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TEST BANK
Psychiatric Mental Health Nursing, 9th Edition
by Sheila Videbeck, Chapters 1 - 24 Complete

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TABLE OF CONTENTS
T T T

UNIT 1 Current Theories and Practice

Chapter 1. Foundations of Psychiatric–Mental Health Nursing
Chapter 2. Neurobiologic Theories and Psychopharmacology
Chapter 3. Psychosocial Theories and Therapy
Chapter 4. Treatment Settings and Therapeutic Programs
UNIT 2 Building the Nurse–Client Relationship
Chapter 5. Therapeutic Relationships
Chapter 6. Therapeutic Communication
Chapter 7. Client’s Response to Illness
Chapter 8. Assessment
UNIT 3 Current Social and Emotional Concerns
Chapter 9. Legal and Ethical Issues
Chapter 10. Grief and Loss
Chapter 11. Anger, Hostility, and Aggression
Chapter 12. Abuse and Violence
UNIT 4 Nursing Practice for Psychiatric Disorders
Chapter 13. Trauma and Stressor-Related Disorders
Chapter 14. Anxiety and Anxiety Disorders
Chapter 15. Obsessive–Compulsive and Related Disorders
Chapter 16. Schizophrenia
Chapter 17. Mood Disorders and Suicide
Chapter 18. Personality Disorders
Chapter 19. Addiction
Chapter 20. Eating Disorders
Chapter 21. Somatic Symptom Illnesses
Chapter 22. Neurodevelopmental Disorders
Chapter 23. Disruptive Behavior Disorders
Chapter 24. Cognitive Disorders

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Chapter 1 Foundations of Psychiatric–Mental Health Nursing

1. The nurse is assessing the factors contributing to the well-

being of a newly admittedclient. Which of the following would the nurse i
dentify as having a positive impact on the individual's mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) ATfamily history of mental illness
D) Striving for total self-
relianceTAns: B
Feedback:
Individual factors influencing mental health include biologic makeup, autono
my, independence, self-
esteem, capacity for growth, vitality, ability to find meaning in life,emotion
al resilience or hardiness, sense of belonging, reality orientation, and coping
or stress management abilities. Interpersonal factors such as intimacy and a
balance of separateness and connectedness are both needed for good mental
health, and therefore ahealthy person would need others for companionship.
A family history of mental illness could relate to the biologic makeup of an i
ndividual, which may have a negativeimpact on an individual's mental health
, as well as a negative impact on an individual's interpersonal and socialñcult
ural factors of health. Total self-
reliance is not possible, and a positive social/cultural factor is access to ade
quate resources.

2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive d
ependencyon or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effecti
vely withdaily life.
E) Individuals suffering from mental illness may experience dissatisfacti
on withrelationships and self.
Ans: A, D, E
Feedback:
Mental illness can cause significant distress, impaired functioning, or both. Me
ntal illness may be related to individual, interpersonal, or social/cultural fact
ors. Excessivedependency on or withdrawal from relationships are interperson
al factors that relate tomental illness. Individuals suffering from mental illnes
s can feel overwhelmed with daily life. Individuals suffering from mental illnes
s may experience dissatisfaction withrelationships and self.

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3. Which of the following are true regarding mental health and mental illness?
A) Behavior that may be viewed as acceptable in one culture is
alwaysunacceptable in other cultures.
B) It is easy to determine if a person is mentally healthy or mentally ill.
C) In most cases, mental health is a state of emotional, psychological, a
nd socialwellness evidenced by satisfying interpersonal relationships,
effective behaviorand coping, positive self-
concept, and emotional stability.
D) Persons who engage in fantasies are me
ntallyill. Ans: C
Feedback:
What one society may view as acceptable and appropriate behavior, another s
ociety maysee that as maladaptive, and inappropriate. Mental health and me
ntal illness are difficultto define precisely. In most cases, mental health is a s
tate of emotional, psychological, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and coping, positive self-
concept, and emotional stability. Persons who engage in fantasies may be men
tally healthy, but the inability to distinguish reality from fantasyis an individu
al factor that may contribute to mental illness.

4. A client grieving the recent loss of her husband asks if she is becoming
mentallyill because she is so sad. The nurse's best response would be,
A) You may have a temporary mental illness because you are experiencing
so muchpain.
B) You are not mentally ill. This is an expected reaction to the loss y
ou haveexperienced.
C) Were you generally dissatisfied with your relationship before your hu
sband'sdeath?
D) Try not to worry about that right now. You never know what the
future brings.TAns:TB
Feedback:
Mental illness includes general dissatisfaction with self, ineffective relationshi
ps, ineffective coping, and lack of personal growth. Additionally the behavior
must not be culturally expected. Acute grief reactions are expected and ther
efore not considered mental illness. False reassurance or overanalysis does not
accurately address the client'sconcerns.

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5. The nurse consults the DSM for which of the following purposes?
A) To devise a plan of care for a newly admitted client
B) To predict the client's prognosisTof treatment outcomes
C) To document the appropriate diagnostic code in the client's medical record
D) To serve as a guide for client assess
mentTAns: D
Feedback:
The DSMTprovides standard nomenclature, presents defining characteristics, a
nd identifies underlying causes of mental disorders. It does not provide care
plans or prognostic outcomes of treatment. Diagnosis of mental illness is not
within the generalist RN's scope of practice, so documenting the code in the m
edical record wouldbe inappropriate.

6. Which would be a reason for a student nurse to use the DSM?

A) Identifying the medical diagnosis
B) Treat clients
C) Evaluate treatments
D) Understand the reason for the admission and the nature of ps
ychiatricillnesses.TAns:TD
Feedback:
Although student nurses do not use the DSM to diagnose clients, they will fin
d it a helpful resource to understand the reason for the admission and to beg
in building knowledge about the nature of psychiatric illnesses. Identifying the
medical diagnosis,treating, and evaluating treatments are not a part of the n
ursing process.

7. The legislation enacted in 1963 was largely responsible for which of the f
ollowingshifts in care for the mentally ill?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitalization
D) Improved rights for clients in long-
term institutional careTAns: A
Feedback:
The Community Mental Health Centers Construction Act of 1963 accomplished
therelease of individuals from long-
term stays in state institutions, the decrease in admissions to hospitals, and t
he development of community-
based services as an alternative to hospital care.

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8. Which one of the following is a result of federal legislation?

A) Making it easier to commit people for mental health treatment against their will.
B) Making it more difficult to commit people for mental health treatme
nt againsttheir will.
C) State mental institutions being the primary source of care for mentally ill persons.
D) Improved care for mentally ill pers
ons.TAns: B
Feedback:
Commitment laws changed in the early 1970s, making it more difficult to com
mit people for mental health treatment against their will. Deinstitutionalizat
ion accomplished the release of individuals from long-
term stays in state institutions. Deinstitutionalization also had negative effects
in that some mentally ill persons are subjected to the revolving door effect, w
hich may limit care for mentally ill persons.

9. The goal of the 1963 Community Mental Health Centers Act was to
A) ensure patients' rights for the mentally ill.
B) deinstitutionalize state hospitals.
C) provide funds to build hospitals with psychiatric units.
D) treat people with mental illness in a humane f
ashion.TAns: B
Feedback:
The 1963 Community Mental Health Centers Act intimated the movement towa
rd treating those with mental illness in a less restrictive environment. This leg
islation resulted in the shift of clients with mental illness from large state inst
itutions to carebased in the community. Answer choices A, C, and D were not p
urposes of the 1963 Community Mental Health Centers Act.

10. The creation of asylums during the 1800s was meant to

A) improve treatment of mental disorders.
B) provide food and shelter for the mentally ill.
C) punish people with mental illness who were believed to be possessed.
D) remove dangerous people with mental illness from the com
munity.TAns:TB
Feedback:
The asylum was meant to be a safe haven with food, shelter, and humane treat
ment for the mentally ill. Asylums were not used to improve treatment of men
tal disorders or topunish mentally ill people who were believed to be possess
ed. The asylum was not created to remove the dangerously mentally ill from
the community.

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11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual resi
dents.TAns: A, C
Feedback:
Clients were often far removed from the local community, family, and frien
ds becausestate institutions were usually in rural or remote settings. Choic
es B and D were notmajor problems associated with large state instruction
s.

12. A significant change in the treatment of people with mental illness occur
red in the1950s when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient's Bill of Rights was enacted.
D) psychotropic drugs became available fo
r use.TAns: D
Feedback:
The development of psychotropic drugs, or drugsTused to treat mental illne
ss, beganin the 1950s. Answer choices A, B, and C did not occur in the 195
0s.

13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public's amusement.
D) providingTa safe refuge or haven offering prote
ction.TAns:TC
Feedback:
In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing an
d ridiculing the mentally ill, who were seen as animals, less than human. Cust
odial carewas not often provided as persons who were considered harmless
were allowed to wander in the countryside or live in rural communities, and
more dangerous lunatics were imprisoned, chained, and starved. In early Chris
tian times, primitive beliefs and superstitions were strong. The mentally ill w
ere viewed as evil or possessed. Priests performed exorcisms to rid evil spirits
, and in the colonies, witch hunts were conductedwith offenders burned at th
e stake. It was not until the period of enlightenment when persons who were
mentally ill were offered asylum as a safe refuge or haven offering protection
at institutions.

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14. The first training of nursesTtoTworkTwithTpersonsTwith mental illness was

TinT1882Tin which state?

A) California
B) Illinois
C) Massachusetts
D) New York
Ans: C Feedb
ack:
The first training for nurses to work with persons with mental illness was in 18
82 atMcLean Hospital in Belmont, Massachusetts.

15. What is meant by the term revolving door effect in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and
persistentmental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment s
ettingsTAns: B
Feedback:
The revolving door effect refers to shorter, but more frequent, hospital stays.
Clients arequickly discharged into the community where services are not adeq
uate; without adequate community services, clients become acutely ill and re
quire rehospitalization. The revolving door effect does not refer to flexible tre
atment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if u
tilized appropriately could result in stabilization and less need for emergency d
epartment visitsand/or rehospitalization. The revolving door effect does not r
elate to the incidence of severe mental illness.

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16. Which of the following statements is true of treatment of people with me

ntal illnessin the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community
programsand support.
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are
declining.TAns: C
Feedback:
Only one in four (25%) adults needing mental health care receives the needed
services.Substance abuse issues cannot be dealt with in the 3 to 5 days typica
l for admissions in the current managed care environment. Money saved by sta
tes when state hospitals wereclosed has not been transferred to community p
rograms and support. Although people with severe and persistent mental illne
ss have shorter hospital stays, they are admitted tohospitals more frequently.
In some cities, emergency department visits for acutely disturbed persons h
ave increased by 400% to 500%.

17. Which of the following is the priority of the Healthy People 2020 objec
tives formental health?
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental ill
nessTAns: D
Feedback:
The objectives are to increase the number of people who are identified, diag
nosed, treated, and helped to live healthier lives. The objectives also strive to
decrease rates ofsuicide and homelessness, to increase employment among t
hose with serious mental illness, and to provide more services both for juveni
les and for adults who are incarcerated and have mental health problems. An
swer choices A, B, and C are not priorities of Healthy People 2020.

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18. Which is a positive aspect of treating clients with mental illness in a co

mmunity-based care?
A) You will not be allowed to go out with your friends while in the program.
B) You will have to have supervision when you want to go anywhere els
e in thecommunity.
C) You will be able to live in your own home while you still
see atherapist regularly.
D) You will have someone in your home at all times to askTquestions if you h
ave anyconcerns.
Ans: C
Feedback:
Clients can remain in their communities, maintain contact with family and fr
iends, andenjoy personal freedom that is not possible in an institution. Full
-time home care is not included in community-based programs.

19. One of the unforeseen effects of the movement toward communit

y mentalhealth services is
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health s
ervices.TAns: C
Feedback:
Although people with severe and persistent mental illness have shorter hospi
tal stays, they are admitted to hospitals more frequently. Although deinstitu
tionalization reducedthe number of public hospital beds by 80%, the numbe
r of admissions to those beds correspondingly increased by 90%. The number
of individuals with mental illness did not change.

20. Which is included in Healthy People 2020 objectives?

A) ToTdecrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, tr
eated, andhelped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for men
tal illnessTAns:TB
Feedback:
One of the Healthy People 2020 objectives is to increase the number of people
who are identified, diagnosed, treated, and helped to live healthier lives. It ma
y not be possible todecrease the incidence of mental illness. At this time, the
focus is on ensuring that persons with mental illness are receiving needed trea
tment. It may not be possible or desirable to provide mental health services o
nly in the community.

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21. A client diagnosed with a mild anxiety disorder has been referred to trea
tment in acommunity mental health center. Treatment most likely prov
ided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilizati
on.TAns:TA
Feedback:
Community mental health centers focus on rehabilitation, vocational needs, ed
ucation,and socialization, as well as on management of symptoms and medic
ation. Daily therapies, constant supervision, and stabilization require a more
acute care inpatient setting.

22. Which of the following is defined as an advanced-

level function in the practice areaof psychiatric mental health nursing?
A) Case management
B) Counseling
C) Evaluation
D) Health teachi
ngTAns:TC
Feedback:
Advanced-
level functions are psychotherapy, prescriptive authority, consultation andliaiso
n, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-
level functions in the practice area of psychiatric mental health nursing.

23. Psychiatric nursing became a requirement in nursing education i

n whichyear? A) 1930
B) 1940
C) 1950
D) 1960
Ans: C
Feedback:
It was not until 1950 that the National League for Nursing, which accredits nurs
ingprograms, required schools to include an experience in psychiatric nursing.

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24. A new graduate nurse has accepted a staff position at an inpatient mental hea
lth facility.The graduate nurse can expect to be responsible for basic-
level functions, including
A) providing clinical supervision.
B) using effectiveTcommunication skills.
C) adjusting client medications.
D) directing progra
mdevelopment. Ans:
B Feedback:
Basic-level functions include counseling, milieu therapy, self-
care activities, psychobiologic interventions, health teaching, case managem
ent, and health promotionand maintenance. Advanced-
level functions include psychotherapy, prescriptive authority for drugs, consu
ltation and liaison, evaluation, program development and management, and
clinical supervision.

25. Which one of the following is one of the American Nurses Association sta
ndardsof practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatric and mental health registered nurses.
B) All aspects of Standard 5: Implementation may be carr
ied outby psychiatric and mental health registered nu
rses.
C) Some aspects of Standard 5: Implementation may only be car
ried outby psychiatric and mental health advanced practice n
urses.
D) Psychiatric and mental health advanced practice nurses are the only
ones whomay provide milieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmental health advanced practice r
egisterednurses in accordance with state and federal laws and regulations. St
andards 5DñG are advanced practice interventions and may be performed only
by the psychiatricñmental health advanced practice registered nurse. Psychiat
ricñmental health registered nurses may provide milieu therapy according to
Standard 5C. This is not restricted to psychiatricñmental health advanced pra
ctice nurses.

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26. Which of the following is a standard of professional performance?

A) Assessment
B) Education
C) Planning
D) Implementati
onTAns: B
Feedback:
Education is a standard of professional performance. Other standards of profess
ionalperformance include the quality of practice, professional practice evalu
ation, collegiality, collaboration, ethics, research, resource utilization, and lea
dership.
Assessment, planning, and implementation are components of the nursing proc
ess, notstandards of professional performance.

27. Which of the following is a standard of practice?

A) Quality of care
B) Outcome identification
C) Collegiality
D) Performance apprai
salTAns:TB
Feedback:
Standards of practice include assessment, diagnosis, outcomes identification, p
lanning,implementation, coordination of care, health teaching and health pro
motion, and milieutherapy. The standards of professional performance include
quality of practice, education, professional practice evaluation, collegiality, c
ollaboration, ethics, research, resource utilization, and leadership.

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28. A student appears very nervous on the first day of clinical in a psychiatri
c setting. The student reviews the instructor's guidelines and appropriatel
y takes which of thefollowing actions? Select all that apply.
A) Tells the client about personal events and interests
B) Discusses the anxious feelings with the instructor
C) Assumes that the client's unwillingness to talk to a student n
urse is apersonal insult or failure
D) Builds rapport with the patient before asking personal questions
E) Consults the instructor if a shocking situation arises
F) Gravitates to clients that the student ma
y knowpersonallyTAns: B, D, E
Feedback:
ListeningTcarefully, showing genuine interest, and caring about the client are
extremelyimportant rather than speaking about oneself. The student must dea
l with his or her ownanxiety about approaching a stranger to talk about very se
nsitive and personal issues.
Student nurses should not see the client's unwillingness to talk to a student
nurse as apersonal insult or behavior. Being available and willing to listen are
often all it takes to begin a significant interaction with someone. Questions
involving personal matters should not be the first thing a student says to the
client. These issues usually arise aftersome trust and rapport have been est
ablished. The nursing instructor and staff are always available to assist if th
e client is shocking or distressing to the student. If the student recognizes s
omeone he or she knows, it is usually best for the student to talk with the c
lient and reassure him or her about confidentiality. The client should be re
assured that the student will not read the client's record and will not be ass
igned to work with the client.

29. The appropriate action for a student nurse who says the wrong thing is to
A) pretend that the student nurse did not say it.
B) restate it by saying, That didn't come out right. What I meant was...
C) state that it was a joke.
D) ignore the error, since no o
ne isperfect.TAns: B
Feedback:
No one magic phrase can solve a client's problems; likewise, no single statem
ent can significantly worsen them. Listening carefully, showing genuine inter
est, and caring about the client are extremely important. A nurse who possess
es these elements but says something that sounds out of place can simply resta
te it by saying, That didn't come outright. What I meant wasÖ Pretending tha
t the student nurse did not say it, stating that itwas a joke, and ignoring the e
rror are not likely to help the student nurse build and maintain credibility wit
h the client.

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Chapter 2. Neurobiologic Theories and Psychopharmacology

1. The nurse is assessing a patient suffering a head injury as a result of an alterc

ation with two other individuals. The patient has difficulty accurately report
ing the events of the altercation and appears very emotional during the asses
sment. The nurse suspects whichpart of the brain received the greatest amo
unt of injury?
A) Cerebrum
B) Cerebellum
C) Medulla
D) Amygdal
aTAns:TA Feed
back:
The frontal lobes of the cerebrum control the organization of thought, body m
ovement, memories, emotions, and moral behavior. The cerebellum is located
below the cerebrumand is the center for coordination of movements and postu
ral adjustments. The medulla,located at the top of the spinal cord, contains
vital centers for respiration and cardiovascular functions. The hippocampus a
nd amygdala are involved in emotional arousal and memory.

2. An abnormality of which of the following structures of the cerebru

m wouldbe associated with schizophrenia?
A) Parietal lobes
B) Frontal lobe
C) Occipital lobe
D) Temporal lob
esTAns: B
Feedback:
Abnormalities in the frontal lobes are associated with schizophrenia, attention
deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interp
ret sensations oftaste and touch and assist in spatial orientation. The tempora
l lobes are centers for the senses of smell and hearing and for memory and e
motional expression. The occipital lobe assists in coordinating language gener
ation and visual interpretation, such as depth perception.

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3. A patient with bipolar disorder asks the nurse, Why did I get this illness? I do
n't wantto be sick. The nurse would best respond with,
A) People who develop mental illnesses often had very traumatic ch
ildhoodexperiences.
B) There is some evidence that contracting a virus during childhood ca
n lead tomental disorders.
C) Sometimes people with mental illness have an overactive immune system.
D) We don'tTfully understand the cause, but mental illnesses do seem
to run infamilies.
Ans: D
Feedback:
Current theories and studies indicate that several mental disorders may be link
ed to aspecific gene or combination of genes, but that the source is not solel
y genetic; nongenetic factors also play important roles. ATcompromised immun
e system could contribute to the development of a variety of illnesses, partic
ularly in populations already genetically at risk. Maternal exposure to a virus
during critical fetal development of the nervous system may contribute to m
ental illness.

4. Which of the following statements about the neurobiologic causes of men

tal illnessis most accurate?
A) GeneticsTand heredity can explain all causes of mental illness.
B) Viral infection has been proven to be the cause of schizophrenia.
C) There is no evidence that the immune system is related to mental illness.
D) Several mental disorders may be linked to genetic and non
geneticfactors.TAns: D
Feedback:
Current theories and studies indicate that several mental disorders may be li
nked to a specific gene or combination of genes, but that the source is not s
olely genetic; nongenetic factors also play important roles. Most studies invol
ving viral theories have focused on schizophrenia, but so far none has provide
d specific or conclusive evidence.ATcompromised immune system could contri
buteTto the development of a variety of illnesses, particularly in populations a
lready genetically at risk. So far, efforts to link aspecific stressor with a speci
fic disease have been unsuccessful. When the inflammatoryresponse is critica
lly involved in illnesses such as multiple sclerosis or lupus erythematosus, mo
od dysregulation and even depression are common.

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5. Which of the following is an inhibitory neurotransmitter?

A) Dopamine
B) GABA
C) Norepinephrine
D) Epinephrin
eTAns: B Feedb
ack:
GABA is the major inhibitory neurotransmitter in the brain and has been
found tomodulate other neurotransmitter systems rather than to provid
e a direct stimulus. Dopamine, norepinephrine, and epinephrine are exc
itatory neurotransmitters.

6. Which of the following is a neuromodulator?

A) Neuropeptides
B) Glutamate
C) Dopamine
D) GABAT
Ans: A Fee
dback:
Neuropeptides are neuromodulators. Glutamate and dopamine are excitatoryn
eurotransmitters. GABATis an inhibitory neurotransmitter.

7. A nurseTis leading a medication education group for patients with depression.

ATpatient states he has read that herbal treatments are just as effective as pr
escription medications.The best response is,
A) When studies are published they can be trusted to be accurate.
B) We need to look at the research very closely to see how reliable the studies are.
C) Your prescribed medication is the best for your condition, so you should
not readthose studies.
D) Switching medications will alter the course of your illness. It is not a
dvised.TAns: B
Feedback:
Often, reports in the media regarding new research and studies are confusin
g, contradictory, or difficult for clients and their families to understand. The
nurse must ensure that clients and families are well informed about progress in
these areas and mustalso help them to distinguish between facts and hypothe
ses. The nurse can explain if or how new research may affect a client's treat
ment or prognosis. The nurse is a good resource for providing information an
d answering questions.

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8. The nurse is preparing a patient for an MRI scan of the head. The nurse sh
ould askthe patient,
A) Have you ever had an allergic reaction to radioactive dye?
B) Have you had anything to eat in the last 24 hours?
C) Does your insurance cover the cost of thisTscan?
D) Are you anxious about being in tight spac
es?TAns: D
Feedback:
The person undergoing an MRI must lie in a small, closed chamber and rema
in motionless during the procedure, which takes about 45 minutes. Those wh
o feel claustrophobic or have increased anxiety may require sedation before
the procedure. PET scans require radioactive substances to be injected into t
he bloodstream. A patient is not required to fast before brain imaging studies.
VerifyingTinsurance benefits is not aprimary role of the nurse.

9. How should the nurse respond to a family member who asks how Alzheimer's
diseaseis diagnosed?
A) It is impossible to know for certain that a person has Alzheimer's disease until the
person dies and his or her brain can be examined via autopsy.
B) Positron emission tomography (PET) scans can identify the amyloid
plaquesand tangles of Alzheimer's disease in living clients.
C) Alzheimer's disease can be diagnosed by using chemical markers that de
monstratedecreased cerebral blood flow.
D) It will be necessary for the patient to undergo positron emission
tomography (PET) scans regularly for a long period of time to kno
w if thepatient has Alzheimer's disease.
Ans: B
Feedback:
Positron emission tomography (PET) scans can identify the amyloid plaques an
d tanglesof Alzheimer's disease in living clients. These conditions previously co
uld be diagnosed only through autopsy. Some persons with schizophrenia also d
emonstrate decreased cerebral blood flow. ATlimitation of PET scans is that the
use of radioactive substances limits the number of times a person can underg
o these tests.

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10. A patient is being seen in the crisis unit reporting that poison letters are
coming inthe mail. The patient has no history of psychiatric illness. Whic
h of the following medications would the patient most likely be started
on?
A) Aripiprazole (Abilify)
B) Risperidone (Risperdal Consta)
C) Fluphenazine (Prolixin)
D) Fluoxetine (Proza
c)TAns:TA
Feedback:
New-
generation antipsychotics are preferred over conventional antipsychotics bec
ause they control symptoms without some of the side effects. Injectable anti
psychotics, suchas Risperdal Consta, are indicated after the client's conditio
n is stabilized with oral doses of these medications. Prozac is an antidepress
ant and is not indicated to relieveof psychotic symptoms.

11. Which one of the following types of antipsychotic medications is most l

ikely toproduce extrapyramidal effects?
A) Atypical antipsychotic drugs
B) First-generation antipsychotic drugs
C) Third-generation antipsychotic drugs
D) Dopamine system stabiliz
ersTAns: B
Feedback:
The conventional, or first-
generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This
makes them effective in treating target symptoms but also produces many ex
trapyramidal side effects because of the blocking of the D2 receptors. Newer,
atypical or second-
generation antipsychotic drugs are relatively weakTblockers of D2, which may
account for the lower incidence of extrapyramidal side effects. The third gen
eration of antipsychotics, called dopamine system stabilizers, is being develop
ed. These drugs are thought to stabilize dopamine output that resultsTin contro
l of symptomswithout some of the side effects of other antipsychotic medicat
ions.

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12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10

mg. daily. The patient asks the nurse how this medicine works. The nurse
explains that the mechanism by which the olanzapine controls the patient'
s psychotic symptoms isbelieved to be
A) increasing the amount of serotonin and norepinephrine in the brain.
B) decreasing the amount of an enzyme that breaks down neurotransmitters.
C) normalizing the levels of serotonin, norepinephrine, and dopamine.
D) blocking dopamine receptors in
thebrain.TAns:TD
Feedback:
The major action of all antipsychotics in the nervous system is to block recepto
rs for theneurotransmitter dopamine. SSRIs and TCSs act by blocking the reupt
ake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, a
n enzyme that breaks down neurotransmitters. Lithium normalizes the reupta
ke of certain neurotransmitters such as serotonin, norepinephrine, acetylchol
ine, and dopamine.

13. A patient with depression has been taking paroxetine (Paxil) for the last 3
months and has noticed improvement of symptoms. Which of the followin
g side effects would the nurse expect the patient to report?
A) ATheadache after eating wine and cheese
B) ATdecrease in sexual pleasure during intimacy
C) An intense need to move about
D) Persistent run
nynose Ans:TB Feed
back:
Sexual dysfunction can result from enhanced serotonin transmission associate
d with SSRI use. Headache caused by hypertension can result when combining
MAOIs with foods containing tyramine, such as aged cheeses and alcoholic bev
erages. SSRIs cause less weight gain than other antidepressants. Dry mouth and
nasal passages are common anticholinergic side effects associated with all ant
idepressants. An intense need to moveabout (akathisia) is an extrapyramidal
side effect that would be expected of an antipsychotic medication. Furtherm
ore, sedation is a common side effect of Paxil.

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14. Which one of the following drugs should the nurse expect the patient t
o requireserum level monitoring?
A) Anticonvulsants
B) Wellbutrin
C) Lithium
D) Proza
cTAns: C Fe
edback:
Toxicity is closely related to serum lithium levels and can occur at therapeu
tic doses. For clients taking lithium and the anticonvulsants, monitoring bloo
d levels periodicallyis important.

15. Which of the following disorders are extrapyramidal symptoms that may b
e causedby antipsychotic drugs? Select all that apply.
A) Akathisia
B) Pseudoparkinsonism
C) Neuroleptic malignant syndrome
D) Dystonia
E) Anticholinergic effects
F) Breast tenderness in men and wo
menTAns: A, B, D
Feedback:
Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia
. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs
but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal
symptom. Breasttenderness in men and women is also a potential side effect
of antipsychotic drugs thatcause elevated prolactin levels, but it is not an ext
rapyramidal symptom.

16. Which of the following antidepressant drugs is a preferred drug for clien
ts at highrisk of suicide?
A) Tranylcypromine (Parnate)
B) Sertraline (Zoloft)
C) Imipramine (Tofranil)
D) Phenelzine (Nard
il)TAns:TB
Feedback:
SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for th
ose whoare potentially suicidal or highly impulsive because they carry no ri
sk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Par
nate and Nardil areMAOIs. Tofranil is a cyclic compound.

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17. The nurse knows that the client understands the rationale for dietary r
estrictionswhen takingTMAOI when the client makes which of the follo
wing statements?
A) I am now allergic to foods that are high in the amino acid tyramine
such asaged cheese, organ meats, wine, and chocolate.
B) Certain foods will cause me to have sexual dysfunction when I ta
ke thismedication.
C) Foods that are high in tyramine will reduce the medication's effectiveness.
D) I should avoid foods that are high in the amino acid tyramine such as
aged cheese, meats, and chocolate because this drug causes the leve
l of tyramine togo up to dangerous levels.
Ans: D
Feedback:
Because the enzyme MAO is necessary to break down the tyramine in certain f
oods, itsinhibition results in increased serum tyramine levels, causing severe,
hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardi
ac dysrhythmias.
Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a co
mmonside effect of MAOIs. There is no evidence that foods high in tyramine w
ill increase sexual dysfunction or reduce the medication's effectiveness.

18. A client who is taking paroxetine (Paxil) reports to the nurse that he has b
een nauseated since beginning the medication. Which of the following actio
ns is indicatedinitially?
A) Instruct the client to stop the medication for a few days to see if the nausea goes
away.
B) Reassure the client that this is an expected side effect that will improve with time.
C) Suggest that the client take the medication with food.
D) Tell the client to contact the physician for a ch
ange inmedication.TAns:TC
Feedback:
Taking selective serotonin reuptake inhibitors with food usually eliminates nau
sea. There is a delayed therapeutic response to antidepressants. The client s
hould not stop taking the drug. It would be appropriate to reassure the client
that this is an expected side effect that will improve with time, but that woul
d not be done initially. ATchange inmedication may be indicated if the nausea
is intolerable or persistent, but that would not be done initially.

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19. In planning for a client's discharge, the nurse must know that the most se
rious riskTfor the client taking a tricyclic antidepressant is which of the f
ollowing?
A) Hypotension
B) Narrow-angle glaucoma
C) Seizures
D) Suicide b
yoverdose Ans
: DFeedback:
Cyclic antidepressants (including tricyclic antidepressants) are potentially leth
al if takenin an overdose. The cyclic antidepressants block cholinergic recep
tors, resulting in anticholinergic effects such as dry mouth, constipation, uri
nary hesitancy or retention, dry nasal passages, and blurred near vision. More
severe anticholinergic effects such asagitation, delirium, and ileus may occur
, particularly in older adults. Other common sideeffects include orthostatic hy
potension, sedation, weight gain, and tachycardia. ClientsTmay develop toler
ance to anticholinergic effects (such as orthostatic hypotension and worsenin
g of narrow-
angle glaucoma, but these side effects are common reasons that clients disco
ntinue drug therapy. The risk of seizures is increased by bupropion, which is
a different type of antidepressant.

20. A client with severe and persistent mental illness has been taking antipsychoti
c medication for 20 years. The nurse observes that the client's behavior includ
es repetitivemovements of the mouth and tongue, facial grimacing, and rocki
ng back and forth. The nurse recognizes these behaviors as indicative of
A) extrapyramidal side effects
B) loss of voluntary muscle control
C) posturing
D) tardive dyskines
iaTAns: D
Feedback:
The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesi
a, a syndrome of permanent involuntary movements, is most commonly caused
by the long-
term use of conventional antipsychotic drugs. Extrapyramidal side effects are r
eversible movement disorders induced by antipsychotic or neuroleptic medicat
ion. The client's behavior is not a loss of voluntary control or posturing.

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21. A client is seen in the clinic with clinical manifestations of an inability to sit
still and arigid posture. These side effects would be correctly identified as
which of the following?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisi
aTAns:TD Feed
back:
Akathisia is reported by the client as an intense need to move about. The clien
t appearsrestless or anxious and agitated, often with a rigid posture or gain a
nd a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) in
clude involuntary movements of the tongue, facial and neck muscles, upper a
nd lower extremities, and truncal musculature. Tongue thrusting and protrud
ing, lip smacking, blinking, grimacing, and other excessive unnecessary facial
movements are characteristic.
Neuroleptic malignant syndrome is a potentially fatal reaction manifested b
y rigidity,high fever, and autonomic instability. Acute dystonia includes acu
te muscular rigidityand cramping, a stiff or thick tongue with difficulty swal
lowing, and, in severe cases,laryngospasm and respiratory difficulties.

22. Which of the following is a term used to describe the occurrence of the e
ye rollingback in a locked position, which occurs with acute dystonia?
A) Opisthotonus
B) Oculogyric crisis
C) Torticollis
D) Pseudoparkinsonis
mTAns: B
Feedback:
Oculogyric crisis is the occurrence of the eye rolling back in a locked positio
n, whichoccurs with acute dystonia. Opisthotonus is tightness in the entire b
ody with the head back and an arched neck. Torticollis is twisted head and
neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acu
te dystonia. Pseudoparkinsonism isdrug-
induced parkinsonism and is often referred to by the generic label of extrap
yramidal side effects.

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23. Which of the following medications rarely causes extrapyramidal side effects (EPS)?
A) Ziprasidone (Geodon)
B) Chlorpromazine (Thorazine)
C) Haloperidol (Haldol)
D) Fluphenazine (Prolixi
n)TAns: A
Feedback:
First-
generation antipsychotic drugs cause a greater incidence of EPS than do atypi
calantipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazin
e, Haldol,and Prolixin are all first-generation antipsychotic drugs.

24. Which of the following increases the riskTfor neuroleptic malignant syndrome (NMS)?
A) Overhydration
B) Intake of vitamins
C) Dehydration
D) Vegetarian di
etTAns: C
Feedback:
Dehydration, poor nutrition, and concurrent medical illness all increase the r
isk for NMS. Overhydration is opposite of dehydration and would therefore no
t increase therisk of NMS. Intake of vitamins would likely reduce the risk of
NMS as it would improve nutritional status. Vegetarian diet would not relate
to NMS.

25. Which of the following was the first nonstimulant medication specifically desi
gned andtested for ADHD?
A) Methylphenidate (Ritalin)
B) Amphetamine (Adderall)
C) Atomoxetine (Strattera)
D) Pemoline (Cyler
t)TAns: C
Feedback:
Strattera was the first nonstimulant medication specifically designed and tes
ted for ADHD. The primary stimulant drugs used to treat ADHD are methylphen
idate (Ritalin),amphetamine (Adderall), and pemoline (Cylert).

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26. Which of the following is the primary consideration with clients taking antidepressants?
A) Decreased mobility
B) Emotional changes
C) Suicide
D) Increased sle
epTAns:TC
Feedback:
Suicide is always a primary consideration when treating clients with depression.

27. Which of the following would not be included as a symptom o

f drug-induced parkinsonism?
A) Stooped posture
B) Cogwheel rigidity
C) Drooling
D) Tachycardi
aTAns:TD Feedb
ack:
Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and droo
ling are allsymptoms of pseudoparkinsonism. Other symptoms of pseudoparki
nsonism include mask-
like facies, decreased arm swing, a shuffling, festinating gait, tremor, and co
arse pill-rolling movements of the thumb and fingers while at rest.

28. Which drug classification is the primary medication treatment for schizophrenia?
A) Anticoagulants
B) Antidepressants
C) Antimanics
D) Antipsychoti
csTAns: D
Feedback:
Antipsychotic drugs are the primary medical treatment for clients diagnosed wi
thschizophrenia and are also used in psychotic episodes of acute mania, psych
oticdepression, and drug-induced psychosis.

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29. A client on the unit suddenly cries out in fear. The nurse notices that the cl
ient's headis twisted to one side, his back is arched, and his eyes have roll
ed back in their sockets. The client has recently begun drug therapy with h
aloperidol (Haldol). Based on this assessment, the first action of the nurse
would be to
A) get a stat. order for a serum drug level.
B) hold the client's medication until the symptoms subside.
C) place an urgent call to the client's physician.
D) give a PRN dose of benztropine (Cogen
tin)IM.TAns: D
Feedback:
The client is having an acute dystonic reaction; the treatment is anticholiner
gic medication. Dystonia is most likely to occur in the first weekTof treatment,
in clientsyounger than 40 years, in males, and in those receiving high-
potency drugs such asHaldol. Immediate treatment with anticholinergic drugs
usually brings rapid relief.

30. One weekTafter beginning therapy with thiothixene (Navane), the client de
monstratesmuscle rigidity, a temperature of 103∞F, an elevated serum crea
tinine phosphokinaselevel, stupor, and incontinence. The nurse should noti
fy the physician because thesesymptoms are indicative of
A) acute dystonic reaction.
B) extrapyramidal side effects.
C) neuroleptic malignant syndrome.
D) tardive dyskinesi
a.TAns: C
Feedback:
The client demonstrates all the classic signs of neuroleptic malignant syndr
ome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick
tongue with difficulty swallowing, and, in severe cases, laryngospasm and re
spiratory difficulties. Extrapyramidal side effects are reversible movement dis
orders induced by antipsychoticor neuroleptic medication. Tardive dyskinesia
isTa late-
onset, irreversible neurologic side effect of antipsychotic medications charac
terized by abnormal, involuntary movements, such as blinking, chewing, and
grimacing.

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31. A client with bipolar disorder has been taking lithium, and today his ser
um bloodlevel is 2.0 mEq/L. What effects would the nurse expect to se
e?
A) Constipation and postural hypotension
B) Fever, muscle rigidity, and disorientation
C) Nausea, diarrhea, and confusion
D) None; the serum level is in therapeutic
rangeTAns: C
Feedback:
Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and leve
ls of morethan 1.5 mEq/L are usually considered toxic. The client would sho
w signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithiu
m are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of
coordination.

32. For a client taking clozapine (Clozaril), which of the following symptoms sh
ould thenurse report to the physician immediately as it may be indicative
of a potentially fatal side effect?
A) Inability to stand still for 1 minute
B) Mild rash
C) Photosensitivity reaction
D) Sore throat and mala
iseTAns: D
Feedback:
Clozapine (Clozaril) produces fewer traditional side effects than do most antip
sychotic drugs, but it has the potentially fatal side effect of agranulocytosis.
This develops suddenly and is characterized by fever, malaise, ulcerative sore
throat, and leukopenia. This side effect may not be manifested immediately a
nd can occur up to 24 weeks afterthe initiation of therapy. Any symptoms of in
fection must be investigated immediately. Agranulocytosis isTcharacterized by
fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photos
ensitivity reaction are not serious side effects.

33. A patient with bipolar disorder takes lithium 300 mg three times d
aily. Thenurse evaluates that the dose is appropriate when the pa
tient reports
A) feeling sleepy and less energetic.
B) weight gain of 7 pounds in the last 6 months.
C) minimal mood swings.
D) increased feelings of self-
worth.TAns:TC
Feedback:
Mood-
stabilizing drugs are used to treat bipolar disorder by stabilizing the client's
mood, preventing or minimizing the highs and lows that characterize bipolar il
lness, andtreating acute episodes of mania. Weight gain is a common side eff
ect, and fatigue andlethargy may indicate mild toxicity. Inflated self-
worth is a target symptom of bipolar disorder, which should diminish with eff
ective treatment.

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34. When the client experiences facial flushing, a throbbing headache, nausea an
d vomitingafter consuming alcohol while taking Disulfiram (Antabuse), the n
urse is aware that this is due to which of the following?
A) ATmild side effect of the medication.
B) The intended therapeutic result.
C) An idiosyncratic reaction
D) ATsevere allergy to t
hemedication. Ans: B Fe
edback:
Disulfiram is a sensitizing agent that causes an adverse reaction when mixed
with alcohol in the body. Five to ten minutes after a person taking disulfiram in
gests alcohol,symptoms begin to appear: facial and body flushing from vasodi
lation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizzines
s, and weakness. These symptoms are not mild side effects because these are
very uncomfortable symptoms.
These symptoms would not be an idiosyncratic reaction because this is the exp
ectedreaction. These symptoms are not indicative of a severe allergy to the m
edication.

35. When the client asks the nurse how long it will take before the SSRI ant
idepressant medication will be effective, which of the following replies i
s mostaccurate and therapeutic?
A) This is a good medication! It will be effective within 20 minutes of the first dose.
B) You will have gradual improvement in symptoms over theTnext few we
eks, butthe changes may be so subtle that you may not notice them
for a while. It is important for you to keep taking the medication.
C) It will probably take months for the medication to work. In the meant
ime, youshould work on improving your attitude.
D) If you believe it will work, then it will. You have to have
faith!TAns:TB
Feedback:
SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of
thesedrugs are an initiating event and that eventual therapeutic effectiveness r
esults whenneurons respond more slowly, making serotonin available at the s
ynapses. The medication will not be effective within 20 minutes of the first d
ose, and it will not likely take monthsTfor the medication. Attitude and faith
will improve with the medication's effectiveness.

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36. A client has a lithium level of 1.2 mEq/L. Which of the following interven
tions bythe nurse is indicated?
A) Call the physician for an increase in dosage.
B) Do not give the next dose, and call the physician.
C) Increase fluid intake for the next week.
D) No intervention is necessary at
thistime. Ans: D
Feedback:
The lithium level is within the therapeutic range. Serum levels of less than
0.5 mEq/Lare rarely therapeutic, and a level of more than 1.5 mEq/L is us
ually considered toxic. Answers A, B, and C are not appropriate interventi
ons for the given lithium level.

37. A patient is seen for frequent exacerbation of schizophrenia due to nonad

herence tomedication regimen. The nurse should assess for which of the
following common contributors to nonadherence?
A) The patient is symptom-
free and therefore does not need to adhere tothe medicatio
n regimen.
B) The patient cannot clearly see the instructions written on the prescription bottle.
C) The patient dislikes the weight gain associated with antipsychotic therapy.
D) The patient sells the antipsychotics to addict
s in theneighborhood. Ans: C
Feedback:
Patients with schizophrenia are less likely to exercise or eat low-
fat nutritionally balanced diets; this pattern decreases the likelihood that the
y can minimize potential weight gain or lose excess weight. Antipsychotics sho
uld be taken regularly and not omitted when free of symptoms. Antipsychotics
do not adversely affect vision, nor dothey have addictive potential.

38. Which of the following side effects of lithium are frequent c

auses ofnoncompliance? Select all that apply.
A) Metallic taste in the mouth
B) Weight gain
C) Acne
D) Thirst
E) Letharg
yTAns: B, E F
eedback:
Lethargy and weight gain areTdifficult to manage or minimize and frequently le
ad tononcompliance.

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39. The nurse is educating a patient and family about strategies to minimize the s
ide effectsof antipsychotic drugs. Which of the following should be included
in the plan? Selectall that apply.
A) Drink plenty of fruit juice.
B) DevelopingTan exercise program is important.
C) Increase foods high in fiber.
D) Laxatives can be used as needed.
E) Use sunscreen when outdoors.
F) For missed doses, take double the dose at the next sc
heduledtime.TAns: B, C, E
Feedback:
Drinking sugar-free fluids and eating sugar-
free hard candy ease dry mouth. The client should avoid calorie-
laden beverages and candy because they promote dental caries, contribute to
weight gain, and do little to relieve dry mouth. Methods to prevent or reliev
e constipation include exercising and increasing water and bulk-
forming foods in the diet. Stool softeners are permissible, but the client shoul
d avoid laxatives. The use ofsunscreen is recommended because photosensitiv
ity can cause the client to sunburn easily. If the client forgets a dose of antips
ychotic medication, he or she can take the missed dose if it is only 3 or 4 hou
rs late. If the dose is more than 4 hours overdue or the next dose is due, the
client can omit the forgotten dose.

40. The nurse has completed health teaching about dietary restrictions for a cl
ient takinga monoamine oxidase inhibitor. The nurse will know that teachin
g has been effectiveby which of the following client statements?
A) I'm glad I can eat pizza since it's my favorite food.
B) I must follow this diet or I will have severe vomiting.
C) It will be difficult for me to avoid pepperoni.
D) None of the foodsTthat are restricted are part of a regul
ar dailydiet.TAns:TC
Feedback:
Pepperoni is one of the foods containing tyramine, so it must be avoided. Parti
cular concern to this client is the potential life-
threatening hypertensive crisis if the clientingests food that contains tyramin
e. Answer choices A, B, and D are inappropriate statements toward effective t
eaching for the client receiving a monoamine oxidase inhibitor.

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41. When teaching a client about restrictions for tranylcypromine (Parnate),

the nursewill tell the client to avoid which of the following foods?
A) Broad beans
B) Citrus fruit
C) Egg products
D) Fried food
sTAns: A Feedb
ack:
Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, a
nd broadbeans contain tyramine. Answers citrusTfruit, egg products, and
fried foods are nottyramine- containing foods.

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Chapter 3. Psychosocial Theories and Therapy

1. The nurse understands that crises are self-

limiting. This implies that upon evaluationof crisis intervention, the nurse
should assess for which outcome?
A) The patient will identify possible causes for the crisis.
B) The patient will discover a new sense of self-sufficiency in coping.
C) The patient will resume the precrisis level of functioning.
D) The patient will express anger regarding the
crisisevent.TAns:TC
Feedback:
Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is res
olved in one of three ways. In the first two, the person either returns to his or
her precrisis level of functioning or begins to function at a higher level; both
are positive outcomes for the individual. The third resolution is that the perso
n's functioning stabilizes at a level lowerthan precrisis functioning, which is a
negative outcome for the individual. Assisting the person to use existing supp
orts or helping the individual find new sources of support can decrease the fe
elings of being alone or overwhelmed. The patient may develop guiltif he or s
he examines possible causes for the crisis. Expression of anger at 4 to 6 weeks
indicates a less than favorable outcome of crisis intervention.

2. A patient who has been working on controlling impulsive behavior s

hows astrengthening ego through which of the following behavior
s?
A) Going to therapy only when there is nothing more desirable to do
B) Weighing the advantages and disadvantages before making a decision
C) Telling others in the group the right way to act
D) Reporting having fun at a recent s
ocialeventTAns:TB
Feedback:
The id is the part of one's nature that reflects basic or innate desires such as
pleasure-
seeking behavior, aggression, and sexual impulses. The id seeks instant gratific
ation, causes impulsive unthinking behavior, and has no regard for rules or soci
al convention. The superego is the part of a person's nature that reflects mora
l and ethical concepts, values, and parental and social expectations; therefore
, it is in direct opposition to the id. The third component, the ego, is the balanc
ing or mediating force between the id and thesuperego. The ego represents m
ature and adaptive behavior that allows a person to function successfully in th
e world.

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Page 1

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3. A patient has just been told she has cervical cancer. When asked about h
ow this isimpacting her, she states, It's just an infection; it will clear up
. The statement indicates that this patient
A) needs education on cervical cancer.
B) is unable to express her true emotions.
C) should be immediately referred to a cancer support group.
D) is using denial to protect herself from an emotionally
painfulthought.TAns:TD
Feedback:
Ego defense mechanisms are methods of attempting to protect the self and
cope withbasic drives or emotionally painful thoughts, feelings, or events.
Most defense mechanisms operate at the unconscious level of awareness, s
o people are not aware ofwhat they are doing and often need help to see th
e reality. Education and referrals are premature at this point in the patient'
s ability to cope.

4. A teenage patient defies the nurse's repeated requests to turn off the video g
ame and goto sleep. The teen says angrily, You sound just like my mother at h
ome! and continues to play the video game. The nurse understands that this
statement likely indicates
A) the need of stricter discipline at home.
B) early signs of oppositional defiant disorder.
C) viewing the nurse as her mother.
D) expression of developing autono
my.TAns: C
Feedback:
Transference occurs when the client displaces onto the therapist attitudes an
d feelingsthat the client originally experienced in other relationships. Transf
erence patterns areautomatic and unconscious in the therapeutic relationshi
p. The occurrence of transference does not indicate ineffective parenting or
disciplinary practices, nor is itindicative of a disorder. Autonomy is develope
d much earlier in the toddler years.

5. A patient reports a pattern of being suspicious and mistrusting of oth

ers, causing difficulty in sustaining lasting relationships. Which stage
according toErikson's psychosocial development was not successfully c
ompleted?
A) Trust
B) Autonomy
C) Initiative
D) Industr
yTAns: ATFee
dback:
The formation of trust is essential: mistrust, the negative outcome of this stag
e, willimpair the person's development throughout his or her life.

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6. The nurse has established a therapeutic relationship with a patient. The p

atient is beginning to share feelings openly with the nurse. The relationship
has entered whichphase according to Peplau's theory?
A) Orientation
B) Identification
C) Exploitation
D) Resolutio
nTAns: B Feed
back:
The orientation phase is directed by the nurse and involves engaging the clie
nt in treatment, providing explanations and information, and answering quest
ions. The identification phase begins when the client works interdependently
with the nurse, expresses feelings, and begins to feel stronger. In the exploita
tion phase, the client makes full use of the services offered. In the resolution
phase, the client no longer needs professional services and gives up dependen
t behavior and the relationship ends.

7. A nurse is meeting with a crisis support group. In efforts to help patient

s identifywith one another, the nurse explains which of the following a
bout the crisis experience?
A) Even happy events can cause a crisis if the stress is overwhelming.
B) Only people who have unfortunate life events will experience a crisis.
C) ATperson has no control over how a crisis will affect him or her.
D) People can prevent all crises if they develop good coping skills
early.TAns: A
Feedback:
Not all events that result in crisis are negative in nature. Events like marri
age, retirement, and childbirth are often desirable for the individual but
may still present overwhelming challenges. All individuals can experience a
crisis when they confrontsome life circumstance or stressor that they cann
ot effectively manage through use oftheir customary coping skills. A numbe
r of factors can influence how a person experiences a crisis.

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8. Which of the following theories could be classified as humanistic theorie

s? Selectall that apply.
A) Cognitive therapy
B) Maslow's hierarchy of needs
C) Gestalt therapy
D) Rogers' client-centered therapy
E) Rational emotive therapy
F) Piaget's cognitive stages of develop
mentTAns: B, D
Feedback:
Humanism represents a significant shift away from the psychoanalytic view of
the individual as a neurotic, impulse-
driven person with repressed psychic problems and away from the focus on and
examination of the client's past experiences. Humanistictheories include Masl
ow's hierarchy of needs and Rogers' client-centered therapy.
Cognitive therapy is an existential therapy that focuses on immediate though
t processingóhow a person perceives or interprets his or her experience and de
termines how he or she feels and behaves. Gestalt therapy is an existential t
herapy that emphasizes the person's feelings and thoughts in the here and no
w. Rational emotive therapy is an existential theory that looks at irrational be
liefs and automatic thoughts that make people unhappy. Piaget's cognitive stag
es of development is a developmentaltheory.

9. Which of the following are examples of adventitious crises? Select all that apply.
A) Death of a loved one
B) Natural disasters
C) Violent crimes
D) War
E) Leaving home for the fi
rsttimeTAns: B, C, D
Feedback:
Adventitious crises include natural disasters like floods, earthquakes, or hurric
anes; war,terrorist attacks; riots; and violent crimes such as rape or murder.
Maturational or developmental crises are predictable events in the normal co
urse of life, such as leavinghome for the first time, getting married, having a
baby, and beginning a career.
Situational crises are unanticipated or sudden events that threaten the i
ndividual'sintegrity, such as the death of a loved one, loss of a job, an
d physical or emotional illness in the individual or family member.

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10. A nursing supervisor reprimands an employee for being chronically late for
work. If the employee handles the reprimand using the defense mechanism
of displacement, hewould most likely do which of the following?
A) Argue with the supervisor that he is usually on time
B) Make a special effort to be on time tomorrow
C) Tell fellow employees that the supervisor is picking on him
D) Tell the unit housekeeper that his w
ork issloppyTAns: D
Feedback:
Displacement involves venting feelings toward another, less threatening pers
on. Arguing is denial. Making a special effort is compensation. Telling fellow e
mployeesthat the supervisor is picking on him is projection.

11. The nurse is assessing a client who is talking about her son's recent dea
th but who shows no emotion of any kind. The nurse recognizes this beh
avior as whichof the following defense mechanisms?
A) Dissociation
B) Displacement
C) Intellectualization
D) Suppressio
nTAns: C Feedb
ack:
The client is aware of the facts of the situation but does not show the emoti
ons associated with the situation. Dissociation involves dealing with emotional
conflict by atemporary alteration in consciousness or identity. Displacement is
the ventilation of intense feelings toward a person less threatening than the
one who aroused those feelings. Suppression is replacing the desired gratificat
ion with one that is more readilyavailable.

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12. A college student decides to go to a party the night before a major exam inst
ead of studying. After receiving a low score on the exam, the student tells a f
ellow student, I have to workTtoo much and don't have time to study. It would
n't matter anyway becausethe teacher is so unreasonable. The defense mech
anisms the student is using are
A) denial and displacement
B) rationalization and projection
C) reaction formation and resistance
D) regression and compensat
ionTAns:TB
Feedback:
When stating that it wouldn't matter if the student studied, the student is us
ing rationalization, which is excusing own behavior to avoid guilt, responsibilit
y, conflict, anxiety, or loss of self-
respect. When stating that the teacher is unreasonable, the studentis using pr
ojection or the unconscious blaming of unacceptable inclinations or thoughts
as an external object. Denial is the failure to acknowledge an unbearable con
dition.
Displacement is the ventilation of intense feelings toward persons less threat
ening thanthe one who aroused those feelings. Reaction formation is acting t
he opposite of what one thinks or feels. Resistance is overt or covert antagon
ism toward remembering or processing anxiety-
producing information. Regression is moving back to a previous development
al stage to feel safe or have needs met. Compensation is overachievement in
one area to offset real or perceived deficiencies in another area.

13. A client is supposed to be ambulating ad lib. Instead, he refuses to get out o

f bed, asksfor a bed bath, and makes many demands of the nurses. He also y
ells that they are lazyand incompetent. The client's behavior is an example
of which of the following defense mechanisms?
A) Introjection
B) Projection
C) Rationalization
D) Reaction formati
onTAns: B
Feedback:
Projection is blaming unacceptable thoughts on others; the client cannot acc
ept the factthat he may be lazy or incompetent to care for himself. Introjecti
on is accepting anotherperson's attitudes, beliefs, and values as one's own. R
ationalization is excusing one's own behavior to avoid guilt, responsibility, co
nflict, anxiety, or loss of self-concept.
Reaction formation is acting the opposite of what one thinks or feels.

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14. A client begins to take stockTof his life and look into the future. The nurs
e assessesthat this client is in which of Erikson's developmental stages?
A) Identity versus role confusion
B) Industry versus inferiority
C) Integrity versus despair
D) Generativity versus stagna
tionTAns: C
Feedback:
Erikson's stage of integrity versus despair is when an adult begins to reflect o
n his or her life. Identity versus role confusion occurs in adolescence when th
e person is forming a sense of self and belonging. Integrity versus despair occ
urs in maturity; accepting responsibility for oneself and life is the correspond
ing task. Generativity versus stagnation occursTin middle adulthood, which incl
udes the tasks of being creativeand productive and establishing the next gene
ration.

15. A basic assumption of Freud's psychoanalytic theory is that

A) all human behavior can be caused and can be explained.
B) human behavior is entirely unconscious.
C) free association is the key to understanding.
D) sexuality does not relate to beh
avior.TAns: A
Feedback:
Freud believed that everything we do has meaning, whether it is conscious o
r unconscious. Freud believed that human behavior can be motivated by subc
onscious thoughts and feelings but could also be in the preconscious or unconsc
ious. Freud based his theory of childhood development on the belief that sexua
l energy, termed libido, wasthe driving force of human behavior.

16. Which of the following is a major developmental task of middle adulthood?

A) DevelopingTintimacy
B) Learning to manage conflict
C) Reexamining life goals
D) ResolvingTth
epastTAns: C Fee
dback:
An important task for middle-
aged adults is to examine life goals, ideally with some satisfaction. Developin
g intimacy occurs in young adulthood. Learning to manage conflict occurs in pr
eschool. Resolving the past and accepting responsibility for oneselfand life occ
ur in maturity.

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17. Which cognitive mode, according to Harry Stack Sullivan, begins in early ch
ildhoodas the child begins to connect experiences in sequence?
A) Prototaxic mode
B) Parataxic mode
C) Bitaxic mode
D) Syntaxic mod
eTAns: B
Feedback:
The parataxic mode begins in early childhood as the child begins to connect
experiences in sequence. The child may not make logical sense of the experi
ences, although he or she may not understand what he or she is doing. The p
rototaxic mode involves brief, unconnected experiences that have no relation
ship to one another. In thesyntaxic mode, the person begins to perceive hims
elf or herself and the world within thecontext of the environment and can an
alyze experiences in a variety of settings. There is not a bitaxic mode.

18. Group members are actively discussing a common topic. Members are sharing
that theyidentify with what others are saying. The nurse leader recognizes t
hat the group is in which stage of group development?
A) Planning
B) Initial
C) Working
D) Terminatio
nTAns:TC Feedb
ack:
The working stage of group development begins as members begin to focus
their attention on the purpose or task the group is trying to accomplish. The
beginning stageof group development, or the initial stage, commences as so
on as the group begins tomeet. Members introduce themselves, a leader ca
n be selected, the group purpose is discussed, and rules and expectations fo
r group participation are reviewed. The final stage, or termination, of the gr
oup occurs before the group disbands. The work of thegroup is reviewed, w
ith the focus on group accomplishments or growth of group members.

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19. The family members of a patient with bipolar disorder express frustratio
n with theunpredictable behaviors of their loved one. Which group should
the nurse suggest asmost helpful to this family?
A) Family therapy group
B) Family education group
C) Psychotherapy group
D) Self-
help support groupTAns: B
Feedback:
Family education discusses the clinical treatment of mental illnesses and te
aches the knowledge and skills that family members need to cope more effe
ctively. The goals of family therapy groups include understanding how famil
y dynamics contribute to the client's psychopathology, mobilizing the family'
s inherent strengths and functional resources, restructuring maladaptive fam
ily behavioral styles, and strengthening familyproblem-
solving behaviors. The goal of a psychotherapy group is for members to learn
about their behavior and to make positive changes in their behavior by inter
acting and communicating with others. In a self-
help group, members share a common experience, but the group is not a fo
rmal or structured therapy group.

20. A student nurse attends a self-

help group as part of a class assignment. While there the student recogniz
es a family friend. Upon returning home, the student talks aboutthe exper
ience with the family. The student's actions can be described as
A) appropriate; persons familiar with group members are allowed self-
help groupmembership.
B) appropriate; self-
help groups are not professional and therefore are open to publicknowle
dge.
C) inappropriate; most self-help groupsThave a rule of confidentiality.
D) inappropriate; the student should not have been allowed to a
ttend thegroup.TAns:TC
Feedback:
Most self-
help groups have a rule of confidentiality: whoever is seen and whatever is sa
id at the meetings cannot be divulged to others or discussed outside the grou
p. In many 12-
step programs, such asTAlcoholics Anonymous and Gamblers Anonymous, people
use only their first names, so their identities are not divulged (although in so
mesettings, group members do know one another's names).

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21. The nurse would recommend individual therapy for the patient who ex
presses adesire to
A) bring about personal changes.
B) gain a sense of belonging.
C) develop leadership skills.
D) learn more about treat
ment.TAns: A
Feedback:
People generally seek individual psychotherapy based on their desire to unde
rstand themselves and their behavior, to make personal changes, to improve i
nterpersonal relationships, or to get relief from emotional pain or unhappine
ss. Groups are recommended for persons to accomplish tasks that require coop
eration, collaboration, orworking together.

22. Which one of the following statements is most accurate regarding the cohes
iveness ofa group in group therapy?
A) It is commonly present in the first meeting of the group.
B) It is necessary for the group to have maximum cohesiveness, the more the better.
C) Group cohesiveness is the degree to which members think alike and ma
ny thingsare left unspoken.
D) Cohesiveness is a desirable group characteristic that is associated wit
h positivegroup outcomes.
Ans: D
Feedback:
Cohesiveness is a desirable group characteristic that is associated with positiv
e group outcomes. It is not common for the group to be cohesive during the fir
st meeting of thegroup. During the first meeting, or the initial stage, members
introduce themselves and the parameters of the group are established. Group
members begin to check out one another and the leaders as they determine t
heir levels of comfort in the group setting.
Cohesiveness is associated with the working stage of a group that may take tw
o or threesessions in a therapy group because members must develop some le
vel of trust before sharing personal feelings or difficult situations. If a group is
overly cohesive, in that uniformity and agreement become the group's implic
it goals, there may be a negative effect on the group outcome as members m
ay not offer needed feedback and this maythwart critical thinking and creativ
e problem solving. Group cohesivenessTis the degree to which members work t
ogether cooperatively to accomplish the purpose.

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23. Which one of the following is an important characteristic of an e

ffectivetherapistñclient relationship in individual psychotherap
y?
A) Homogeneity between the client and the therapist.
B) Mutual benefit for the client and the therapist.
C) The client must adapt to the therapist's style of therapy and theoretical beliefs.
D) Match between the theoretical beliefs and style of therapy and t
he client'sneeds and expectations of therapy.
Ans: B
Feedback:
Compatibility between the therapist and the client is required for therapy to b
e effective.The client must select a therapist whose theoretical beliefs and s
tyle of therapy are congruent with the client's needs and expectations of ther
apy. It is not required that the client and therapist be the same. The client's b
enefit is the most important consideration.The client also may have to try diff
erent therapists to find a good match.

24. Which of the following is most essential when planning care for a cli
ent whois experiencing a crisis?
A) Explore previous coping strategies
B) Explore underlying personality dynamics
C) Focus on emotional deficits
D) Offer a referral to a self-
helpgroupTAns: A
Feedback:
Crisis intervention focuses on using the person's strengths, such as previous c
oping skills, and providing support to deal with the current situation. Explorin
g underlying personality dynamics and focusing on emotional deficits would no
t help the client in thecrisis situation. When the client is in a crisis situation, o
ffering a self-help group would not be appropriate.

25. During the initial interview with a client in crisis, the initial priority is to
A) assess the adequacy of the support system.
B) assess for substance use.
C) determine the precrisis level of functioning.
D) evaluate the potential for self-
harm.TAns: D
Feedback:
Safety is always the priority; clients in crisis may be suicidal. Assessing the ade
quacy ofthe support system, assessing for substance use, and determining the
precrisis level of functioning would be important assessmentsTbut not as high
priority as evaluating the potential for self-harm.

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