Principles And Practice of Psychiatric Nursing,10th Edition by Gail Wiscarz Stuart  – Test Bank

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Principles And Practice of Psychiatric Nursing,10th Edition by Gail Wiscarz Stuart  – Test Bank

 

Sample  Questions

 

Chapter 6: Psychological Context of Psychiatric Nursing Care

Test Bank

 

MULTIPLE CHOICE

 

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 A patient admitted for treatment of uncontrolled diabetes mellitus is withdrawn and tearful.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

 

 

ANS:  B

The primary purpose would be to assess emotional factors that may have an effect on the patient’s current condition. The patient has given clues to psychological distress. Holistic care requires the assessment of biological, psychological, and sociocultural health status.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 88-89

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Patients with whom the nurse has established rapport will feel understood by the examiner and will be more willing to cooperate with the examiner’s questions. Although the remaining options have an impact on the success of the interview, they are not the primary factor.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 89

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

Participant observation is a clinical approach that allows the nurse to critically observe a patient while structuring the examination in a way that allows for the broad exploration of many areas to screen for potential problems and for the in-depth exploration of obvious symptoms or maladaptive coping responses. Discussing treatment options is not the purpose of this intervention. Verbalization and attentive listening are required but may not need to be increased.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Pages: 89-90

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

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

 

 

ANS:  C

Many observations can be made during other aspects of the nursing assessment, and specific questions can be blended into the general flow of the interview. Planning to compare results requires the assumption that more than one assessment will be conducted. This examination requires input from the patient that is best secured when the patient-nurse relationship has been established.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 88

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

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

 

 

ANS:  A

Dress, eye contact, personal hygiene, speech and use of language, personal space, and body language are a few aspects of the mental status examination that vary with culture and social status.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 88

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Confabulation means covering one’s inability to remember by making up a story of something that might have happened.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 93

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

Suicidal intent should be openly and directly investigated. The other options either provide false hope or are not directed at the most serious patient issue.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 90-91

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

The mental status examination is designed to give a picture of the patient’s current level of functioning. The information provided may be a factor in prognosis, but that is not the primary function of the examination. Family history and general patient information are derived from other sources and the general nursing interview.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 88

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

Mood is the patient’s self-report of his or her prevailing emotional/affective state. The remaining options are more related to cognition and thought.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 91

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

Attentive listening, observation, and focused questions allow for the use of empathic statements and make a patient feel understood, which fosters rapport. The other options are broadly related to communication in general.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 88

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

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

 

 

ANS:  D

Patients with mania often dress in bright colors and mix a variety of patterns. Their attire may give them an eccentric or bizarre look. “Drab” usually reflects more of a personal preference in dress, whereas “slovenly” and “seductive” may be considered indicators of mental illness if seen in combination with other specific assessment observations.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 90

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

Patients with mania show excessive body movement, whereas many patients with depression show little body activity. Tics and grimaces may be medication-related, whereas bizarre gesturing and posturing are not usually associated with mood disorders.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 90

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  A

Reporting significant life events with little emotional response suggests a blunted or flattened affect. Lability refers to swift shifts in affect. Congruent affect is appropriate emotional expression for the current circumstances. Elation is an exaggerated display of happiness. The patient is not showing fear or anxiety, which would be appropriate in this case, nor is the patient displaying exaggerated happiness, which would be inappropriate under the circumstances.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 91

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  A

Lability is identified when the patient’s affect shifts rapidly, such as from happy to sad or angry to elated. The remaining options are thought-content descriptors.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 91

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Hallucinations are false sensory perceptions while delusions are non-reality–based beliefs. The remaining options are related to thought or cognitive disorders.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 91

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

Grandiose delusions are beliefs that one possesses greatness or special powers. A phobia is a morbid fear, depersonalization is a loss of self-identity, and idea of reference is the incorrect interpretation of casual events.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 92

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

The correct option involves judgment since it is asking what the patient would do with $10,000. The remaining options assess the patient’s orientation to self, time, and place.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 95

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

Interpersonal intelligence and intrapersonal intelligence form one’s personal intelligence or “emotional quotient.”

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 95

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Recent memory is tested when the patient is asked to recall several words 15 minutes after hearing them for the first time.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 93

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

These symptoms indicate the presence of a thought disorder seen more often in patients with schizophrenia than in those with panic or depression. Defensive coping is not a diagnosis.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 91

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

Judgment involves making decisions that are constructive and adaptive. The other options relate information but do not require critical thinking to produce a judgment.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 95

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

The Mini-Mental State Examination is a simplified scored form of the cognitive mental status examination. It consists of 11 questions, including “what is today’s date?”, “what month is it?”, and “where are you right now?”, and it requires only 10 minutes to administer.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 96

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  D

Interpreting proverbs gives clues to the patient’s ability to move from concrete to abstract thinking by stating meaning in terms symbolic of human behavior or events.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 95

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  C

The observation of tension and suspicion indicates current stress and possible paranoia. The scar, the condition of the clothing, and the absence of a shoe are not as relevant to the patient’s current mental state because they originated in a time other than the present.

 

DIF:    Cognitive Level: Analysis               REF:   Text Page: 92

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Pressured speech is rapid, forcefully delivered speech that is often loud and excessive.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 90

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  A

Thought insertion is the delusion that thoughts are placed into the mind by people or influences outside of the self.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 92

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

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

 

 

ANS:  B

Subtle emotions are transmitted during the mental status evaluation, but they may register only as suspicions. Examples are subtle hostility that may make the nurse feel threatened or angry and sadness or hopelessness that may make the nurse feel sad.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 89

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

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

 

 

ANS:  A, B, D

This tool is not designed to predict the possibility/probability of relapse or identify co-morbid physiological disorders.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 97

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

Chapter 7: Social, Cultural, and Spiritual Context of Psychiatric Nursing Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Sociocultural risk factors are identified by assessing which patient characteristic?
a. Belief system
b. Daily health habits
c. Stress management habits
d. Restfulness of the home environment

 

 

ANS:  A

Six patient characteristics, influenced by social norms, cultural values, and spiritual beliefs, are known to act as risk factors. These are patient age, ethnicity, gender, education, income, and beliefs. The remaining options are representative of protective factors.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 100

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Which of these statements by a nurse suggests that the nurse will display cultural sensitivity when interviewing a patient from a different culture?
a. “The patient’s cultural background is very different from my own.”
b. “I think introducing ethnic humor is an effective way of establishing rapport.”
c. “I have to remember to document the patient’s ethnic origin and religion in the record.”
d. “Before the interview I will take a few minutes to review actions that might offend a patient of this culture.”

 

 

ANS:  D

The nurse should use established references in order to be familiar with specific patient cultures. Simple actions, gestures, and attitudinal displays that are part of the nurse’s culture may be offensive to a patient of a different culture. Understanding this indicates that the nurse will make an effort to display cultural sensitivity.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 99

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. Which statement will be most important for planning future community mental health services?
a. The population over age 65 years will continue to increase.
b. Many more people will move out of rural and into urban areas.
c. The U.S. population will increase drastically by the year 2050.
d. The U.S. population will become more diverse with regard to race and ethnicity.

 

 

ANS:  D

By 2050, Hispanics will make up about 25% of the U.S. population; African Americans will make up about 14%, Asians and Pacific Islanders about 8%, and whites about 53%. Although the other options relate to community population, they are very general in regard to population size and not specific to issues pertaining to mental health education.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 100

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse working with individuals from ethnic minority groups recognizes which as a factor that affects mental health care?
a. They often delay seeking help until problems become intense or chronic.
b. They characteristically do not engage in early termination from care.
c. They tend to dislike using community support systems.
d. They tend to avoid using family support systems.

 

 

ANS:  A

Research suggests that members of minority groups delay seeking help until their problems are intense, chronic, and at a stage that is difficult to treat, and until community and family support systems have been exhausted. Delays in accessing care and early termination from care create a cyclical reliance on more costly health care services.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 101

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. When conducting an admission interview, a mental health nurse asks a patient a series of questions related to personal beliefs. When the patient asks why these questions are being asked, how should the nurse respond?
a. “These questions are routine and are a mandatory part of the admission process.”
b. “The prime reason is that these questions help the staff to identify any specific health care practices that would conflict with your religious beliefs.”
c. “Mental health can be affected by personal belief systems, so it is important that your treatment plan be developed to be compatible with your beliefs.”
d. “These questions are asked of every patient and are confidential, but if you are not comfortable answering them I will simply note that in your chart.”

 

 

ANS:  C

A person’s belief system, worldview, religion, or spirituality can have a positive or negative effect on mental health. Belief systems play a vital role in determining whether a particular explanation and associated treatment plan will have meaning for the patient and others in the patient’s social network. Declaring that something is routine/mandatory does not address the patient’s question nor does ensuring confidentiality. Addressing religious beliefs is only a partial focus of the interview process.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 103

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse working in a mental health center would determine which patient to be the best candidate for a spirituality-based 12-step intervention program?
a. A patient who has generalized anxiety disorder
b. A patient who has an addiction to alcohol
c. A patient with a personality disorder
d. A patient who has agoraphobia

 

 

ANS:  B

Spirituality-based intervention programs, such as 12-step programs, which encourage the individual to surrender control to an external supreme being, are commonly used treatments for addictive disorders, including addiction to alcohol.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 103

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A student nurse asks an instructor, “Since most of the patients on the unit are female, does that mean that women experience more mental illness than men?” The instructor replies:
a. “That’s a very astute observation. You’re right.”
b. “The prevalence is relatively the same for men and women.”
c. “As a matter of fact, mental illness is more prevalent among men.”
d. “I’m sure that you will be able to find that information in your textbook.”

 

 

ANS:  B

Although there appear to be distinctive male and female patterns of risk, when all psychiatric disorders are included, the prevalence of mental illness among males and females is roughly equal. Correcting the student’s misconception immediately would be more beneficial than assuming the student will acquire the information. The two remaining options present incorrect information.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 101

TOP:   Nursing Process: N/A                     MSC:  NCLEX: Psychosocial Integrity

 

  1. During a team conference about a patient, the patient’s spouse states, “My spouse is Irish, so I should have expected a drinking problem.” This statement is an example of:
a. racism.
b. intolerance.
c. stereotyping.
d. discrimination.

 

 

ANS:  C

Stereotypes are depersonalized conceptions of individuals within a group. Racism is a prejudice originating out of bias toward a particular racial group. Intolerance is an attitude of not accepting or respecting different opinions, practices, or people, whereas discrimination is unfair treatment of a person or group on the basis of prejudice.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 104

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. One task of an administrator of a culturally sensitive mental health system would be to:
a. eliminate all staff bias related to cultural diversity.
b. hire significant numbers of minority health care providers.
c. incorporate the values of culture competency into all levels of care.
d. keep access to care open for the dominant ethnic, social, and religious groups.

 

 

ANS:  C

Incorporating the value of culture into all levels of care is desirable. Eliminating all staff bias is unlikely, hiring significant numbers of minority health care providers is not appropriate or realistic, and keeping access to care open for minority groups would be an act that is independent of cultural sensitivity.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 106

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Asian patients prescribed psychiatric medications:
a. exhibit better response to antidepressants and phenothiazine than do African-American patients.
b. have less tendency to abuse alcohol with their medications than do white patients.
c. have extrapyramidal side effects at lower dosage levels than do other ethnic groups.
d. experience fewer side effects when taking anticholinergic medications than do white patients taking the same dosage.

 

 

ANS:  C

The occurrence of extrapyramidal side effects among Asians is the only statement about racial/ethnic psychobiological differences listed that is accurate.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 108

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Which intervention will the nurse consider to be a central responsibility when planning for culturally competent treatment?
a. Learn what the illness means to the patient and how the patient’s beliefs can help mediate the stressors.
b. Learn as much as possible regarding the beliefs of both the patient and the patient’s extended family.
c. Ask the patient about beliefs in a formal organized religion and daily or weekly religious practices that can be factored into treatment.
d. Tell the patient that it will be important to examine together the belief systems of both the nurse and patient to be sure that they are congruent.

 

 

ANS:  A

In terms of treatment planning, the psychiatric nurse needs to be sensitive to sociocultural issues but also must transcend them. A central responsibility of the nurse is to understand what the illness means to the patient and the way in which the patient’s beliefs can help to mediate the stressful events or make them easier to bear by redefining them as opportunities for personal growth.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 103

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. With regard to sociocultural risk factors, nursing care should be based on the premise that:
a. risk for individual development of a psychiatric disorder usually remains constant over time.
b. all members of ethnic groups have the same risk for developing a psychiatric disorder.
c. risk factors interact constantly, so different factors become important at different times.
d. sociocultural risk factors affect assessment and nursing care planning more than implementation of care.

 

 

ANS:  C

Risk factors interact constantly, so risk factors may assume greater or lesser significance for an individual over time. Cultural group members vary in terms of risk for specific mental health disorders, and sociocultural risk factors affect the nurse working with the patient during all phases of the nursing process.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 100

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. An elderly Hispanic woman has become depressed after the death of her husband. The nurse would anticipate that this patient is most likely to:
a. be less able to adapt than before.
b. recover and return to her preillness state.
c. believe the death is a punishment for past acts.
d. suffer recurrences of depression because of cultural strain.

 

 

ANS:  B

It has been found that as age increases, the prevalence of depression decreases. Older people have a greater capacity to adapt and tend to recover from depression more quickly than younger individuals; they are also less likely to have a recurrence.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 103-104

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse assessing sociocultural risk factors for a 34-year-old female, single, poorly educated immigrant with three young children and who receives support from social services, should be most concerned about the effects of:
a. age.
b. gender.
c. immigration.
d. disadvantagement.

 

 

ANS:  D

Disadvantagement factors, such as lack of basic resources and low education level, create profound problems in prevention, diagnosis, and treatment of psychiatric disorders.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 104

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A 32-year-old Caucasian female college graduate who weighs 150 pounds is heavily sedated by the amount of lorazepam (Ativan) prescribed for anxiety reduction. A Hispanic male heavy laborer who is the same age and weight as the female patient has taken the same dose of Ativan and states that his anxiety is barely under control. What factor most likely accounts for this difference?
a. The male is Hispanic, whereas the female is Caucasian.
b. Social stratification and poverty make treatment more difficult.
c. Men more often underrate the efficacy of antianxiety medication.
d. The female gastrointestinal system more readily absorbs benzodiazepines.

 

 

ANS:  D

The difference is gender-based. The lesser amount of stomach acid secreted by women means that benzodiazepines are better absorbed.

 

DIF:    Cognitive Level: Analysis               REF:   Text Page: 108

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Two patients, an African-American agnostic man and a Caucasian Baptist woman, are both diagnosed with schizophrenia, paranoid type. Both patients are 42 years old and live at the poverty level. The age of onset for the illness was 21 years in the male patient and 41 years in the female patient. What sociocultural factor accounts for the male patient’s less favorable prognosis?
a. His religious belief system
b. Caucasian Americans are more amenable to treatment.
c. Males living in poverty receive less social support than women living in poverty.
d. He had an earlier onset of illness that has resulted in his longer course of illness.

 

 

ANS:  D

Males tend to have earlier onset of schizophrenia than females. The mean age of onset is 31 years for males and 41 years for females. Age of onset is a critical factor in the prognosis for schizophrenia because early onset is associated with a longer course of illness and poorer prognosis. It is also known that women have a better response to both pharmacological and psychosocial treatments. Religious beliefs are not known to have a negative impact on the prognosis of schizophrenia. No available research supports the idea that Americans are less amenable to treatment or that males receive less social support than females when both live in poverty.

 

DIF:    Cognitive Level: Analysis               REF:   Text Pages: 100-102

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. A culturally competent nurse possesses which characteristics? (Select all that apply.)
a. Flexibility
b. An unbiased nature
c. Sensitivity to diversity
d. Willingness to learn
e. Mastery of nursing skills

 

 

ANS:  A, B, C, D

Cultural competency requires sensitivity to differences and a willingness to learn about cultural beliefs and practices. These characteristics need to be joined with an unbiased ability to move past traditional methods and demonstrate a willingness to change. Skills mastery is not directly related to cultural competency.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 99

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Which factor is most likely to delay a member of a minority group from seeking needed medical care? (Select all that apply.)
a. Access to medical insurance
b. Ability to speak English as a second language
c. Availability of primary physicians for referrals
d. Amount of support provided by ethnic community
e. Familiarity of the community where care is being offered

 

 

ANS:  A, B, C

Although community support and familiarity are factors in general health care attitudes and practices, they usually do not negatively affect the decision to seek medical assistance as much as the remaining options do. Lack of insurance, low access to primary physicians for referral, and language barriers that make it difficult to negotiate an unfamiliar system are factors that promote a delay in seeking help.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 100-101

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

Chapter 9: Policy and Advocacy in Mental Health Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Health professionals planning treatment initiatives should be most concerned with the burden of disease created by:
a. violence and injury.
b. environmental quality.
c. behavioral health problems.
d. irresponsible sexual behavior.

 

 

ANS:  C

Depression ranks as the second most common cause of disability measured in disability-adjusted life years in the United States, and four other psychiatric disorders are in the top 10 worldwide, including alcohol use, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. Which disorder is the leading psychiatric cause of disability in the world?
a. Depression
b. Schizophrenia
c. Bipolar disorder
d. Obsessive-compulsive disorder

 

 

ANS:  A

A large international study found that depression was the number one psychiatric cause of disability in the world. Four other psychiatric disorders also were among the top 10, including alcohol abuse, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

 

DIF:    Cognitive Level: Knowledge          REF:   Text Page: 127

TOP:   Nursing Process: N/A                     MSC:  NCLEX: Health Promotion and Screening

 

  1. To work effectively within the health care system, a nurse must understand the current interface between mental health care and the environment. Which statement accurately reflects this interface?
a. The once simple system has grown from two to six parts, which has significantly complicated the interface.
b. Biases on the part of providers have largely been abolished, greatly improving the effectiveness of the interface.
c. Reimbursers and insurers are primarily concerned with protecting the patient’s constitutional rights regarding access to care and treatment received.
d. In general, families are becoming less concerned with education and empowerment for family members who are patients.

 

 

ANS:  A

The interface between mental health care and the environment has become increasingly complex in recent years. It once consisted only of mental health providers and patients, but the interface now includes patients, providers, families, reimbursers and insurers, lawmakers and regulators, and the judiciary; each of these components has its own agenda.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 127

TOP:   Nursing Process: N/A

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. Managed behavioral health care settings are involved in:
a. health care reform.
b. universal health care.
c. health care for the underserved.
d. treating mental and substance abuse disorders.

 

 

ANS:  D

Behavioral health covers both mental illness and substance abuse disorders.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: N/A

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A committee is formed to increase the public’s understanding that mental health is essential to overall health. A nurse would expect that the focus of this group’s work would be:
a. improving access to quality care that is culturally competent.
b. protecting and enhancing the rights of people with mental illness.
c. developing and implementing integrated electronic health record and personal health information systems.
d. collaborating with the emergency department to treat mental health problems with the same urgency as physical health problems.

 

 

ANS:  D

Recommendations of the New Freedom Commission on Mental Health would address the means of having mental health issues handled with the same urgency as physical health issues.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 128-130

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A patient receiving mental health services complains about having to get a referral from a primary care physician in order to obtain mental health services. The nurse should explain to the patient that this is a cost control practice used in managed care that is described as:
a. gatekeeping.
b. utilization review.
c. case management.
d. preadmission certification.

 

 

ANS:  A

Gatekeeping is a process that limits direct access to specialists, hospitals, and expensive procedures. Patients select a primary care provider who manages everyday care and is a gatekeeper for referral to other health care providers.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A patient tells a nurse, “I belong to a health maintenance organization (HMO) that advertises being a capitated system. What does that mean?” The nurse replies:
a. “It’s complicated but if you like I’ll have the payments office discuss it with you.”
b. “You pay a sliding fee for each illness based on your monthly take-home income.”
c. “You pay a fixed fee per month while the HMO provides all medically necessary care.”
d. “The HMO pays your physician a flat fee for a particular episode of illness regardless of the number of office visits you make.”

 

 

ANS:  C

Capitation calls for the consumer to pay a fixed fee or a per-member-per-month premium. In return, the managed care company agrees to provide all medically necessary health care for all covered people.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. Access to care refers to the:
a. availability of health care.
b. degree to which services are comprehensive.
c. overall use of mental health services in a community.
d. convenience and ease of obtaining service and information.

 

 

ANS:  D

Access is the degree to which services and information about care are easily obtained. The ideal comprehensive system would provide multiple points of entry for treatment, including direct access through self-referral.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. In many rural communities the ratio of consumers to doctors is higher than it is in cities. This is an example of:
a. a health access problem in rural areas.
b. a lack of compassion among physicians.
c. reimbursement barriers in rural states.
d. appropriate distribution of health care providers.

 

 

ANS:  A

Access is the degree to which services and information about care are easily obtained. When the consumer/doctor ratio is high, access is often compromised.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: N/A

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A psychiatric nurse advocating for behavioral health system change would focus on which topic?
a. Abolishing the health maintenance organization (HMO) system
b. Strengthening current utilization review guidelines
c. Limiting consumer empowerment initiative options
d. Increasing resources for chronic care mental health services

 

 

ANS:  D

Although gains have been made in medical treatment for behavioral illness, little attention has been given to preventive, rehabilitative, and chronic care services. This is a topic worthy of nursing advocacy.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 131

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A case manager at the local mental health center evaluates the clinical appropriateness of a patient’s current level of care. To do this, the case manager will assess:
a. the type of service currently provided.
b. the vigor of the patient to whom the service is provided.
c. the type, amount, and level of care needed to achieve positive outcomes.
d. whether the level of the patient’s care is currently considered cost effective.

 

 

ANS:  C

Clinical appropriateness is the degree to which the type, amount, and level of clinical services are delivered to promote the best clinical outcomes.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 131

TOP:   Nursing Process: Evaluation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A nurse works in an organization that provides an integrated behavioral continuum of care. The goal of treatment in the crisis clinic is:
a. remission.
b. recovery.
c. stabilization.
d. optimal level of wellness.

 

 

ANS:  C

The goal of crisis treatment is stabilization, with the expected outcome being no harm to self or others.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 132

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. Which is a suitable goal and expected outcome for a patient who is admitted for the recurrence of psychotic symptoms related to noncompliance with medication therapy?
a. Goal, safety; outcome, no risk for violence
b. Goal, remission; outcome, symptom relief
c. Goal, recovery; outcome, improved functioning
d. Goal, rehabilitation; outcome, attain optimal quality of life

 

 

ANS:  B

The goal of remission can probably be attained if the patient resumes medication therapy. The outcome of symptom relief will be attained during an acute, short-term stay.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 132

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. Which type of managed care plan allows the most flexibility in choosing health services and providers?
a. Health maintenance organization (HMO)
b. Independent practice organization (IPO)
c. Preferred provider organization (PPO)
d. Point of service plan (POS)

 

 

ANS:  D

A POS plan allows consumers to choose between delivery systems at the time they seek care. The other types of plans listed limit the clinicians and/or the agencies that can be used for health care services.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: N/A

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A nurse who advocates for consumer empowerment will seek to help psychiatric patients:
a. achieve a sense of self-responsibility.
b. comply with provider-prescribed treatment programs.
c. understand that their viewpoints are flawed by mental illness.
d. use resources predominantly from the formal mental health system.

 

 

ANS:  A

Nurses who advocate for consumer empowerment for patients with mental health disorders assist patients in achieving a sense of personal responsibility, in collaborating with health professionals to determine their treatment plans, in being respected for the legitimacy of their points of view, and in using resources from the entire community rather than just the formal mental health system.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 132

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. Which nurse in a managed care setting has the greatest responsibility for allocating resources to an individual patient?
a. Treatment nurse
b. Case manager
c. Risk manager
d. Patient educator

 

 

ANS:  B

The case manager has the greatest responsibility for allocating resources for a particular patient through the development of a comprehensive treatment plan; he or she then coordinates with all involved staff and agencies.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 134

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A trend in psychiatric nursing related to cost controls imposed in the managed care environment is:
a. reduced emphasis on utilization review.
b. a marked increase in the use of risk managers.
c. reduced use of patient and family educators to promote compliance.
d. a shift from acute inpatient to community-based positions.

 

 

ANS:  D

With cost consciousness, greater emphasis is being placed on the continuum of care. The number of inpatient hospitalization days will continue to decrease, and nurses will be needed to staff alternate treatment sites.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 133

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A health provider study group should explore which option as a means to improve access to care in rural areas servicing a scattered population?
a. Installation of telehealth services
b. An increased number of satellite centers
c. Implementation of mobile mental health clinics
d. Federal grants to supplement the agency budget for personnel

 

 

ANS:  A

Health technology and telehealth improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 127

TOP:   Nursing Process: Planning

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A psychiatric nurse notes that the expected outcome of treatment for a patient with depression is the relief of symptoms. The nurse determines that this patient is in which stage of treatment in an integrated behavioral continuum of care?
a. Crisis
b. Acute
c. Maintenance
d. Health promotion

 

 

ANS:  B

The expected outcome for a patient during the acute stage of treatment is symptom relief. The expected outcome during crisis is that the patient does no harm to self or others. The expected outcome during maintenance is improved functioning. The expected outcome during health promotion is to attain an optimal quality of life.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 132

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient’s goal of treatment is stabilization. The patient is in which stage of treatment in an integrated behavioral continuum of care?
a. Crisis
b. Acute
c. Maintenance
d. Health promotion

 

 

ANS:  A

The expected goal for a patient in crisis is stabilization. The goal during the acute stage of treatment is remission. The goal during the maintenance stage of treatment is recovery. The goal during the health promotion phase is optimal level of wellness.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 132

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient is transferred to a rehabilitation-oriented residential mental health program. Which expected outcome applies to the new care setting?
a. Symptom relief
b. Improved functioning
c. No harm to self or others
d. Attain optimal quality of life

 

 

ANS:  B

A rehabilitation-oriented residential treatment program is a level of care provided during the maintenance stage of treatment in an integrated behavioral continuum of care. The expected outcome of care in this stage is improved functioning, and the overall goal is recovery.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 132

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. A patient asks a nurse, “How do managed care systems control costs?” The nurse should reply that the HMO’s cost saving strategies include using: (Select all that apply.)
a. utilization reviews.
b. case management.
c. easy repayment plans.
d. preadmission certifications.
e. inexpensive health care plans.

 

 

ANS:  A, B, D

Preadmission certification ensures the proper treatment setting; utilization review evaluates the appropriateness and necessity of services; and case management focuses on desirable outcomes, appropriate lengths of stay, and efficient use of resources. Each of these helps control costs. The remaining options are not suggested by HMOs. The correct response does not respond to the patient in an effective way.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 129

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. When a facility administrator mentions that the employee assistance program (EAP) may be discontinued because of its expense, the health liaison nurse disagrees, stating that the program pays for itself through: (Select all that apply.)
a. prevention of illness encouraged by educational programs.
b. early disease detection brought about by offered screenings.
c. its primary focus on alcohol and drug abuse awareness sessions.
d. decreased work-related injuries resulting from ergonomics training.
e. mandated immunization policies regarding acquired job-related illnesses.

 

 

ANS:  A, B, D, E

Cost-effectiveness studies document the value of EAPs, particularly their contributions to prevention in areas such as workplace education, skill development, and policy and environmental changes. The primary focus is not abuse awareness.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 129-130

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

Chapter 13: Crisis Intervention

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient comes to the mental health clinic with insomnia, irritability, increased tension, and headaches. The symptoms began 1 week ago after the patient was laid off from work. The patient expresses concern that this will result in a relocation that will be hard on the entire family. The patient is most likely experiencing:
a. an anxiety reaction.
b. a situational crisis.
c. a maturational crisis.
d. an adjustment disorder.

 

 

ANS:  B

A situational crisis occurs when a life event upsets an individual’s psychological equilibrium. Loss of a job can give rise to a situational crisis.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 183

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A jet plane carrying 140 passengers crashes in a nearby community. One can reliably predict that the survivors, families, and community will initially experience:
a. a situational crisis.
b. problem resolution.
c. adjustment disorders.
d. psychological equilibrium.

 

 

ANS:  A

A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 183

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient comes to the mental health center and relates feeling very anxious since graduating from high school 1 week ago. The patient is having difficulty concentrating and feels shaky. This typifies:
a. a situational crisis.
b. a maturational crisis.
c. psychological equilibrium.
d. a pseudopsychological crisis.

 

 

ANS:  B

Maturational crises are developmental events requiring role change.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 183

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient comes to the mental health center after being held hostage during a bank robbery 2 days ago. The patient relates a number of symptoms, including intrusive thoughts, nightmares, and feelings of helplessness. The nurse should consider the possibility that the patient is experiencing a _____ crisis.
a. situational
b. maturational
c. developmental
d. pseudopsychological

 

 

ANS:  A

A situational crisis occurs when an accidental, uncommon, or unexpected event upsets psychological equilibrium.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 183

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient who undergoes a hostage experience begins crisis intervention therapy. The patient asks, “How long before I will feel like myself again?” The reply that shows the best understanding of the parameters of crisis intervention therapy would be:
a. “No one can really say.”
b. “It usually takes about 6 weeks.”
c. “My best guess would be 6 months.”
d. “The experience usually results in permanent changes.”

 

 

ANS:  B

Successful crisis intervention therapy is usually limited to 6 weeks’ duration.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 184

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A teenaged new mother reports she has felt apathetic, fatigued, and helpless since giving birth. She states, “I don’t know what’s expected of me.” The nurse believes the patient will benefit from:
a. crisis intervention.
b. short hospitalization.
c. neuroleptic medication.
d. antidepressant medication.

 

 

ANS:  A

The patient is probably experiencing a maturational crisis related to the role changes required by the birth of the baby. Crisis intervention is appropriate.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 184

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. The outcome of crisis intervention therapy that should be identified for a patient who has been apathetic, fatigued, and feeling helpless since the recent birth of her baby is that she will:
a. experience reduced anxiety.
b. undergo personality change.
c. identify the need for a support system.
d. return to the precrisis level of functioning.

 

 

ANS:  D

A return to the precrisis level of functioning is the expected outcome for crisis intervention.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 187

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient is being seen for crisis intervention as a result of receiving a poor job evaluation. The self-esteem need that nursing assessment will most likely reveal a problem with:
a. dependency.
b. role mastery.
c. biological functioning.
d. unmet financial responsibility.

 

 

ANS:  B

Self-esteem is threatened when role mastery is not attained. Role mastery is achieved when the person attains work, sexual, and family role successes.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 186

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. When a crisis clinic nurse asks a patient, “Who takes care of you when you are sick?” the nurse is exploring the balancing factors of:
a. situational support.
b. problem resolution.
c. coping mechanisms.
d. perception of the event.

 

 

ANS:  A

Balancing factors are important in the development and resolution of a crisis and include the precipitating stressor, the patient’s perception of the stressor, the nature and strength of a patient’s support systems and coping resources, and previous strengths and coping mechanisms. Family, friends, religious leaders, and co-workers are considered part of the patient’s support system.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 187

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. To understand the effects of a precipitating event such as the loss of one’s job, a nurse must assess the:
a. patient’s appraisal of the event.
b. perception of the support group.
c. patient’s awareness or lack of awareness of options.
d. patient’s own feelings about his or her response to the situation.

 

 

ANS:  D

The patient’s perception is a key factor. What may be trivial to one may seem overwhelming to another and vice versa. If the patient does not perceive the event as problematical, a crisis may be averted.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 187

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Survivors of a hurricane are grieving the loss of loved ones and homes. Which level of crisis intervention would be most appropriate for a nurse to use?
a. General support
b. Generic approach
c. Individual approach
d. Environmental manipulation

 

 

ANS:  B

The generic approach is designed to reach high-risk individuals and large groups as quickly as possible.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 188

TOP:   Nursing Process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. A critically ill postsurgical patient tells a nurse about recent emergency surgery and the expected long-term postoperative course. As the patient speaks, the nurse notices that the speech lacks affect. Which technique of crisis intervention would be most therapeutic to use initially?
a. Catharsis
b. Manipulation
c. Raising self-esteem
d. Reinforcement of behavior

 

 

ANS:  A

Catharsis is the release of feelings that takes place as the patient talks about the event. The nurse solicits the patient’s feelings about the situation by asking open-ended, explorative questions and focusing on feelings.

 

DIF:    Cognitive Level: Analysis               REF:   Text Page: 189

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse working with a parent in crisis suggests that the parent send both children to stay with their grandparents temporarily. This is an example of:
a. reducing dependency.
b. environmental manipulation.
c. reducing the children’s stressors.
d. increasing contact with the extended family.

 

 

ANS:  B

Environmental manipulation includes interventions that directly change the patient’s physical or interpersonal situation. These interventions provide situational support or remove stress.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Pages: 187-188

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient comes to the clinic and states, “I’ve just lost my job, and I’m afraid that I’m at an age where I’ll no longer be able to find work in my career field.” Which approach will be most appropriate for this patient?
a. Environmental manipulation
b. Individual approach
c. Generic approach
d. General support

 

 

ANS:  B

This type of crisis intervention can be effective with all types of crises. It is particularly useful in combined situational and maturational crises.

 

DIF:    Cognitive Level: Application          REF:   Text Pages: 188-189

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse working with a patient in individual crisis intervention would characterize the approaches used as:
a. open-ended.
b. passive and indirect.
c. active, focused, and explorative.
d. psychoanalytic-based techniques.

 

 

ANS:  C

Because of time constraints, nurses performing crisis intervention use techniques that are active, focused, and explorative to carry out the interventions. Interventions must be aimed at achieving quick resolution. Nurses must be creative, flexible, and competent in the use of many techniques.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Pages: 189-190

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. While working with a patient in crisis, a nurse attempts to help the patient identify the relationship between the event precipitating the crisis and the patient’s subsequent feelings and behaviors. This is an example of:
a. clarification.
b. support of defenses.
c. reinforcement of behavior.
d. raising the patient’s self-esteem.

 

 

ANS:  A

Clarification is used when a nurse helps the patient identify the relationship among events, behavior, and feelings. For example, clarification can mean helping a patient see that the patient only felt too sick to go to work after being passed over for a promotion.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 189

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse notes that a patient is using alcohol each evening as a means of coping with the loneliness associated with a recent divorce. Pointing this out and encouraging the patient to join an exercise club or try jogging in lieu of drinking are examples of an approach called:
a. clarification.
b. support of defenses.
c. raising self-esteem.
d. reinforcement of behavior.

 

 

ANS:  B

Support of defenses encourages the use of adaptive defenses and discourages maladaptive and unhealthy coping strategies.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 189

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A crisis intervention clinic nurse responds to a patient who has many concerns about marriage by saying, “You seem to be very committed to the success of your marriage. I think you have the ability to work through these issues and end up with a stronger relationship.” This is an example of which technique?
a. Clarification
b. Support of defenses
c. Raising self-esteem
d. Exploration of solutions

 

 

ANS:  C

Raising self-esteem helps a patient regain feelings of self-worth by communicating confidence that the patient has strengths and can find solutions to problems.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 189

TOP:   Nursing Process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient was the driver of a car that struck and killed a child. The patient tells a nurse, “I killed a child! I’m haunted by the sight of the body being thrown into the air. If I hadn’t been drinking I might have been able to stop. I don’t know how I can go on living with myself!” The crisis nurse should give priority to assessing the patient’s:
a. suicidal risk.
b. physical condition.
c. recent drug dependency.
d. current alcohol consumption.

 

 

ANS:  A

Whenever a patient alludes to the possibility of suicide the nurse should actively explore the topic.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 189

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. When a patient in crisis intervention therapy alludes to the possibility of self-harm, the nurse should:
a. arrange for someone to check in on the patient.
b. take all steps necessary to ensure the patient’s safety.
c. advise the patient that such thoughts are common in crisis.
d. tell the patient that he or she is too intelligent to consider that as a solution.

 

 

ANS:  B

All suicidal thoughts are serious, and a nurse’s first priority is keeping the patient safe.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 189

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. When evaluating care of a crisis patient, a psychiatric nurse must remember that one of the primary goals of crisis intervention is to:
a. support the patient through the process.
b. help the patient return to the precrisis state.
c. give the patient new, healthy coping mechanisms.
d. listen to the patient to help reduce the stress levels.

 

 

ANS:  B

The last phase of crisis intervention is evaluation, when the nurse and patient evaluate whether the intervention resulted in a positive resolution of the crisis. One area to explore is whether the patient has returned to the precrisis level of functioning.

 

DIF:    Cognitive Level: Comprehension   REF:   Text Page: 190

TOP:   Nursing Process: Evaluation           MSC:  NCLEX: Psychosocial Integrity

 

  1. Which statement made by a person in a crisis state indicates the presence of a balancing factor?
a. “I’ve been drinking more than usual.”
b. “I’ve always been a loner. I don’t need other people.”
c. “I pray when things get tough. It’s always helped me survive trouble.”
d. “My spouse just went to the store. I don’t believe it when they tell me my spouse is dead.”

 

 

ANS:  C

Praying represents a coping mechanism previously and successfully used by the patient.

 

DIF:    Cognitive Level: Analysis               REF:   Text Page: 187

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A variety of crisis intervention modalities are available in contemporary society depending on the needs of patients. Some of them are:
a. in mobile crisis programs.
b. available only during non-daytime hours.
c. in primary care provider (PCP) office settings.
d. available only to members of certain patient populations.

 

 

ANS:  A

Mobile crisis teams provide front-line interdisciplinary crisis intervention to individuals, families, and communities. It is not true that crisis intervention is only available during non-daytime hours, is usually available in PCP office settings, or is only available to members of certain patient populations.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 194

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. A patient who was held hostage for 12 hours by a carjacker now repeatedly states, “I can’t believe it happened to me!” while admitting to feeling anxious and being afraid of strangers and of ever driving again. The nurse’s interventions should target: (Select all that apply.)
a. denial.
b. anxiety.
c. confusion.
d. self-efficacy.
e. suicide potential.

 

 

ANS:  A, B, D

The patient is using denial, admits to anxiety, and has self-doubts. These would be appropriate targets for intervention.

 

DIF:    Cognitive Level: Application          REF:   Text Page: 190

TOP:   Nursing Process: Assessment          MSC:  NCLEX: Psychosocial Integrity