial concern.

Which neurotransmitter imbalance has been shown to be related to impulsive aggression?

A Low levels of ã-aminobutyric acid
B Low levels of serotonin
C High levels of dopamine
D High levels of acetylcholine

Correct Answer – B

Low serotonin levels have been implicated in several research studies as being a factor in impulsive aggression.

When working with an angry client, it is best to
A encourage the client to fully explore and express his or her anger.
B help the client deny and repress the feelings of anger.
C help the client reframe the anger-producing situation.
D ignore the client’s anger and change the subject.

Correct Answer – C

De-escalation occurs more quickly with this strategy than when other approaches are used.

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of

A isolation.
B confidence.
C competence.
D vulnerability.

Correct Answer – D

The progression is vulnerability, perception of event as a threat, arousal, and then uneasiness and anxiety.

Which would be the most appropriate response by the nurse to help a client who is demonstrating escalating anger?

A Walk the client to his room and help him practice stress-reduction techniques, such as deep breathing or muscle relaxation
B Suggest that the client spend some time in the gym with a punching bag to relieve his stress
C Suggest that the client spend some time pacing rapidly in the hallway until he feels less stressed
D Sit with the client in the day room so that he can vent his anger and not isolate himself

Correct Answer – A

In settings in which the staff can reasonably expect episodes of client anger and aggression, regular teaching and practice of verbal and nonverbal interventions are essential. The most appropriate response by the nurse would be to help the client to a quiet environment and teach or coach the client to use positive coping skills.

The more a nurse’s intervention is prompted by emotion

A the less likely it is to be therapeutic.
B the less likely it is to be aggressive.
C the more likely it is to be effective.
D the more likely it is to be empathetic.

Correct Answer – A

One study reported in the text found that the nurse’s response to anger from a client varied according to the interpretation given to the client’s anger and to the nurse’s self-appraised ability to manage the situation. Only when self-efficacy was perceived as adequate did the nurse move to help the client. When self-efficacy was not seen as adequate, nurses showed a decreased ability to process the client’s message and a decreased ability to problem-solve.

The most restrictive method for dealing with an aggressive client who is out of control is

A seclusion.
B a show of force.
C verbal intervention.
D antipsychotic medication.

Correct Answer – A

Seclusion is the most restrictive method listed, because it curtails the client’s freedom of ambulation

Ghe client at highest risk for violence directed at others is one who

A has a history of recurrent severe depression.
B is in an alcohol rehabilitation program.
C has delusions of persecution.
D who has somatic symptoms for which no organic basis is found.

Correct Answer – C

The client who perceives others to be against him may lash out if he feels threatened.

A client experiencing manic hyperactivity stands up, glares challengingly at clients and staff, and shouts, “This food is garbage! I’ll fight anyone who says it’s not!” The nurse’s most relevant assessment is that the client

A is upset with the quality of the food.
B is getting rid of tension in a harmless way.
C is frustrated by limits imposed by hospitalization.
D has a high potential for other-directed violence.

Correct Answer – D

The client’s offers to fight are suggestive of a high potential for violence. Clients may have coping skills that are adequate for day-to-day events in their lives but are overwhelmed by the stresses of illness or hospitalization. Other clients may have a pattern of maladaptive coping, which is marginally effective and consists of a set of coping strategies that have been developed to meet unusual or extraordinary situations.

Which intervention strategy should be avoided by staff working with a client who is shouting and flailing his arms?

A Defusing the situation by laughing or making a joke of the challenge
B Saying “Let’s go to your room to talk about this”
C Moving a few staff close together as a group to provide a show of force
D Allowing one staff person to speak to the client while others provide support

Correct Answer – A

Ridiculing a client should always be avoided. The other options are constructive approaches to deescalation.

An adolescent male is swearing and shouting at his physician, who refused to give him a pass to leave the unit. This behavior

A is acceptable if directed at staff but not when directed at other clients.
B may reduce tension and prevent the client from physically acting out.
C is a major indicator that the client may become physically aggressive.
D can be attributed to lack of parental controls applied at an early age.

Correct Answer – C

Physical aggression is preceded by anger, which may be expressed by swearing and shouting, pacing, and other menacing behaviors.

A client waiting to see the physician is pacing and looking both angry and tense. When it’s determined that the client won’t be seen for another 30 minutes, the nurse addresses the client’s agitation by
A telling the client that pacing will not help the rate at which clients are seen.
B adjusting the appointment schedule to allow the client to be seen next.
C empathizing with the long wait and asking the client if he would mind sitting down until his turn comes.
D explaining to the client what caused the back-up and suggesting that he has time to go to the coffee shop.

Correct Answer – D

Taking time to explain to clients and offering measures that will provide comfort can be helpful in reducing tension and anger associated with waiting.

An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior?
A Tell him they will not change his dressing if he is going to abuse them.
B When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control.
C Assure him they will complete the dressing change as quickly as possible.
D Explain that they are professionals and unused to being shouted at by people they are trying to help.

Correct Answer – B

The nurse is using behavioral techniques to reinforce desirable behavior (spending time with the client when he is calm) and limit reinforcement of undesirable behavior (leaving when he is acting out anger).

A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, “I will calm down when that nurse isn’t in my face.” The nurse best demonstrates the ability to help the client deescalate by

A continuing to manage the situation personally.
B telling the client, “It isn’t safe for me to leave the room.”
C moving to the rear of the staff group.
D apologizing for upsetting the client.

Correct Answer – C

There is no need for the nurse to stand her ground to save face. The goal is to deescalate the situation. When the client makes a request that can be met without compromising safety, granting the request is acceptable.

A client has a history of demonstrating aggression physically. An appropriate short-term goal to help the client manage this anger is to

A strike objects rather than people.
B limit aggression to verbal outbursts.
C isolate in lieu of striking people.
D identify situations that precipitate hostility.

Correct Answer – D

The identification of situations that create hostile feelings must occur if the client is to develop new coping strategies.

When a client diagnosed with a cognitive deficit experiences a catastrophic reaction, the priority intervention is to

A decrease sensory stimuli.
B smile and call the client by name.
C take the client to the bathroom.
D calmly ask the client what’s wrong.

Correct Answer – B

Getting the client’s attention by calling his or her name is necessary. Smiling is necessary to convey the lack of a threat.

A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include

A observation every 30 minutes.
B releasing the client every 8 hours.
C increasing sensory stimulation.
D providing for nutrition and hydration.

Correct Answer – D

Clients must be given meals on schedule and frequently offered cold liquids in paper cups (at least every 2 hours; hourly if the client is highly hyperactive).

Peter, a 21-year-old patient, asks you, “What’s wrong with my brain that I have such a problem with aggression?” Your response is based on the knowledge that:

A the prevailing theory is that diminishment of stress hormones causes anger and aggression.
B no abnormalities of the brain have been identified that correlate with anger and aggression.
C the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.
D personality type plays a much greater part in anger and aggression than physical factors.

Correct Answer – C

These have all been implicated by research as playing a part in anger and aggression. The other responses are untrue.

One older concept that is being used currently that may help in violence reduction in patients is:

A aired grievances.
B trauma-informed care.
C shared governance.
D learned helplessness.

Correct Answer – B

Trauma-informed care is an older concept of providing care that has been reintroduced. It is based on the notion that disruptive patients often have histories that include violence and victimization. These traumatic histories can impede patients’ ability to self-soothe, result in negative coping responses, and create a vulnerability to coercive interventions (e.g., restraint) by staff. Trauma-informed care focuses on the patients’ past experiences of violence or trauma and the role it currently plays in their lives. The other options do not refer to a care concept that helps reduce violence.

You are working in the emergency department. You notice Matt, your patient’s husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which of the following statements to Matt may help prevent escalation and/or violence?

A “You need to stay with your wife. She needs you.”
B “Hey, what’s up buddy? You look pissed.”
C “I am calling security to deal with your behavior.”
D “You appear upset. Can I help you with anything?”

Correct Answer – D

Approaching a patient or a visitor with a calm, sincere, and caring manner can de-escalate a situation because the person may feel you are interested in helping. The other responses will not prevent escalation and may in fact anger the person further.

You are working on an adolescent psychiatric unit. Katy, aged 16 years, has been angry all day because her boyfriend was not allowed to visit last night. Katy is in the hallway and begins yelling, “It’s not fair! You all hate me! I hate this place!” She begins pounding her fists on the wall. To deal with the situation and prevent further escalation, your best response would be to say:

A “Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?”
B “Katy, you may yell and bang your fists but you must do it in your own room so you don’t upset the other patients.”
C “Katy, stop that right now! You will not be allowed to behave like that!”
D “Katy, you will have to go into seclusion and restraints right now.”

Correct Answer – A

Approaching the patient in a calm manner and giving choices may de-escalate the situation and gives the patient some control. The patient would not be allowed to yell or possibly hurt herself alone in her room. Commands such as “stop that right now!” could further escalate the situation. Seclusion and restraint may be premature because the situation may be able to be resolved using least restrictive means.

When you approach Katy, what considerations should you take?

A Stand close to Katy for reassurance and to convey caring.
B Have other staff as backup, and stand far enough away to avoid injury.
C Take Katy to her room so you can speak with her alone.
D Call security and wait until they arrive before approaching Katy.

Correct Answer – B

Safety considerations for staff include enlisting other staff to be present, keeping a safe distance from the patient, and approaching the patient in a nonthreatening or nonconfrontational manner. The other options do not allow for staff safety; security personnel may escalate the patient’s behavior and should be kept in the background until needed to assist. Furthermore, the patient has an immediate need to be assisted by staff if possible without waiting for security.

You are caring for Malcolm, an 83 year old African American patient with Alzheimer’s Disease. Malcolm exhibits agitated behavior at times, especially when he feels he is missing work, and he sometimes attempts to leave the unit to “get to the school where I teach.” Which of the following interventions is appropriate for de-escalating Malcolm’s agitation?

A Medicate Malcolm with prn medication at regular intervals to prevent agitation
B Repeatedly explain to Malcolm that he is retired and no longer teaches as the repetition will reinforce the patient’s orientation
C Use validation therapy and ask Malcolm about the school and his job
D reduce stimulation in the environment by having Malcolm sit by himself in his room until the agitation passes.

Correct Answer – C

Ian makes the following statements to you while admitting him. Which statement indicates an increased likelihood of violent behavior?

A “When I get mad, I want to be left alone.”
B “Last time I was in here, I ended up in seclusion for punching my roommate.”
C “My old man was meek and mild and I’ve always said I’m not going to be like him.”
D “My girlfriend says I yell way too much and she’s threatened to leave me.”

Correct Answer – B

You respond to a loud, angry voice coming from the day room where you find Alex pacing and shouting that he isn’t “going to take this (expletive) anymore.” Which of the following responses is likely to be helpful in de-escalating Alex? *Select all that apply*

A Remain calm, quiet and in control
B Tell Alex that his actions are unacceptable and that he must go to his room
C Match Alex’s volume level so that he is able to hear over his own shouting
D Ask Alex if he can tell you what is upsetting him so you may be able to help
E Stand close to Alex so you can intervene physically if needed to help others
F Tell Alex that he could be placed in seclusion if he cannot control himself so that the patient is aware of negative consequences

Correct Answer – A & D

Andie is a patient anxiously waiting her turn to speak with you. As you are very busy, you ask Andie if she can wait a few minutes so that you can finish your task. Unfortunately, the task takes longer than anticipated and you are delayed getting back to Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak with you. Which response is most likely to be therapeutic at this time?

A “You are angry that I didn’t speak with you when I promised I would.”
B “I’m sorry for being late but screaming at me is not the best way to handle it.”
C “You are too angry to talk right now. I’ll come back in 20 minutes and we can try again.”
D “Why are you angry? I told you that I was busy and would get to you as soon as I could.”

Correct Answer – A

Which statement about violence and nursing is accurate?

A Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence
B To date, no legislation exists that addresses workplace violence against nurses
C Emergency, psychiatric and step-down units have the highest rates of violence toward staff
D Violence primarily affects inexperienced or unskilled staff who cannot calm their patients

Correct Answer – C

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