Exam 1 Flashcards
(153 cards)
1
Q
A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced
practice nurse to perform which additional intervention?
a. Conduct mental health
assessments.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
A
ANS: B
In most states, prescriptive privileges are granted to master’s-prepared nurse practitioners and
clinical nurse specialists who have taken special courses on prescribing medication. The nurse
prepared at the basic level is permitted to perform mental health assessments, establish
relationships, and provide individualized care planning.
2
Q
A nursing student expresses concerns that mental health nurses “lose all their clinical nursing
skills.” Select the best response by the mental health nurse.
a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient
ratios must be better because of the nature of the patients’ problems.”
b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve
multidimensional problems. I am challenged by those situations.”
c. “That’s a misconception. Psychiatric nurses frequently use high technology monitoring
equipment and manage complex intravenous therapies.”
d. “Psychiatric nurses do not have to deal with as much pain and suffering as medical–
surgical nurses do. That appeals to me.”
A
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical–surgical
nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients
with medical as well as mental health problems, reflecting the holistic perspective these
nurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased,
just like other specialties. Psychiatric nursing involves clinical practice, not just
documentation. Psychosocial pain and suffering are as real as physical pain and suffering.
3
Q
When a new bill introduced in Congress reduces funding for care of persons diagnosed with
mental illness, a group of nurses write letters to their elected representatives in opposition to
the legislation. Which role have the nurses fulfilled?
a. Recovery
b. Attending
c. Advocacy
d. Evidence-based practice
A
ANS: C
An advocate defends or asserts another’s cause, particularly when the other person lacks the
ability to do that for self. Examples of individual advocacy include helping patients
understand their rights or make decisions. On a community scale, advocacy includes political
activity, public speaking, and publication in the interest of improving the human condition.
Since funding is necessary to deliver quality programming for persons with mental illness, the
letter-writing campaign advocates for that cause on behalf of patients who are unable to
articulate their own needs.
4
Q
A family has a long history of conflicted relationships among the members. Which family
member’s comment best reflects a mentally healthy perspective?
a. “I’ve made mistakes but everyone else in this family has also.”
b. “I remember joy and mutual respect from our early years together.”
c. “I will make some changes in my behavior for the good of the family.”
d. “It’s best for me to move away from my family. Things will never change.”
A
ANS: C
The correct response demonstrates the best evidence of a healthy recognition of the
importance of relationships. Mental health includes rational thinking, communication skills,
learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may
be healthy, but the correct response shows a higher level of mental health. The other incorrect
responses show blaming and avoidance.
5
Q
Which assessment finding most clearly indicates that a patient may be experiencing a mental
illness? The patient
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between “as if” and “for real.”
d. perceives difficulty making a decision about whether to change jobs.
A
ANS: B
The correct response describes a mood alteration, which reflects mental illness. The
distracters describe behaviors that are mentally healthy or within the usual scope of human
experience.
6
Q
Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was
achieved for an adult patient? The patient
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of own life.
A
ANS: A
The correct response describes an adaptive, healthy behavior. The distracters describe
maladaptive behaviors.
7
Q
A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form.
Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health Problems
(ICD-10)
b. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice
c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
d. A behavioral health reference manual
A
ANS: C
The DSM-V gives the criteria used to diagnose each mental disorder. It is the official guideline
for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a
psychiatric illness.
8
Q
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource
would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. DSM-V
c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10
A
ANS: B
The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official
guideline for diagnosing psychiatric disorders. The other references are good resources but do
not define the diagnostic criteria.
9
Q
Which individual is demonstrating the highest level of resilience? One who
a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for 2 years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
A
ANS: D
Resilience is closely associated with the process of adapting and helps people facing
tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the
resources they need to support their well-being. Repression and depression are unhealthy.
Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related
audience response question.
10
Q
Complete this analogy. NANDA: clinical judgment: NIC: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ a. patient outcomes. b. nursing actions. c. diagnosis. d. symptoms.
A
ANS: B
Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis
Association, identifies diagnostic statements regarding human responses to actual or potential
health problems. These statements represent clinical judgments. NIC (Nursing Interventions
Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing
care activities may be direct or indirect.
11
Q
Which disorder is an example of a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depressive disorder
A
ANS: C
Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized
by people in those cultures. A syndrome recognized in parts of Southeast Asia is running
amok, in which a person (usually a male) runs around engaging in furious, almost
indiscriminate violent behavior.
12
Q
The DSM-V classifies:
a. deviant behaviors.
b. present disability or distress.
c. people with mental disorders.
d. mental disorders people have.
A
ANS: D
The DSM-V classifies disorders people have rather than people themselves. The terminology
of the tool reflects this distinction by referring to individuals with a disorder rather than as a
“schizophrenic” or “alcoholic,” for example. Deviant behavior is not generally considered a
mental disorder. Present disability or distress is only one aspect of the diagnosis.
13
Q
A citizen at a community health fair asks the nurse, “What is the most prevalent mental disorder
in the United States?” Select the nurse’s correct response.
a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer’s disease
A
ANS: D
The 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65% and 50%
for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence
of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.
14
Q
In the majority culture of the United States, which individual has the greatest risk to be labeled
mentally ill? One who
a. describes hearing God’s voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals.
d. always has an optimistic viewpoint about life and having own needs met.
A
ANS: A
The question asks about risk. Hearing voices is generally associated with mental illness, but in
charismatic religious groups, hearing the voice of God or a prophet is a desirable event.
Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The
individuals described in the other options are less likely to be labeled mentally ill.
15
Q
A patient’s relationships are intense and unstable. The patient initially idealizes the significant
other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will
benefit from interventions to develop which aspect of mental health?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
A
ANS: D
The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or
activities.
16
Q
Which belief will best support a nurse’s efforts to provide patient advocacy during a
multidisciplinary patient care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are unchanged from culture to culture.
d. Assessment findings in mental illness reflect a person’s cultural patterns
A
ANS: D
Symptoms must be understood in terms of a person’s cultural background. A nurse who
understands that a patient’s symptoms are influenced by culture will be able to advocate for
the patient to a greater degree than a nurse who believes that culture is of little relevance. The
distracters are untrue statements.
17
Q
A nurse is part of a multidisciplinary team working with groups of depressed patients. One
group of patients receives supportive interventions and antidepressant medication. The other
group receives only medication. The team measures outcomes for each group. Which type of
study is evident?
a. Incidence
b. Prevalence
c. Comorbidity
d. Clinical epidemiology
A
ANS: D
Clinical epidemiology is a broad field that addresses studies of the natural history (or what
happens if there is no treatment and the problem is left to run its course) of an illness, studies
of diagnostic screening tests, and observational and experimental studies of interventions used
to treat people with the illness or symptoms. Prevalence refers to numbers of new cases.
Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the
number of new cases of mental disorders in a healthy population within a given period. See
related audience response question
18
Q
The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how events
from childhood have anything to do with this disabling illness.” Which response by the nurse
will best help the spouse understand the cause of this disorder?
a. “Psychological stress is the basis of most mental disorders.”
b. “This illness results from developmental factors rather than stress.”
c. “Research shows that this condition more likely has a biological basis.”
d. “It must be frustrating for you that your spouse is sick so much of the time.”
A
ANS: C
Many of the most prevalent and disabling mental disorders have strong biological influences.
Genetics are only one part of biological factors. Empathy does not address increasing the
spouse’s level of knowledge about the cause of the disorder. The other distracters are not
established facts.
19
Q
A category 5 tornado occurred in a community of 400 people. Many homes and businesses were
destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with
posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases?
a. Prevalence
b. Comorbidity
c. Incidence
d. Parity
A
ANS: C
Incidence refers to the number of new cases of mental disorders in a healthy population within
a given period of time. Prevalence describes the total number of cases, new and existing, in a
given population during a specific period of time, regardless of when they became ill. Parity
refers to equivalence, and legislation required insurers that provide mental health coverage to
offer annual and lifetime benefits at the same level provided for medical–surgical coverage.
Comorbidity refers to having more than one mental disorder at a time.
20
Q
Which component of treatment of mental illness is specifically recognized by Quality and
Safety Education for Nurses (QSEN)?
a. All genomes are unique.
b. Care is centered on the patient.
c. Healthy development is vital to mental health.
d. Recovery occurs on a continuum from illness to health.
A
ANS: B
The key areas of care promoted by QSEN are patient-centered care, teamwork and
collaboration, evidence-based practice, quality improvement, safety, and informatics.
21
Q
Select the best response for the nurse to a question from another health professional regarding
the difference between a diagnosis in DSM-V and a nursing diagnosis.
a. “There is no functional difference between the two. Both identify human disorders.”
b. “The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture
into account.”
c. “The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not
explore etiology.”
d. “The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a
framework for identifying interventions for issues a patient is
experiencing.”
A
ANS: D
The medical diagnosis is concerned with the patient’s disease state, causes, and cures, whereas
the nursing diagnosis focuses on the patient’s response to stress and possible caring
interventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also
consider potential problems.
22
Q
Which nursing intervention below is part of the scope of an advanced practice
psychiatric/mental health nurse rather than a basic level registered nurse?
a. Coordination of
care
b. Health teaching
c. Milieu therapy
d. Psychotherapy
A
ANS: D
Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters
are within a basic level registered nurse’s scope of practice.
23
Q
An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you
automatically know how to take care of patients experiencing psychosis.” Which factors should
the new graduate consider when analyzing this comment? (Select all that apply.)
a. The experienced nurse may have lost sight of patients’ individuality, which may compromise the
integrity of practice.
b. New research findings should be integrated continuously into a nurse’s practice to provide
the most effective care.
c. Experience provides mental health nurses with the essential tools and skills needed for
effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients
through trial and error.
e. An intuitive sense of patients’ needs guides effective psychiatric nurses.
A
ANS: A, B
Evidence-based practice involves using research findings and standards of care to provide the
most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely
on experience. The effective nurse also maintains respect for each patient as an individual.
Overgeneralization compromises that perspective. Intuition and trial and error are
unsystematic approaches to care.
24
Q
Which findings are signs of a person who is mentally healthy? (Select all that apply.)
a. Says, “I have some weaknesses, but I feel I’m important to my family and friends.”
b. Adheres strictly to religious beliefs of parents and family of origin.
c. Spends all holidays alone watching old movies on television.
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
A
ANS: A, D, E
Mental health is a state of well-being in which each individual is able to realize his or her own
potential, cope with the normal stresses of life, work productively, and make a contribution to
the community. Mental health provides people with the capacity for rational thinking,
communication skills, learning, emotional growth, resilience, and self-esteem.
25
A patient in the emergency department says, “Voices say someone is stalking me. They want to
kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a
threat.” Which aspects of the patient’s mental health have the greatest and most immediate
concern to the nurse? (Select all that apply.)
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept
ANS: B, C, E
The aspects of mental health of greatest concern are the patient’s appraisal of and control over
behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of
persecution, and delusions of grandeur. In addition, the patient’s control over behavior is
tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest
that the other aspects of mental health (happiness and effectiveness in work) are of immediate
concern.
26
A parent says, “My 2-year-old child refuses toilet training and shouts ‘No!’ when given
directions. What do you think is wrong?” Select the nurse’s best reply.
a. “Your child needs firmer control. It is important to set limits now.”
b. “This is normal for your child’s age. The child is striving for independence.”
c. “There may be developmental problems. Most children are toilet trained by age 2.”
d. “Some undesirable attitudes are developing. A child psychologist can help you
develop a plan.”
ANS: B
This behavior is conventional of a child around the age of 2 years, whose developmental
task is to develop autonomy. The distracters indicate the child’s behavior is abnormal.
27
A nurse wants to find information on current evidence-based research, programs, and practices
regarding mental illness and addictions. Which resource should the nurse consult?
a. American
Psychiatric Association
b. American Psychological Association (APA)
c. Clinician’s Quick Guide to Interpersonal Psychotherapy
d. Substance Abuse and Mental Health Services Administration (SAMHSA)
ANS: D
The SAMHSA maintains a National Registry of Evidence-based Practices and Programs.
New therapies are entered into the database on a regular basis. The incorrect responses are
resources but do not focus on evidence-based information.
28
```
A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!”
Which psychosocial crisis is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
```
ANS: D
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining
control of self and environment, as exemplified by toilet training. This psychosocial crisis
occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant.
Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry
versus inferiority is the crisis of the 6- to 12-year-old child.
29
A 4-year-old grabs toys from other children and says, “I want that now!” From a
psychoanalytic perspective, this behavior is a product of impulses originating in which system
of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The
ego acts as a mediator of behavior and weighs the consequences of the action, perhaps
determining that taking the toy is not worth the mother’s wrath. The superego would oppose
the impulsive behavior as “not nice.” The preconscious is a level of awareness rather than
an aspect of personality
30
The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and
using good manners. These qualities are likely to be internalized and become part of which
system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: C
The superego contains the “shoulds,” or moral standards internalized from interactions with
significant others. Praise fosters internalization of desirable behaviors. The id is the center
of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and
reality-testing portion of the personality that negotiates solutions with the outside world.
The preconscious is a level of awareness from which material can be retrieved easily with
conscious effort. This item relates to an audience response question
31
A nurse supports a parent for praising a child who behaves in helpful ways to others. When this
child behaves with politeness and helpfulness in adulthood, which feeling will most likely
result?
a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings about
self. The other options are incorrect because each represents a negative feeling.
32
An adult says, “I never know the answers,” and “My opinion does not count.” Which
psychosocial crisis was unsuccessfully resolved for this adult?
a. Initiative versus guilt
b. Trust versus mistrust
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption
ANS: C
These statements show severe self-doubt, indicating that the crisis of gaining control over
the environment was not met successfully. Unsuccessful resolution of the crisis of initiative
versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus
mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful
resolution of the crisis of generativity versus self-absorption results in self-absorption that
limits the ability to grow as a person.
33
Which statement by a patient would lead the nurse to suspect unsuccessful completion of the
psychosocial developmental task of infancy?
a. “I know how to do things right, so I prefer jobs where I work alone rather than on a
team.”
b. “I do not allow other people to truly get to know me.”
c. “I depend on frequent praise from others to feel good about myself.”
d. “I usually need to do things several times before I get them right.”
ANS: B
According to Erikson, the developmental task of infancy is the development of trust. The
correct response is the only statement clearly showing lack of ability to trust others. An
inability to work with others, coupled with a sense of superiority, suggests unsuccessful
completion of the task of intimacy versus isolation. Relying on praise from others suggests
unsuccessful completion of the task of identity versus role confusion. Shame suggests
failure to resolve the crisis of initiative versus guilt.
34
```
A patient is suspicious and frequently manipulates others. To which psychosexual stage do
these traits relate?
a. Oral
b. Anal
c. Phallic
d. Genital
```
ANS: A
The behaviors in the stem develop as the result of attitudes formed during the oral stage,
when an infant first learns to relate to the environment. Anal-stage traits include stinginess,
stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness,
pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genitalstage traits include the ability to form satisfying sexual and emotional relationships with
members of the opposite sex, emancipation from parents, a strong sense of personal identity,
or the opposites of these traits.
35
A patient expresses a desire to be cared for by others and often behaves in a helpless fashion.
Which stage of psychosexual development is most relevant to the patient’s needs?
a. Latency
b. Phallic
c. Anal
d. Oral
ANS: D
Fixation at the oral stage sometimes produces dependent infantile behaviors in adults.
Latency fixations often result in difficulty identifying with others and developing social
skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having
difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in
retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an
audience response question.
36
A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels,
coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking care
of myself to volunteer to help others.” Which psychosocial developmental task do these
statements contrast?
a. Trust and mistrust
b. Intimacy and isolation
c. Industry and inferiority
d. Generativity and self-absorption
ANS: D
Both retirees are in middle adulthood, when the developmental crisis to be resolved is
generativity versus self-absorption. One exemplifies generativity; the other embodies selfabsorption. This developmental crisis would show a contrast between relating to others in a
trusting fashion and being suspicious and lacking trust. Failure to negotiate this
developmental crisis would result in a sense of inferiority or difficulty learning and working
as opposed to the ability to work competently. Behaviors that would be contrasted would be
emotional isolation and the ability to love and commit oneself.
37
An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which
statement by a sibling best indicates a sense of self-actualization?
a. “Of all of us, I am the most experienced with planning these types of events.”
b. “Funerals are supposed to be conducted quietly, respectfully, and according to a social
protocol.”
c. “This death was unfair but I hope we can plan a service that everyone feels is a
celebration of life.”
d. “This death was probably the consequence of years of selfish and inconsiderate
behavior by our sibling.”
ANS: C
The correct response shows an accurate perception of reality as well as a focus on solving
the problem in a way that involves others. These factors are characteristic of selfactualization. The incorrect responses demonstrate self-centeredness, rigidity, and blaming
which are characteristic of a failure to achieve self-actualization.
38
A student nurse says, “I don’t need to interact with my patients. I learn what I need to know by
observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to
this student by responding:
a. “Interactions are required in order to help you develop therapeutic communication
skills.”
b. “Nurses cannot be isolated. We must interact to provide patients with opportunities to
practice interpersonal skills.”
c. “Observing patient interactions will help you formulate priority nursing diagnoses and
appropriate interventions.”
d. “It is important to pay attention to patients’ behavioral changes, because these
signify adjustments in personality.”
ANS: B
The nurse’s role includes educating patients and assisting them in developing effective
interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and
empathy are cornerstones of Sullivan’s theory. The nurse who does not interact with the
patient cannot demonstrate these cornerstones. Observations provide only objective data.
Priority nursing diagnoses usually cannot be accurately established without subjective data
from the patient. The other distracters relate to Maslow and behavioral theory. This item
relates to an audience response question.
39
A nurse consistently encourages patient to do his or her own activities of daily living. If the
patient is unable to complete an activity, the nurse helps until the patient is once again
independent. This nurse’s practice is most influenced by which theorist?
a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
ANS: C
Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this
has relevance to the seriously and persistently mentally ill patient.
40
A nurse uses Maslow’s hierarchy of needs to plan care for a patient diagnosed with mental
illness. Which problem will receive priority? The patient
a. refuses to eat or bathe.
b. reports feelings of alienation from family.
c. is reluctant to participate in unit social activities.
d. is unaware of medication action and side effects.
ANS: A
The need for food and hygiene are physiological and therefore take priority over
psychological or meta-needs in care planning.
41
Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly
mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
ANS: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats
are rewards and reinforce speech through positive reinforcement.
42
The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I have
done differently to prevent this illness?” Select the nurse’s best response.
a. “Although schizophrenia results from impaired family relationships, try not to feel
guilty. No one can predict how a child will respond to parental guidance.”
b. “Schizophrenia is a biological illness resulting from changes in how the brain and
nervous system function. You are not to blame for your child’s illness.”
c. “There is still hope. Changing your parenting style can help your child learn to cope
effectively with the environment.”
d. “Most mental illnesses result from genetic inheritance. Your genes are more at
fault than your parenting.”
ANS: B
The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response should
address these feelings as well as provide information. Patients and families need reassurance
that the major mental disorders are biological in origin and are not the “fault” of parents.
One distracter places the burden of having faulty genes on the shoulders of the parents. The
other distracters are neither wholly accurate nor reassuring.
43
A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient.
Interventions should focus on
a. rewarding desired behaviors.
b. use of assertive communication.
c. changing the patient’s self-concept.
d. administering medications to relieve anxiety.
ANS: B
The nurse–patient relationship is structured to provide a model for adaptive interpersonal
relationships that can be generalized to others. Helping the patient learn to use assertive
communication will improve the patient’s interpersonal relationships. The distracters apply
to theories of cognitive, behavioral, and biological therapy.
44
A patient participated in psychotherapy weekly for 5 months. The therapist used free
association, dream analysis, and facilitated transference to help the patient understand conflicts
and foster change. Select the term that applies to this method.
a. Rational-emotive behavior
therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning
ANS: B
The techniques are aspects of psychodynamic psychotherapy. The distracters use other
techniques.
45
Consider this comment from a therapist: “The patient is homosexual but has kept this
preference secret. Severe anxiety and depression occur when the patient anticipates family
reactions to this sexual orientation.” Which perspective is evident in the speaker?
a. Theory of
interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory
ANS: A
The theory of interpersonal relationships recognizes the anxiety and depression as resulting
from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material
that relates to the patient problem.
46
A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent
with psychoanalytic psychotherapy?
a. Identifying the patient’s strengths and assets
b. Praising the patient for describing feelings of isolation
c. Focusing on feelings developed by the patient toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
ANS: C
Positive or negative feelings of the patient toward the therapist indicate transference.
Transference is a psychoanalytic concept that can be used to explore previously unresolved
conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of
psychoeducational materials is a common “homework” assignment used in cognitive
therapy.
47
A person says, “I was the only survivor in a small plane crash. Three business associates died. I
got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings
related to being a survivor, and I’m better now.” Which type of therapy was used?
a. Systematic
desensitization
b. Psychoanalysis
c. Behavior modification
d. Interpersonal psychotherapy
ANS: D
Interpersonal psychotherapy returned the patient to his former level of functioning by
helping him come to terms with the loss of friends and guilt over being a survivor.
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior,
such as the fear of flying. Psychoanalysis would call for a long period of exploration of
unconscious material. Behavior modification would focus on changing a behavior rather
than helping the patient understand what is going on in his life.
48
Which technique is most applicable to aversion therapy?
a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement
ANS: A
Aversion therapy is akin to punishment. Aversive techniques include pairing of a
maladaptive behavior with a noxious stimulus, punishment, and avoidance training.
49
A patient says to the nurse, “My father has been dead for over 10 years, but talking to you is
almost as comforting as the talks he and I had when I was a child.” Which term applies to the
patient’s comment?
a. Superego
b. Transference
c. Reality testing
d. Counter-transference
ANS: B
Transference refers to feelings a patient has toward the health care workers that were
originally held toward significant others in his or her life. Counter-transference refers to
unconscious feelings that the health care worker has toward the patient. The superego
represents the moral component of personality; it seeks perfection.
50
A college student received an invitation to attend the wedding of a close friend who lives across
the country. The student is afraid of flying. Which type of therapy would be most helpful for
this patient?
a. Psychoanalysis
b. Aversion therapy
c. Systematic desensitization
d. Short-term dynamic therapy
ANS: C
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior,
such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover
conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.
51
A patient repeatedly stated, “I’m stupid.” Which statement by that patient would show progress
resulting from cognitive-behavioral therapy?
a. “Sometimes I do stupid things.”
b. “Things always go wrong for me.”
c. “I always fail when I try new things.”
d. “I’m disappointed in my lack of ability.”
ANS: A
“I’m stupid” is a cognitive distortion. A more rational thought is “Sometimes I do stupid
things.” The latter thinking promotes emotional self-control. The distracters reflect irrational
or distorted thinking. This item relates to an audience response question.
52
A patient says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks because
the entire American workforce is incompetent.” This patient is experiencing a
a. self-esteem
deficit.
b. cognitive distortion.
c. deficit in motivation.
d. deficit in love and belonging.
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and
misinterpretations. See related audience response question.
53
A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient.
The therapist and patient then stand in an elevator with the door open for 5 minutes and later
with the elevator door closed for 5 minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback
ANS: B
Systematic desensitization is a form of behavior modification therapy that involves the
development of behavior tasks customized to the patient’s specific fears. These tasks are
presented to the patient while using learned relaxation techniques. The patient is
incrementally exposed to the fear.
54
```
A patient says, “I always feel good when I wear a size 2 petite.” Which type of cognitive
distortion is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization
```
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and
misinterpretations. The stem offers an example of overgeneralization. See related audience
response question.
55
Which comment best indicates a patient is self-actualized?
a. “I have succeeded despite a world filled with evil.”
b. “I have a plan for my life. If I follow it, everything will be fine.”
c. “I’m successful because I work hard. No one has ever given me anything.”
d. “My favorite leisure is walking on the beach, hearing soft sounds of rolling waves.”
ANS: D
The self-actualized personality is associated with high productivity and enjoyment of life.
Self-actualized persons experience pleasure in being alone and an ability to reflect on
events.
56
A nurse presents a community education program about mental illness. Which comment by a
participant best demonstrates a correct understanding of mental illness from a biological
perspective?
a. “Some people experience life events so traumatic that they cannot be overcome.”
b. “Disturbed and conflicted family relationships are usually a starting place for mental
illness.”
c. “My friend has had bipolar disorder for years and many problems have resulted.
It’s not her fault.”
d. “Mental illness is the result of developmental complications that cause a person
not to grow to their full potential.”
ANS: C
The correct response demonstrates an understanding that mental illness is physical in origin.
The physical origins of mental illness are aspects of the biological model. The incorrect
responses assign the origins of mental illness to interpersonal relationships and traumatic
events.
57
Which patient is the best candidate for brief psychodynamic therapy?
a. An accountant with a loving family and successful career who was involved in a short
extramarital affair
b. An adult with a long history of major depression who was charged with driving under
the influence
c. A woman with a history of borderline personality disorder who recently cut both
wrists
d. An adult male recently diagnosed with anorexia nervosa
ANS: A
The best candidates for psychodynamic therapy are relatively healthy and well-functioning
individuals, sometimes referred to as the “worried well,” who have a clearly circumscribed
area of difficulty and are intelligent, psychologically minded, and well-motivated for
change. Patients with psychosis, severe depression, borderline personality disorders, and
severe character disorders are not appropriate candidates for this type of treatment.
58
A patient states, “I’m starting cognitive-behavioral therapy. What can I expect from the
sessions?” Which responses by the nurse would be appropriate? (Select all that apply.)
a. “The therapist will be active and questioning.”
b. “You will be given some homework assignments.”
c. “The therapist will ask you to describe your dreams.”
d. “The therapist will help you look at your ideas and beliefs about yourself.”
e. “The goal is to increase subjectivity about thoughts that govern your behavior.”
ANS: A, B, D
Cognitive therapists are active rather than passive during therapy sessions because they help
patient’s reality-test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at the next therapy session. The goal of
cognitive therapy is to assist the patient in identifying inaccurate cognitions and in realitytesting and formulating new, accurate cognitions. One distracter applies to psychoanalysis.
Increasing subjectivity is not desirable.
59
Which comments by an elderly person best indicate successful completion of the individual’s
psychosocial developmental task? (Select all that apply.)
a. “I am proud of my children’s
successes in life.”
b. “I should have given to community charities more often.”
c. “My relationship with my father made life more difficult for me.”
d. “My experiences in the war helped me appreciate the meaning of life.”
e. “I often wonder what would have happened if I had chosen a different career.”
ANS: A, D
The developmental crisis for an elderly person relates to integrity versus despair. Pride in
one’s offspring indicates a sense of fulfillment. Recognition of the wisdom gained from
difficult experiences (such as being in a war) indicates a sense of integrity. Blaming and
regret indicate despair and unsuccessful resolution of the crisis.
60
Which comments by an adult best indicate self-actualization? (Select all that apply.)
a. “I am content with a good book.”
b. “I often wonder if I chose the right career.”
c. “Sometimes I think about how my parents would have handled problems.”
d. “It’s important for our country to provide basic health care services for everyone.”
e. “When I was lost at sea for 2 days, I gained an understanding of what is
important. ”
ANS: A, D, E
Self-actualized persons enjoy privacy, have a sense of democracy, and show positive
outcomes associated with peak experiences. Self-doubt, defensiveness, and blaming are not
consistent with self-actualization.
61
Which activities represent the art of nursing? (Select all that apply.)
a. Administering medications on time to a group of patients
b. Listening to a new widow grieve her husband’s death
c. Helping a patient obtain groceries from a food bank
d. Teaching a patient about a new medication
e. Holding the hand of a frightened patient
ANS: B, C, E
Peplau described the science and art of professional nursing practice. The art component of
nursing consists of the care, compassion, and advocacy nurses provide to enhance patient
comfort and well-being. The science component of nursing involves the application of
knowledge to understand a broad range of human problems and psychosocial phenomena,
intervening to relieve patients’ suffering and promote growth. See related audience response
question.
62
Which therapies involve electrical brain stimulation for treatment of mental illness? (Select all
that apply.)
a. Aversion therapy
b. Operant conditioning
c. Systematic desensitization
d. Electroconvulsive therapy (ECT)
e. Transcranial magnetic stimulation (TMS)
ANS: D, E
ECT and TMS are therapies that use electrical stimulation of the brain as a form of
treatment for mental illness. The incorrect responses are therapies that are interpersonal in
nature.
63
1. Which Western cultural feature may result in establishing unrealistic outcomes for
patients of other cultural groups?
a. Interdependence
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems
ANS: D
Directly confronting problems is a highly valued approach in the American culture but not
part of many other cultures in which harmony and restraint are valued. American nurses
sometimes mistakenly think that all patients should take direct action. Patients with other
values will be unable to meet this culturally inappropriate outcome. Present orientation,
interdependence, and a flexible perception of time are not valued in Western culture. These
views are more predominant in other cultures. See relationship to audience response
question.
64
A psychiatric nurse leads a medication education group for Hispanic patients. This nurse holds
a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After
the group, the patients are most likely to believe
a. the nurse was uncaring.
b. the session was effective.
c. the teaching was efficient.
d. they were treated respectfully.
ANS: A
Hispanic individuals usually value relationship behaviors. Their needs are for learning
through verbal communication rather than reading and for having time to chat before
approaching the task.
65
To provide culturally competent care, the nurse should
a. accurately interpret the thinking of individual patients.
b. predict how a patient may perceive treatment interventions.
c. formulate interventions to reduce the patient’s ethnocentrism.
d. identify strategies that fit within the cultural context of the patient.
ANS: D
The correct answer is the most global response. Cultural competence requires ongoing
effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain
cultural knowledge and determine nursing care measures that patients find acceptable and
helpful. Interpreting the thinking of individual patients does not ensure culturally competent
care. Reducing a patient’s ethnocentrism may not be a desired outcome.
66
A black patient, originally from Haiti, has a diagnosis of major depressive disorder. A colleague
tells the nurse, “This patient often looks down and is reluctant to share feelings. However, I’ve
observed the patient spontaneously interacting with other black patients.” Select the nurse’s
best response.
a. “Black patients depend on the church for support. Have you consulted the patient’s
pastor?”
b. “Encourage the patient to talk in a group setting. It will be less intimidating than one-toone interaction.”
c. “Don’t take it personally. Black patients often have a resentful attitude that takes a long
time to overcome.”
d. “The patient may have difficulty communicating in English. Have you considered
using a cultural broker?”
ANS: D
Society expects a culturally diverse patient to accommodate and use English. Feelings are
abstract, which requires a greater command of the language. This may be especially difficult
during episodes of high stress or mental illness. Cultural brokers can be helpful with
language and helping the nurse to understand the Haitian worldview and cultural nuances.
67
A Haitian patient diagnosed with major depressive disorder tells the nurse, “There’s nothing
you can do. This is a punishment. The only thing I can do is see a healer.” The culturally aware
nurse assesses that the patient
a. has delusions of persecution.
b. has likely been misdiagnosed with depression.
c. may believe the distress is the result of a curse or spell.
d. feels hopeless and helpless related to an unidentified cause.
ANS: C
Individuals of African American or Caribbean cultures who have a fatalistic attitude about
illness may believe they are being punished for wrongdoing or are victims of witchcraft or
voodoo. They may be reticent to share information about curses with therapists. No data are
present in the scenario to support delusions. Misdiagnosis more often labels a patient with
depression as having schizophrenia.
68
A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient, who
was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best explains
this behavior?
a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behavior indicates feelings of self-importance that the patient wants others to
appreciate.
ANS: C
Culture is more than ethnicity and social norms; it includes religious, geographic,
socioeconomic, occupational, ability- or disability-related, and sexual orientation-related
beliefs and behaviors. In this instance, the patient’s military experience represents an aspect
of the patient’s behavior. The military culture values timeliness. The distracters represent
misinterpretation of the patient’s behavior and have no bearing on the situation.
69
A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at
1230 for a 1000 appointment. A Native American patient does not keep an appointment at all.
What understanding will improve the nurse’s planning? These patients are
a. members of
cultural groups that have a different view of time.
b. immature and irresponsible in health care matters.
c. acting-out feelings of anger toward the system.
d. displaying passive-aggressive tendencies.
ANS: A
Hispanic Americans and Native Americans traditionally treat time in a way unlike the
Western culture. They tend to be present-oriented; that is, they value the current interaction
more than what is to be done in the future. If engaged in an activity, for example, they may
simply continue the activity and appear later for an appointment. Understanding this, the
nurse can avoid feelings of frustration and anger when the nurse’s future orientation comes
into conflict with the patient’s present orientation.
70
The sibling of an Asian American patient tells the nurse, “My sister needs help for pain. She
cries from the hurt.” Which understanding by the nurse will contribute to culturally competent
care for this patient? Persons of an Asian American heritage
a. often express emotional distress
with physical symptoms.
b. will probably respond best to a therapist who is impersonal.
c. will require prolonged treatment to stabilize these symptoms.
d. should be given direct information about the diagnosis and prognosis.
ANS: A
Asian Americans commonly express psychological distress as a physical problem. The
patient may believe psychological problems are caused by a physical imbalance. Treatment
will likely be short. The patient will probably respond best to a therapist who is perceived as
giving. Asian Americans usually have strong family ties and value hope more than truth.
71
Which communication strategy would be most effective for a nurse to use during an assessment
interview with an adult Native American patient?
a. Open and friendly; ask direct questions; touch the patient’s arm or hand occasionally for
reassurance.
b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional face to
express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
ANS: C
Native American culture stresses living in harmony with nature. Cooperative, sharing styles
rather than competitive or intrusive approaches are preferred; thus, the more passive style
described would be best received. The other options would be more effective to use with
patients of a Western orientation
72
A Native American patient sadly describes a difficult childhood. The patient abused alcohol as a
teenager but stopped 10 years ago. The patient now says, “I feel stupid and good for nothing. I
don’t help my people.” How should the treatment team focus planning for this patient?
a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytical approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.
ANS: D
Native Americans, because of their beliefs in the interrelatedness of parts and about being in
harmony with nature, respond best to a holistic approach. No data are present to support
dual diagnosis, because the patient has resolved the problem of excessive alcohol use.
Psychopharmacological and somatic therapies may be part of the treatment, but the focus should be more holistic. Psychoanalysis is a long-term expensive therapy; cognitive therapy
might be a better choice.
73
A Native American patient describes a difficult childhood and dropping out of high school.
The patient abused alcohol as a teenager to escape feelings of isolation but stopped 10 years
ago. The patient now says, “I feel stupid. I’ve never had a good job. I don’t help my people.”
Which nursing diagnosis applies?
a. Risk for other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation
ANS: B
The patient has given several indications of chronic low self-esteem. Forming a positive
self-image is often difficult for Native American individuals because these indigenous
people must blend together both American and Native American worldviews. No defining
characteristics are present for the other nursing diagnoses.
74
Which viewpoint of an Asian American family will most affect decision making about care?
a. The father is the authority figure.
b. The mother is head of the household.
c. Women should make their own decisions.
d. Emotional communication styles are desirable.
ANS: A
Asian American families traditionally place the father in the position of power as the head of
the household. Mothers, as well as other women, are usually subservient to fathers in these
cultures. Asian Americans are more likely to be reserved.
75
Which intervention best demonstrates that a nurse correctly understands the cultural needs of a
hospitalized Asian American patient diagnosed with a mental illness?
a. Encouraging the
family to attend community support groups
b. Involving the patient’s family to assist with activities of daily living
c. Providing educational pamphlets to explain the patient’s mental illness
d. Restricting homemade herbal remedies the family brings to the hospital
ANS: B
The Asian community values the family in caring for each other. The Asian community uses
traditional medicines and healers, including herbs for mental symptoms. The Asian
community describes illness in somatic terms. The Asian community attaches a stigma to
mental illness, so interfacing with the community would not be appealing.
76
A nurse speaks with family members of a Chinese American parent recently diagnosed with
major depressive disorder. Which comment by the nurse will the family find most comforting?
“The nursing staff will
a. take good care of your parent.”
b. pray with your parent several times a day.”
c. teach your parent important self-care strategies.”
d. educate your parent about safety information regarding medication.”
ANS: A
Chinese Americans hold an Eastern (balance) worldview. Persons who are ill or need health
care are vulnerable and need protection. The family will find comfort in a nurse’s statement
that good care will be provided. The distracters apply to persons with a Western or
indigenous worldview.
77
A patient in the emergency department shows a variety of psychiatrical symptoms, including
restlessness and anxiety. The patient says, “I feel sad because evil spirits have overtaken my
mind.” Which worldview is most applicable to this individual?
a. Eastern/balance
b. Southern/holistic
c. Western/scientific
d. Indigenous/harmony
ANS: D
Persons of an indigenous worldview believe disease results from a lack of personal,
interpersonal, environmental, or spiritual harmony and that evil spirits exist. The holism of
body–mind–spirit is a key component of this view. If one believes an evil spirit has taken
control, distress results. Western and Eastern worldviews do not embrace spirits. See
relationship to audience response question.
78
A nurse prepares to teach important medication information to a patient of Mexican heritage.
How should the nurse manage the teaching environment?
a. Stand very close to the patient
while teaching.
b. Maintain direct eye contact with the patient while teaching.
c. Maintain a neutral emotional tone during the teaching session.
d. Sit 4 feet or more from the patient during the teaching session.
ANS: A
Latin American cultures use close personal space, closer than many other minority groups.
Standing very close to the patient frequently indicates acceptance. Direct eye contact should
not be prolonged with this patient. Persons of this cultural heritage have high emotionality.
79
A Chinese American patient diagnosed with an anxiety disorder says, “My problems began
when my energy became imbalanced.” The nurse asks for the patient’s ideas about how to treat
the imbalance. Which comment would the nurse expect from this patient?
a. “My family will
bring special foods to help me get well.”
b. “I hope my health care provider will prescribe some medication to help me.”
c. “I think I would benefit from talking to other patients with a similar problem.”
d. “I would like to have a native healer perform a ceremony to balance my energy.”
ANS: A
The concept of energy imbalance as a source of illness is an explanatory model familiar to
Asian cultures. A source of healing is dietary change to include either “hot” or “cold” foods
to correct the imbalance. “Hot” and “cold” in this case do not refer to thermal properties of
the foods. Medication would not be a treatment suggested by a patient with an Eastern
worldview. Someone from an indigenous culture may suggest rituals. Group discussion of
mental illness would not be appealing to a Chinese American.
80
An experienced psychiatric nurse plans to begin a new job in a community-based medication
clinic. The clinic sees culturally diverse patients. Which action should the nurse take first to
prepare for this position?
a. Investigate cultural differences in patients’ responses to psychotropic medications.
b. Contact the clinical nurse specialist for guidelines regarding cultural competence.
c. Examine the literature on various health beliefs of members of diverse cultures.
d. Complete an online continuing education offering about psychopharmacology.
ANS: A
An experienced nurse working on a mental health inpatient unit would be familiar with the
action and side effects of most commonly prescribed psychotropic medications. However,
because the clinic serves a culturally diverse population, reviewing cultural differences in
patients’ responses to these medications is helpful and vital to patient safety. The distracters
identify actions the nurse would take later.
81
A psychoeducational session will discuss medication management for a culturally diverse
group of patients. Group participants are predominantly members of minority cultures. Of the
four staff nurses below, which nurse should lead this group?
a. Very young registered nurse
b. Older, mature registered nurse
c. Newly licensed registered nurse
d. A registered nurse who is very thin
ANS: B
Persons of minority cultures value age and wisdom. Persons with a Western worldview tend
to value youth. An older, mature registered nurse would be the most credible leader of this
group. The nurse’s size has no bearing on credibility.
82
A nurse wants to engage an interpreter for a severely anxious 21-year-old male who
immigrated to the United States 2 years ago. Of the four interpreters below who are available
and fluent in the patient’s language, which one should the nurse call?
a. 65-year-old female
professional interpreter
b. 24-year-old male professional interpreter
c. A member of the patient’s family
d. The patient’s best friend
ANS: B
A professional interpreter will be most effective because he/she will be able to interpret both
language and culture. When an interpreter is engaged, the interpreter should be matched to
the patient as closely as possible in gender, age, social status, and religion. Interpreters
should not be relatives or friends of the patient. The stigma of mental illness may prevent
the openness needed during the encounter.
83
A patient who has been hospitalized for 3 days with a serious mental illness says, “I’ve got to
get out of here and back to my job. I get 60 to 80 messages a day, and I’m getting behind on
my email correspondence.” What is this patient’s perspective about health and illness?
a. Fateful, magical
b. Eastern, holistic
c. Western, biomedical
d. Harmonious, religious
ANS: C
The Western biomedical perspective holds the belief that sick people should be as
independent and self-reliant as possible. Self-care is encouraged; one gets better by “getting
up and getting going.” An ability to function at a high level is valued. See relationship to
audience response question.
84
A white patient of German descent rocks back and forth, grimaces, and rubs both temples.
What is the nurse’s best action?
a. Assess the patient for extrapyramidal symptoms.
b. Sit beside the patient and rock in sync.
c. Offer to pray with the patient.
d. Assess the patient for pain.
ANS: D
This patient of German descent would hold a Western worldview and be stoic about pain.
This patient will keep pain as silent as possible and be reluctant to disclose pain unless the
nurse actively assesses for it. The patient’s nonverbal communication suggests pain rather
than EPS (extrapyramidal symptoms). The patient would probably not respond positively to
prayer or the nurse’s rocking behavior.
85
```
A Vietnamese patient’s family reports that the patient has wind illness. Which menu selection
will be most helpful for this patient?
a. Iced tea
b. Ice cream
c. Warm broth
d. Gelatin dessert
```
ANS: C
Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population.
It is characterized by a fear of cold, wind, or drafts. It is treated by keeping very warm and
avoiding foods, drinks, and herbs that are cold. Warm broth would be most in sync with the
patient’s culture and provide the most comfort. The distracters are cold foods.
86
A Mexican American patient puts a picture of the Virgin Mary on the bedside table. What is
the nurse’s best action?
a. Move the picture so it is beside a window.
b. Send the picture to the business office safe.
c. Leave the picture where the patient placed it.
d. Send the picture home with the patient’s family.
ANS: C
Cultural heritage is expressed through language, works of art, music, dance, customs,
traditions, diet, and expressions of spirituality. This patient’s prominent placement of the
picture is an example of expression of cultural heritage and spirituality. The nurse should
not move it unless the patient’s safety is jeopardized.
87
A nurse begins work in an agency that provides care to members of a minority ethnic
population. The nurse will be better able to demonstrate cultural competence after
a. identifying culture-bound issues.
b. implementing scientifically proven interventions.
c. correcting inferior health practices of the population.
d. exploring commonly held beliefs and values of the population.
ANS: D
Cultural competence is dependent on understanding the beliefs and values of members of a
different culture. A nurse who works with an individual or group of a culture different from
his or her own must be open to learning about the culture. The other options have little to do
with cultural competence or represent only a portion of the answer
88
A nurse cares for a first-generation American whose family emigrated from Germany.
Which worldview about the source of knowledge would this patient likely have?
a. Knowledge is acquired through use of affective or feeling senses.
b. Science is the foundation of knowledge and proves something exists.
c. Knowledge develops by striving for transcendence of the mind and body.
d. Knowledge evolves from an individual’s relationship with a supreme being
ANS: B
The European-American perspective of acquiring knowledge evolves from science. The
distracters describe the beliefs of other cultural groups. See relationship to audience
response question.
89
The nurse administers medications to a culturally diverse group of patients on a psychiatric
unit. What expectation should the nurse have about pharmacokinetics?
a. Patients of different cultural groups may metabolize medications at different rates.
b. Metabolism of psychotropic medication is consistent among various cultural groups.
c. Differences in hepatic enzymes will influence the rate of elimination of psychotropic
medications.
d. It is important to provide patients with oral and written literature about their
psychotropic medications.
ANS: A
Cytochrome enzyme systems, which vary among different cultural groups, influence the rate
of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic
medication; hepatic function influences metabolism rates. Information about medication is
important but does not apply to pharmacokinetics.
90
A nurse prepares to assess a newly hospitalized patient who moved to the United States 6
months ago from Somalia. The nurse should first determine a. if the patient’s immunizations
are current.
b. the patient’s religious preferences.
c. the patient’s specific ethnic group.
d. whether an interpreter is needed.
ANS: D
The assessment depends on communication. The nurse should first determine whether an
interpreter is needed. The other information can be subsequently assessed.
91
Which questions should the nurse ask to determine an individual’s worldview? (Select all that
apply. )
a. What is more important: the needs of an individual or the needs of a community?
b. How would you describe an ideal relationship between individuals?
c. How long have you lived at your present residence?
d. Of what importance are possessions in your life?
e. Do you speak any foreign languages?
ANS: A, B, D
The answers provide information about cultural values related to the importance of
individuality, material possessions, relational connectedness, community needs versus
individual needs, and interconnectedness between humans and nature. These will assist the
nurse to determine a patient’s worldview. Other follow-up questions are needed to validate
findings.
92
Why is the study of culture so important for psychiatric nurses in the United States? (Select all
that apply.)
a. Psychiatric nurses often practice in other countries.
b. Psychiatric nurses must advocate for the traditions of the Western culture.
c. Cultural competence helps protect patients from prejudice and discrimination.
d. Patients should receive information about their illness and treatment in terms they
understand.
e. Psychiatric nurses often interface with patients and their significant others over a
long period of time.
ANS: C, D, E
One purpose of cultural competence is for the psychiatric nurse to relate and explain
information about the patient’s illness and treatment in an understandable way,
incorporating the patient’s own beliefs and values. A fundamental aspect of nursing practice
is advocacy. Cultural competence promotes recognition of prejudices in care, such as stigma
and misdiagnosis. Psychiatric nurses often interface with patients and families over years
and in community settings.
93
3. The nurse should be particularly alert to expression of psychological distress through
physical symptoms among patients whose cultural beliefs include (Select all that apply)
a. mental illness reflects badly on the family.
b. mental illness shows moral weakness.
c. intergenerational conflict is common.
d. the mind, body, and spirit are merged.
e. food choices influence one’s health.
ANS: A, B, D
Physical symptoms are seen as more acceptable in cultural groups in which interdependence
and harmony of the group are emphasized. Mental illness is often perceived as reflecting a
failure of the entire family. In groups in which mental illness is seen as a moral weakness
and both the individual and family are stigmatized, somatization of mental distress is better
accepted. In groups in which mind, body, and spirit are holistically perceived, somatization
of psychological distress is common. Somatization and food are not commonly related.
Intergenerational conflict has not been noted as a risk factor for somatization.
94
Which action by a psychiatric nurse best applies the ethical principle of autonomy?
a. Exploring alternative solutions with the patient, who then makes a choice.
b. Suggesting that two patients who were fighting be restricted to the unit.
c. Intervening when a self-mutilating patient attempts to harm self.
d. Staying with a patient demonstrating a high level of anxiety.
ANS: A
Autonomy is the right to self-determination, that is, to make one’s own decisions. By
exploring alternatives with the patient, the patient is better equipped to make an informed,
autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.
95
A nurse finds a psychiatric advance directive in the medical record of a patient currently
experiencing psychosis. The directive was executed during a period when the patient was stable
and competent. The nurse should
a. review the directive with the patient to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the patient to revise the directive in light of the current health problem.
ANS: B
The nurse has an obligation to honor the right to self-determination. An advanced
psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of
the directive now apply.
96
Two hospitalized patients fight whenever they are together. During a team meeting, a nurse
asserts that safety is of paramount importance, so treatment plans should call for both patients to
be secluded to keep them from injuring each other. This assertion a. reinforces the autonomy of
the two patients.
b. violates the civil rights of both patients.
c. represents the intentional tort of battery.
d. correctly places emphasis on safety.
ANS: B
Patients have a right to treatment in the least restrictive setting. Safety is important, but less
restrictive measures should be tried first. Unnecessary seclusion may result in a charge of
false imprisonment. Seclusion violates the patient’s autonomy. The principle by which the
nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.
97
In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by
using restraint to prevent one patient from self-mutilation, while the care plan for another selfmutilating patient requires one-on-one supervision.” Which ethical principle most clearly applies
to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
ANS: D
The nurse is concerned about justice, that is, fair distribution of care, which includes
treatment with the least restrictive methods for both patients. Beneficence means promoting
the good of others. Autonomy is the right to make one’s own decisions. Fidelity is the
observance of loyalty and commitment to the patient.
98
Select the example of a tort.
a. The plan of care for a patient is not completed within 24 hours of the patient’s
admission.
b. A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the unit
is short-staffed.
c. An advanced practice nurse recommends hospitalization for a patient who is dangerous
to self and others.
d. A patient’s admission status changed from involuntary to voluntary after the patient’s
hallucinations subside.
ANS: B
A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary
medication for the convenience of staff controls behavior in a manner similar to secluding
a patient; thus, false imprisonment is a possible charge. The other options do not exemplify
torts.
99
What is the legal significance of a nurse’s action when a patient verbally refuses medication and
the nurse gives the medication over the patient’s objection? The nurse
a. has been negligent.
b. committed malpractice.
c. fulfilled the standard of care.
d. can be charged with battery.
ANS: D
Battery is an intentional tort in which one individual violates the rights of another through
touching without consent. Forcing a patient to take medication after the medication was
refused constitutes battery. The charge of battery can be brought against the nurse. The
medication may not necessarily harm the patient; harm is a component of malpractice.
100
Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, “I’m getting out of here, and no one can stop
me.” The nurse restrains this patient without a health care provider’s order and then
promptly obtains an order.
b. A patient has been irritating and attention seeking much of the day. A nurse escorts the
patient down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric
unit. The nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with homicidal ideation attempts to leave the
facility. A nurse calls the security team and uses established protocols to prevent
the patient from leaving.
ANS: B
False imprisonment involves holding a competent person against his or her will. Actual
force is not a requirement of false imprisonment. The individual needs only to be placed in
fear of imprisonment by someone who has the ability to carry out the threat. If a patient is
not competent (confused), then the nurse should act with beneficence. Patients admitted
involuntarily should not be allowed to leave without permission of the treatment team.
101
Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The
patient who
a. is noncompliant with the treatment regimen.
b. fraudulently files for bankruptcy.
c. sold and distributed illegal drugs.
d. threatens to harm self and others.
ANS: D
Involuntary hospitalization protects patients who are dangerous to themselves or others and
cannot care for their own basic needs. Involuntary commitment also protects other
individuals in society. The behaviors described in the other options are not sufficient to
require involuntary hospitalization.
102
A nurse prepares to administer a scheduled intramuscular injection of an antipsychotic
medication to an outpatient diagnosed with schizophrenia. As the nurse swabs the site, the
patient shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.”
Select the nurse’s best action.
a. Assemble other staff for a show of force and proceed with the injection, using restraint if
necessary.
b. Stop the medication administration procedure and say to the patient, “Tell me more
about the side effects you’ve been having.”
c. Proceed with the injection but explain to the patient that there are medications that will
help reduce the unpleasant side effects.
d. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m
required to give it, but let’s talk to the doctor about delaying next month’s dose.”
ANS: B
Patients diagnosed with mental illness retain their civil rights unless there is clear, cogent,
and convincing evidence of dangerousness. The patient in this situation presents no
evidence of dangerousness. The nurse, as an advocate and educator, should seek more
information about the patient’s decision and not force the medication.
103
A nurse is concerned that an agency’s policies are inadequate. Which understanding about the
relationship between substandard institutional policies and individual nursing practice should
guide nursing practice?
a. Agency policies do not exempt an individual nurse of responsibility to practice
according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and
therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the supervisor
and discontinue patient care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis and
therefore cannot be predicted.
ANS: A
Nurses are professionally bound to uphold standards of practice regardless of lesser
standards established by a health care agency or a state. Conversely, if the agency standards
are higher than standards of practice, the agency standards must be upheld. The Courts may
seek to establish the standard of care through the use of expert witnesses when the issue is
clouded.
104
A newly admitted acutely psychotic patient is a private patient of the medical director and a
private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of
care?
a. Medical director
b. Hospital
c. Profession
d. Patient
ANS: D
Although the nurse is accountable to the health care provider, the agency, the patient, and
the profession, the duty of care is owed to the patient. This duty reflects both legal and
ethical standards of nursing practice.
105
Which action by a nurse constitutes a breach of a patient’s right to privacy?
a. Documenting the patient’s daily behavior during hospitalization
b. Releasing information to the patient’s employer without consent
c. Discussing the patient’s history with other staff during care planning
d. Asking family to share information about a patient’s pre-hospitalization behavior
ANS: B
Release of information without patient authorization violates the patient’s right to privacy.
The other options are acceptable nursing practices. See relationship to audience response
question.
106
An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill
my father, but you can’t tell anyone.” Select the nurse’s best response.
a. “You are right. Federal law requires me to keep clinical information private.”
b. “I am obligated to share that information with the treatment team.”
c. “Those kinds of thoughts will make your hospitalization longer.”
d. “You should share this thought with your psychiatrist.”
ANS: B
Breach of nurse–patient confidentiality does not pose a legal dilemma for nurses in these
circumstances because a team approach to delivery of psychiatric care presumes
communication of patient information to other staff members to develop treatment plans and
outcome criteria. The patient should also know that the team has a duty to warn the father of
the risk for harm.
107
A voluntarily hospitalized patient tells the nurse, “Get me the forms for discharge. I want to
leave now.” Select the nurse’s best response.
a. “I will get the forms for you right now and bring them to your room.”
b. “Since you signed your consent for treatment, you may leave if you desire.”
c. “I will get them for you, but let’s talk about your decision to leave treatment.”
d. “I cannot give you those forms without your health care provider’s permission.”
ANS: C
A voluntarily admitted patient has the right to demand and obtain release in most states.
However, as a patient advocate, the nurse is responsible for weighing factors related to the
patient’s wishes and best interests. By asking for information, the nurse may be able to help
the patient reconsider the decision. Facilitating discharge without consent is not in the
patient’s best interests before exploring the reason for the request.
108
Insurance will not pay for continued private hospitalization of a mentally ill patient. The family
considers transferring the patient to a public hospital but expresses concern that the patient will
not get any treatment if transferred. Select the nurse’s most helpful reply.
a. “By law, treatment
must be provided. Hospitalization without treatment violates patients’ rights.”
b. “All patients in public hospitals have the right to choose both a primary therapist and
a primary nurse.”
c. “You have a justifiable concern because the right to treatment extends only to
provision of food, shelter, and safety.”
d. “Much will depend on other patients, because the right to treatment for a psychotic
patient takes precedence over the right to treatment of a patient who is stable.”
ANS: A
The right to medical and psychiatric treatment is conferred on all patients hospitalized in
public mental hospitals under federal law.
109
Which individual diagnosed with mental illness may need emergency or involuntary
admission? The individual who
a. resumes using heroin while still taking naltrexone (ReVia).
b. reports hearing angels playing harps during thunderstorms.
c. does not keep an outpatient appointment with the mental health nurse.
d. throws a heavy plate at a waiter at the direction of command hallucinations.
ANS: D
Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to
others. This behavior meets the criteria for emergency or involuntary hospitalization for
mental illness. The behaviors in the other options evidence mental illness but not
dangerousness. See related audience response question.
110
A patient in alcohol rehabilitation reveals to the nurse, “I feel terrible guilt for sexually abusing
my 6-year-old before I was admitted.” Select the nurse’s most important action.
a. Anonymously report the abuse by phone to the local child protection agency.
b. Reply, “I’m glad you feel comfortable talking to me about it.”
c. File a written report with the agency’s ethics committee.
d. Respect nurse–patient relationship confidentiality.
ANS: A
Laws regarding child abuse reporting discovered by a professional during the suspected
abuser’s alcohol or drug treatment differ by state. Federal law supersedes state law and
prohibits disclosure without a court order except in instances in which the report can be
made anonymously or without identifying the abuser as a patient in an alcohol or drug
treatment facility.
111
A family member of a patient with delusions of persecution asks the nurse, “Are there any
circumstances under which the treatment team is justified in violating a patient’s right to
confidentiality?” The nurse should reply that confidentiality may be breached
a. under no
circumstances.
b. at the discretion of the psychiatrist.
c. when questions are asked by law enforcement.
d. if the patient threatens the life of another person.
ANS: D
The duty to warn a person whose life has been threatened by a psychiatric patient overrides
the patient’s right to confidentiality. The right to confidentiality is not suspended at the
discretion of the therapist or for legal investigations.
112
A new antidepressant is prescribed for an elderly patient diagnosed with major depressive
disorder, but the dose is more than the usual geriatric dose. The nurse should
a. consult a reliable drug reference.
b. teach the patient about possible side effects and adverse effects.
c. withhold the medication and confer with the health care provider.
d. encourage the patient to increase oral fluids to reduce drug concentration.
ANS: C
The dose of antidepressants for elderly patients is often less than the usual adult dose. The
nurse should withhold the medication and consult the health care provider who wrote the
order. The nurse’s duty is to practice according to professional standards as well as
intervene and protect the patient.
113
A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient
threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with
the correct rationale. The psychiatrist
a. released information without proper authorization.
b. demonstrated the duty to warn and protect.
c. violated the patient’s confidentiality.
d. avoided charges of malpractice.
ANS: B
It is the health care professional’s duty to warn or notify an intended victim after a threat of
harm has been made. Informing a potential victim of a threat is a legal responsibility of the
health care professional. It is not a violation of confidentiality.
114
A patient experiencing psychosis became aggressive, struck another patient, and required
seclusion. Select the best documentation.
a. Patient struck another patient who attempted to leave day room to go to bathroom.
Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two
patients away from each other for 24 hours.
b. Seclusion ordered by physician at 1415 after command hallucinations told the patient to
hit another patient. Careful monitoring of patient maintained during period of seclusion.
c. Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2
hours without incident. Outcome: Patient calmer and apologized for outburst.
d. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At
1415 patient yelled, “I’ll punch anyone who gets near me,” and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD
at 1430.
ANS: D
Documentation must be specific and detail the key aspects of care. It should demonstrate
implementation of the least restrictive alternative. Justification for why a patient was
secluded should be recorded, along with interventions attempted in an effort to avoid
seclusion. Documentation should include a description of behavior and verbalizations,
interventions tried and their outcomes, and the name of the health care provider ordering the
use of seclusion.
115
A person in the community asks, “Why aren’t people with mental illness kept in state
institutions anymore?” Select the nurse’s best response.
a. “Less restrictive settings are available now to care for individuals with mental illness.”
b. “There are fewer persons with mental illness, so less hospital beds are needed.”
c. “Most people with mental illness are still in psychiatric institutions.”
d. “Psychiatric institutions violated patients’ rights.”
ANS: A
The community is a less restrictive alternative than hospitals for treatment of persons with
mental illness. The distracters are incorrect and part of the stigma of mental illness.
116
A patient experiencing psychosis asks a psychiatric technician, “What’s the matter with me?”
The technician replies, “Nothing is wrong with you. You just need to use some self-control.”
The nurse who overheard the exchange should take action based on
a. the technician’s
unauthorized disclosure of confidential clinical information.
b. violation of the patient’s right to be treated with dignity and respect.
c. the nurse’s obligation to report caregiver negligence.
d. the patient’s right to social interaction.
ANS: B
Patients have the right to be treated with dignity and respect. The technician’s comment
disregards the seriousness of the patient’s illness. The Code of Ethics for Nurses requires
intervention. Patient emotional abuse has been demonstrated, not negligence. An interaction
with the technician is not an aspect of social interaction. The technician did not disclose
clinical information.
117
Which documentation of a patient’s behavior best demonstrates a nurse’s observations?
a. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
b. Calmer; more cooperative. Participated actively in group. No evidence of psychotic
thinking.
c. Appeared to hallucinate. Frequently increased volume on television, causing conflict
with others.
d. Wore four layers of clothing. States, “I need protection from evil bacteria trying to
pierce my skin.”
ANS: D
The documentation states specific observations of the patient’s appearance and the exact
statements made. The other options are vague or subjective statements and can be
interpreted in different ways.
118
After leaving work, a nurse realizes documentation of administration of a prn medication was
omitted. This off-duty nurse phones the nurse on duty and says, “Please document
administration of the medication for me. My password is alpha1.” The nurse receiving the call
should
a. fulfill the request promptly.
b. document the caller’s password.
c. refer the matter to the charge nurse to resolve.
d. report the request to the patient’s health care provider
ANS: C
Fraudulent documentation may be grounds for discipline by the state board of nursing.
Referring the matter to the charge nurse will allow observance of hospital policy while
ensuring that documentation occurs. Notifying the health care provider would be
unnecessary when the charge nurse can resolve the problem. Nurses should not provide
passwords to others.
119
Which individual diagnosed with a mental illness may need involuntary hospitalization? An
individual
a. who has a panic attack after her child gets lost in a shopping mall.
b. with visions of demons emerging from cemetery plots throughout the community.
c. who takes 38 acetaminophen tablets after the person’s stock portfolio becomes
worthless.
d. diagnosed with major depression who stops taking prescribed antidepressant
medication.
ANS: C
Involuntary hospitalization protects patients who are dangerous to themselves or others and
cannot care for their own basic needs. Involuntary hospitalization also protects other
individuals in society. An overdose of acetaminophen indicates dangerousness to self. The
behaviors described in the other options are not sufficient to require involuntary
hospitalization.
120
An aide in a psychiatric hospital says to the nurse, “We don’t have time every day to help each
patient complete a menu selection. Let’s tell dietary to prepare popular choices and send them
to our unit.” Select the nurse’s best response.
a. “Thanks for the suggestion, but that idea may not work because so many patients take
MAOI (monoamine oxidase inhibitor) antidepressants.”
b. “Thanks for the idea, but it’s important to treat patients as individuals. Giving choices is
one way we can respect patients’ individuality.”
c. “Thank you for the suggestion, but the patients’ bill of rights requires us to allow
patients to select their own diet.”
d. “Thank you. That is a very good idea. It will make meal preparation easier for the
dietary department.”
ANS: B
The nurse’s response to the aide should recognize patients’ rights to be treated with dignity
and respect as well as promote autonomy. This response also shows respect for the aide and
fulfills the nurse’s obligation to provide supervision of unlicensed personnel. The incorrect
responses have flawed rationale or do not respect patients as individuals.
121
In order to release information to another health care facility or third party regarding a patient
diagnosed with a mental illness, the nurse must obtain
a. a signed consent by the patient for release of information stating specific information to
be released.
b. a verbal consent for information release from the patient and the patient’s guardian or
next of kin.
c. permission from members of the health care team who participate in treatment planning.
d. approval from the attending psychiatrist to authorize the release of information.
ANS: A
Nurses have an obligation to protect patients’ privacy and confidentiality. Clinical
information should not be released without the patient’s signed consent for the release.
122
In which situations would a nurse have the duty to intervene and report? (Select all that apply.)
a. A peer has difficulty writing measurable outcomes.
b. A health care provider gives a telephone order for medication.
c. A peer tries to provide patient care in an alcohol-impaired state.
d. A team member violates relationship boundaries with a patient.
e. A patient refuses medication prescribed by a licensed health care provider.
ANS: C, D
Both keyed answers are events that jeopardize patient safety. The distracters describe
situations that may be resolved with education or that are acceptable practices.
123
Which actions violate the civil rights of a psychiatric patient? The nurse (Select all that apply)
a. performs mouth checks after overhearing a patient say, “I’ve been spitting out my
medication. ”
b. begins suicide precautions before a patient is assessed by the health care provider.
c. opens and reads a letter a patient left at the nurse’s station to be mailed.
d. places a patient’s expensive watch in the hospital business office safe.
e. restrains a patient who uses profanity when speaking to the nurse.
ANS: C, E
The patient has the right to send and receive mail without interference. Restraint is not
indicated because a patient uses profanity; there are other less restrictive ways to deal with
this behavior. The other options are examples of good nursing judgment and do not violate
the patient’s civil rights.
124
A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “This
patient is like one of my grandparents … so helpless.” Which response is the nurse
demonstrating?
a. Transference
b. Countertransference
c. Catastrophic reaction
d. Defensive coping reaction
ANS: B
Countertransference is the nurse’s transference or response to a patient that is based on the
nurse’s unconscious needs, conflicts, problems, or view of the world. See relationship to
audience response question.
125
Which statement shows a nurse has empathy for a patient who made a suicide attempt?
a. “You must have been very upset when you tried to hurt yourself.”
b. “It makes me sad to see you going through such a difficult experience.”
c. “If you tell me what is troubling you, I can help you solve your problems.”
d. “Suicide is a drastic solution to a problem that may not be such a serious matter.”
ANS: A
Empathy permits the nurse to see an event from the patient’s perspective, understand the
patient’s feelings, and communicate this to the patient. The incorrect responses are nursecentered (focusing on the nurse’s feelings rather than the patient’s), belittling, and
sympathetic.
126
After several therapeutic encounters with a patient who recently attempted suicide, which
occurrence should cause the nurse to consider the possibility of countertransference?
a. The
patient’s reactions toward the nurse seem realistic and appropriate.
b. The patient states, “Talking to you feels like talking to my parents.”
c. The nurse feels unusually happy when the patient’s mood begins to lift.
d. The nurse develops a trusting relationship with the patient.
ANS: C
Strong positive or negative reactions toward a patient or over-identification with the patient
indicate possible countertransference. Nurses must carefully monitor their own feelings and
reactions to detect countertransference and then seek supervision. Realistic and appropriate
reactions from a patient toward a nurse are desirable. One incorrect response suggests
transference. A trusting relationship with the patient is desirable. See relationship to
audience response question.
127
A patient says, “Please don’t share information about me with the other people.” How should the
nurse respond?
a. “I will not share information with your family or friends without your permission, but I
will share information about you with other staff.”
b. “A therapeutic relationship is just between the nurse and the patient. It is up to you to
tell others what you want them to know.”
c. “It depends on what you choose to tell me. I will be glad to disclose at the end of each
session what I will report to others.”
d. “I cannot tell anyone about you. It will be as though I am talking about my own
problems, and we can help each other by keeping it between us.
ANS: A
A patient has the right to know with whom the nurse will share information and that
confidentiality will be protected. Although the relationship is primarily between the nurse
and patient, other staff needs to know pertinent data. The other incorrect responses promote
incomplete disclosure on the part of the patient, require daily renegotiation of an issue that
should be resolved as the nurse–patient contract is established, and suggest mutual problem
solving. The relationship must be patient centered. See relationship to audience response
question.
128
A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent
most of the session. Another patient comes to the door of the room, interrupts, and says to the
nurse, “I really need to talk to you.” The nurse should
a. invite the interrupting patient to join in the session with the current patient.
b. say to the interrupting patient, “I am not available to talk with you at the present time.”
c. end the unproductive session with the current patient and spend time with the
interrupting patient.
d. tell the interrupting patient, “This session is 5 more minutes; then I will talk with
you.”
ANS: D
When a specific duration for sessions has been set, the nurse must adhere to the schedule.
Leaving the first patient would be equivalent to abandonment and would destroy any trust
the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be
trusted and that the patient and the sessions are important. The incorrect responses preserve
the nurse–patient relationship with the silent patient but may seem abrupt to the interrupting
patient, abandon the silent patient, or fail to observe the contract with the silent patient.
129
Termination of a therapeutic nurse–patient relationship has been successful when the nurse
a. avoids upsetting the patient by shifting focus to other patients before the discharge.
b. gives the patient a personal telephone number and permission to call after discharge.
c. discusses with the patient changes that happened during the relationship and evaluates
outcomes.
d. offers to meet the patient for coffee and conversation three times a week after
discharge.
ANS: C
Summarizing and evaluating progress help validate the experience for the patient and the
nurse and facilitate closure. Termination must be discussed; avoiding discussion by
spending little time with the patient promotes feelings of abandonment. Successful
termination requires that the relationship be brought to closure without the possibility of
dependency-producing ongoing contact.
130
What is the desirable outcome for the orientation stage of a nurse–patient relationship? The
patient will demonstrate behaviors that indicate
a. self-responsibility and autonomy.
b. a greater sense of independence.
c. rapport and trust with the nurse.
d. resolved transference.
ANS: C
Development of rapport and trust is necessary before the relationship can progress to the
working phase. Behaviors indicating a greater sense of independence, self-responsibility,
and resolved transference occur in the working phase.
131
During which phase of the nurse–patient relationship can the nurse anticipate that identified
patient issues will be explored and resolved?
a. Preorientation
b. Orientation
c. Working
d. Termination
ANS: C
During the working phase, the nurse strives to assist the patient in making connections
among dysfunctional behaviors, thinking, and emotions and offers support while alternative
coping behaviors are tried.
132
At what point in the nurse–patient relationship should a nurse plan to first address termination?
a. During the orientation phase
b. At the end of the working phase
c. Near the beginning of the termination phase
d. When the patient initially brings up the topic
ANS: A
The patient has a right to know the conditions of the nurse–patient relationship. If the
relationship is to be time-limited, the patient should be informed of the number of sessions.
If it is open-ended, the termination date will not be known at the outset, and the patient
should know that the issue will be negotiated at a later date. The nurse is responsible for
bringing up the topic of termination early in the relationship, usually during the orientation
phase.
133
A nurse introduces the matter of a contract during the first session with a new patient because
contracts
a. specify what the nurse will do for the patient.
b. spell out the participation and responsibilities of each party.
c. indicate the feeling tone established between the participants.
d. are binding and prevent either party from prematurely ending the relationship.
ANS: B
A contract emphasizes that the nurse works with the patient rather than doing something for
the patient. “Working with” is a process that suggests each party is expected to participate
and share responsibility for outcomes. Contracts do not, however, stipulate roles or feeling
tone, and premature termination is forbidden.
134
As a nurse escorts a patient being discharged after treatment for major depression, the patient
gives the nurse a necklace with a heart pendant and says, “Thank you for helping mend my
broken heart.” Which is the nurse’s best response?
a. “Accepting gifts violates the policies and procedures of the facility.”
b. “I’m glad you feel so much better now. Thank you for the beautiful necklace.”
c. “I’m glad I could help you, but I can’t accept the gift. My reward is seeing you with a
renewed sense of hope.”
d. “Helping people is what nursing is all about. It’s rewarding to me when patients
recognize how hard we work.”
ANS: C
Accepting a gift creates a social rather than therapeutic relationship with the patient and
blurs the boundaries of the relationship. A caring nurse will acknowledge the patient’s
gesture of appreciation, but the gift should not be accepted. See relationship to audience
response question.
135
Which remark by a patient indicates passage from orientation to the working phase of a nurse–
patient relationship?
a. “I don’t have any problems.”
b. “It is so difficult for me to talk about problems.”
c. “I don’t know how it will help to talk to you about my problems.”
d. “I want to find a way to deal with my anger without becoming violent.”
ANS: D
Thinking about a more constructive approach to dealing with anger indicates a readiness to
make a behavioral change. Behavioral change is associated with the working phase of the
relationship. Denial is often seen in the orientation phase. It is common early in the
relationship, before rapport and trust are firmly established, for a patient to express
difficulty in talking about problems. Stating skepticism about the effectiveness of the nurse–
patient relationship is more typically a reaction during the orientation phase.
136
A nurse explains to the family of a mentally ill patient how a nurse–patient relationship differs
from social relationships. Which is the best explanation?
a. “The focus is on the patient. Problems are discussed by the nurse and patient, but
solutions are implemented by the patient.”
b. “The focus shifts from nurse to patient as the relationship develops. Advice is given by
both, and solutions are implemented.”
c. “The focus of the relationship is socialization. Mutual needs are met, and feelings are
shared openly.”
d. “The focus is creation of a partnership in which each member is concerned with
growth and satisfaction of the other.”
ANS: A
Only the correct response describes elements of a therapeutic relationship. The remaining
responses describe events that occur in social or intimate relationships
137
A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The
nurse should
a. restate what the patient says.
b. use congruent communication strategies.
c. use self-revelation in patient interactions.
d. consistently interpret the patient’s behaviors.
ANS: B
Genuineness is a desirable characteristic involving awareness of one’s own feelings as they
arise and the ability to communicate them when appropriate. The incorrect options are
undesirable in a therapeutic relationship.
138
A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger
toward the patient. The nurse should
a. suppress the angry feelings.
b. express the anger openly and directly with the patient.
c. tell the nurse manager to assign the patient to another nurse.
d. discuss the anger with a clinician during a supervisory session.
ANS: D
The nurse is accountable for the relationship. Objectivity is threatened by strong positive or
negative feelings toward a patient. Supervision is necessary to work through
countertransference feelings.
139
A nurse wants to enhance growth of a patient by showing positive regard. The nurse’s action
most likely to achieve this goal is
a. making rounds daily.
b. staying with a tearful patient.
c. administering medication as prescribed.
d. examining personal feelings about a patient.
ANS: B
Staying with a crying patient offers support and shows positive regard. Administering daily
medication and making rounds are tasks that could be part of an assignment and do not
necessarily reflect positive regard. Examining feelings regarding a patient addresses the
nurse’s ability to be therapeutic.
140
A patient says, “I’ve done a lot of cheating and manipulating in my relationships.” Select a
nonjudgmental response by the nurse.
a. “How do you feel about that?”
b. “I am glad that you realize this.”
c. “That’s not a good way to behave.”
d. “Have you outgrown that type of behavior?”
ANS: A
Asking a patient to reflect on feelings about his or her actions does not imply any judgment
about those actions, and it encourages the patient to explore feelings and values. The
remaining options offer negative judgments.
141
A patient says, “People should be allowed to commit suicide without interference from others.”
A nurse replies, “You’re wrong. Nothing is bad enough to justify death.” What is the best
analysis of this interchange?
a. The patient is correct.
b. The nurse is correct.
c. Neither person is correct.
d. Differing values are reflected in the two statements.
ANS: D
Values guide beliefs and actions. The individuals stating their positions place different
values on life and autonomy. Nurses must be aware of their own values and be sensitive to
the values of others.
142
Which issues should a nurse address during the first interview with a patient with a psychiatric
disorder?
a. Trust, congruence, attitudes, and boundaries
b. Goals, resistance, unconscious motivations, and diversion
c. Relationship parameters, the contract, confidentiality, and termination
d. Transference, countertransference, intimacy, and developing resources
ANS: C
Relationship parameters, the contract, confidentiality, and termination are issues that should
be considered during the orientation phase of the relationship. The remaining options are
issues that are dealt with later.
143
An advanced practice nurse observes a novice nurse expressing irritability regarding a patient
with a long history of alcoholism and suspects the new nurse is experiencing
countertransference. Which comment by the new nurse confirms this suspicion?
a. “This patient
continues to deny problems resulting from drinking.”
b. “My parents were alcoholics and often neglected our family.”
c. “The patient cannot identify any goals for improvement.”
d. “The patient said I have many traits like her mother.”
ANS: B
Countertransference occurs when the nurse unconsciously and inappropriately displaces
onto the patient feelings and behaviors related to significant figures in the nurse's past. In
this instance, the new nurse’s irritability stems from relationships with parents. The
distracters indicate transference or accurate analysis of the patient’s behavior.
144
Which behavior shows that a nurse values autonomy? The nurse
a. suggests one-on-one supervision for a patient who has suicidal thoughts.
b. informs a patient that the spouse will not be in during visiting hours.
c. discusses options and helps the patient weigh the consequences.
d. sets limits on a patient’s romantic overtures toward the nurse.
ANS: C
A high level of valuing is acting on one’s belief. Autonomy is supported when the nurse
helps a patient weigh alternatives and their consequences before the patient makes a
decision. Autonomy or self-determination is not the issue in any of the other behaviors
145
As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an
arts and crafts group. What is the nurse’s best action?
a. Recognize the effectiveness of the relationship and patient’s thoughtfulness. Accept the
card.
b. Inform the patient that accepting gifts violates policies of the facility. Decline the card.
c. Acknowledge the patient’s transition through the termination phase but decline the card.
d. Accept the card and invite the patient to return to participate in other arts and crafts
groups.
ANS: A
The nurse must consider the meaning, timing, and value of the gift. In this instance, the
nurse should accept the patient’s expression of gratitude. See relationship to audience
response question.
146
A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you
ask the doctor to change my privileges?” What is the nurse’s best response?
a. “Why are you
asking me when you’re able to speak for yourself?”
b. “I will be glad to address it when I see your doctor later today.”
c. “That’s a good topic for you to discuss with your doctor.”
d. “Do you think you can’t speak to a doctor?”
ANS: C
Nurses should encourage patients to work at their optimal level of functioning, which in turn
promotes autonomy. A nurse does not act for the patient unless it is necessary. Acting for a
patient increases feelings of helplessness and dependency.
147
A community mental health nurse has worked with a patient for 3 years but is moving out of the
city and terminates the relationship. When a novice nurse begins work with this patient, what is
the starting point for the relationship?
a. Begin at the orientation phase.
b. Resume the working relationship.
c. Initially establish a social relationship.
d. Return to the emotional catharsis phase
ANS: A
After termination of a long-term relationship, the patient and new nurse usually have to
begin at ground zero, the orientation phase, to build a new relationship. If termination is
successfully completed, the orientation phase sometimes progresses quickly to the working
phase. Other times, even after successful termination, the orientation phase may be
prolonged
148
As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites
the patient to the annual staff picnic. What is the best analysis of this scenario?
a. The invitation
facilitates dependency on the nurse.
b. The nurse’s action blurs the boundaries of the therapeutic relationship.
c. The invitation is therapeutic for the patient’s diversional activity deficit.
d. The nurse’s action assists the patient’s integration into community living.
ANS: B
| The invitation creates a social relationship rather than a therapeutic relationship.
149
A nurse says, “I am the only one who truly understands this patient. Other staff members are
too critical.” The nurse’s statement indicates
a. boundary blurring.
b. sexual harassment.
c. positive regard.
d. advocacy.
ANS: A
When the role of the nurse and the role of the patient shift, boundary blurring may arise. In
this situation the nurse is becoming overinvolved with the patient as a probable result of
unrecognized countertransference. When boundary issues occur, the need for supervision
exists. The situation does not describe sexual harassment. Data are not present to suggest
positive regard or advocacy.
150
Which comment best indicates that a patient perceived the nurse was caring? “My nurse
a. always asks me which type of juice I want to help me swallow my medication.”
b. explained my treatment plan to me and asked for my ideas about how to make it better.”
c. spends time listening to me talk about my problems. That helps me feel like I am not
alone. ”
d. told me that if I take all the medicines the doctor prescribes, then I will get discharged
sooner. ”
ANS: C
Caring evidences empathetic understanding as well as competency. It helps change pain and
suffering into a shared experience, creating a human connection that alleviates feelings of
isolation. The distracters give examples of statements that demonstrate advocacy or giving
advice.
151
A nurse ends a relationship with a patient. Which actions by the nurse should be included in the
termination phase? (Select all that apply.)
a. Focus dialogues with the patient on problems that may occur in the future.
b. Help the patient express feelings about the relationship with the nurse.
c. Help the patient prioritize and modify socially unacceptable behaviors.
d. Reinforce expectations regarding the parameters of the relationship.
e. Help the patient to identify strengths, limitations, and problems.
ANS: A, B
The correct actions are part of the termination phase. The other actions would be used in the
working and orientation phases.
152
A novice psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily
recalls feelings of embarrassment about the parent’s behavior in the community. Select the
best ways for this nurse to cope with these feelings. (Select all that apply.)
a. Seek ways to use the understanding gained from childhood to help patients cope with
their own illnesses.
b. Recognize that these feelings are unhealthy. The nurse should try to suppress them when
working with patients.
c. Recognize that psychiatric nursing is not an appropriate career choice. Explore other
nursing specialties.
d. The nurse should begin new patient relationships by saying, “My own parent had mental
illness, so I accept it without stigma.”
e. Recognize that the feelings may add sensitivity to the nurse’s practice, but
supervision is important.
ANS: A, E
The nurse needs support to explore these feelings. An experienced psychiatric nurse is a
resource that may be helpful. The knowledge and experience gained from the nurse’s
relationship with a mentally ill parent may contribute sensitivity to compassionate practice.
Self-disclosure and suppression are not adaptive coping strategies. The nurse should not
give up on this area of practice without first seeking ways to cope with the memories.
153
A novice nurse tells a mentor, “I want to convey to my patients that I am interested in them and
that I want to listen to what they have to say.” Which behaviors will be helpful in meeting the
nurse’s goal? (Select all that apply.)
a. Sitting behind a desk, facing the patient
b. Introducing self to a patient and identifying own role
c. Maintaining control of discussions by asking direct questions
d. Using facial expressions to convey interest and encouragement
e. Assuming an open body posture and sometimes mirror imaging
ANS: B, D, E
Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial
expressions that convey interest and encouragement support the nurse’s verbal statements to
that effect and strengthen the message. An open body posture conveys openness to listening
to what the patient has to say. Mirror imaging enhances patient comfort. A desk would place
a physical barrier between the nurse and patient. A face-to-face stance should be avoided
when possible and a less intense 90- or 120-degree angle used to permit either party to look
away without discomfort.
