Basic Concepts Of Psychiatric Mental Health Nursing 8th Edition by Louise Rebraca Shives -Test Bank

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Basic Concepts Of Psychiatric Mental Health Nursing 8th Edition by Louise Rebraca Shives -Test Bank

 

Sample  Questions

 

1. A 74-year-old widow is being seen in the mental health clinic. She has never fully regained the level of activity she had prior to her husband’s death. She continues to have symptoms of depression and has not been able to work or volunteer. In addition, she complains of “anxiety attacks” that occur nearly every night. What type of grief reaction is this client exhibiting?
A) She is experiencing a normal grief reaction and does not need any intervention at this time.
B) She is experiencing a prolonged reaction but within normal limits of the grieving process.
C) She is having a prolonged reaction to her husband’s death, but since she is surrounded by family members who support her, she does not need any interventions at this time.
D) She is experiencing an unresolved, or dysfunctional, grieving reaction. She needs to have a comprehensive mental health assessment.
Ans: D
Feedback:
In the case of dysfunctional grief, it is important to treat as soon as possible. Unresolved grieving can lead to other psychological, as well as physical, problems if left untreated. Even in the case of extensive family support, medications are often needed to assist the individual to recover completely from this type of grief reaction.

 

 

2. A client with terminal cancer is discussing health care alternatives with the nurse. The nurse would be correct in giving which of the following explanations of advance care planning?
A) A plan for care in the event that the individual is rendered unconscious while hospitalized
B) A plan for parent disposition that is drawn up by the children when parent(s) reach the age of 75
C) A plan drawn up by the primary nurse that delineates the steps to be taken by nurses on opposite shifts in the event of the client’s death
D) A plan that involves a thoughtful, facilitated discussion encompassing a lifetime of values, beliefs, and goals to complete an advance directive
Ans: D
Feedback:
Advance care planning is a thoughtful, facilitated discussion encompassing a lifetime of values, beliefs, and goals and involves completing an advance directive, such as a Living Will, Health Care Directive, or Health Care Proxy. Advance care planning allows the individual to participate fully in decisions regarding end-of-life care or care during catastrophic illness.

 

 

3. A client has just been diagnosed with terminal brain cancer and given approximately two months to live. He wishes to visit his mother soon to “say goodbye.” The nurse acknowledges this reaction as which of the following?
A) Anticipatory
B) Bereavement
C) Mourning
D) Loss
Ans: A
Feedback:
Anticipatory grief refers to the reactions that occur when an individual, family, significant other, or friends are expecting a loss or death to occur. Bereavement is the process of grief that includes feelings of sadness, insomnia, poor appetite, deprivation, and desolation. Mourning describes an individual’s outward expression of grief regarding the loss of a loved object or person. Loss is a change in the status of a significant object or situation.

 

 

4. A nurse is caring for a client with terminal cancer. The client states, “If I promise to change my bad habits, the cancer will go away.” The nurse knows that this statement is an example of which of Kubler-Ross’ stages of grief?
A) Denial
B) Anger
C) Bargaining
D) Acceptance
Ans: C
Feedback:
This scenario is an example of bargaining to prolong one’s life. Denial serves as a temporary escape from reality. In the anger stage, the client appears difficult, demanding, and ungrateful. In the acceptance stage, the client has achieved an inner and outer peace due to a personal victory over fear.

 

 

5. A client’s quality of life is decreasing as a result of uncontrolled diabetes. Which of the following types of loss is the client experiencing?
A) Anticipatory
B) Unexpected
C) Gradual
D) Sudden
Ans: C
Feedback:
Loss of function due to a medical condition usually causes a gradual loss over time. It would not be considered sudden, unexpected, or anticipatory at this point.

 

 

6. A client is exhibiting dysfunctional grieving. When obtaining a health history, the nurse would expect which assessment finding to be noted?
A) Stupor
B) Hostility
C) Euphoria
D) Calmness
Ans: B
Feedback:
Clinical features of dysfunctional grief include expressions of distress or denial of the loss, changes in eating and sleeping patterns, and mood disturbances such as anger, hostility, and crying. The other options would not necessarily occur in a client with dysfunctional grieving.

 

 

7. The Patient Self-Determination Act (PDSA) advocates which of the following ethical principles?
A) Justice
B) Autonomy
C) Beneficence
D) Veracity
Ans: B
Feedback:
The PDSA was passed in 1990 and states that every competent individual has the right to make decisions about his or her health care (autonomy). Justice encompasses fair and equal treatment for all. Beneficence is doing good. Veracity is a term for “to be truthful.”

 

 

8. A client is inquiring to the nurse about hospice care. The nurse would be correct in giving which information regarding this form of end-of-life care?
A) A terminal diagnosis is required.
B) The client must wish to pursue aggressive treatment.
C) Chronically ill patients qualify.
D) It limits support to the client during the dying process.
Ans: A
Feedback:
Hospice care refers to a program that supports the client and family through the dying process and the surviving family members through the process of bereavement. To qualify for hospice, the individual must be terminally ill with a life expectancy of 6 months or less.

 

 

9. At what age do children typically begin to accept death as a final state?
A) 7 years
B) 10 years
C) 13 years
D) 16 years
Ans: A
Feedback:
Children from the ages of 6 to 9 begin to accept death as a final state.

 

 

10. A client with end-stage renal disease has appointed his son to make decisions in the event that he is not able to. The nurse understands that the client is displaying autonomy in using which type of advance care planning?
A) Dying declaration exception to hearsay
B) Living will
C) Health care proxy
D) Durable health care power of attorney
Ans: D
Feedback:
A durable health care power of attorney or health care proxy permits an individual to name a health care decision maker or surrogate to make medical decisions in the event that the individual is unable to make these decisions or give informed consent. Dying declaration exception to hearsay allows statements referred to as “death bed declarations” to be honored by the medical and nursing staff. A living will is a document filled out by the client with specific instructions addressing issues of CPR, life support, and emergency measures.

 

 

11. The nurse is providing care for a group of siblings following the unexpected death of their father. The nurse should recognize which of the following principles about children and the death of a parent?
A) Most children are able to adapt to the death of a parent, provided they are supported.
B) The grief process undergone by children normally excludes active mourning.
C) The emotional trauma of losing a parent is not experienced fully until adulthood.
D) Children typically move through the grieving process much more quickly than adults.
Ans: A
Feedback:
It has been found that most children and adolescents can adapt effectively to the death of a parent and even learn and grow from the experience; however, they cannot do it alone. Children mourn, and the trauma of losing a parent is not delayed until adulthood. Children do not necessarily go through the stages of grief more quickly than adults.

 

 

12. An 81-year-old woman has been experiencing episodes of increasing forgetfulness in recent months, a problem that prompted her to seek care from her primary care physician. After tests and referrals, she has just received a diagnosis of early-stage Alzheimer’s disease. What type of loss is this woman most likely to experience?
A) Sudden and perceived
B) Gradual and observable
C) Temporary and unexpected
D) Anticipatory and perceived
Ans: B
Feedback:
Cognitive declines are typically gradual in progression and the effects are readily observable to others. Such a loss would likely be unexpected and anticipatory, but it would not be perceived (ie, invisible to others) or temporary.

 

 

13. Anticipatory grief has the potential to facilitate what?
A) Clear examination of treatment options
B) Admission to hospice care
C) An earlier and less painful death
D) Acceptance of impending death
Ans: D
Feedback:
Anticipatory grief allows the individual and others to get used to the reality of the loss or death and to complete unfinished business.

 

 

14. Mr. Taylor’s lung cancer has recently metastasized to his bones, resulting in a sudden worsening of his prognosis and a sharp increase in his pain. Despite his earlier declarations to “fight this thing to the bitter end” and the absence of a living will, he has now informed the nurse that the only medication he now wants is for pain control. How should the care team respond to Mr. Taylor’s statement?
A) Maintain aggressive medical treatment until Mr. Taylor produces a written statement.
B) Discontinue medical treatment if Mr. Taylor’s family members unanimously agree.
C) Document and honor Mr. Taylor’s wishes.
D) Refer the matter to the hospital’s ethics committee.
Ans: C
Feedback:
The dying declaration exception to hearsay allows statements referred to as “death bed declarations” to be honored by the medical and nursing staff. For example, a client, who is aware that death is imminent and has not completed a living will, may inform the nursing staff that he wants all medication, including intravenous (IV) therapy, to be discontinued. Such a request can be honored if documented.

 

 

15. After receiving word from his oncologist that his tumor is malignant, the patient says to the nurse, “If you people had the faintest clue what you were doing, I wouldn’t be like this.” The nurse should recognize that the patient may be experiencing which stage of grief?
A) Denial
B) Anger
C) Bargaining
D) Depression
Ans: B
Feedback:
The patient’s hostile statement indicates that he may be in the anger stage of grief, during which an individual may become difficult or demanding.

 

 

16. The nurse is providing care for a hospital patient who has a living will. Which of the following interventions is most appropriate for this patient?
A) Intravenous analgesics
B) Cardiopulmonary resuscitation (CPR)
C) Total parenteral nutrition (TPN)
D) Respiratory ventilation
Ans: A
Feedback:
CPR, TPN, and ventilation are considered life-sustaining treatments that would likely be precluded by a living will. Pain medications, however, are considered supportive care.

 

 

17. Prior to his cognitive deterioration from an organic brain disease, a client established a durable health care power of attorney. This document allows the person designated in the document to do what?
A) Distribute the client’s possessions after his death.
B) Make treatment decisions on the client’s behalf.
C) Override the client’s expressed wishes.
D) Pursue all available treatment options until death.
Ans: B
Feedback:
A durable health care power of attorney permits an individual to name a health care decision maker or surrogate to make medical decisions in the event that the individual is unable to make these decisions or give informed consent. The document does not direct the distribution of the client’s assets after death nor is it intended to contradict the client’s wishes.

 

 

18. Mr. Tan’s latest diagnostic imaging tests reveal severe and untreatable heart disease, but his family is adamant that the care team refrain from revealing this finding to Mr. Tan. The nurse should recognize that which of the following factors may underlie the family’s wishes?
A) The family members may have an inadequate understanding of the severity of his condition.
B) The family may be enacting their own form of anticipatory grief by keeping Mr. Tan uninformed.
C) The family may prefer to avoid making difficult decisions about treatment options.
D) The family may be “protecting” Mr. Tan or ensuring that he does not lose hope.
Ans: D
Feedback:
Culturally diverse families (eg, Asian Americans) may believe that explicitly telling the client bad news will cause unnecessary suffering or cause the client to lose hope. This is not likely a consequence of misunderstanding a diagnosis, grieving, or avoiding difficult decisions.

 

 

19. A patient’s acquired immunodeficiency syndrome (AIDS) has progressed to the point that he is now eligible for hospice care. What is the primary focus of hospice care?
A) Comfort, dignity, and personal growth near the end of life
B) The use of nonapproved or experimental treatments that cannot be performed in the hospital setting
C) Withholding medical interventions in order to focus on an individual’s spiritual needs
D) Reframing the death process into a positive and enlightening event
Ans: A
Feedback:
The essential philosophy of hospice care is the focus on comfort, dignity, and personal growth at life’s end. Hospice care is not a venue for experimental medical treatment. Despite the focus on wholeness at the end of life, hospice care does not promote death as always being “positive” or “enlightening.” Curative treatments are not typically undertaken, but medical treatments such as pain control are common and important.

 

 

20. Amelia’s children have downplayed her grief following the death of her partner, claiming that their mother and her partner were only together for a few months and that “he was no good for her anyways.” Amelia is at risk of experiencing what?
A) Unresolved grief
B) Atypical grief
C) Disenfranchised grief
D) Dysfunctional grief
Ans: C
Feedback:
Disenfranchised grief is a term that describes the experience of individuals whose grief is not acknowledged or supported by their social network or who are excluded from participating in grief-related rituals.

 

1. While talking with a schizophrenic client, the nurse observes that he is looking straight ahead, maintains no eye contact, and moves his facial muscles very little, even though he is telling her about a very emotional episode he just experienced with his roommate. When describing the client’s affect, the nurse documents it as what?
A) Labile
B) Constricted
C) Flat
D) Blunted
Ans: C
Feedback:
The client’s affect, or facial expression, would be described as “flat.” Labile affect is the abnormal fluctuation or variability of one’s expressions, such as repeated, rapid, or abrupt shifts. Constricted affect relates to a reduction in one’s expressive range and intensity of affective responses. Blunted affect is a severe reduction or limitation in the intensity of one’s affective responses to a situation.

 

 

2. A client has obsessive–compulsive disease, which has seriously interfered with his ability to work. To help the client, the nurse must understand that a compulsion is what?
A) A feeling of unreality or strangeness concerning oneself, the environment, or both
B) An insistent thought recognized as arising from the self but not controllable by the person
C) A repetitive intrusive and unwanted urge to perform or performance of an act contrary to one’s usual standards
D) A fixed false belief not true to fact and not ordinarily accepted by other members of the person’s culture
Ans: C
Feedback:
A compulsion is an urge to perform a behavior or the actual performance of the behavior (such as washing the hands), while an obsession is an intrusive thought that recurs, even when unwanted. Depersonalization is a feeling of unreality or strangeness, concerning self, environment, or both. Obsessions are insistent thoughts, recognized as arising from the self, which cannot be controlled. Delusions encompass fixed false beliefs not true and not ordinarily accepted by other members of the person’s culture.

 

 

3. Which of the following statements made by a client diagnosed with depression would indicate that she may have a thought disorder?
A) “I’m so angry. Wait until my daughter hears about this!”
B) “I’m a little confused. What time is it?”
C) “I can’t find my mesmer foot holders. Have you seen them?”
D) “I’m fine. It’s my husband who has the problem.”
Ans: C
Feedback:
The incorrect answers reflect cognitive awareness and clear thought, while the correct answer reveals that the client has made up a new word (neologism) for her shoes, which indicates the presence of a thought disorder.

 

 

4. When differentiating a tactile hallucination from a gustatory one, the nurse understands that a gustatory hallucination is evidenced by what?
A) An unusual sensation not felt by others
B) A complaint of tasting something unusual
C) Hearing voices not based in reality
D) Seeing things that are not there
Ans: B
Feedback:
Tactile hallucinations involve the sense of touch, while gustatory hallucinations involve the sense of taste. Gustatory hallucination is related to sensory perceptions of taste that occur in the absence of an actual external stimulus.

 

 

5. The nurse observes a female client rubbing the chest of her asthmatic daughter with a coin. Which of the following reflects a culturally sensitive, or transcultural, response to this client?
A) “Stop! You’re hurting your child!”
B) “What is it that you are doing right now?”
C) “I’ll have to inform the doctor that you are not following instructions.”
D) “You are making your daughter cry.”
Ans: B
Feedback:
The correct answer reflects that the nurse is attempting to ask a question that will help her to understand the client’s behaviors, which would be a culturally sensitive approach. The other answers demonstrate nonacceptance or a negative attitude from the nurse.

 

 

6. Which of the following statements made by a client would indicate that she has delusions of grandeur?
A) “I am a magician, and my magic powers are good when the moon is full.”
B) “I let my baby die. I don’t deserve to live.”
C) “I hear messages from aliens that tell me to steal cars.”
D) “I can’t eat this food. It’s poisoned.”
Ans: A
Feedback:
The correct answer is the only statement that reflects that the client believes she has powers, abilities, or characteristics that go beyond those of normal individuals (delusions of grandeur).

 

 

7. During a conversation, the client states, “It’s raining outside and raining in my heart. Did you know that St. Valentine used to visit jails? I’ve never been to jail.” The nurse assesses that the client is experiencing a speech pattern commonly seen in manic episodes called what?
A) Perseveration
B) Circumstantiality
C) Neologisms
D) Flight of ideas
Ans: D
Feedback:
Flight of ideas is the expression of multiple, unrelated ideas in a string of statements. Neologisms are new words, circumstantiality is when the client speaks about topics that are loosely related with each other, and perseveration is the repetition of words or ideas over and over.

 

 

8. A male client has been diagnosed with schizophrenia. Of the following facts, which one would be the most important factor in determining whether or not the client would be diagnosed with a mental disorder?
A) The client is unable to continue his school work and has been sitting on his bed for three days.
B) The client has been receiving good grades in college and has a GPA of 3.8.
C) The client used cocaine up until one week ago.
D) The client’s father died in a tragic automobile accident when he was 10 years old.
Ans: A
Feedback:
Disturbance in functional status, or activities of daily living, is the most important factor in determining whether or not a mental disorder is present. Other data in the answers listed could be present even in the absence of mental disorder.

 

 

9. A mental health nurse is caring for a schizophrenic client. The nurse observes the client laughing about the recent death of her father. The nurse would correctly document this mood as which of the following?
A) Blunted
B) Inappropriate
C) Flat
D) Labile
Ans: B
Feedback:
The correct answer is inappropriate affect or lack of harmony between one’s voice and movements with one’s speech or verbalized thoughts. Blunted affect is a severe reduction or limitation in the intensity of one’s affective responses to a situation. Flat affect describes absence or near absence of any signs of affective responses. Labile affect is the abnormal fluctuation of one’s expressions.

 

 

10. A manic client recently admitted to a locked ward in the psychiatric unit is talking with the nurse. He states, “The car is red. Are you ready for lunch? My head is hurting. Dogs bark loud.” The client is exhibiting which type of speech?
A) Echolalia
B) Clang association
C) Neologism
D) Looseness of association
Ans: D
Feedback:
Looseness of association is a disturbance of thinking shown by speech in which ideas shift from one unrelated, or minimally unrelated, subject to another. Echolalia is the parrot-like repetition of overheard words or phrases. Clang association is a type of thinking in which the sound of a word (rhyming) substitutes for logic during communication. Neologism describes the use of a new word or combination of several words coined or self-invented by a person and not readily understood by others.

 

 

11. A 20-year-old patient who has a diagnosis of schizophrenia frequently experiences delusions of persecution. At the prompting of the client’s mother, the nurse attempts to determine the character and severity of these delusions on a particular day. In doing so, the nurse is conducting what type of assessment?
A) Comprehensive
B) Focused
C) Screening
D) Secondary
Ans: B
Feedback:
A focused assessment includes the collection of specific data regarding a particular problem as determined by the client, a family member, or a crisis situation. A comprehensive assessment is broader in scope, while a screening assessment aims to identify the presence or absence of health problems.

 

 

12. A nurse who provides care at a community mental health center (CMHC) is conducting an assessment of a new client who has long-standing diagnosis of major depression. How can the nurse best assess the client’s perspective of her mental health problem?
A) “Have you had any thoughts of suicide in the past 24 hours?”
B) “Do you have a family history of depression?”
C) “Have you been taking your medications consistently?”
D) “What do you think has contributed to your depression in the past?”
Ans: D
Feedback:
Asking for a client’s explanation of the etiology and contributing factors to his or her disease can provide insight into the client’s overall perspective of the illness. Questions about medications, family history, and medication use are appropriate assessment questions, but they do not ascertain the client’s perspective of her illness.

 

 

13. As part of a focused assessment, the nurse asked the client to describe her mood this morning. In response, the client stated, “It is what it is.” Which of the following examples of nursing documentation is most appropriate?
A) “Client is nonspecific about her mood.”
B) “Client states about her mood, ‘It is what it is.’”
C) “Client is currently feeling ambivalent.”
D) “Client feels resigned to her symptoms of depression.”
Ans: B
Feedback:
When documenting assessment findings, it is important to use the client’s own words whenever possible. Subjectively describing a client’s mood or speculating about underlying meanings is inappropriate and potentially inaccurate.

 

 

14. A former soldier has returned from a tour of duty with posttraumatic stress disorder. During a therapy session, he has been asked to describe some of the scenes he witnessed. Which of the following responses would prompt the nurse to document the client’s affect as flat?
A) The client describes the death of a fellow soldier in darkly comic terms.
B) The client fights back tears when describing a fellow soldier’s suffering from injuries.
C) The client adamantly refuses to describe what he witnessed overseas.
D) The client provides a factual but monotone and nonexpressive description of wartime events.
Ans: D
Feedback:
A flat affect is characterized by an absence or near absence of any signs of affective responses, such as an immobile face and monotonous tone of voice.

 

 

15. The nurse has entered a hospital patient’s room and asked him if he plans to attend the morning’s scheduled group life-skills session. Which of the following responses should signal the presence of thought blocking to the nurse?
A) “Warning, warning, watch your back.”
B) “I might. I’ll give it some….”
C) “Well, that’s certainly the end of that.”
D) The client makes eye contact with the nurse but does not respond verbally.
Ans: B
Feedback:
Blocking refers to a sudden stoppage in the spontaneous flow or stream of thinking or speaking for no apparent external or environmental reason. Clanging involves perceived similarities in meaning between words of similar sound (“morning”; “warning”). Mutism is the absence of a verbal response.

 

 

16. A hospital patient is unwilling to enter the unit’s shower room, stating, “That’s the place where the special forces lie in wait.” The nurse would recognize that this patient may have what kind of delusion?
A) Persecution
B) Nihilism
C) Grandeur
D) Somatic
Ans: A
Feedback:
Delusions of persecution involve a perception that a person is under threat or being singled out for harassment. A nihilistic delusion involves the denial of a body part or self, and a delusion of grandeur is a misperception of importance.

 

 

17. During the scheduled assessment of a patient who is experiencing acute alcohol withdrawal, the nurse has identified that the patient does not know where he is and that he feels like there are bugs crawling on his forearms. The nurse would document the presence of what?
A) Olfactory hallucinations and delusions
B) Perseveration and lack of orientation
C) Looseness of association and lack of insight
D) Disorientation and tactile hallucinations
Ans: D
Feedback:
The fact that an individual does not know his or her present location constitutes a lack of orientation; feeling a sense of touch from an object that is not present is an example of a tactile hallucination.

 

 

18. A well-known client with a diagnosis of schizophrenia has been brought to the emergency department by police after causing a disturbance in a store. Which of the nurse’s assessment questions would best identify whether the client has insight into his illness?
A) “Why do you think the police brought you here?”
B) “Do you think that you’re sick?”
C) “Has anything like this happened to you before?”
D) “Do you ever hear voices or see things that other people do not see?”
Ans: B
Feedback:
Insight is defined as self-understanding about the origin, nature, and mechanisms of one’s attitudes and behavior; it can often be ascertained by asking whether the client believes himself to be in need of treatment. Asking a client about hallucinations or previous encounters with the law or the medical system is less likely to reveal the client’s presence or absence of insight.

 

 

19. During a therapy session, a client reveals that he masturbates eight to ten times daily and feels powerless to stop doing so, despite the fact that his behavior causes him shame and self-loathing. This client is exhibiting which of the following problems?
A) Compulsion
B) Obsession
C) Dyssomnia
D) Paramnesia
Ans: A
Feedback:
Compulsions are insistent, repetitive, intrusive, and unwanted urges to perform an act contrary to one’s ordinary wishes or standards. An obsession is characterized by intrusive thinking; dyssomnias are disorders in which a client has difficulty with the amount, quality, or timing of sleep; paramnesia is the falsification of memory.

 

 

20. Which of the following clients or patients is exhibiting the signs of primary insomnia?
A) Jason, who has delusions of persecution and drinks copious quantities of energy drinks to remain vigilant
B) Mr. Kwan, whose debts and business problems have caused him great stress in recent months.
C) Mrs. Fleming, who has frequent awakenings since becoming depressed
D) Amber, a methamphetamine user who sometimes goes several nights without sleep.
Ans: B
Feedback:
Primary insomnia is caused by emotional discomfort such as chronic stress. It is not caused by the direct physiologic effects of a substance or a general medical condition. Secondary insomnia is the inability to initiate or maintain sleep or nonrestorative sleep due to a psychiatric disorder such as depression, schizophrenia, or substance abuse.

 

1. Robinul, an atropine-like medication, is given prior to ECT. Which of the following statements by the client would indicate that the medication is taking effect?
A) “I am feeling really calm and ready to fall asleep.”
B) “My mouth feels so dry.”
C) “I think I need to use the bathroom.”
D) “I can feel my legs and feet tingling.”
Ans: B
Feedback:
Robinul is administered prior to ECT to reduce oral secretions, and therefore the client’s mouth would feel dry. Robinul would neither calm the client nor result in increased urination or tingling of legs/feet.

 

 

2. The most important nursing intervention during post-op recovery from ECT is what?
A) Monitoring the client’s vital signs every hour for 4 hours
B) Placing the client in Trendelenburg’s position
C) Encouraging early ambulation
D) Reorienting the client to time and place
Ans: D
Feedback:
The most common adverse side effects of ECT are confusion and temporary memory loss. Continuous orientation to time and place is important as the client is waking up from ECT. Vital signs should be monitored for 15 minutes, and the client should be placed in a side-lying position to reduce the risk of aspiration. The client should remain on bed rest until he or she is fully alert and oriented.

 

 

3. Which of the following indications is the primary use for ECT?
A) Major depression with psychotic features
B) Substance abuse with mood disorder
C) Personality disorder
D) Noncompliance with treatment regimen
Ans: A
Feedback:
ECT is indicated for treating major depression with psychotic features. ECT is not used in substance abuse or personality disorders; it would not be appropriate to treat with ECT for the sole reason that the client does not comply with treatment.

 

 

4. In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure?
A) The client’s heart rate is 120 and a slight arrhythmia is detected.
B) The client has a seizure in the recovery room.
C) The client is highly agitated and trying to get out of the bed.
D) The client cannot remember to which inpatient unit he or she is returning.
Ans: D
Feedback:
Short-term memory loss is a common side effect of the ECT procedure. Arrhythmias, tachycardia, seizures, and agitation are not expected following ECT; they should be thoroughly assessed.

 

 

5. A client is admitted to the psychiatric unit with a diagnosis of major depression with psychotic features. When the client does not respond to antidepressant medications, ECT is ordered. What is the mechanism of action of this therapy?
A) It is thought that ECT causes a temporary loss of serotonergic tone in the CNS.
B) The mechanism of action of ECT remains unknown.
C) ECT causes the client to believe psychologically that punishment has occurred.
D) ECT causes hyperproduction of CNS chemicals and neurotransmitters.
Ans: B
Feedback:
The exact mechanism by which ECT exerts its therapeutic effects remains a mystery. Theories have focused on the idea that ECT may cause significant changes (although it is unknown in which direction and which neurotransmitters) in several neurotransmitters in the CNS, which then lead to lessening of depressive symptoms.

 

 

6. You are working with a 56-year-old female who is a candidate for ECT. The client states, “I would think about doing this ECT, but I heard that I won’t remember anything after I wake up, and that scares me very much.” The most therapeutic nursing response to the client’s statement is what?
A) “Don’t worry; you will be just fine after ECT. Lots of people are afraid of losing their memory, but it’s not really a problem.”
B) “Who told you that? It’s not really much of an issue with ECT. Sometimes people do lose some of their memory, but it is not a long-term problem.”
C) “I hear what you are saying. What is it that makes you so afraid of losing your memory?”
D) “I understand your concern. You may experience some short-term memory loss right after the procedure, but it is not a long-term effect.”
Ans: D
Feedback:
The correct answer provides empathy for the client’s concerns, followed by patient teaching about the effects of ECT. Memory loss after ECT is usually short term, with a return to normal function in a few days or weeks.

 

 

7. A client is emerging from anesthesia following ECT. The client is agitated and incoherent. The nurse may expect to administer which medication to stabilize these symptoms?
A) Diazepam
B) Brevital
C) Robinul
D) Caffeine
Ans: A
Feedback:
When postictal agitation occurs, the client may require intravenous diazepam (Valium). During the ECT procedure, the client is given a quick-acting anesthetic, such as Brevital, after being placed on a padded mat or table. An atropine-like drug, Robinul, is given to dry up body secretions and prevent aspiration. Caffeine would be an inappropriate drug to give this patient for these symptoms.

 

 

8. Which of the following conditions is associated with an increased risk of complications during ECT?
A) Aortic aneurysm
B) Hypertension
C) Tuberculosis
D) Recent fracture
Ans: B
Feedback:
Hypertension is a condition associated with increased risk during ECT. Special considerations are given to clients with aortic aneurysm, tuberculosis, and recent fractures.

 

 

9. A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT?
A) The procedure is done with a full bladder.
B) NPO will be employed 8 hours prior to the procedure.
C) There will be mild to moderate pain.
D) The client will be awake during the procedure.
Ans: B
Feedback:
Prior to the ECT procedure, the client is NPO for 8 hours. The client will empty his bladder just before or after vital signs are taken prior to the ECT. The client will not be harmed or feel any pain. The client will be asleep during the procedure.

 

 

10. Which of the following is not included as a guideline prepared by the American Psychiatric Association (APA) for use of ECT?
A) There are no absolute contraindications to ECT.
B) It is an alternate treatment for clients unresponsive to pharmacotherapy.
C) ECT is used as a last resort in depressed clients.
D) ECT is used in clients who exhibit suicidal tendencies.
Ans: C
Feedback:
ECT should not be reserved as a last resort. The most common use of ECT is with clients who have not responded to alternative treatments such as pharmacotherapy, exhibit a deterioration in clinical symptoms, or exhibit suicidal ideations.

 

 

11. Clients who have which of the following psychiatric–mental health diagnoses are likely candidates for ECT? (Select all that apply.)
A) Alzheimer’s disease
B) Alcohol abuse disorder
C) Delusional depression
D) Acute schizophrenia
E) Obsessive–compulsive disorder (OCD)
Ans: C, D, E
Feedback:
Among the many psychiatric–mental health problems that may be treated with ECT are delusional depression, acute schizophrenia, and OCD. Alzheimer’s disease and alcohol abuse disorder are not commonly treated with ECT.

 

 

12. A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse’s following teaching points about the procedure is most accurate?
A) “Most people who are depressed experience a permanent improvement in their mood after their first treatment.”
B) “The permanent memory loss associated with ECT is a small price to pay for curing your depression.”
C) “You will probably not be able to use antidepressant medications for several months after the treatment, but they will likely be unnecessary.”
D) “Even though the exact way that ECT helps depression isn’t known, the therapy has been shown to be safe and effective.”
Ans: D
Feedback:
The exact therapeutic mechanisms of ECT are unclear, but the therapy itself has been proven safe and effective. Repeat treatments are the norm, and any resulting memory loss is not permanent. ECT does not contraindicate the use of antidepressants.

 

 

13. Which of the following clients most likely faces the highest risk of experiencing adverse effects of ECT?
A) A man who has diagnoses of depression and poorly controlled hypertension and who experienced a myocardial infarction 3 months ago
B) A woman who has been admitted to the hospital after a suicide attempt and who has type I diabetes mellitus
C) A man who has schizophrenia, who is an intravenous user of heroin and cocaine, and who smokes marijuana on a daily basis
D) A morbidly obese woman whose depression has been treated with a sustained serotonin reuptake inhibitor (SSRI) for the past several months
Ans: A
Feedback:
Hypertension and recent MI are both associated with an increased risk of adverse effects during ECT. Diabetes, antidepressant therapy, and drug use are not noted to appreciably increase the risk of adverse effects.

 

 

14. After today’s ECT treatment, a client has emerged from anesthesia agitated, confused, and incoherent. Which of the following interventions should the nurse anticipate?
A) Placing the client in seclusion until the client’s behavior normalizes
B) Close monitoring and administration of an intravenous benzodiazepine
C) Application of physical restraints and sublingual lorazepam (Ativan) administration
D) Administration of an anesthetic and a repeat ECT treatment
Ans: B
Feedback:
Postictal agitation may require intravenous diazepam (Valium) to stabilize the symptoms. Seclusion would be unsafe, and restraints would be a measure of last resort. The ECT treatment would not be repeated.

 

 

15. Which of the following client factors would override the need to obtain informed consent from the client before administering ECT?
A) Presence of delusions
B) Legal incapacitation
C) A documented history of violence
D) Noncompliance with previous medication regimen
Ans: B
Feedback:
The only time that informed consent for ECT would not be required from a client is if the client has been declared legally incapacitated by a court.

 

 

16. A client who has been admitted to the hospital after a suicide attempt has been diagnosed with major depression and the client’s care team has recommended ECT. Which of the following teaching points should the nurse include in client education before the procedure?
A) “I’ll teach you some techniques to help you remain calm and focused during the procedure.”
B) “You’ll be required to fast from solid food for 24 hours before your ECT procedure.”
C) “After their ECT, most clients say that the pain they experienced was very manageable.”
D) “You might feel a bit confused or disoriented after your treatment, but this will pass.”
Ans: D
Feedback:
The confusion and disorientation that may accompany the immediate recovery period after ECT are temporary and resolve spontaneously. The client is unconscious during the procedure and is NPO for 8 hours prior. ECT is painless.

 

 

17. Mrs. Taylor’s psychiatrist has explained the potential benefits of ECT in the treatment of her depression. Which of the following nursing diagnoses is most likely to apply to a client who is scheduled to soon begin ECT?
A) Risk for anxiety
B) Risk for decisional conflict
C) Risk for impaired physical mobility
D) Risk for ineffective protection
Ans: A
Feedback:
The prospect of beginning a regimen of ECT is likely to cause anxiety in a client. This likely supersedes the risks of decisional conflict, impaired mobility, or ineffective protection.

 

 

18. After being presented with the potential benefits of ECT, a client has replied, “I’ve seen enough movies to know there’s no way I’m going to have any shock therapy.” What is the most therapeutic response to this client’s concerns?
A) “Ultimately it will be up to your psychiatrist to decide whether you will have the treatment or not.”
B) “Don’t believe what you see in movies. ECT is safe and effective and you’re asleep the whole time.”
C) “I know it looks violent, but you need to weigh the potential costs and benefits carefully before you make a decision.”
D) “You won’t have to go through it alone. Doctors and nurses will be present the whole time to reassure and protect you during ECT.”
Ans: B
Feedback:
ECT has been demonstrated to be safe and effective. Contrary to most popular portrayals, the client is unconscious during the procedure. The client can refuse treatment unless he or she is legally incapacitated.

 

 

19. Which of the following electrode placements during ECT is associated with the best outcomes?
A) Bilateral electrode placement on the client’s temporal areas
B) Unilateral electrode placement on the client’s right temporal area
C) Midline on the client’s forehead, with one electrode above the other
D) Unilateral electrode placement on the client’s left temporal area
Ans: A
Feedback:
Both BL and RUL placements are used in ECT, but the clinical efficacy of BL placement exceeds that of RUL placement.

 

 

20. A client has a long-standing diagnosis with a dystonic disorder that has been minimally responsive to pharmacological treatment. Which of the following alternative somatic therapies may be clinically appropriate?
A) Vagus nerve stimulation (VNS)
B) Transcranial magnetic stimulation (TMS)
C) Magnetic seizure therapy (MST)
D) Deep brain stimulation (DBS)
Ans: D
Feedback:
DBS is a minimally invasive yet significant form of neurosurgery in which a surgically implanted neurostimulator in the brain helps control Parkinson’s disease, essential tremor, and dystonic disorders.

 

1. When teaching a client with newly diagnosed bipolar I disorder, the nurse states that the difference between bipolar I disorder and bipolar II disorder is what?
A) Bipolar I disorder is often more disruptive than bipolar II disorder.
B) Bipolar I disorder more often affects women.
C) Bipolar I disorder is characterized by hypomanic episodes.
D) Bipolar I disorder involves altered moods of anger and paranoia.
Ans: A
Feedback:
Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.

 

 

2. A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client’s feelings of sadness and hopelessness, the nurse assessed which of the following somatic or physiologic symptoms of depression?
A) Anxiety, unconscious anger, and hostility
B) Guilt, indecisiveness, and poor self-concept
C) Psychomotor retardation and agitation
D) Meticulous attention to grooming and hygiene
Ans: C
Feedback:
Psychomotor retardation, or agitation, often accompanies depression. The incorrect answers are not physiologic or somatic but psychological or functional symptoms of depression. Usually in depressive illness, grooming and hygiene are not tended to.

 

 

3. You are working with a 50-year-old woman admitted for major depressive episode. The client has remained isolated and withdrawn since her admission and is reluctant to speak. Which of the following therapeutic communication skills is most likely to encourage the client to vent her feelings?
A) Direct confrontation
B) Reality orientation
C) Projective identification
D) Silence and active listening
Ans: D
Feedback:
Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism.

 

 

4. A client was admitted to the psychiatric unit after being picked up by police officers who found her frantically running back and forth across the freeway. Her husband related that she stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what?
A) Psychomotor retardation, fatigue, and apathy
B) Pressured speech, combative behavior, and impaired judgment
C) Catatonic excitement, loose associations, and recurrent illusions
D) Self-destructive behavior, overidealization, and devaluation
Ans: B
Feedback:
A manic episode would be characterized by pressured speech, potentially combative behavior, and impaired judgment. Neither psychomotor retardation is present nor are recurrent illusions. Self-destructive behavior is not a classic symptom of mania; more often, clients may have accidents caused by their lack of judgment and psychomotor agitation.

 

 

5. When completing discharge medication education for the client, he asks how long it will take before the effects of his prescribed SSRI could be felt. The nurse states that it will likely take?
A) 1 to 2 days
B) 5 to 7 days
C) 2 to 3 weeks
D) 3 to 4 weeks
Ans: C
Feedback:
Most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks.

 

 

6. Nursing interventions for the depressed person include which of the following staff attitudes?
A) Acceptance, honesty, empathy, and patience
B) Cheerfulness, gregariousness, and happiness
C) Decisiveness and business-like efficiency
D) Confrontation, questioning, and authority
Ans: A
Feedback:
When working with depressed individuals, it is most therapeutic to maintain an attitude of acceptance, honesty, empathy, and patience. Being too cheerful can convey a nongenuine approach. Being too business-like can convey the attitude of not having time to care for the client, and confrontation is not necessary under the condition of depression.

 

 

7. Before a client became depressed, she was an active, involved mother with her three children, often attending their school functions and serving as a volunteer. She is hospitalized for major depressive episode and now reveals that she feels like an unnecessary burden on her family. Which of the following nursing diagnoses is most appropriate?
A) Anxiety related to side effects of medication
B) Disturbance of self-concept related to feelings of worthlessness
C) Anger related to marital disagreements
D) Apathy related to fatigue and sleeplessness
Ans: B
Feedback:
The client does not express anxiety, anger, or apathy. Instead, she has experienced a change from being an involved, interested mother to feeling as though she is a burden, which would be reflective of a disturbance of her self-concept. The self-concept changes she is experiencing are related to feelings of worthlessness brought on by the depressive episode.

 

 

8. A client is receiving lithium carbonate (Eskalith) for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment?
A) Obtain scheduled lithium levels.
B) Watch for low urine output.
C) Give medication on an empty stomach.
D) Decrease fluid intake to prevent edema.
Ans: A
Feedback:
There is a narrow range between therapeutic lithium levels and lithium toxicity. It is important to obtain scheduled drug levels to prevent toxicity from occurring. The nurse should monitor for polyuria. Teaching includes taking the medication with food or milk after meals and ensuring an adequate daily intake of fluid (2,500 to 3,000 mL) daily.

 

 

9. A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include which of the following?
A) The client will discuss the cause of the fatigue.
B) The client will demonstrate improved ability to express self.
C) The client will identify factors that reduce activity tolerance.
D) The client will differentiate between reality and fantasy.
Ans: B
Feedback:
An appropriate outcome would include demonstrating improved ability to express self.

 

 

10. An appropriate assessment tool to determine the client’s overall functioning during a specific period encompassing psychiatric illness and health would include which of the following?
A) Beck Depression Inventory
B) Global Assessment Scale
C) Behavior and Symptom Identification Scale
D) General Health Questionnaire
Ans: B
Feedback:
The Global Assessment Scale is a single-item rating scale for evaluating the overall functioning of a client during a specific period on a continuum from psychiatric illness to health. The Beck Depression Inventory assesses the intensity of depression in individuals between the ages of 13 and 80 years. The Behavior and Symptom Identification Scale is a comprehensive measure of self-reported symptoms and functional health status that may indicate the need for inpatient psychiatric treatment. The General Health Questionnaire is a self-administered screening instrument to detect psychiatric disorders in community settings and nonpsychiatric clinical settings.

 

 

11. According to the biochemical theory of mood disorders, a client with a diagnosis of depression is likely to have alterations in the levels and function of which of the following neurotransmitters?
A) Epinephrine, histamine, and melatonin
B) Acetylcholine, adenosine, and glutamate
C) Serotonin, norepinephrine, and dopamine
D) Aspartate, GABA, and serine
Ans: C
Feedback:
Monoamines such as serotonin, norepinephrine, and dopamine have been implicated in the etiology of mood disorders such as depression.

 

 

12. A client has been diagnosed with depression after a series of visits to his primary care provider. Within the context of the behavioral theory of mood disorders, what factors may underlie the client’s diagnosis?
A) A perception that life’s events are beyond his control, leading to feelings of helplessness and hopelessness
B) A long-standing pattern of underachievement and public failure that causes him to feel shame
C) A family history of inadequate coping skills, unresolved conflict, and fragmented communication that leads to feelings of isolation
D) A belief that there is ultimately no higher meaning to life, leading to feelings of fatalism and resignation
Ans: A
Feedback:
Behavioral theorists regard mood disorders as a form of acquired or learned behavior.

Clients possess a perception that situations or events are their own fault and are beyond their control and that nothing can be done to change them. This perception promotes feelings of helplessness and hopelessness. Behavioral theory does not emphasize the role of family history, failure, or fatalism, though each may accompany or contribute to mood disorders.

 

 

13. A client has been diagnosed with major depressive disorder. The clinical symptoms that would be included when the clinician makes this diagnosis are what?
A) A significant failure in an occupational or relational setting
B) A significant decrease in appetite
C) Demonstrated examples of unwise decisions
D) Claims by family, friends, or coworkers that the client is depressed
Ans: B
Feedback:
Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client’s depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

 

 

14. Marlene is a 26-year-old woman whose family describes her as being “very, very different.” She has a history of periods of unpredictable behavior and disregard for consequences, which tend to occur a few times each year. Marlene has recently been diagnosed with bipolar I disorder, a problem that is characterized by what?
A) The presence of objective signs of depression without the presence of anhedonia
B) An elevated mood that lasts for at least one week
C) Failure to respond to conventional pharmacological treatments for mood disorders
D) The client’s admission of a mood disorder
Ans: B
Feedback:
During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client’s admission of a mood disorder are neither diagnostic nor typical of bipolar disorder.

 

 

15. A client has been recently diagnosed with depression and has just begun medication management. Which of the client’s following statements indicates an accurate understanding of this aspect of treatment?
A) “I’m still trying to decide whether antidepressants will be helpful in my treatment.”
B) “I understand that I probably won’t feel much better for a couple of weeks after I start the drugs.”
C) “I can tell that I get a lift each morning after I take my antidepressant.”
D) “I know that few people actually see an improvement in their mood with antidepressants, but I suppose I’ll try anyhow.”
Ans: B
Feedback:
Antidepressants are proven therapy in the treatment of depression, but effects are not normally observable or felt until 2 to 3 weeks after treatment starts.

 

 

16. Which of the following sleep patterns is suggestive of a manic episode?
A) A client stays awake for several days and nights before “crashing” and sleeping for a long period.
B) A client experiences day-night reversal, sleeping until late in the afternoon, and going to bed near dawn.
C) A client reports having fitful sleep that is characterized by frequent awakenings and nightmares.
D) A client takes multiple short naps at varied times throughout the day and night.
Ans: A
Feedback:
During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.

 

 

17. Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)?
A) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy
B) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode
C) A woman whose major depression has not responded appreciably to antidepressants
D) A client whose recent strange behavior has been attributed to cyclothymic disorder
Ans: C
Feedback:
While ECT is used to treat an increasing range of psychiatric–mental health problems, individuals with major depression are often among the best candidates for the treatment. ECT would not be used as a response to noncompliance, and a person who is currently experiencing a manic episode is less commonly treated with ECT. Cyclothymic disorder is less severe than bipolar II disorder and is consequently less likely to warrant ECT.

 

 

18. Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with which one of the following?
A) Anaclitic depression
B) Moderate depression
C) A mood disorder due to a general medical condition
D) Postpartum psychosis
Ans: B
Feedback:
Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild-to-moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.

 

 

19. A client’s physician has prescribed paroxetine (Paxil) for the treatment of her depression. Which of the following teaching points should the nurse include in the client education related to this treatment?
A) “If you don’t feel noticeably better within three weeks, increase your dose by 50 %.”
B) “Make sure that you don’t change the quantity or timing of your medication without first consulting your doctor.”
C) “If you forget to take a dose one day, take a double dose the next day and be sure to let your doctor know.”
D) “The advantage of Paxil is that it will normally relieve depression in a few weeks and it has no side effects.”
Ans: B
Feedback:
During client education, it is necessary to stress the importance of consulting the prescriber before discontinuing or changing the dosing of any medication. Paxil, like all drugs, carries the potential of adverse side effects.

 

 

20. A 29-year-old first-time mother has been diagnosed with postpartum psychosis after disconcerting changes in behavior that were reported by her partner. In the planning of this client’s care, which of the following outcomes should the nurse prioritize?
A) The client will describe the causes of her fatigue.
B) The client will demonstrate an improved ability to express herself.
C) The client will consume at least 1,500 calories each day.
D) The client will demonstrate the ability to differentiate between fantasy and reality.
Ans: D
Feedback:
An inability to differentiate fantasy from reality is a hallmark of psychosis, and the ability to do so should be a priority goal in the care of a client with postpartum psychosis. Fatigue, nutrition, and self-expression are less likely to be central issues.