Test Bank For Neeb's Mental Health Nursing 5th Edition Linda M. Gorman, Robynn Anwar Chapter 1-22

Complete Test Bank for all Chapters (Chapter 1-22) Chapter 1. History of Mental Health Nursing Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The act of developing a clean environment is a factor in providing effective health care as

demonstrated by: 1. Nightingale.

2. Benner.

3. Swanson.

4. King. ____

2. What is the name of the publication written by Florence Nightingale?

1. Nursing Sanitation Notes 2. Nursing 101 3. Notes on Nursing

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4. Nursing Notes ____

3. A long-term goal for inpatient mental health treatment is generally to: 1. Return the patient to the community.

2. Locate a facility for long-term care.

3. Be arrested and placed in prison.

4. Be completely cured of the disorder.

____

4. The mentally ill were once housed in mental institutions known as: 1. Hospitals.

2. Long-term care facilities.

3. Asylums.

4. Free-standing treatment centers.

____

5. Which nursing theorists promoted the interpersonal theory between the nurse and the patient?

1. Hildegard Peplau 2. Hattie Bessent 3. Mary Mahoney 4. Linda Richards

Completion Complete each statement.

6. The first psychiatric program of study was established by which nursing leader? ______ _______

_________ 7. Which nurse theorist was the first American-trained nurse credited with teaching how to provide

care for people with mental illness? ___________ ____________ 8. The greatest advance in the early years of mental health care was the introduction of

___________________.

9. The legislation that provided funding for improving the care of the mentally ill is known as the

National Mental Health Act of what year? ______.

10. One of the goals of the American Nurses association (ANA) is to promote ________________ of

nursing care in the United States.

11. ______________ ____________ has always been called the “founder of nursing.”

12. A schoolteacher by the name of _____________ _________helped established asylums and

psychiatric hospitals for the mentally ill.

13. The first psychotropic drug category was known as ____________________.

14. The first major federal law to address mental illness was called the _____-_______ Act.

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Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 15. What trends contributed to the deinstitutionalization of mental health facilities to outpatient care

(select all that apply)?

1. Cost of the facilities 2. The increased use of phenothiazines 3. Staff cost 4. Establishment of outpatient clinics 5. Development of the Patient Bill of Rights

Chapter 1. History of Mental Health Nursing Answer Section MULTIPLE CHOICE 1. ANS: 1

Page: 2 Integrated Processes: Teaching/Learning Content Area: Community Health Cognitive Level: Application Client Need: Safe and Effective Care Environment: Safety and Infection Control Chapter 1: History of Mental Health Nursing; The Trailblazers; Florence Nightingale Feedback 1 The relationship between sanitary conditions and healing became known and accepted due to Nightingale’s observations and diligence. Her commitment to improved outcomes at a military hospital was directly related to introducing sanitation methods.

2 Benner did not emphasize developing a clean environment as a factor in providing effective health care.

3 Swanson did not emphasize developing a clean environment as a factor in providing effective health care.

4 King did not emphasize developing a clean environment as a factor in providing effective health care.

PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Florence Nightingale 2. ANS: 3

Page: 3 Integrated Processes: Teaching/Learning Content Area: Nursing Trends Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Health Promotion/Disease Prevention Chapter 1: History of Mental Health Nursing; The Trailblazers; Florence Nightingale Feedback 1 Although Florence Nightingale did write a book on the relationship of sanitary Copyright © 2019 F. A. Davis Company

2 3 4

techniques to medical facilities, it was called Notes on Hospitals, not Nursing Sanitation Notes.

Florence Nightingale did not write Nursing 101.

Florence Nightingale wrote the book Notes on Nursing, which was the most respected nursing textbook of its day.

Florence Nightingale did not write Nursing Notes.

PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Florence Nightingale 3. ANS: 1

Page: 8 Integrated Processes: Nursing Process: Planning Content Area: Mental Health Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 1: History of Mental Health Nursing; The Breakthroughs Feedback 1 People who had formerly required long hospital stays were now able to leave the institutions and return to their communities due to appropriate medications and deinstitutionalization.

2 Locating a facility for long-term care is not a long-term goal for inpatient mental health treatment.

3 Being arrested and placed in prison is not a long-term goal for inpatient mental health treatment.

4 The long-term goal is not to be completely cured of the disorder but control unwanted behaviors.

PTS: 1 4. ANS: 3

REF: Chapter 1: History of Mental Health Nursing; The Breakthroughs

Page: 7 Integrated Processes: Teaching/Learning Content Area: Mental Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Environment Chapter 1: History of Mental Health Nursing; The Facilities; Asylums Feedback 1 Hospitals are not mental institutions but can handle patients with psychological needs according to the size of the hospital and its resources.

2 Long-term care facilities are not mental institutions.

3 Early on, these special facilities were called asylums, which Webster’s online dictionary defines as “an institution for the care of the needy or sick and especially of the insane.”

4 Free-standing treatment centers are not mental institutions but can handle patients that need detoxification (detox centers) or help managing a crisis (crisis centers).

Copyright © 2019 F. A. Davis Company

PTS: 1 5. ANS: 1

REF: Chapter 1: History of Mental Health Nursing; The Facilities; Asylums

Page: 5 Integrated Processes: Communication and Documentation Content Area: Nursing Trends Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization Feedback 1 In her book Interpersonal Relations in Nursing (1952), Peplau brought together interpersonal theories from psychiatry and melded them with theories of nursing and communication.

2 Dr. Hattie Bessent is credited with the development and directorship of a grant that researched minority nurses who were choosing to upgrade to master’s and doctorate levels of practice.

3 Mary Mahoney is considered to be America’s first African American professional nurse.

4 Linda Richards worked to upgrade nursing education, opened a nursing school, and taught the care of the mentally ill.

PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Hildegard Peplau COMPLETION 6. ANS:

Effie Jane Taylor Page: 4 Rationale: In 1913, the first psychiatric program for nurses was established by Effie Jane Taylor. Ms. Taylor also believed in patient-centered care.

Integrated Processes: Teaching/Learning Content Level: Nursing Trends Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Effie Jane Taylor 7. ANS:

Linda Richards Page: 4 Rationale: Linda Richards wanted to upgrade the nursing education field and opened the Boston City Hospital Training School for Nurses to teach the specialty of caring for the mentally ill.

Integrated Processes: Teaching/Learning Content Area: Nursing Trends Cognitive Level: Knowledge Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 8. ANS:

REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Linda Richards

phenothiazines Page: 7 Rationale: With the discovery of phenothiazines, people living with mental disorders could control unwanted behaviors (to a degree) and were able to function more independently.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Knowledge Client Need: Physiological Integrity: Pharmacological Therapies; Expected Actions/Outcomes Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Breakthroughs; Psychotropic Medications 9. ANS:

1946 Page: 10 Rationale: The National Mental Health Act of 1946 provided money for training nurses and several other disciplines to improve treatment for the mentally ill.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Law; The National Mental Health Act of 1946 10. ANS:

standardization Page: 8 Rationale: The ANA has developed standards for a number of different nursing practices areas in the United States, including psychiatric nursing.

Integrated Processes: Teaching/Learning Content Area: Nursing Trends Cognitive Level: Knowledge Client Need: Safe and Effective Care Management: Coordinated Care: Establishing Priorities Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Breakthroughs; Organizations for Mental-Health Nurses and Others 11. ANS:

Florence Nightingale Page: 2 Copyright © 2019 F. A. Davis Company

Rationale: Florence Nightingale has been called the founder of nursing based upon her numerous contributions to the nursing profession.

Integrated Processes: Teaching/Learning Content Area: Nursing Trends Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Safety and Infection Control Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Florence Nightingale 12. ANS:

Dorothea Dix Page: 3 Rationale: Dorothea Dix was not a nurse but was concerned about the treatment of the mentally ill and prisoners. Because of her efforts, 32 states developed asylums or “psychiatric hospitals” to care for the mentally ill that treated patients humanely.

Integrated Processes: Teaching/Learning Content Area: Nursing Trends Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care: Advocacy Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 13. ANS:

REF: Chapter 1: History of Mental Health Nursing; The Trailblazers; Dorothea Dix

phenothiazines Page: 7 Rationale: In 1955, a group of psychotropic medications called phenothiazines was discovered to have the effect of calming and tranquilizing people.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Knowledge Client Need: Physiological Integrity: Pharmacological Therapies: Expected Actions/Outcomes Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Breakthroughs; Psychotropic Medications 14. ANS:

Hill-Burton Page: 10 Rationale: The Hill-Burton Act of 1946 provided much needed funding to build psychiatric units in hospitals and was the first major federal law to address mental illness.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Legal Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 1: History of Mental Health Nursing; The Law; Hill-Burton Act

MULTIPLE RESPONSE 15. ANS: 1, 2, 3, 4

Page: 8 Integrated Processes: Teaching/Learning Content Area: Mental Health Cognitive Level: Synthesis Client Need: Safe and Effective Care Environment: Coordinated Care: Advocacy Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization 1.

2.

3.

4.

5.

Feedback Correct. It became costly to run these large buildings even though the patient population was declining.

Correct. Phenothiazines were so effective that state hospitals saw a large decline in population.

Correct. It became costly to continue to employ staff even though the patient population was declining.

Correct. Other facilities, such as outpatient clinics, dedicated to the care and treatment of people with mental illness caused a decline in state hospitals’ patient population.

Incorrect. The Patient Bill of Rights provides “vulnerable” people with certain rights.

PTS: 1 REF: Chapter 1: History of Mental Health Nursing; The Breakthroughs; Deinstitutionalization

Chapter 2. Basics of Communication Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. Which question by the nurse would gain the most information from a patient experiencing a marital

crisis?

1. “Do you hate your spouse?”

2. “Do you get along with your in-laws?”

3. “Do you talk out your problems with your spouse?”

4. “What is it like at home with your spouse?” ____

2. The mother of a young patient with schizophrenia seeks out the nurse and begins to cry. The mother

expresses concern over her daughter’s behavior. The nurse’s best response to this woman is: 1. “What is it that concerns you the most?”

2. “Well, you know, that is part of the illness.”

3. “Here is a book on schizophrenia. This will help you.”

4. “Are you afraid your daughter will always be like this?” ____

3. Linda is pacing the floor and appears extremely anxious. The day-shift nurse approaches Linda in an

attempt to lessen her anxiety. The most therapeutic statement by the nurse would be: Copyright © 2019 F. A. Davis Company

1.

2.

3.

4. ____

“How about watching a football game?”

“Tell me how you are feeling today.”

“What do you have to be upset about now?”

Ignore the patient.

4. A patient states, “I don’t know what the pills are for or why I am taking them, so I don’t want them.”

What therapeutic communication would best help this patient?

1. Ask for what you need 2. Silence 3. Using general leads 4. Giving information ____

5. To practice effectively in mental health, the nurse should be able to: 1. Solve his or her own personal problems without assistance from others.

2. Comfortably point out patient shortcomings and provide advice about how to

improve.

3. Bring patients and coworkers into compliance with societal rules and norms.

4. Demonstrate therapeutic communication.

Completion Complete each statement.

6. Communication has three parts including the sender, the message, and the _____________.

7. When appropriate, the nurse can use _____________________ as part of an interaction when there

is no talking. This can communicate support.

8. A theory of communication that emphasizes the three ways to communicate—hearing, seeing, and

touching—is called ___________ ______________.

9. Expressive, receptive, and global are types of _______________.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 10. A nurse is working with a patient and attempts to communicate effectively with the patient.

Techniques the nurse can use to help communication include (select all that apply): 1. Clarifying terms.

2. Remaining silent.

3. Asking open-ended questions.

4. Offering false reassurance.

5. Discouraging the person from expressing feelings that are unacceptable. ____ 11. The three components of communication are (select all that apply): 1. Impairment.

2. Message.

3. Sender.

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4. Receiver.

5. Therapeutic. ____ 12. Nurses understand that when caring for patients with mental illnesses, a nurse’s communication is

(select all that apply): 1. An active process that includes participating and listening and speaking.

2. A complex activity.

3. Exchanging information.

4. Verbal and nonverbal.

5. A one-way path from nurse to patient.

6. Advising. ____ 13. The patient is concerned about his doctor and what the doctor has prescribed. The nurse making

rounds notices the patient sitting on the side of the bed in deep thought. The nurse comes into the room and the patient begins to tell the nurse his concerns about a new order. The nurse advises the patient, “If I were you, I would find another doctor.” How does this statement by the nurse block communication (select all that apply)?

1. It tells the patient that his concerns are not valid.

2. It gives the idea that the nurse’s values are the correct ones.

3. It sounds judgmental.

4. It sets the stage for expectations that the patient may not be able to meet.

5. It discourages yes or no answers.

6. It blocks the patient from telling the nurse what his concerns are. ____ 14. The following types of patients require adaptive communication techniques (select all that apply): 1. A patient who is blind 2. A patient who has aphasia 3. A patient with schizophrenia 4. A patient who is elderly 5. A patient with dysphagia 6. A patient who has language differences from the staff ____ 15. Which of the following are characteristics of assertive communication (select all that apply)?

1. Statements begin with the word “you.”

2. Statements deal with thoughts and feelings.

3. It is a form of blaming.

4. It puts responsibility for the interaction on the other person.

5. It is a technique of personal empowerment.

6. It is self-responsible.

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Chapter 2. Basics of Communication Answer Section MULTIPLE CHOICE 1. ANS: 4

Page: 21 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Therapeutic Communication Feedback 1 This is a closed-ended question. These are forms of questions that make it possible for a one-word “yes” or “no” answer. They discourage the patient from giving full answers to the questions. “Hate” is judgmental and makes an assumption for the marital crisis.

2 This is a closed-ended question. These are forms of questions that make it possible for a one-word “yes” or “no” answer. They discourage the patient from giving full answers to the questions.

3 This is a closed-ended question. These are forms of questions that make it possible for a one-word “yes” or “no” answer. They discourage the patient from giving full answers to the questions.

4 This is an open-ended question which encourages expression of feelings rather than a yes/no answer. Use of open-ended questions facilitate more open communication.

PTS: 1 2. ANS: 1

REF: Chapter 2: Basics of Communication; Therapeutic Communication

Page: 21 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Psychotic Disorders: Therapeutic Nursing Process Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Therapeutic Communication Feedback 1 2 3 4

This is an open-ended question allowing the mother to explain why she is upset.

This minimizes the problem, implying the mother’s feelings are not special.

Changing the subject sends the message to the mother that the nurse does not care or that this problem is not worthy of the nurse’s time.

This is a closed-ended question and makes an assumption of why the mother is upset.

PTS: 1 3. ANS: 2

REF: Chapter 2: Basics of Communication; Therapeutic Communication

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Page: 21 Integrated Processes: Caring Content Area: Mental Health: Communication Cognitive Level: Synthesis Client Need: Psychosocial Integrity: Stress Management Chapter 2: Basics of Communication; Therapeutic Communication 1 2 3 4

Feedback Although this is an open-ended question, it changes the subject and does not deal with the anxiety.

To keep open communication with the patient, the nurse should ask open-ended questions that will facilitate discussion.

Although this is an open-ended question, it belittles the patient and implies that the patient’s feelings are not special.

Ignoring the patient is not therapeutic communication and will make the anxiety worse.

PTS: 1 4. ANS: 4

REF: Chapter 2: Basics of Communication; Therapeutic Communication

Page: 19–20 Integrated Processes: Teaching/Learning Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication/Health Promotion and Maintenance: Principles of Teaching/Learning Chapter 2: Basics of Communication; Therapeutic Communication; Techniques of Therapeutic/Helping Communication 1 2

3

4

Feedback Asking for what you need requires the user to start the sentence with the words “I want” or “I need,” which is not needed in this instance.

Although silence can be therapeutic, it is not appropriate for this situation. The patient does not need time to collect thoughts; an answer is needed in the form of patient teaching.

Although general leads are therapeutic, they are not appropriate in this instance.

Saying “Yes” or “Go on” is not best because the patient has already stated the need: “I don’t know what the pills are for and why I am taking them.”

Giving information relates to the helping relationship because it involves a form of patient teaching, which is what this patient needs.

PTS: 1 REF: Chapter 2: Basics of Communication; Therapeutic Communication; Techniques of Therapeutic/Helping Communication 5. ANS: 4

Page: 16 Integrated Processes: Communication and Documentation Copyright © 2019 F. A. Davis Company

Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Techniques of Therapeutic/Helping Communication 1 2

3

4

Feedback The goal in mental health is for the nurse to be the “tool” for ensuring positive interpersonal relationships with patients, not solve problems without assistance.

The goal in mental health is for the nurse to be the “tool” for ensuring positive interpersonal relationships with patients, not pointing out shortcomings. Giving advice is a block or barrier to therapeutic communication.

The goal in mental health is for the nurse to be the “tool” for ensuring positive interpersonal relationships with patients, not to make people comply with societal rules and norms.

Good communication skills are essential for working in mental health.

Therapeutic communication is the appropriate use of verbal and nonverbal communication skills that cements the relationship with patients and ultimately promotes their healing.

PTS: 1 REF: Chapter 2: Basics of Communication; Techniques of Therapeutic/Helping Communication COMPLETION 6. ANS:

receiver Page: 14 Feedback: One of the challenging parts of communicating with others is that the process requires three parts: a sender, a message, and a receiver. Communication is not just about getting the message out; it also involves how the message is received.

Integrated Processes: Communication and Documentation Content Area: Mental Health: Communication Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Communication Theory PTS: 1 7. ANS:

REF: Chapter 2: Basics of Communication; Communication Theory

silence Page: 23 Feedback: Silence allows the nurse and the patient time to collect their thoughts. It is a therapeutic technique of communication and demonstrates patience and acceptance.

Integrated Processes: Caring/Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Communication Copyright © 2019 F. A. Davis Company

Chapter 2: Basics of Communication; Therapeutic Communication; Techniques of Therapeutic/Helping Communication PTS: 1 REF: Chapter 2: Basics of Communication; Therapeutic Communication; Techniques of Therapeutic/Helping Communication 8. ANS:

neurolinguistic programming Page: 16 Feedback: Neurolinguistic programming (NLP) was developed by John Grinder and Richard Bandler. NLP can assist the health-care provider in communicating more effectively with the patient, which in turn may lead him or her to change behavior and choose a healthier lifestyle.

Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Types of Communication PTS: 1 9. ANS:

REF: Chapter 2: Basics of Communication; Types of Communication

aphasia Page: 18 Feedback: A person with aphasia has no speech from damage to a portion of the brain. The three types of aphasia include the following: expressive—difficulty in verbal expression; receptive— difficulty with interpretation of written or verbal communication; and global—combination of receptive and expressive.

Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Challenges to Communication; Table 2-1, Types of Aphasia PTS: 1 REF: Chapter 2: Basics of Communication; Challenges to Communication; Table 2-1 Types of Aphasia MULTIPLE RESPONSE 10. ANS: 1, 2, 3

Page: 21 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Techniques of Therapeutic/Helping Communication 1.

Feedback Correct. Clarifying terms is a therapeutic technique. Nurses must be sure that

Copyright © 2019 F. A. Davis Company

2.

3.

4.

5.

the terms they choose are correct and mean the same thing to all parties involved in the interaction. If the nurse does not clarify simple words, she or he could incorrectly infer the patient’s level of ability or cooperation.

Correct. Remaining silent is a therapeutic technique. First, it allows the nurse and the patient a short time to collect their thoughts; second, it shows patience and acceptance on the part of the nurse.

Correct. Asking open-ended questions is a therapeutic technique. Open-ended communication allows the patient to become more involved in his or her plan of care.

Incorrect. Offering false reassurance is a nontherapeutic technique. These are phrases nurses may use to sound supportive. In social communication, these expressions sound friendly, but in a therapeutic relationship, they invalidate the patient’s concerns.

Incorrect. Discouraging expression of feelings that are unacceptable is a nontherapeutic technique. The goal of therapeutic communication is for patients to express positive and negative feelings.

PTS: 1 REF: Chapter 2: Basics of Communication; Techniques of Therapeutic/Helping Communication 11. ANS: 2, 3, 4

Page: 14 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Communication Theory 1.

2.

3.

4.

5.

Feedback Incorrect. Impairment is not a component of communication.

Correct. Message is a component of communication. Message is what the sender delivers (sends) to the receiver.

Correct. Sender is a component of communication. Sender is the person who transmits (sends) the message.

Correct. Receiver is a component of communication. Receiver is the person who accepts (receives) the message.

Incorrect. Therapeutic is not a component of communication.

PTS: 1 12. ANS: 1, 2, 3, 4

REF: Chapter 2: Basics of Communication; Communication Theory

Page: 16 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Therapeutic Communication

Copyright © 2019 F. A. Davis Company

1.

2.

3.

4.

5.

6.

Feedback Correct. Communication is an active, two-way process between patient and nurse. It is not passive.

Correct. Communication is a complex activity requiring a sender, message, and receiver, as well as cultural influences.

Correct. Communication is the exchange of information.

Correct. Communication involves verbal and nonverbal.

Incorrect. Communication is a two-way process between patient and nurse.

Incorrect. Communication is not advising; in fact, the nurse’s role is to listen and support, not advise.

PTS: 1 13. ANS: 2, 3, 4, 6

REF: Chapter 2: Basics of Communication; Therapeutic Communication

Page: 19 Integrated Processes: Communication and Documentation Content Area: Mental Health: Communication Cognitive Level: Evaluation Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Therapeutic Communication 1.

2.

3.

4.

5.

6.

Feedback Incorrect. False reassurance/social clichés, not advising, tell the patient his or her concerns are not valid.

Correct. Advising sets up, in the patient’s mind, some sort of value system that puts the nurse’s value as the “right” one.

Correct. Giving advice can sound very judgmental.

Correct. Advising sets the stage for expectations that the patient may not be able to meet.

Incorrect. Open-ended questions discourage yes or no answers, not advising.

Correct. Advising is a nontherapeutic technique that blocks communication.

PTS: 1 14. ANS: 1, 2, 5, 6

REF: Chapter 2: Basics of Communication; Therapeutic Communication

Page: 24 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Challenges to Communication 1.

Feedback Correct. A patient who is blind requires adaptive communication techniques.

Sightless people cannot see a wave of the hand or when someone leaves or enters a room; these events must be verbalized. Patient teaching for a person with a visual impairment may involve physically moving or touching him or her and verbally explaining in much more detail than usual, like using a clock

Copyright © 2019 F. A. Davis Company

2.

3.

4.

5.

6.

face to describe food positions on a plate.

Correct. A patient who has aphasia requires adaptive communication techniques depending on the type of aphasia present.

Incorrect. A patient who with schizophrenia does not require adaptive techniques. Patients with challenges to sight, sound, and speech require adaptive techniques.

Incorrect. A patient who is elderly does not require adaptive techniques.

Correct. A patient with dysphasia requires adaptive communication techniques.

Patients with dysphasia have great difficulty with speech.

Correct. A patient who has language differences from the staff requires adaptive communication techniques. Adaptive techniques to ensure understanding is needed.

PTS: 1 15. ANS: 2, 5, 6

REF: Chapter 2: Basics of Communication; Challenges to Communication

Page: 15 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 2: Basics of Communication; Types of Communication; Aggressive Communication Versus Assertive Communication 1.

2.

3.

4.

5.

6.

Feedback Incorrect. Statements that begin with the word “you” are aggressive statements, not assertive.

Correct. Statements that deal with thoughts and feelings are assertive statements. Saying “I think” or “I feel” helps to keep people in control of their emotions, while allowing honest, open expression of the feelings they have as a result of someone else’s behavior.

Incorrect. Aggressive statements, not assertive, place blame.

Incorrect. Aggressive statements, not assertive, put the responsibility for the interaction on the other person.

Correct. Assertive behavior and communication are techniques of personal empowerment.

Correct. Assertive behavior is self-responsible, expressing the speaker’s thoughts and feelings honestly.

PTS: 1 REF: Chapter 2: Basics of Communication; Types of Communication; Aggressive Communication Versus Assertive Communication

Chapter 3. Ethics and Law Multiple Choice Identify the choice that best completes the statement or answers the question.

Copyright © 2019 F. A. Davis Company

____

1. A patient is expressing anger when the nurse attempts to make him take a medication, which he is

refusing. If the nurse pushes to give the medication against his will, the nurse is: 1. Violating the patient’s rights.

2. Achieving a treatment goal to get the medication in the patient any way possible.

3. Supporting the family’s demand that he takes the medication.

4. Following orders from the charge nurse. ____

2. A mental health nurse bumps into one of the members from the church, who begins questioning the

nurse about a former neighbor. The lady from the church asks the nurse, “How is Rachael? We have been friends for over 20 years, and I have seen her come out of your clinic a few times. Is she seeing one of the psychiatrists?” The nurse’s response is: 1. “The HIPAA Act prevents me from disclosing any information about any patient.”

2. “All I can say is she is seeing Dr. Leone.”

3. “Rachael is seeing Dr. Leone because she is concerned about feeling extremely happy sometimes and feeling extremely depressed other times.”

4. “Rachael was only there to renew her medication.” ____

3. You are working on a mental health unit and have a diverse group of patients. Some of the patients

are of Middle Eastern descent. These patients have communicated to you that they would like to follow the same period for praying as they did before admission. What is your response?

1. “Since you are in America now, it would be best to acclimate to Western religious traditions.”

2. “You can go back to your regular time for praying when you are discharged.”

3. “How can I accommodate you with your prayer time?”

4. “Would you like to learn another prayer?” ____

4. The nursing student uses the patient’s full name on the assigned care plan during a recent clinical

rotation. What is the instructor’s priority intervention?

1. Express the importance of factual documentation and that it should include the patient’s name.

2. Remind the student of the importance of maintaining patient confidentiality.

3. Discuss with student that the patient is homeless and illiterate. As a result of this, maybe the patient will not be embarrassed about their homelessness status; therefore confidentiality is not an issue.

4. Explain to the student that because the patient was committed involuntary, confidentiality is not an issue. ____

5. The telephone rings at the nurses’ station of an inpatient psychiatric facility. The caller asks to speak

with Ms. Honey. Which nursing response protects the patient’s rights and confidentiality?

1. “I cannot confirm or deny that Ms. Honey is admitted here.”

2. “Ms. Honey is in group therapy at present.”

3. “Hold on, I’ll go see if she is in her room.”

4. “Are you a family member? Ms. Honey can only receive calls from family members.”

Completion Complete each statement.

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6. Another term to describe the ethical principle of veracity is _________________.

7. Another term for accepting responsibility is ________________.

8. _____________________ relates to the study of how different cultures relate to space.

9. The Nurse Practice _____ indicates the acceptable scope of nursing practice for the different levels

of nursing.

10. Immunity for citizens who stop to assist someone in need of medical help is protected by the Good

___________ Law. 11. The _________Commission is the leading national accrediting body of health care organizations.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

____ 12. Patient’s Bill of Rights includes the rights to (select all that apply): 1. Open mail.

2. Have privacy and visitors.

3. Treat staff in a disrespectful manner.

4. Have opportunities for daily exercise.

5. Choose one’s own nurse.

____ 13. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was developed by the Department of Health and Human Services to provide national standards pertaining to transmission and communication of medical information. Which of the following are true about HIPAA (select all that apply)?

1. Only applies to an electronic chart, not the paper one 2. Provides national standards relating to the electronic transmission and communication of medical information among patients, providers, employers, and insurers 3. Allows less control on the part of the patient as to what part of health information is disclosed Copyright © 2019 F. A. Davis Company

4. Eliminates the need for patients to sign informed consents 5. Was implemented in 2003

____ 14. The goals and objectives of the Joint Commission (JC) include (select all that apply): 1. Committing to quality on a daily basis within the entire facility.

2. Reducing risk of undesirable patient outcomes.

3. Encouraging continuous improvement.

4. Reducing health-care costs.

5. Promoting nursing education through scholarships and financial aid.

____ 15. LPNs/LVNs will use the Nurse Practice Act as a guide in their practice. The Nurse Practice Act (select all that apply): 1. Is a federal document that all states must follow.

2. Is established by each state to define the scope of nursing practice in that state.

3. Protects nurses from lawsuits for violating rules about patients’ confidentiality.

4. Established fair compensation and benefits for nurses.

5. Dictates the acceptable scope of practice for the different levels of nursing.

Copyright © 2019 F. A. Davis Company

Chapter 3. Ethics and Law Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 37 Integrated Processes: Nursing Process: Implementation Content Area: Legal Cognitive Level: Application Client Need: Safe and Effective Care Environment: Client Rights Chapter 3: Ethics and Law; Patient’s Rights Feedback 1

Patients’ rights include the right to accept or refuse medical treatment. This is also protected by law in the Patient Self-Determination Act (PSDA). The nurse has a responsibility to advocate for the patients and assure them of their rights.

In addition, patients have the right to be educated about medications and treatment, which will allow them to make an informed decision.

2

A treatment goal that violates patient’s rights to refuse medication is not appropriate or acceptable.

3

The patient is the priority, not the family. The patient’s rights cannot be violated.

4

Following orders that violate the patient’s right is not ethical or legal.

PTS: 1

REF: Chapter 3: Ethics and Law; Patient’s Rights

2. ANS: 1 Page: 34 Integrated Processes: Communication and Documentation Content Area: Legal Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Safe and Effective Care Environment: Confidentiality/Information Chapter 3: Ethics and Law; Patient’s Rights Feedback 1

Confidentiality is so important that it is mentioned in both federal and state patient rights legislation. The Health Insurance Portability and Accountability Act (HIPAA) states what can be disclosed about a patient and emphasizes patient privacy.

2

Sharing who is providing care to Rachael is a violation of the patient’s right to confidentiality, which is protected by both federal and state requirements.

Confidentiality is a standard of care that must be maintained.

3

Noting why Rachel is receiving care is a violation of the patient’s right to confidentiality, which is protected by both federal and state requirements.

Confidentiality is a standard of care that must be maintained.

4

Sharing any information about Rachael’s medical care, including whether or not she is renewing a prescription is violation of Rachael’s right to confidentiality.

This is protected by both federal and state requirements. Confidentiality is a standard of care that must be maintained.

PTS: 1

REF: Chapter 3: Ethics and Law; Confidentiality

3. ANS: 3 Page: 40 Integrated Processes: Nursing Process: Planning Content Area: Cultural Diversity Cognitive Level: Analysis Client Need: Psychosocial Integrity: Religious and Spiritual Influences on Health Chapter 3: Ethics and Law; Patient Advocacy Feedback

Copyright © 2019 F. A. Davis Company

1

This is condescending and disrespects the patient’s cultural and spiritual needs.

Instead, the nurse should be the patient’s advocate.

2

The nurse’s personal views must give way to consistent behaviors that provide patients with the best possible care, including spiritual beliefs. The nurse should be the patient’s advocate.

3

Part of a nurse’s scope of practice is to be a voice, or an advocate, for the patients under his or her care. The nurse’s personal views must give way to consistent behaviors that provide patients with the best possible care, including spiritual beliefs.

4

The patient’s beliefs take precedence over the nurse’s beliefs for competent, holistic care. The nurse should be the patient’s advocate.

PTS: 1

REF: Chapter 3: Ethics and Law; Patient Advocacy

4. ANS: 2 Page: 33 Integrated Processes: Communication and Documentation Content Area: Mental Health: Confidentiality Cognitive Level: Application Client Need: Safe and Effective Care Environment: Confidentiality/Information Security Chapter 3: Ethics and Law; Confidentiality Feedback 1

This would violate the patient’s right to confidentiality and is an inappropriate intervention.

2

All patient information is confidential, according to federal and state regulations. The nursing student should not disclose the patient’s full name, and the nursing instructor must intervene.

3

Regardless of the situation, patient confidentiality is required. Homelessness and being illiterate do not allow the nursing student to break confidentiality.

Copyright © 2019 F. A. Davis Company

4

Even patients admitted involuntarily do not lose their right to confidentiality.

PTS: 1

REF: Chapter 3: Ethics and Law; Confidentiality

5. ANS: 1 Page: 33 Integrated Processes: Communication and Documentation Content Area: Legal Cognitive Level: Synthesis Client Need: Safe and Effective Care Environment: Confidentiality/Information Security Chapter 3: Ethics and Law; Confidentiality Feedback 1

Patient information is confidential; this includes acknowledging the presence of that person in the facility.

2

This response acknowledges that Ms. Honey is receiving treatment at this facility, which violates the her right for confidentiality.

3

This response indicates that Ms. Honey is at the facility. This violates the patient’s right for confidentiality, which is a professional standard for nurses.

4

A professional standard for nurses is to maintain the confidentiality of patients, regardless of the identity of the caller. This response indicates that Ms. Honey is at the inpatient psychiatric facility.

PTS: 1

REF: Chapter 3: Ethics and Law; Confidentiality

COMPLETION 6. ANS: honesty Page: 31 Copyright © 2019 F. A. Davis Company

Rationale: Honesty, or veracity, is one of the qualities of professionalism. No matter one’s level of nursing, the professional choice is always to tell the truth.

Integrated Processes: Teaching/Learning Content Area: Nursing Ethics Cognitive level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care: Ethical Practice Chapter 3: Ethics and Law; Honesty/Veracity PTS: 1

REF: Chapter 3: Ethics and Law; Honesty/Veracity

7. ANS: accountability Page: 36 Rationale: Accountability for nurses is part of working independently within their scope of practice.

Nurses are accountable for their own actions.

Integrated Processes: Teaching/Learning Content Area: Legal Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Concepts of Management and Supervision Chapter 3: Ethics and Law; Accountability PTS: 1

REF: Chapter 3: Ethics and Law; Accountability

8. ANS: Proxemics Page: 32 Rationale: Proxemics is the study of how different cultures relate to space. It is important for nurses to understand, however, that the concept of personal space is highly dependent on culture.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Therapeutic Communication Cognitive Level: Knowledge Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 3: Ethics and Law; Culture of Nurses PTS: 1

REF: Chapter 3: Ethics and Law; Culture of Nurses

9. ANS: Act Page: 29 Rationale: The Nurse Practice Act dictates the acceptable scope of nursing practice for the different levels of nursing. The Nurse Practice Acts varies from state to state.

Integrated Processes: Teaching/Learning Content Area: Nursing Licensure Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care: Legal Rights and Responsibilities Chapter 3: Ethics and Law; Nurse Practice Act PTS: 1

REF: Chapter 3: Ethics and Law; Nurse Practice Act

10. ANS: Samaritan Page: 36 Rationale: Good Samaritan laws offer immunity from prosecution for citizens who stop to assist someone in need of medical help. Nurses, physicians, and other medically trained personnel may not always be protected by Good Samaritan laws.

Integrated Processes: Teaching/Learning Content Area: Legal Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care: Legal Responsibilities Chapter 3: Ethics and Law; Abiding by the Current Laws

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 3: Ethics and Law; Abiding by the Current Laws

11. ANS: Joint Page: 35 Rationale: The Joint Commission (JC) is the leading national accrediting body of health-care organizations. Earning accreditation by the JC indicates commitment to quality on a daily basis within the entire facility. Two other goals of a JC accreditation are reducing the risk of undesirable patient outcomes and encouraging continuous improvement.

Integrated Processes: Nursing Process: Evaluation Content Area: Management of Care Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 3: Ethics and Law; Joint Commission PTS: 1

REF: Chapter 3: Ethics and Law; Joint Commission

MULTIPLE RESPONSE 12. ANS: 1, 2, 4 Page: 38 Integrated Processes: Teaching/Learning Content Area: Mental Health: Patient Advocacy/Legal Cognitive Level: Analysis Client Need: Safe and Effective Care Environment: Legal Responsibilities Chapter 3: Ethics and Law; Patient’s Rights; Table 3-1, Most Frequently Adopted Patient Rights

Feedback 1.

Correct. It is a patient right to receive and open uncensored mail.

2.

Correct. It is a patient right to have privacy and to visit with anyone he or she

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chooses.

3.

Incorrect. It is not a patient right to treat staff in a disrespectful manner.

4.

Correct. It is a patient right to have daily exercise, even if it is only passive range of motion.

5.

Incorrect. It is not a patient right to choose one’s own nurse.

PTS: 1 REF: Chapter 3: Ethics and Law; Patient’s Rights; Table 3-1 Most Frequently Adopted Patient Rights 13. ANS: 2, 5 Page: 34 Integrated Processes: Communication and Documentation Content Area: Legal Cognitive Level: Application Client Need: Safe and Effective Care Environment; Coordinated Care: Confidentiality/Information Security Chapter 3: Ethics and Law; Confidentiality; Health Insurance Portability and Accountability Act

Feedback 1.

Incorrect. HIPAA applies to all medical records, electronic and paper. HIPAA addresses the security and privacy involved with medical records and how that information is identified and passed between care providers.

2.

Correct. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was developed by the Department of Health and Human Services to provide national standards pertaining to the electronic transmission and communication of medical information among patients, providers, employers, and insurers.

Copyright © 2019 F. A. Davis Company

3.

Incorrect. HIPAA allows more control on the part of the patient as to what part of his or her information is disclosed.

4.

Incorrect. HIPAA does not affect other patient rights, such as giving informed consent.

5.

Correct. HIPAA was implemented in April 2003.

PTS: 1 REF: Chapter 3: Ethics and Law; Confidentiality; Health Insurance Portability and Accountability Act 14. ANS: 1, 2, 3 Page: 35 Integrated Processes: Teaching/Learning Content Area: Management of Care Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Coordinated Care: Concepts of Management Chapter 3: Ethics and Law; Joint Commission

Feedback 1.

Correct. Earning accreditation by the JC indicates commitment to quality on a daily basis within the entire facility.

2.

Correct. A goal of the JC accreditation is reducing the risk of undesirable patient outcomes.

3.

Correct. A goal of the JC accreditation is encouraging continuous improvement.

4.

Incorrect. Reducing health-care costs is not a goal of the JC.

5.

Incorrect. The goals and the objective of the JC focus on healthcare organizations, not nursing education.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 3: Ethics and Law; Joint Commission

15. ANS: 2, 5 Page: 29 Integrated Processes: Teaching/Learning Content Area: Nursing Licensure/Legal Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Legal Responsibilities Chapter 3: Ethics and Law; Professionalism: Nurse Practice Act Feedback 1.

Incorrect. The Nurse Practice Act is specific to each state; it is not a federal document.

2.

Correct. The Nurse Practice Act is established by each state to define the scope of nursing practice in that state.

3.

Incorrect. The Nurse Practice Act focuses on defining the acceptable scope of practice for the different levels of nursing, not protecting nurses who violate confidentiality.

4.

Incorrect. The Nurse Practice Act focuses on defining the acceptable scope of practice for the different levels of nursing, not establishing fair compensation and benefits for nurses.

5.

Correct. The Nurse Practice Act dictates the acceptable scope of nursing practice for the various levels of nursing.

PTS: 1

REF: Chapter 3: Ethics and Law; Professionalism: Nurse Practice Act

Chapter 4. Developmental Psychology Throughout the Life Span Multiple Choice Identify the choice that best completes the statement or answers the question.

Copyright © 2019 F. A. Davis Company

____ 1. Joy is occupied exclusively with thoughts of her father’s death. Although Joy is preoccupied with his death, she is still planning to purchase a gift for his birthday, which would have been in 2 weeks. Dr. Leone advises the nurse to assist Joy through this stage of grief, which is known as: 1. Denial.

2. Anger.

3. Bargaining.

4. Acceptance.

____ 2. Which level of Maslow’s Hierarchy of Needs pyramid is necessary for survival?

1. Love and belonging 2. Physiological needs 3. Self-actualization 4. Safety and security

____ 3. Which theorist developed the theory of moral reasoning, which demonstrates how a person justifies right or wrong?

1. Freud 2. Erikson 3. Kohlberg 4. Peters

____ 4. Jean Piaget’s cognitive theory elaborates on the way a person thinks and how these thoughts are used to adapt to the surrounding environment. The age-group for the formal operation is: 1. Birth to 2 years of age.

2. 3 to 7 years of age.

3. 8 to 11 years of age.

4. 12 years of age to adulthood.

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____ 5. Karen Horney was a follower of Dr. Sigmund Freud. Dr. Horney believed that the abnormal behavior experienced by patients was the result of ineffective: 1. Parenting.

2. Mother–child bonding.

3. Environmental stressors.

4. Genetic markers.

____ 6. When caring for a young child, Nurse Andrea realizes that “trust” is a normal part of growth and further development. “Trust” is primary in which age group according to Erikson?

1. Birth–18 months 2. 3–6 years old 3. 12–18 years old 4. Over 65 years old

Completion Complete each statement.

7. The treatment method known as behavior modification is based on the theory of the behavioral theorists Skinner and ____________________.

8. According to Freud, ______ is the part of the personality that is concerned with the gratification of self.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 9. The physiological needs components in Maslow’s Hierarchy of Needs are (select all that apply): 1. Water Copyright © 2019 F. A. Davis Company

2. Oxygen 3. Elimination 4. Safety 5. Freedom from fear 6. Giving and receiving affection

____ 10. The components of self-actualization in Maslow’s Hierarchy of Needs are (select all that apply): 1. Achievement 2. Working to one’s potential 3. Achieve success 4. Love 5. Self-fulfillment 6. Giving and receiving of affection

____ 11. Which of the following are components of Freud’s theory of personality (select all that apply)?

1. Personality is fully developed by age 12.

2. The personality is not fully developed until after adolescence.

3. Developmental behaviors can happen at any age.

4. Failure to progress in a particular manner will lead to dysfunction.

5. Behaviors resulting from ineffective personality development are unconscious.

6. Ineffective personality development was in some way related to the relationship of the child to the parent and is called psychosexual development.

____ 12. Toni T is a 5-year-old girl who has a broken pelvis as a result of falling out of her tree house. Toni was ordered to stay in bed for 3 weeks. What would be the most appropriate activities for this child (select all that apply)?

1. An age-appropriate video game 2. Sports video Copyright © 2019 F. A. Davis Company

3. Finger paints 4. A chess set 5. A punching bag 6. A Scrabble game set

____ 13. The expected behavioral development of the child that is between the ages of 6 and 12 is the following (select all that apply): 1. Learning to share 2. Forming friendships with same-sex friends 3. Beginning to show acceptance of moral issues by questions and discussions 4. Socializing 5. Being self-centered 6. Learning independence

Other 14. Maslow’s Hierarchy of Needs is arranged from the lowest level to the highest level (place in the order they will occur beginning with the lowest level as 1 working up the hierarchy to 5 as the highest level): ___A. Self-actualization ___B. Self-esteem ___C. Physiological needs ___D. Love and belonging ___E. Safety and security 15. The five stages of death and dying based on Elisabeth Kübler-Ross’s work are (place in the order they will occur beginning with the first stage as 1 working up the stages to 5 as the last stage): ___ A. Anger ___ B. Acceptance Copyright © 2019 F. A. Davis Company

___ C. Denial ___ D. Bargaining ___ E. Depression

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Chapter 4. Developmental Psychology Throughout theLife Span Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 64 Integrated Processes: Caring Content Area: Mental Health: Grief Cognitive Level: Synthesis Client Need: Psychosocial Integrity: Coping Mechanism Chapter 4: Developmental Psychology Throughout theLife Span; Elisabeth Kübler-Ross (1926– 2004); Table 4-8, Five Stages of Grief/Death and Dying Feedback 1

Joy is in denial. She refuses to believe thereality of her father’s death, which is demonstrated by desire to purchase a gift for his birthday.

2

Joy is not in theanger stage. People in theanger stage express envy, resentment, and frustration with younger people and/or those who are not dying.

3

Joy is not in thebargaining stage. People in thebargaining stage may become very religious or “good” in an effort to gain another chance at life or more time to live.

4

Joy is not in acceptance. People in acceptance enter a state of expectation; may begin to call family members near; need to complete “unfinished business”; and prepare spiritually to die.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Elisabeth Kübler-Ross (1926–2004); Table 4-8 Five Stages of Grief/Death and Dying Copyright © 2019 F. A. Davis Company

2. ANS: 2 Page: 54 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Developmental Stages Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908–1970) Feedback 1

Love and belonging is not thehierarchy need for survival.

2

Physiological needs are thefoundation of thepyramid; it must be met before any other needs can be addressed because they are necessary for survival.

3

Self-actualization is thehighest rung on thehierarchy of needs and is not necessary for survival.

4

Safety and security is a step above thelevel necessary for survival.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908– 1970) 3. ANS: 3 Page: 50 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Analysis Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Lawrence Kohlberg (1927-1987); Table 4-4, Lawrence Kohlberg’s Theory of Development of Moral Reasoning Feedback Copyright © 2019 F. A. Davis Company

1

Freud did not develop thetheory of moral reasoning. In addition to his five psychosexual stages of development, Sigmund Freud had a model for thecomponents of personality (id, ego, and superego).

2

Erikson did not develop thetheory of moral reasoning. Erikson developed theeight stages of development with developmental tasks. thedevelopmental tasks are always listed as contradiction of each other.

3

Kohlberg’s theory is called theDevelopment of Moral Judgment (preconventional, conventional, and postconventional), theprocess for people to have theability to understand and judge right and wrong.

4

Peters did not develop thetheory of moral reasoning.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Lawrence Kohlberg (19271987); Table 4-4, Lawrence Kohlberg’s Theory of Development of Moral Reasoning 4. ANS: 4 Page: 49 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-3, Developmental Theory of Jean Piaget Feedback 1

Birth to 2 years of age is thesensorimotor stage. In this stage, thechild uses senses to learn about self and develop a schemata (ways of learning to assimilate and accommodate).

2

Two to 7 or 8 years is thepreoperational stage. In this stage, thechild thinks in mental images, develops own languages, and displays egocentrism (sees only

Copyright © 2019 F. A. Davis Company

own point of view).

3

Eight to 12 years is theconcrete operational stage. In this stage thechild has ability for logical thought, moral judgment begins to develop, and numbers and spatial ability become more logical.

4

Twelve years to adulthood is theage for formal operations. In this stage theperson develops adult logic, plans for thefuture, and is able to think in concepts or abstracts.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-3, Developmental Theory of Jean Piaget 5. ANS: 2 Page: 52 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span: Karen Horney (1885-1952) Feedback 1

Horney focused on mother–child bonding for abnormal behavior, not parenting.

2

Horney believed abnormal behaviors were related to ineffective mother and child bonding. Karen Horney developed thepsychoanalytic social theory, which contends that a person’s childhood contributes to and influences an individual’s personality in later life.

3

Horney focused on mother–child bonding for abnormal behavior, rather than environmental stressors.

4

Horney focused on mother–child bonding for abnormal behavior, rather than genetic markers.

Copyright © 2019 F. A. Davis Company

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span: Karen Horney (1885-1952) 6. ANS: 1 Page: 47 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-2, Erikson’s Eight Stages of Development Feedback 1

Birth to 18 months is thestage called trust versus mistrust.

2

Three- to 6-year-old are in thestage called initiative versus guilt.

3

Twelve- to 18-year-olds are in thestage called identity versus role confusion.

4

Over 65 is thestage called integrity versus despair.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-2, Erikson’s Eight Stages of Development COMPLETION 7. ANS: Pavlov Page: 52 Rationale: Behavior modification is used to eliminate and decrease thefrequency of identified negative behaviors. Skinner and Pavlov were leaders in developing this theory.

Copyright © 2019 F. A. Davis Company

Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 4: Developmental Psychology Throughout theLife Span; Ivan Pavlov (1849–1936) and B. F. Skinner (1904–1990) PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Ivan Pavlov (1849–1936) and B. F. Skinner (1904–1990) 8. ANS: id Page: 45 Rationale: Sigmund Freud described thethree components of thepersonality as theid, theego, and thesuperego. All three parts are set in theunconscious. Id is thepart of thepersonality that is concerned with thegratification of self. theid wants to fulfill primal urges for food, sex, power, and entertainment.

Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Sigmund Freud (1856–1939) PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Sigmund Freud (1856– 1939) MULTIPLE RESPONSE 9. ANS: 1, 2, 3 Copyright © 2019 F. A. Davis Company

Page: 54 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Application Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908–1970)

Feedback 1.

Correct. Physiological needs are elements people need to survive, such as water.

2.

Correct. Physiological needs are elements people need to survive, such as oxygen.

3.

Correct. Physiological needs are elements people need to survive like elimination.

4.

Incorrect. When individuals feel comfortable that their physical needs are being met, they begin to feel a sense of safety that they can maintain their survival.

5.

Incorrect. Freedom from fear falls within thesafety and security need, a step up from physiological needs.

6.

Incorrect. Giving and receiving affection falls within love and belonging and is not a physiological need.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908– 1970) 10. ANS: 1, 2, 3, 5 Page: 54 Integrated Processes: Teaching/Learning Content Area: Growth and Development Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908–1970)

Feedback 1.

Correct. Self-actualization is thefifth and final rung on Maslow’s hierarchy and includes achievement.

2.

Correct. Self-actualization is thefifth and final rung on Maslow’s hierarchy and includes working to one’s potential.

3.

Correct. Self-actualization is thefifth and final rung on Maslow’s hierarchy and includes achieving success.

4.

Incorrect. Love belongs in thelove and belonging level, not self-actualization.

5.

Correct. Self-actualization is thefifth and final rung on Maslow’s hierarchy and includes self-fulfillment.

6.

Incorrect. Giving and receiving of affection falls within thelove and belonging level, not self-actualization.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908– 1970) 11. ANS: 1, 4, 5, 6 Page: 45 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Sigmund Freud (1856–1939)

Copyright © 2019 F. A. Davis Company

Feedback 1.

Correct. Freud believed, after observing behaviors of children, that thepersonality was developed as early as age 5 years and fully developed by age 12 years.

2.

Incorrect. Freud believed, after observing behaviors of children, that thepersonality was developed as early as age 5 years and fully developed by age 12 years.

3.

Incorrect. Freud said that thepersonality must develop in a certain way and at strictly defined ages.

4.

Correct. Freud said that thepersonality must develop in a certain way and at strictly defined ages and that failure to progress in this manner would certainly lead to dysfunction.

5.

Correct. One of Freud’s main tenets, or beliefs, is that behaviors resulting from ineffective personality development are unconscious.

6.

Correct. Freud believed that ineffective personality development was in some way related to therelationship of thechild to theparent and that it was related to what he called psychosexual development.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Sigmund Freud (1856– 1939) 12. ANS: 1, 3 Page: 57 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Application Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-7, Overall View of Human Development Copyright © 2019 F. A. Davis Company

Feedback 1.

Correct. An age-appropriate video game fosters thecognitive development that is a primary activity in 5-year-olds.

2.

Incorrect. Sports video is for theolder child. At 5 years old, play is important for self-expression and cognitive development.

3.

Correct. Finger paints would be appropriate for a 5-year-old because play is important for self-expression.

4.

Incorrect. A chess set is too advanced for a 5-year-old. the5-year-old needs toys that stimulate self-expression.

5.

Incorrect. A punching bag is for an older child. the5-year-old needs toys that stimulate self-expression.

6.

Incorrect. A Scrabble game set is too advanced for a 5-year-old. the5-year-old needs toys that stimulate self-expression.

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-7, Overall View of Human Development 13. ANS: 1, 2, 3 Page: 57 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Developmental Stages and Transitions Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-7, Overall View of Human Development Feedback

Copyright © 2019 F. A. Davis Company

1.

Correct. School age, 6- to 12-year-old, children learn to share.

2.

Correct. School-age, 6- to 12-year-old children form friendships with same-sex friends.

3.

Correct. School age, 6- to 12-year-old, children begin to show acceptance of moral issues by questions and discussions.

4.

Incorrect. Preschoolers, 3–6 years, socialize.

5.

Incorrect. Toddlers, 11/2–3 years, are self-centered.

6.

Incorrect. Toddlers, 11/2–3 years, are learning autonomy (independence).

PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Table 4-7, Overall View of Human Development ORDERED RESPONSE 14. ANS: A: 5 B: 4 C: 1 D: 3 E: 2 Page: 54 Rationale: Maslow’s Hierarchy of Needs starts at thelowest level, beginning with thelevel of survival. thelowest level necessary for survival is physiological needs, then safety and security, then love and belonging, then self-esteem, then ending with self-actualization as thehighest level.

Integrated Processes: Analysis Content Area: Growth and Development Cognitive Level: Knowledge Client Need: Health Promotion and maintenance: Developmental Stages and Transitions

Copyright © 2019 F. A. Davis Company

Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908–1970); Figure 4-9, Maslow’s Hierarchy of Needs PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Abraham Maslow (1908– 1970); Figure 4-9 Maslow’s Hierarchy of Needs 15. ANS: A: 2 B: 5 C: 1 D: 3 E: 4 Page: 64 Rationale: thefive stages of death and dying in order: denial, anger, bargaining, depression, and acceptance. According to Kübler-Ross, theresult of experiencing thefive stages of grief or dying is theability to die in peace and with dignity. These stages apply not only to dying people and those they leave behind but also to other major losses in life.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Grief Cognitive Level: Analysis Client Need: Psychosocial Integrity: Grief and Loss Chapter 4: Developmental Psychology Throughout theLife Span; Elisabeth Kübler-Ross (1926– 2004); Table 4-8, Five Stages of Grief/Death and Dying by Dr. Elisabeth Kübler-Ross PTS: 1 REF: Chapter 4: Developmental Psychology Throughout theLife Span; Elisabeth Kübler-Ross (1926–2004); Table 4-8, Five Stages of Grief/Death and Dying by Dr. Elisabeth Kübler-Ross Chapter 5. Sociocultural Influences on Mental Health Multiple Choice Copyright © 2019 F. A. Davis Company

Identify thechoice that best completes thestatement or answers thequestion. ____ 1. Which of thefollowing is appropriate with a patient who is homeless?

1. Treat patient according to his or her ability to pay.

2. The homeless patient is only treated in theemergency department and only admitted if he or she has a life-threatening condition.

3. Treat thehomeless patient thesame as any other patient.

4. Some parts of thePatient Bill of Rights do not apply to thehomeless.

____ 2. A student recently moved from theMiddle East and is attending a new school in theUnited States. thestudent’s peers refrain from having conversations with him discussing Christmas because they assume that he does not understand anything about theholiday. thestudent’s peers are most likely doing what to this new student?

1. Being hateful 2. Showing prejudice 3. Believing stereotypes 4. Being rude

____ 3. According to Diana Baumrind, there are three types of parenting. A parent who sets up therules and excludes thevoice of thechild is known as a: 1. A permissive parent.

2. An authoritarian parent.

3. An authoritative parent.

4. An administrative parent.

____ 4. According to Diana Baumrind, there are three types of parenting. Which type of parent provides a minimum amount of structure, and thechild does not learn any boundaries?

1. Permissive parent Copyright © 2019 F. A. Davis Company

2. Authoritarian parent 3. Authoritative parent 4. Administrative parent

____ 5. Janet, an African American female, fell at themall shopping and was transported to an urgent care center to be examined. thex-rays were negative for fracture, and Janet was not prescribed anything for her pain. At theurgent care center where Janet was treated, thehealth-care providers were aware that this type of injury can be painful. According to recent studies within health care, failure to offer Janet pain medication could be a form of: 1. Prejudice.

2. Ethnocentrism.

3. Stereotype.

4. Malpractice.

____ 6. Cultural competency is: 1. The responsibility of thepatient.

2. The nurse is competent in his or her own culture.

3. The nurse is able to adapt care to meet theneeds of patients from different backgrounds.

4. A written test required for all Americans.

Completion Complete each statement.

7. _________________is a shared way of life and thecombination of traditions and beliefs that make a group of people bond together.

8. Language, country of origin, and skin color are considered parts of one’s __________________.

Copyright © 2019 F. A. Davis Company

9. ________________ is judging a person or a situation before all thefacts are available.

10. A mother, a father, and biological children were once known as the___________ family.

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion. ____ 11. The following are classified as a nontraditional family (select all that apply): 1. Single-parent family 2. Blended family 3. Mother, father, and biological children 4. Gay family 5. Global family with adopted children of different races

____ 12. Identify ways a nurse can enhance cultural sensitivity (select all that apply): 1. Maintain an open mind.

2. Be aware of own prejudices that may influence care.

3. Communicate interest about thepatient’s beliefs and values.

4. Approach thepatient as an individual.

5. Assume all people from one cultural background hold thesame beliefs.

____ 13. Which questions should thenurse ask a patient when collecting data about culture (select all that apply)?

1. “Who in thefamily takes responsibility for health concerns and decisions?”

2. “Do you have any dietary considerations related to religion?”

3. “What is your primary language?”

4. “What type of insurance do you have?”

5. “What are your expectations of health care?”

Copyright © 2019 F. A. Davis Company

____ 14. Which information is true about abuse (select all that apply)?

1. Violence is a learned behavior.

2. Abuse is misuse of a person, substance, or situation.

3. If a person has a rationale for theabuse, it is not abuse.

4. A person gambling is displaying abusive behavior.

5. The abuser was probably abused at some point in his or her life.

True/False Indicate whether thestatement is true or false. ____ 15. Culture is thesame as ethnicity. True or False?

Copyright © 2019 F. A. Davis Company

Chapter 5. Sociocultural Influences on Mental Health Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 74 Integrated Processes: Caring Content Area: Cultural Diversity Cognitive Level: Application Client Need: Health Promotion and Maintenance: Lifestyle Choices Chapter 5: Sociocultural Influences on Mental Health; Homelessness Feedback 1

Patients who are homeless are treated because they are sick and are not provided treatment according to their ability to pay.

2

The homeless may be brought to a facility through theemergency department or by a law enforcement agency. Sometimes medication is given to stabilize thepatient, and he or she is returned to thecommunity; other times thepatient is admitted to a medical unit.

3

Patients who are homeless should be treated like any other patient.

4

Patients who are homeless maintain all patient rights.

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Homelessness

2. ANS: 3 Page: 70 Integrated Processes: Caring Content Area: Cultural Diversity Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity: Cultural Diversity Chapter 5: Sociocultural Influences on Mental Health; Culture Feedback 1

Although thestudents did make poor assumptions, their actions would likely not be considered hateful.

2

The students are not showing prejudice. Prejudice is judging a person or situation before all thefacts are known. Prejudice is a destructive behavior.

These students made poor assumptions.

3

The students are believing a stereotype. A stereotype is a fixed, often incorrect or incomplete, notion or conviction about a group of people or a situation. These students may have believed that someone from theMiddle East is not Christian and has no interest in Christmas.

4

The students are not being rude. They made poor assumptions.

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Culture

3. ANS: 2 Page: 78 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Health and Wellness Chapter 5: Sociocultural Influences on Mental Health; Parenting Feedback 1

The permissive parent provides little structure and few guidelines; thechild is not sure of his or her boundaries.

2

The authoritarian parent makes all of thedecisions; thechildren do not have a voice in this family.

Copyright © 2019 F. A. Davis Company

3

The authoritative parent is firm, has consistent rules and limits, and allows for discussion and occasional flexibility of those rules.

4

In Baumrind’s classic work on parenting, there is no parent called administrative.

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Parenting

4. ANS: 1 Page: 78 Integrated Processes: Teaching/Learning Content Area: Growth and Development Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Health and Wellness Chapter 5: Sociocultural Influences on Mental Health; Parenting Feedback 1

The permissive parent provides little structure and few guidelines; thechild is not sure of his or her boundaries.

2

The authoritarian parent makes all of thedecisions; thechildren do not have a voice in this family.

3

The authoritative parent is firm, has consistent rules and limits, and allows for discussion and occasional flexibility of those rules.

4

In Baumrind’s classic work on parenting, there is no parent called administrative.

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Parenting

5. ANS: 1 Page: 71 Integrated Processes: Caring Copyright © 2019 F. A. Davis Company

Content Area: Nursing Ethics Cognitive Level: Application Client Need: Psychosocial Integrity: Cultural Diversity Chapter 5: Sociocultural Influence on Mental Health; Ethnicity Feedback 1

This is a form of prejudice. Prejudice is judging a person or situation before all thefacts are known. Prejudice is a destructive behavior; it is hurtful. Previous health-care studies had shown that blacks often receive less care than whites.

2

This is not a form of ethnocentrism. Ethnocentrism is thebelief that one’s own ethnic or religious group deserves rights and benefits more than others. Recent health-care studies have shown that whites often receive more care than was necessary.

3

This is not a form of stereotyping. A stereotype is a fixed, often incorrect or incomplete, notion or conviction about a group of people or a situation. For example, one stereotype is that Muslims only marry other Muslims.

4

This is not a form of malpractice but of racial prejudice.

PTS: 1

REF: Chapter 5: Sociocultural Influence on Mental Health; Ethnicity

6. ANS: 3 Page: 69 Integrated Processes: Teaching/Learning Content Area: Culture Diversity Cognitive Level: Comprehension Client Needs: Psychosocial Integrity: Cultural Diversity Chapter 5: Sociocultural Influences on Mental Health: Culture Feedback 1

Cultural competency is theresponsibility of thenurse, not thepatient.

Copyright © 2019 F. A. Davis Company

2

Cultural competency focuses on thepatient’s culture, not thenurse’s culture.

3

Culturally diverse care and cultural competency means that thenurse, no matter his or her own cultural background, adapts care in a manner congruent with thepatient’s culture.

4

Cultural competency is not a written test required for all Americans but a focus on thepatient in thefollowing areas: communication, space, social organization, time, environmental control, and biological variation.

PTS: 1

REF: Chapter 5: Sociocultural Influences in Mental Health: Culture

COMPLETION 7. ANS: Culture Page: 68 Rationale: Culture is not based on skin color, religion, or a person’s genetic makeup; it is based on thesurrounding environment a person is raised in or interacts with over a period of time.

Integrated Processes: Teaching/Learning Content Area: Cultural Diversity Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Cultural Diversity Chapter 5: Sociocultural Influences on Mental Health; Culture PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Culture

8. ANS: ethnicity Page: 71 Rationale: Ethnicity is made up of one’s language, country of origin, and skin color.

Integrated Processes: Teaching/Learning Copyright © 2019 F. A. Davis Company

Content Area: Cultural Diversity Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Cultural Awareness Chapter 5: Sociocultural Influences on Mental Health; Ethnicity PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Ethnicity

9. ANS: Prejudice Page: 71 Rationale: Prejudice is judging a person or situation before all thefacts are known. Prejudice is a destructive behavior. It is hurtful, and it shuts thedoor on theenrichment of thesociety.

Integrated Processes: Teaching/Learning Content Area: Cultural Diversity Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Cultural Awareness Chapter 5: Sociocultural Influences on Mental Health; Ethnicity PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Ethnicity

10. ANS: traditional Page: 73 Rationale: thedefinition of the“traditional family” (father-mother-children) has changed.

Nontraditional lifestyles have expanded thedefinition of family.

Integrated Processes: Caring Content Area: Adolescent, Child, Adult, Aging Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Lifestyle Choices Chapter 5: Sociocultural Influences on Mental Health; theChanging Family

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; theChanging

Family MULTIPLE RESPONSE 11. ANS: 1, 2, 4, 5 Page: 72 Integrated Processes: Caring Content Area: Cultural Diversity Cognitive Level: Application Client Need: Health Promotion and Maintenance: Lifestyle Choices Chapter 5: Sociocultural Influences on Mental Health; theChanging Family

Feedback 1.

Correct. A nontraditional family is a single-parent family.

2.

Correct. A nontraditional family is a blended family, in which each spouse has his or her own children, whom they bring into a new family.

3.

Incorrect. thetraditional family is a mother, father, and biological children.

4.

Correct. A nontraditional family is a gay family, in which a single-parent or both parents are gay.

5.

Correct. A nontraditional family is a global family, in which theadopted children are of different races.

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; theChanging

Family 12. ANS: 1, 2, 3, 4 Page: 72 Integrated Processes: Caring Copyright © 2019 F. A. Davis Company

Content Area: Cultural Diversity Cognitive Level: Application Client Need: Psychosocial Integrity: Cultural Awareness Chapter 5: Sociocultural Influences on Mental Health; Box 5-2 Enhancing Cultural Sensitivity Feedback 1.

Correct. A nurse should maintain an open mind to enhance cultural sensitivity.

2.

Correct. A nurse should be aware of own prejudices that may influence care to enhance cultural sensitivity.

3.

Correct. thenurse should communicate interest about thepatient’s beliefs and values to enhance cultural sensitivity.

4.

Correct. thenurse should approach thepatient as an individual to enhance cultural sensitivity.

5.

Incorrect. thenurse should avoid assuming that all people from one cultural background hold thesame beliefs.

PTS: 1 REF: Chapter 5: Sociocultural Influences on Mental Health; Box 5-2 Enhancing Cultural Sensitivity 13. ANS: 1, 2, 3, 5 Page: 70 Integrated Processes: Nursing Process: Data Collection Content Area: Cultural Diversity Cognitive Level: Application Client Need: Psychosocial Integrity: Cultural Awareness Chapter 5: Sociocultural Influences on Mental Health; Box 5-1 Cultural Assessment-Questions to Ask Feedback

Copyright © 2019 F. A. Davis Company

1.

Correct. Who makes health decisions is a part of collecting data for culture.

2.

Correct. Religious and dietary needs are a part of collecting data for culture.

3.

Correct. Language is a part of collecting data for culture.

4.

Incorrect. Insurance is not a part of collecting data for culture.

5.

Correct. Expectations of health care are a part of collecting data for culture.

PTS: 1 REF: Chapter 5: Sociocultural Influences on Mental Health; Box 5-1 Cultural AssessmentQuestions to Ask 14. ANS: 1, 2, 4, 5 Page: 77 Integrated Processes: Teaching and Learning Content Area: Violence Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Abuse or Neglect Chapter 5: Sociocultural Influences on Mental Health; Abuse Feedback 1.

Correct. Violence is a learned behavior; this is true.

2.

Correct. Abuse is misuse of a person, substance, or situation; this is true.

3.

Incorrect. Sometimes people say that they cannot be abusing because they have a rationale for their behavior. This is not true.

4.

Correct. Anyone who mistreats another person or who misuses or overuses a substance or a situation (such as gambling or power) is displaying abusive behavior.

5.

Correct. It is well documented that in themajority of physical abuse situations, theabuser was abused at some point.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 5: Sociocultural Influences on Mental Health; Abuse

TRUE/FALSE 15. ANS: F Page: 71 Rationale: Culture is a shared way of life, thecombination of traditions and beliefs that make a group of people bond together. It is unrelated to country of origin, race, or skin color (ethnicity).

Integrated Processes: Teaching/Learning Content Area: Cultural Diversity Cognitive Level: Comprehension Client Needs: Psychosocial Integrity: Cultural Diversity Chapter 5 Sociocultural Influences on Mental Health; Culture and Ethnicity PTS: 1

REF: Chapter 5 Sociocultural Influences on Mental Health; Culture and

Ethnicity Chapter 6. Nursing Process in Mental Health Multiple Choice Identify thechoice that best completes thestatement or answers thequestion. ____ 1. After theadmission of thepatient, Nurse Toni will get specific information from thepatient. This method of getting information is known as the: 1. Termination phase.

2. Working phase.

3. Patient interview.

4. Working phase.

Copyright © 2019 F. A. Davis Company

____ 2. A patient is admitted to theMental Illness and Chemical Abuse (MICA) unit for detoxification from alcohol. During theinterview, thepatient states, “My wife would rather see me dead.” To which part of thenursing process does this belong?

1. Planning 2. Implementation 3. Evaluation 4. Assessment

____ 3. You find a patient on thefloor at shift change. She is awake and alert. She is confused now and was not confused before being found on thefloor. What is your first step in thenursing process in this situation?

1. Leave thepatient to get help.

2. Gather more information by making observations about thepatient.

3. Call thepatient’s health-care provider from your cell phone.

4. Help thepatient get up and then document your findings in thechart.

____ 4. In theMental Health Status Examination, which of thefollowing focuses on what theperson is thinking?

1. Speech and theability to communicate 2. Judgment 3. Memory 4. Thinking/Content of thought

____ 5. The component of theMental Health Status Examination that focuses on theway a person experiences reality is assessing theperson’s: 1. Thinking/content of thought.

2. Perception.

3. Judgment.

Copyright © 2019 F. A. Davis Company

4. Mood and affect.

____ 6. In theplanning phase of thenursing process, establishing short- and long-term goals is important.

Planning should: 1. Include positive and negative outcomes.

2. Be realistic and measurable.

3. Be formal and informal.

4. Focus on thebest possible options even if unrealistic.

____ 7. Which is an accurate planning goal?

1. The patient will lose 20 pounds when he agrees to follow theprescribed diet.

2. The patient will lose 20 pounds in 20 days.

3. The patient will lose 1 to 2 pounds a week until thegoal of 20 pounds is reached.

4. The patient will lose 4 to 5 pounds a week by working with a nutritionist.

Completion Complete each statement.

8. The final step in thenursing process is ____________________.

9. The component of thenursing process that follows assessment, precedes thenursing intervention, and is prepared by theregistered nurse is the____________ ___________.

10. When theLPN/LVN sets a specific time to sit with thepatient to go over diabetes education, this is considered ________________ teaching.

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion.

Copyright © 2019 F. A. Davis Company

____ 11. The following are guidelines for thenurse–patient interview (select all that apply): 1. Advise thepatient.

2. Be aggressive.

3. Be sensitive.

4. Use empathy.

5. Use open-ended questions.

____ 12. The following are components of theprinciples of teaching (select all that apply): 1. Know thepatient.

2. Lecture.

3. Demonstration.

4. Be flexible.

5. Plan to allow a few minutes after theclass for questions.

6. Have a teaching plan.

____ 13. The Mental Health Status Examination is an assessment of thepatient’s mental status and current mental functioning. thefollowing are components of theMental Health Status Examination (select all that apply): 1. Appearance and behavior 2. Level of awareness and orientation 3. Glasgow Scale 4. Judgment 5. Mood and effect

____ 14. The role of theLPN/LVN to thenursing process is (select all that apply): 1. Assisting theregistered nurse with theplan of care.

2. Collecting data.

Copyright © 2019 F. A. Davis Company

3. Completing theinitial assessment.

4. Developing principles of teaching.

5. Planning care and prioritizing goals.

Other 15. The nursing process is a systematic method of caring for a patient (place in theorder they will occur beginning with thefirst step starting with 1 and ending with 5): ____A. Evaluation ____B. Planning ____C. Assessment ____D. Nursing diagnosis ____E. Implementation

Copyright © 2019 F. A. Davis Company

Chapter 6. Nursing Process in Mental Health Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 82 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 6: Nursing Process in Mental Health; 1. Intake/Admission Interview Feedback 1

The termination phase is when nurses prepare both themselves and their patients for theending of therelationship.

2

Hildegard Peplau stressed thephases of a working relationship between thenurse and patient. Getting specific information from thepatient after admission is not thetime for theworking phase.

3

For thepurposes of this text, theword interview pertains to any nurse–patient interaction that requires a nurse to obtain specific information from a patient. thepatient interview is usually theprimary method of data gathering.

4

Hildegard Peplau stressed thephases of a working relationship between thenurse and patient. thenurse initiates theprocess.

PTS: 1

REF: Chapter 6: Nursing Process in Mental Health; 1. Intake/Admission

Interview 2. ANS: 4 Page: 82 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Assessment (Data Collection) Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Synthesis Client Need: Safe and Effective Care Environment: Coordinated Care: Continuity of Care Chapter 6: Nursing Process in Mental Health; Step 1: Assessing thePatient’s Mental Health Feedback 1

Planning involves thesetting and prioritizing of short-term and long-term goals, not gathering data.

2

Implementation is carrying out specific steps that will help thepatient reach goals, not gathering data.

3

Observations and documentation about theeffect of theinterventions on thepatient and progress in attaining thegoal are of great importance in theevaluation stage.

4

This information is data. Data collection is made during every contact a nurse has with a patient and occurs in theassessment phase. It is essential to thewellbeing of thepatient and in assisting themedical team in making thebest choices concerning that person.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 1: Assessing thePatient’s Mental Health 3. ANS: 2 Page: 82 Integrated Processes: Nursing Process: Implementation Content Area: Management of Care Cognitive Level: Application Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 6: Nursing Process in Mental Health; Step 1: Assessing thePatient’s Mental Health Feedback

Copyright © 2019 F. A. Davis Company

1

This is not thefirst step to take. Leaving thepatient to get help is an unsafe and inappropriate response.

2

Being thefirst person on thescene, you need to find out as much information as possible to report to thecharge nurse as part of assessment/data collection, thefirst step in thenursing process.

3

This is not thefirst step to take. You must gather data to correctly inform themedical doctor of thesituation, and thehealth-care provider should not be notified on your cell phone.

4

Although you will help thepatient get up and document findings, this is not thefirst step in thenursing process.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 1: Assessing thePatient’s Mental Health 4. ANS: 4 Page: 84 Integrated Processes: Communication/Documentation Content Area: Mental Health: Therapeutic Nursing Process: Management of Care Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Data-Collection Techniques Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination Feedback 1

Speech and ability to communicate assesses aspects of thepatient’s use of verbal and nonverbal communication. Alterations can include word repetition or neologisms, which may indicate physical or psychological illness.

2

Abstract thinking/Judgment assesses thepatient’s ability to make appropriate decisions about his or her situation or to understand concepts. Alterations can include inability to interpret sayings in an acceptable manner or answers

Copyright © 2019 F. A. Davis Company

questions very literally.

3

Memory is theassessment of themind’s ability to recall previously known recent and remote (long-term) information. Alterations can include being unable to accurately perform recent or remote recall exercises.

4

Thinking/Content of thought is an assessment of what thepatient is thinking and theprocess thepatient uses in thinking. Alterations can include flight of ideas or obsessions.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination 5. ANS: 2 Page: 86 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Data-Collection Techniques Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination Feedback 1

Thinking/Content of thought is an assessment of what thepatient is thinking and theprocess thepatient uses in thinking. Alterations can include flight of ideas or obsessions.

2

Perception assesses theway a person experiences reality. This assessment also is based on thepatient’s statement of his or her environment and behaviors associated with those statements. Alterations can include hallucinations or illusions.

3

Abstract thinking/Judgment assesses thepatient’s ability to make appropriate decisions about his or her situation or to understand concepts. Alterations can

Copyright © 2019 F. A. Davis Company

include being unable to interpret sayings in an acceptable manner or answering questions very literally.

4

Mood and affect uses subjective and objective assessment of thepatient’s stated feelings and emotions. Alterations can include when mood and affect do not match.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination 6. ANS: 2 Page: 88 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Analysis Client Need: Safe and Effective Care Environment: Coordinated Care: Establishing Priorities Chapter 6: Nursing Process in Mental Health; Step 3: Planning (Short- and Long-Term Goals).

Feedback 1

Goals include positive outcomes, not negative. theaim of selecting goals that will improve mental health status is to keep themind–body connection intact. It will be of great help to thepatient if thenurse is able to set goals with thepatient to maintain thebest outlook and strongest possible effective coping skills.

2

Goals should be realistic and measurable with a target date for them to be completed so that thepatient is aware that by specific dates certain outcomes are expected.

3

Teaching can be formal or informal; it does not relate to goals.

4

Although goals should focus on thebest possible options, thegoal must be realistic.

PTS: 1 Copyright © 2019 F. A. Davis Company

REF: Chapter 6: Nursing Process in Mental Health; Step 3: Planning (Short- and Long-Term Goals).

7. ANS: 3 Page: 88 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Application Client Need: Safe and Effective Care Environment: Coordinated Care: Establishing Priorities Chapter 6: Nursing Process in Mental Health; Step 3: Planning (Short- and Long-Term Goals) Feedback 1

This goal does not meet thecriteria. There is no target date. thepatient should already have agreed since goal setting is a mutual process between thenurse and thepatient.

2

This goal does not meet thecriteria. thegoal is unrealistic in that 1 pound a day is supposed to occur.

3

This goal meets thecriteria. Goals should be realistic and measurable with a target date for them to be completed so that thepatient is aware that by specific dates, certain outcomes are expected.

4

This goal does not meet thecriteria. thegoal does not have a target date.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 3: Planning (Short- and Long-Term Goals) COMPLETION 8. ANS: evaluation Page: 93

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Rationale: In thefinal step of thenursing process, evaluation, theLPN/LVN plays an assisting role. theLPN/LVN’s observations and documentation about theeffect of theinterventions on thepatient and progress in attaining thegoal are of great importance.

Integrated Processes: Nursing Process: Evaluation Content Area: Management of Care Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Coordinated Care: Continuity of Care Chapter 6: Nursing Process in Mental Health; Step 5: Evaluating Interventions PTS: 1

REF: Chapter 6: Nursing Process in Mental Health; Step 5: Evaluating

Interventions 9. ANS: nursing diagnosis Page: 88 Rationale: It is theRN’s responsibility to assimilate thedata that has been collected and choose one or more potential nursing diagnoses for thepatient. theLPN/LVN needs to understand thefunction of thenursing diagnosis. Nursing diagnoses are a universal language on which theinterventions are based.

Integrated Processes: Nursing Process: Nursing Diagnosis Content Area: Mental Health: Nursing Process in Mental Health Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 6: Nursing Process in Mental Health; Step 2: Nursing Diagnosis: Defining Patient Problems PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 2: Nursing Diagnosis: Defining Patient Problems 10. ANS: formal Copyright © 2019 F. A. Davis Company

Page: 90 Rationale: Formal teaching is any situation in which a class or a group is scheduled or a specific objective must be met such as management of blood sugars for diabetes education. Informal teaching, or adjunctive teaching, happens anytime, anywhere, whenever thepatient needs information.

Integrated Processes: Teaching/Learning Content Area: Management of Care Cognitive Level: Application Client Need: Health Promotion and Maintenance: Principles of Teaching/Learning Chapter 6: Nursing Process in Mental Health; Step 4: Implementations/Interventions; Patient Teaching PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 4: Implementations/Interventions; Patient Teaching MULTIPLE RESPONSE 11. ANS: 3, 4, 5 Page: 88 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Application Client Need: Health Promotion and Maintenance: Data-Collection Techniques Chapter 6: Nursing Process in Mental Health; Guidelines for Nurse–Patient Helping Interview

Feedback 1.

Incorrect. thenurse–patient interview is to gather data, not advise thepatient.

2

Incorrect. thenurse should be assertive, not aggressive.

3.

Correct. thenurse should be sensitive. Sometimes thequestions are difficult or

Copyright © 2019 F. A. Davis Company

embarrassing for thepatient to answer. thenurse should assure thepatient that he or she understands thepatient’s feelings.

4.

Correct. thenurse should use empathy. thenurse should let thepatient know that he or she is interested in what is being said and that thenurse is there to be helpful. Acknowledge thepatient’s feelings but do not judge thepatient.

5.

Correct. thenurse should use open-ended questions. Personalize thequestions as much as possible. Use this time to discuss and clarify as much information as you can to avoid having to repeat parts of theinterview later.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Guidelines for Nurse–Patient Helping Interview 12. ANS: 1, 4, 5, 6 Page: 91 Integrated Processes: Teaching/Learning Content Area: Management of Care Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Principles of Teaching/Learning Chapter 6: Nursing Process in Mental Health; Principles of Teaching

Feedback 1.

Correct. thenurse should know thepatient(s) when teaching. What are their abilities? What is their prior level of knowledge?

2.

Incorrect. Lecture is a teaching method, not a principle of teaching.

3.

Incorrect. Demonstration is a teaching method, not a principle of teaching.

4.

Correct. thenurse should be flexible when teaching and be able to teach in several different styles for thedifferent types of learners.

5.

Correct. thenurse should plan for questions after class. There are always people

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who are not comfortable asking questions in a group, so allow some time to clarify their concerns after class or set up a time to help them later in theday.

6.

Correct. The nurse should have a teaching plan. A good teaching plan will improve a nurse’s confidence and delivery of the material.

PTS: 1

REF: Chapter 6: Nursing Process in Mental Health; Principles of Teaching

13. ANS: 1, 2, 4, 5 Page: 83 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance: Health Screening Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination Feedback 1.

Correct. Appearance and behavior are components of the mental health status examination. Alterations can include apathy about appearance, while alterations in behavior include being hostile or uncooperative.

2.

Correct. Level of awareness and orientation are components of the mental health status examination. Alterations for level of awareness include difficult to arouse, while alterations in orientation include inability to correctly answer questions pertaining to the patient.

3.

Incorrect. The Glasgow Scale is not a component of the mental health status examination. This is an assessment tool to use when the patient has neurological damage to determine severity of a coma.

4.

Correct. Judgment is a component of the mental health status examination.

Alterations in judgment include inability to problem-solve questions appropriately.

Copyright © 2019 F. A. Davis Company

5.

Correct. Mood and affect are components of the mental health status examination. Alterations occur when mood and affect do not match (e.g., facial expression does not change when stating opposite feelings).

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Table 6-2, Mental Health Status Examination 14. ANS: 1, 2 Page: 82, 88– 89 Integrated Processes: Nursing Process Content Area: Nursing Licensure Cognitive Level: Comprehension Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 6: Nursing Process in Mental Health; Step 1, Step 2, Step 3, and Step 4 of the Nursing Process Feedback 1.

Correct. In collaborative nursing practice, LPN/LVNs can make suggestions and offer Feedbacks to the RN that may be incorporated into the patient’s plan of care.

2.

Correct. The LPN/LVN collects data. Data collection is made during every contact a nurse has with a patient. It is essential to the well-being of the patient and in assisting the medical team in making the best choices concerning that person.

3.

Incorrect. The RN is responsible for the initial assessment when the patient is admitted or transferred in a facility. The LPN/LVN is not responsible for the initial assessment, although the LPN/LVN does learn the importance of subjective and objective assessment data.

4.

Incorrect. LPN/LVNs do not develop principles of teaching but can determine the teaching method.

Copyright © 2019 F. A. Davis Company

5.

Incorrect. Planning care and prioritizing goals is the responsibility of the RN, not the LPN/LVN. The LPN/LVN role is again as a partner in care planning.

The ANA believes that the RN has responsibility for the planning step of the nursing process.

PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Step 1, Step 2, Step 3, and Step 4 of the Nursing Process ORDERED RESPONSE 15. ANS: A: 5 B: 3 C: 1 D: 2 E: 4 Page: 82 Rationale: The order of the nursing process is assessment, nursing diagnosis, planning, implementation, and evaluation. The nursing process is a systematic approach in taking care of a patient.

Integrated Processes: Nursing Process Content Area: Mental Health: Therapeutic Nursing Process Cognitive Level: Application Client Need: Safe and Effective Care Environment: Coordinated Care Chapter 6: Nursing Process in Mental Health; Table 6-,1 The Nursing Process; Figure 6-1, Steps in the Nursing Process PTS: 1 REF: Chapter 6: Nursing Process in Mental Health; Table 6-1 The Nursing Process; Figure 6-1 Copyright © 2019 F. A. Davis Company

Steps in the Nursing Process Chapter 7. Coping and Defense Mechanisms Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Your patient is sternly criticized by her doctor for not complying with the medication regimen. The patient walks out of the office and yells at the parking attendant. This may be an example of which defense mechanism?

1. Projection 2. Sublimation 3. Reaction formation 4. Displacement

____ 2. Which of the following best describes what defense mechanisms are?

1. Abnormal coping mechanisms 2. Genetically “wired” responses 3. Protective devices that reduce anxiety 4. Conscious acts or behaviors

____ 3. A new patient with schizophrenia is admitted to the psychiatric unit. He is standing at the locked exit door and yelling, “Help me, I don’t belong here.” This behavior is most likely an example of what defense mechanism?

1. Denial 2. Regression 3. Enabling 4. Projection

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____ 4. Nurse Anne recognizes that John is always blaming others for his shortcomings. Finger pointing is usually related to the defense mechanism of: 1. Scapegoating.

2. Identification.

3. Restitution.

4. Avoidance.

____ 5. Joy has just experienced her fifth spontaneous abortion. She is unable to understand why this is happening to her. Joy voices her anger toward her physician and the nurses by accusing them of incompetence. Assessing the situation, the nurse recognizes that the patient may be using the coping mechanism of: 1. Conversion reaction.

2. Displacement.

3. Denial.

4. Regression.

____ 6. Marion, a 25-year-old patient who lives with her parents, explains to the nurse at the community clinic, “I really don’t need to talk to anyone, even my parents.” The patient expresses that she is too busy and does not have the time to sit and talk. The nurse recognizes that the patient is most likely using the defense mechanism known as: 1. Conversion reaction.

2. Avoidance.

3. Isolation.

4. Denial.

____ 7. Audrey, a mental health nurse, has noticed that every day before going to work, she starts off with headaches, loose stools, and episodes of feeling light-headed and other disorders. These symptoms may be an expression of emotional disturbances. Audrey is aware she could be experiencing: Copyright © 2019 F. A. Davis Company

1. Isolation.

2. Repression.

3. Dissociation.

4. Conversion.

____ 8. Lila’s three-year-old daughter is an only child who recently started day care. Lila toilet trained her daughter 6 months ago; however, her daughter has started wetting herself and crawling after 1 week in the day care. Her mother has become quite concerned. The school nurse explained to her that her daughter probably is experiencing: 1. Regression.

2. Depression.

3. Manipulation.

4. Compensation.

____ 9. An overweight male college student is unable to participate in competitive sports. Although he can’t be a sports hero, the student becomes the life of the party when socializing. This student also uses his student loan to purchase a new sports car. The student is displaying: 1. Compensation.

2. Reaction formation.

3. Transference.

4. Identification.

Completion Complete each statement.

10. __________________is an unconscious “burying” or “forgetting” mechanism.

11. Using a logical-sounding excuse is known as ___________________________.

Copyright © 2019 F. A. Davis Company

12. “I can quit smoking any time I want to.” The person is in ___________________.

13. _________________ is the way a person adapts to a stressor psychologically, physically, and behaviorally.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 14. Defense mechanisms are methods used for reducing anxiety. Defense mechanisms unconsciously assist a person in handling stressful events in an effective manner. People have a group of defense mechanisms learned from childhood. The following are defense mechanisms (select all that apply): 1. Compensation 2. Rationalization 3. Depression 4. Regression 5. Denial

____ 15. Which of the following are defense mechanisms that people typically use in times of stress (select all that apply): 1. Denial 2. Bargaining 3. Compensation 4. Rationalization 5. Acceptance

Copyright © 2019 F. A. Davis Company

Chapter 7. Coping and Defense Mechanisms Answer Section MULTIPLE CHOICE 1. ANS: 4 Page: 99 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Feedback 1

Projection is attributing feelings or impulses unacceptable to oneself to others.

2

Sublimation diverts unacceptable traits or characteristics into acceptable traits or characteristics.

3

Reaction formation is similar to compensation, except the person usually develops the opposite trait.

4

Displacement is transferring anger and hostility to another person or object that is perceived to be less powerful.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 2. ANS: 3 Page: 98 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Coping Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 7: Coping and Defense Mechanisms; Defense Mechanisms Feedback 1

Although defense mechanisms can be maladaptive, they are not considered abnormal.

2

People are not born with defense mechanisms; they are learned.

3

Defense mechanisms are learned responses to anxiety that help us cope.

4

Although defense mechanisms appear to be very purposeful, they exist, for the most part, on the unconscious level. People tend to use them (unconsciously) over and over.

PTS: 1

REF: Chapter 7: Coping and Defense Mechanisms; Defense Mechanisms

3. ANS: 1 Page: 99 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Feedback 1

This patient is struggling to accept a painful reality. Denial serves as a way to avoid this reality.

2

Regression is emotionally returning to an earlier time in life when there was far less stress.

3

Enabling is not a defense mechanism.

4

Projection is attributing feelings or impulses unacceptable to oneself to others.

PTS: 1 Copyright © 2019 F. A. Davis Company

REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 4. ANS: 1 Page: 101 Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanism Feedback 1

Scapegoating is blaming others.

2

Identification is “taking on” someone else’s traits.

3

Restitution is undoing, making amends for a behavior one thinks is unacceptable.

4

Avoidance is unconsciously staying away from events or situations that might open feelings of aggression or anxiety.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms, Table 7-1; Commonly Used Defense Mechanism 5. ANS: 2 Page: 100 Integrated Processes: Caring Content Area: Mental Health: Defense Mechanism Cognitive Level: Analysis Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanism; Table 7-1, Commonly Used Defense Mechanism Copyright © 2019 F. A. Davis Company

Feedback 1

Conversion reaction is channeling anxiety into physical symptoms.

2

Displacement is transferring anger and hostility to another person or object that is perceived less powerful.

3

Denial is the unconscious refusal to see reality.

4

Regression is emotionally returning to an earlier time in life when there was far less stress.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanism; Table 7-1 Commonly Used Defense Mechanism 6. ANS: 2 Page: 101 Integrated Processes: Teaching/Learning Content Area: Mental Health: Defense Mechanisms Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Feedback 1

Conversion reaction channels anxiety into physical symptoms.

2

The patient is using avoidance by avoiding situations that may open up feelings of aggression or anxiety.

3

Isolation is separating the emotion from the original feeling.

4

Denial is the unconscious refusal to see reality.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Copyright © 2019 F. A. Davis Company

Mechanisms 7. ANS: 4 Page: 101 Integrated Processes: Caring Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Feedback 1

Isolation is separating emotion from the original feeling.

2

Repression is an unconscious burying or “forgetting” mechanism.

3

Dissociation causes painful events or situations to be separated or dissociated from the conscious mind.

4

The nurse is using conversion. Anxiety about going to work can be channeled into physical symptoms; once the anxiety of work is reduced, the physical symptoms disappear.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7- 1, Commonly Used Defense Mechanisms 8. ANS: 1 Page: 100 Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Copyright © 2019 F. A. Davis Company

Feedback 1

The child is emotionally returning to an early time in her life when there was far less stress. This is known as regression.

2

Although depression may occur, this is not a defense mechanism.

3

Manipulation is not a defense mechanism.

4

Compensation is making up for something a person perceives as an inadequacy by developing some other desirable trait.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 9. ANS: 1 Page: 99 Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanism Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanism Feedback 1

The student is using compensation. Compensation is making up for something a person perceives as an inadequacy by developing some other desirable trait.

2

Reaction formation is similar to compensation, except the person usually develops the opposite trait.

3

Transference can occur in a therapeutic relationship.

4

Identification is the “taking on” of someone else’s traits.

Copyright © 2019 F. A. Davis Company

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanism COMPLETION 10. ANS: Repression Page: 100 Rationale: Repression is the unconscious exclusion of painful impulses, desires, or fears from the conscious mind; a step deeper than “denial.”

Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 11. ANS: rationalization Page: 99 Rationale: Rationalization substitutes acceptable reasons for the true reasons for personal behavior because admitting true reasons is too threatening.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Copyright © 2019 F. A. Davis Company

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 12. ANS: denial Page: 99 Rationale: Denial is usually the first defense learned and used. It is an unconscious refusal to see reality.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms 13. ANS: Coping Page: 96 Rationale: Coping is the ability to deal consciously with problems and stress.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Coping PTS: 1

REF: Chapter 7: Coping and Defense Mechanisms; Coping

Copyright © 2019 F. A. Davis Company

MULTIPLE RESPONSE 14. ANS: 1, 2, 4, 5 Page: 99–100 Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Analysis Client Need: Psychosocial Integrity: Coping Mechanism Chapter 7: Coping and Defense Mechanisms; Defense Mechanism; Commonly Used Defense Mechanisms

Feedback 1.

Correct. Compensation, a defense mechanism, is making up for something a person perceives as an inadequacy by developing some other desirable trait.

2.

Correct. Rationalization, a defense mechanism, substitutes acceptable reasons for the true reasons for personal behavior because admitting true reasons is too threatening.

3.

Incorrect. Depression is not a defense mechanism.

4.

Correct. Regression, a defense mechanism, allows a person to return to an earlier time in life when there was far less stress.

5.

Correct. Denial, a defense mechanism, is unconscious refusal to see reality.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Defense Mechanism; Commonly Used Defense Mechanisms 15. ANS: 1, 3, 4 Page: 99 Copyright © 2019 F. A. Davis Company

Integrated Processes: Teaching/Learning Content Area: Mental Health: Coping Cognitive Level: Analysis Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Feedback 1.

Correct. Denial, a defense mechanism, is unconscious refusal to see reality.

2.

Incorrect. Bargaining is not a defense mechanism; this is a stage in dying and grieving according to Kübler-Ross.

3.

Correct. Compensation, a defense mechanism, is making up for something a person perceives as an inadequacy by developing some other desirable trait.

4.

Correct. Rationalization, a defense mechanism, substitutes acceptable reasons for the true reasons for personal behavior because admitting true reasons is too threatening.

5.

Incorrect. Acceptance is not a defense mechanism; this is a stage in dying and grieving according to Kübler-Ross.

PTS: 1 REF: Chapter 7: Coping and Defense Mechanisms; Table 7-1, Commonly Used Defense Mechanisms Chapter 8. Mental Health Treatments Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Pete has recently been admitted to the hospital and is being treated for bipolar disorder. When you go to check in on him, he tells you that he is feeling very weak and has been vomiting. He is also running a fever and has severe diarrhea. You suspect that Pete’s problem is caused by: 1. Anxiety over his new surroundings after being admitted to the hospital for Copyright © 2019 F. A. Davis Company

treatment.

2. Side effects of the lithium therapy he is receiving.

3. A hospital-acquired viral infection.

4. Food poisoning.

____ 2. Lynn, the LPN/LVN, is providing care for a patient diagnosed with depression. The patient is not responding to any of the medications ordered. The nurse foresees this patient may be a candidate for: 1. Neuroleptic medication.

2. Short-term seclusion.

3. Psychosurgery.

4. Electroconvulsive therapy.

____ 3. When teaching Mary, who has depression, about foods to avoid while taking phenelzine (Nardil), which of the following would Audrey LPN include?

1. Peanut butter 2. Fresh fish 3. Salami 4. Soup

____ 4. When developing a care plan for Ms. Smith, who was diagnosed with schizophrenia and is receiving haloperidol, which of the following medications would Nurse Janet expect to administer if the patient developed extrapyramidal side effects (EPS)?

1. Olanzapine (Zyprexa) 2. Paroxetine (Paxil) 3. Benztropine mesylate (Cogentin) 4. Lorazepam (Ativan)

Copyright © 2019 F. A. Davis Company

____ 5. Andrea, the charge nurse, spoke to the director of nursing about one of the staff nurses having a crisis. The nurse suggested a crisis intervention group to the staff nurse. Crisis intervention is successful because: 1. The crisis intervention worker is a psychologist and understands the presenting behavior patterns.

2. It supplies an A-B-C format to change the patient’s way of thinking.

3. The patient is encouraged to identify triggers to change negative behaviors.

4. The patient is assisted to develop skills and return to the precrisis phase.

____ 6. A patient being medicated with haloperidol for more than 4 weeks has started to display symptoms of involuntary movements of the mouth that resemble chewing. Of the following extrapyramidal adverse reactions, the patient is showing signs of: 1. Dystonia.

2. Akathisia.

3. Drug-induced parkinsonism.

4. Tardive dyskinesia.

____ 7. A patient comes to the outpatient mental health clinic 2 days after being discharged from the hospital. The patient was given a 1-week supply of clozapine (Clozaril). The nurse reviews information about clozapine with the patient. Which patient statement indicates an accurate understanding of the nurse’s teaching about this medication?

1. “I don’t need to see my doctor for a new prescription when this runs out.”

2. “I need to keep my appointment this week for a blood test.”

3. “I can have a martini with this medication.”

4. “I don’t need to come into the clinic for a few months if I don’t have side effects.”

____ 8. When observing a patient receiving tricyclic antidepressant therapy, ________________would bring attention to the nurse that the patient was undergoing anticholinergic side effects.

Copyright © 2019 F. A. Davis Company

1. urinary retention 2. respiratory depression 3. delirium 4. cardiac arrhythmias

Completion Complete each statement.

9. A therapeutic environment in mental health terminology is called a ________________.

10. The form of therapy that focuses on the cause of the problem, originated from Sigmund Freud, is _____________________.

11. A patient consents to be hospitalized for psychiatric treatment. This is a(n) ____________________ admission.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 12. Which of the following should be included in patient teaching about antidepressants (select all that apply)?

1. Medications take 1 week to become effective.

2. Encourage patients to continue taking the medication.

3. Not all antidepressant medications have to be tapered gradually.

4. Patients do not have to be monitored for suicidal ideations.

5. If it is an MAOI antidepressant, the patient should avoid foods containing the amino acid tyramine.

____ 13. The following medications are used for treatment in mental health disorders (select all that apply): Copyright © 2019 F. A. Davis Company

1. Antipsychotics 2. Antibiotics 3. Antifungals 4. Stimulants 5. Mood stabilizers

____ 14. Which of the following items should be included when providing patient teaching about monoamine oxidase inhibitor (MAOI) antidepressants (select all that apply): 1. Avoid foods containing the amino acid tyramine.

2. Have blood levels screened weekly for leukopenia.

3. Need sun exposure at least 1 hour a day.

4. Do not take prescribed or over-the-counter medications without consulting the physician.

5. Take the selective serotonin reuptake inhibitor with the MAOI at lunch.

____ 15. Nursing preparations for a patient undergoing electroconvulsive therapy (ECT) resemble those used for general anesthesia (select all that apply): 1. Monitor the patient’s vital signs before and after the procedure.

2. Medicate before procedure if ordered.

3. Educate patient and patient’s family.

4. Do not obtain patient’s signature for informed consent.

5. Monitor the patient for confusion after the procedure.

Copyright © 2019 F. A. Davis Company

Chapter 8. Mental Health Treatments Answer Section MULTIPLE CHOICE 1. ANS: 2 Page: 112 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments: Lithium Carbonate Feedback 1

Anxiety is not the issue; lithium toxicity is the problem.

2

Lithium is used to treat bipolar disorder. Signs of lithium toxicity include severe diarrhea, persistent nausea and vomiting, muscle weakness, tremors, blurred vision, slurred speech, and seizures.

3

Although he does have a fever, it is not a hospital-acquired viral infection. The manifestations indicate lithium toxicity.

4

Food poisoning is not the problem; the manifestations indicate lithium toxicity.

PTS: 1

REF: Chapter 8: Mental Health Treatments: Lithium Carbonate

2. ANS: 4 Page: 123 Integrated Processes: Communication and Documentation Content Area: Mental Health: Treatment Cognitive Level: Comprehension Client Need: Physiological Integrity: Therapeutic Procedures Chapter 8: Mental Health Treatments; Electroconvulsive Therapy Copyright © 2019 F. A. Davis Company

Feedback 1

Neuroleptic medication is another name for antipsychotics that are used to treat schizophrenia. This medication would not be appropriate for this situation.

2

Short-term seclusion is used as a last resort, when other measures have not worked to de-escalate an out-of-control or violent patient. This action would not be appropriate for this situation.

3

Psychosurgery is not a typical treatment for depression and would be inappropriate for this situation.

4

Electroconvulsive therapy is not used indiscriminately as it once was. Today, it is used when other therapies have not been helpful or produced positive outcomes.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Electroconvulsive Therapy

3. ANS: 3 Page: 111 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments; Monoamine Oxidase Inhibitors (MAOIs) Feedback 1

Peanut butter is not high in tyramine and can be eaten.

2

Fresh fish is not high in tyramine and can be eaten.

3

Foods containing the amino acid tyramine should be avoided. Phenelzine, a monoamine oxidase inhibitor (MAOI), blocks the metabolism of tyramine, resulting in an increase of norepinephrine. Aged and processed meats are examples. A hypertensive crisis may occur.

Copyright © 2019 F. A. Davis Company

4

Soup is not high in tyramine and can be eaten.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Monoamine Oxidase Inhibitors

(MAOIs) 4. ANS: 3 Page: 107 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments; Psychopharmacology-Antiparkinson Agents Feedback 1

Olanzapine is an atypical antipsychotic agent and is given for schizophrenia, not EPS.

2

Paroxetine is a commonly used antidepressant for depression, not EPS.

3

Benztropine is an antiparkinson agent with anticholinergic properties and is given for EPS.

4

Lorazepam is an antianxiety drug for anxiety, not EPS.

PTS: 1 REF: Chapter 8: Mental Health Treatments; Psychopharmacology-Antiparkinson Agents 5. ANS: 4 Page: 125 Integrated Processes: Teaching/Learning Content Area: Mental Health: Crisis Copyright © 2019 F. A. Davis Company

Cognitive Level: Analysis Client Need: Psychosocial Integrity: Crisis Intervention Chapter 8: Mental Health Treatments; Crisis Intervention Feedback 1

A psychologist, psychiatrist, or other mental health therapist uses psychotherapy and counseling to treat an individual. A nurse can be a crisis intervention worker.

2

Ellis’s rational-emotive therapy (RET) is one of the best-known cognitive therapies and is based on an A-B-C format (activating event, belief system, consequence).

3

Behavior modification helps patients identify triggers that change his or her behavior to eliminate or greatly decrease the frequency of negative behaviors.

4

No matter what level of crisis intervention the patient requires, the ultimate goal is for him or her to learn the skills necessary to cope with stress in a more positive way than before the crisis-return the patient to precrisis (or better) level of functioning.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Crisis Intervention

6. ANS: 4 Page: 106 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments; Psychopharmacology-Antipsychotics Feedback Copyright © 2019 F. A. Davis Company

1

Dystonia manifests as bizarre distortions or involuntary movements of any muscle group. Tongue, eyes, face, neck (torticollis), or any larger muscle mass can become tightened into an unnatural position or have irregular spastic movements.

2

Symptoms of akathisia are agitation and motor restlessness, and they seem to appear more frequently in women.

3

The major symptoms of drug-induced parkinsonism are akinesia (muscle weakness), shuffling gait, drooling, fatigue, mask-like facial expression, tremors, and muscle rigidity.

4

The frequently seen manifestations of tardive dyskinesia (TD) are rhythmic, involuntary movements that look like chewing, sucking, or licking motions.

Frowning and blinking constantly are also common. TD is irreversible.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Psychopharmacology-

Antipsychotics 7. ANS: 2 Page: 106 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments; Psychopharmacology-Antipsychotics Feedback 1

The patient needs to continue the medication for more than 1 week. It is important to instruct the patient not to alter the dose without first consulting with his or her health-care provider. If antipsychotic medications are discontinued, it should be done slowly, not abruptly.

Copyright © 2019 F. A. Davis Company

2

Some antipsychotics, such as clozapine (Clozaril), are known to cause serious blood dyscrasias and require regular monitoring of blood counts.

3

Patients should be taught to avoid consuming alcohol.

4

Careful teaching by health-care providers and nurses can help the patient to understand that these are very strong medications.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Psychopharmacology-

Antipsychotics 8. ANS: 1 Page: 107 Integrated Processes: Nursing Process: Assessment Content Area: Pharmacology Cognitive Level: Knowledge Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 8: Mental Health Treatments; Antidepressants and Antiparkinson Agents Feedback 1

Urinary retention is an anticholinergic side effect as is dry mouth and a change in blood glucose.

2

Respiratory depression is not an anticholinergic side effect.

3

Delirium is not an anticholinergic side effect.

4

Cardiac arrhythmias are not anticholinergic side effects.

PTS: 1 REF: Chapter 8: Mental Health Treatments; Antidepressants and Antiparkinson Agents COMPLETION 9. ANS: Copyright © 2019 F. A. Davis Company

milieu Page: 114 Rationale: In mental health, this therapeutic environment is called a milieu, or therapeutic milieu. It is believed that the environment affects behavior.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Therapeutic Environment Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 8: Mental Health Treatments; Milieu PTS: 1

REF: Chapter 8: Mental Health Treatments; Milieu

10. ANS: psychoanalysis Page: 115 Rationale: Psychoanalysis is the form of therapy that originated from the theories of Sigmund Freud.

In psychoanalysis, the focus is on the cause of the problem, which is buried somewhere in the unconscious. Freud believed it had something to do with poor parent–child relationships and ineffective psychosexual development.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 8: Mental Health Treatments: Psychoanalysis PTS: 1

REF: Chapter 8: Mental Health Treatments: Psychoanalysis

11. ANS: voluntary Page: 128

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Rationale: Voluntary admission means the patient has given informed consent to seek care in the facility. The informed consent means that the patient has been made aware of his or her behaviors, the implications of the behaviors, and expectations from the treatment.

Integrated Processes: Teaching/Learning Content Area: Legal Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts; Safe and Effective Care Environment: Coordinated Care: Legal Responsibilities Chapter 8 Mental Health Treatments; Legal Considerations in Crisis Intervention PTS: 1 REF: Chapter 8 Mental Health Treatments; Legal Considerations in Crisis Intervention MULTIPLE RESPONSE 12. ANS: 2, 5 Page: 111 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Pharmacology Cognitive Level: Synthesis Client Need: Physiological Integrity: Pharmacological Therapies: Expected Actions/Outcomes Chapter 8: Mental Health Treatments; Psychopharmacology-Antidepressants Feedback 1.

Incorrect. Antidepressants generally take several weeks to effect a change in mood, not 1 week.

2.

Correct. Nurses should encourage patients to continue taking the medication for the desired effect. Patients should not stop using these medications abruptly.

3.

Incorrect. Do not abruptly discontinue the medication, except under the supervision of a health-care provider. Serotonin syndrome, which includes altered mental status, restlessness, tachycardia, and labile blood pressure, can

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occur with abrupt discontinuation as well as when selective serotonin reuptake inhibitors (SSRIs) are combined with some other medications.

4.

Incorrect. In October 2004, producers of SSRIs were required by the U.S. Food and Drug Administration (FDA) to place a “black box” warning on the medication container, cautioning about the danger of increased risk of suicidal tendencies in children, adolescents, and young adults while taking these medications.

5.

Correct. To prevent a hypertensive crisis, foods containing the amino acid tyramine should not be taken with MAOIs.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Psychopharmacology-

Antidepressants 13. ANS: 1, 4, 5 Page: 105 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Knowledge Client Need: Physiological Integrity: Pharmacological Therapies: Expected Actions/Outcomes Chapter 8: Mental Health Treatments; Psychopharmacology Feedback 1.

Correct. Antipsychotics are used to mental health disorders, like schizophrenia.

2.

Incorrect. Antibiotics are used to treat bacterial infections, not mental health disorders.

3.

Incorrect. Antifungals are used to treat fungal infections, not mental health disorders.

4.

Correct. Stimulants are used to treat mental health disorders, like attentiondeficit/hyperactivity disorder in children.

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5.

Correct. Mood stabilizers, such as lithium carbonate, are used to treat mental health disorders, like bipolar mania.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Psychopharmacology

14. ANS: 1, 4 Page: 111 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Expected Actions/Outcomes Chapter 8: Mental Health Treatments; Antidepressants Feedback 1.

Correct. Teach patients to avoid and provide them with a list of foods containing the amino acid tyramine, a precursor of norepinephrine, while taking these medications. MAOIs block the metabolism of tyramine, resulting in increased norepinephrine. A hypertensive crisis may occur.

2.

Incorrect. The antipsychotic clozapine, not MAOIs, cause blood dyscrasias, like leukopenia.

3.

Incorrect. Sun exposure is avoided. Photosensitivity (sunburn potential) is one of the side effects of MAOIs.

4.

Correct. Other prescriptions and over-the-counter products should be taken only after consulting a doctor or a pharmacist.

5.

Incorrect. People using monoamine oxidase inhibitors (MAOIs) or who are within 14 days of discontinuing MAOIs should not use selective serotonin reuptake inhibitors.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Antidepressants

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15. ANS: 1, 2, 3, 5 Page: 124 Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Application Client Need: Physiological Integrity: Reduction of Risk Potential: Potential for Complications of Diagnostic Tests/Treatments/Procedures Chapter 8: Mental Health Treatments; Electroconvulsive Therapy Feedback 1.

Correct. Nurses carefully monitor blood pressure and pulse before and after treatment.

2.

Correct. Patients are generally given a sedative before the treatment.

3.

Correct. Because of patients’ misperceptions, it is important for health-care providers to educate them about ECT.

4.

Incorrect. An informed consent is required for ECT.

5.

Correct. The patient may feel confused and forgetful immediately after the treatment.

PTS: 1

REF: Chapter 8: Mental Health Treatments; Electroconvulsive Therapy

Chapter 9. Complementary and Alternative Treatment Modalities Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The home health nurse is informed by her patient that she is taking an herbal over-the-counter medication. What action should the nurse take with this information?

1. This information is not part of the medication record.

2. The nurse should document this information and add it to the patient’s medication Copyright © 2019 F. A. Davis Company

list and notify the charge nurse of the change.

3. Research the benefits of this medication before deciding if it should be added to medication record.

4. Tell the patient that herbal medications are not considered safe to take.

____ 2. Reflexology is based on the massage of this body part: 1. Hands 2. Feet 3. Spine 4. Temples

____ 3. Reiki is a term that means: 1. “Universal life energy.”

2. “Universal energy.”

3. “Energizing the universe.”

4. “Universal energy life.”

____ 4. The three primary methods of sensory representations are: 1. Visual, auditory, and kinesthetic.

2. Visual, auditory, and kindred.

3. Visa, authority, and kinesthetic.

4. Seeing, hearing, and smelling.

____ 5. Which mind–body method of healing facilitates balance, flexibility, slows breathing, and reduces stress?

1. Yoga 2. Hypnotherapy Copyright © 2019 F. A. Davis Company

3. Reflexology 4. Biofeedback

Completion Complete each statement.

6. Important to the effectiveness of any type of treatment are the patient’s _______________.

7. The type of therapy that seeks a response through the sense of smell is known as __________________________.

8. _____________________________ therapy is done by massaging the feet of the patient to act upon pathways, unblocking and renewing energy flow.

9. ________________ is a training program designed to develop one’s ability to control the autonomic nervous system.

10. __________________ are the assumptions people make when forming communication.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 11. The side effects of ginkgo biloba include (select all that apply): 1. Bleeding 2. Nausea and vomiting 3. Diarrhea 4. Fishy reflux 5. Headache

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____ 12. It is helpful as a nurse to be able to recognize the channel through which your patient communicates if following the primary sensory representation philosophy. Your patient Tamara’s sensory representation is visual. Determine which terms would identify visual sensory predicates (select all that apply): 1. An eyeful 2. An earful 3. In light of 4. In view of 5. Hang in there

____ 13. When teaching patients taking St. John’s wort, the nurse will inform them of the following information (select all that apply): 1. Dry mouth is a side effect.

2. Children can take small amounts for mild depression.

3. Increase the length of time in sunlight.

4. Consult your physician before taking any over-the-counter flu and cold medications.

5. It may decrease the effects of monoamine oxidase inhibitors (MAOIs).

____ 14. The following are true for hypnotherapy (select all that apply): 1. People enter a trance every day.

2. A trance is sleep.

3. Hypnosis is very deep relaxation.

4. Hypnotherapy is one of the most controversial complementary and alternative treatment modalities.

5. The patient assumes the pose, called asanas, to focus on internal experiences.

____ 15. Which statements are true about Milton Erickson and hypnosis (select all that apply)?

Copyright © 2019 F. A. Davis Company

1. Focused on patients’ histories 2. Focused on patients’ present and future outcomes 3. Focused on well-being 4. Focused on hypnosis for modern therapeutic purposes 5. Focused on diagnosing problems and treating symptoms

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Chapter 9. Complementary and Alternative Treatment Modalities Answer Section MULTIPLE CHOICE 1. ANS: 2 Page: 136 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments; Herbal and Nutritional Therapy Feedback 1

Any over-the-counter medication should be included on the medication list.

2

Many herbs interact negatively with prescription medications. As a result, it is vital that the nurse include direct questions to the patient about the use of any complementary and alternative medicine (CAMs). These need to be included on the medication list.

3

Deciding whether it should be added to the medication record is not a function of the nurse; all types of medications should be added to the list.

4

Although some herbal medications may not be safe to take, this is not true for all herbs.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments; Herbal and Nutritional Therapy 2. ANS: 2 Page: 140 Copyright © 2019 F. A. Davis Company

Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Massage, Energy, and Touch Feedback 1

Reflexology does not involve hand massage.

2

Reflexologists use massage of the feet to act on these pathways, unblocking and renewing the energy flow. Reflexology is also based on the belief that energy pathways and zones cross the body, connecting vital organs and body parts.

3

Reflexology does not involve spine massage.

4

Reflexology does not involve temple massage.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Massage, Energy, and Touch 3. ANS: 1 Page: 140 Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Massage, Energy, and Touch Feedback 1

Reiki is a term that means “universal life energy” and refers to the process in which this energy is drawn along the body’s meridians. Unlike methods that use physical movement, pressure, or massage to unblock these channels, Reiki uses the flow of life energy itself to accomplish the task.

Copyright © 2019 F. A. Davis Company

2

Reiki does not mean “universal energy.”

3

Reiki does not mean “energizing the universe.”

4

Reiki does not mean “universal energy life.”

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Massage, Energy, and Touch 4. ANS: 1 Page: 142 Integrated Processes: Teaching/Learning Content Area: Mental Health: Therapeutic Communication Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 9: Complementary and Alternative Treatment Modalities; Primary Sensory Representation Feedback 1

The three primary methods of sensory representation are the visual, auditory, and kinesthetic channels (seeing, hearing, and touching).

2

Although visual and auditory are primary methods of sensory representations, kindred is not.

3

Although kinesthetic is a primary method of sensory representations, visa and authority are not.

4

Of course, people also use taste and smell to gather information, but these paths are rarely the most important channels, and they are generally ignored.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Primary Sensory Representation

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5. ANS: 1 Page: 141 Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Yoga Feedback 1

Yoga, which has been in existence for more than 5000 years, is a mind–body method of healing that uses body positions to facilitate balance and flexibility.

Benefits of yoga are that it creates body relaxation, slows breathing, and reduces stress.

2

Hypnosis is a means for entering an altered state of consciousness, and in this state, using visualization and suggestion to bring about desired changes in behavior and thinking.

3

Reflexology is also based upon the belief that energy pathways and zones cross the body, connecting vital organs and body parts. Reflexologists use massage of the feet to act upon these pathways, unblocking and renewing the energy flow.

4

Biofeedback is a training program designed to develop one’s ability to control the autonomic nervous system. While it can slow breathing and reduce stress, it does not facilitate balance or flexibility.

PTS: 1

REF: Chapter 9: Complementary and Alternative Treatment Modalities; Yoga

COMPLETION 6. ANS: beliefs Page: 133

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Rationale: Important to the effectiveness of any type of treatment are the patient’s beliefs. To a large extent, a person’s beliefs will determine the success of a given treatment.

Integrated Processes: Teaching/Learning Content Area: Mental Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Religious and Spiritual Influences on Health Chapter 9: Complementary and Alternative Treatment Modalities; Mind, Body, and Belief PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Mind, Body, and Belief 7. ANS: aromatherapy Page: 134 Rationale: Related to herbal therapy, aromatherapy provides treatment by both the direct pharmacological effects of aromatic plant substances and the indirect effects of certain smells on mood and affect.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Treatment Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Aromatherapy PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Aromatherapy 8. ANS: Reflexology Page: 140 Rationale: Reflexology is based upon the belief that energy pathways and zones cross the body, connecting vital organs and body parts.

Copyright © 2019 F. A. Davis Company

Integrated Processes: Teaching/Learning Content Area: Mental Health: Complementary and Alternative Therapy Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments 9. ANS: Biofeedback Page: 134 Rationale: Biofeedback is a training program designed to develop one’s ability to control the autonomic nervous system. The primary purpose of biofeedback training is to teach patients to be aware of tension within the body and to respond with relaxation.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Complementary and Alternative Therapy Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Biofeedback PTS: 1

REF: Chapter 9: Complementary and Alternative Treatment Modalities;

Biofeedback 10. ANS: Presuppositions Page: 142

Copyright © 2019 F. A. Davis Company

Rationale: Presuppositions are the assumptions people make when forming communication. They are most often not spoken or written, but understood within the context of what is being communicated.

Integrated Processes: Communication and Documentation Content Area: Mental Health: Complementary and Alternative Therapy Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 9: Complementary and Alternative Treatment Modalities; Neurolinguistic Programming PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Neurolinguistic Programming MULTIPLE RESPONSE 11. ANS: 1, 2, 3, 5 Page: 137 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments; Table 9-1, Common Herbal and Dietary Therapies

Feedback 1.

Correct. Bleeding is a side effect of ginkgo biloba.

2.

Correct. Nausea and vomiting are side effects of ginkgo biloba.

3.

Correct. Diarrhea is a side effect of ginkgo biloba.

4.

Incorrect. A fishy reflux is a side effect of omega 3 fatty acids, not ginkgo

Copyright © 2019 F. A. Davis Company

biloba.

5.

Correct. A headache is a side effect of ginkgo biloba.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Common Complementary and Alternative Treatments; Table 9-1 Common Herbal and Dietary Therapies 12. ANS: 1, 3, 4 Page: 143 Integrated Processes: Communication and Documentation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 9: Complementary and Alternative Treatment Modalities; Primary Sensory Representation; Table 9-2, Learning Style Predicates Feedback 1.

Correct. An eyeful is visual.

2.

Incorrect. An earful is auditory.

3.

Correct. In light of is visual.

4.

Correct. In view of is visual.

5.

Incorrect. Hang in there is kinesthetic (touch).

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Primary Sensory Representation; Table 9-2 Learning Style Predicates 13. ANS: 1, 4 Page: 139 Copyright © 2019 F. A. Davis Company

Integrated Processes: Teaching/Learning Content Area: Mental Health: Complementary and Alternative Therapy: Pharmacology Cognitive Level: Evaluation Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 9: Complementary and Alternative Treatment Modalities; Table 9-1, Common Herbal and Dietary Therapies Feedback 1.

Correct. Dry mouth and constipation are side effects of St. John’s wort.

2.

Incorrect. St. John’s wort is contraindicated in children.

3.

Incorrect. Severe photosensitivity can occur with St. John’s wort; decreasing length in the sunlight is recommended.

4.

Correct. Patients should consult their physician before taking any over-thecounter flu and cold medications. St. John’s wort can increase the effects of OTC flu and cold medications.

5.

Incorrect. St. John’s wort increases the effects of MAOIs.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Table 9-1, Common Herbal and Dietary Therapies 14. ANS: 1, 3, 4 Page: 141 Integrated Processes: Teaching/Learning Content Area: Mental Health: Complementary and Alternative Therapy Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions

Copyright © 2019 F. A. Davis Company

Feedback 1.

Correct. Called a trance, this state of focused attention is one people enter every day. The English language even contains references to this common experience of “zoning out.”

2.

Incorrect. Trance is not sleep but rather a state of mind wherein a person is less aware of what is going on around him or her and instead is very focused on an internal experience, like a memory or an imagined event.

3.

Correct. Hypnosis is very deep relaxation.

4.

Correct. Hypnotherapy is one of the most controversial complementary and alternative treatment modalities.

5.

Incorrect. Once the yoga poses, called asanas, have been mastered, yoga can be practiced in a group, in the privacy of the home, or in the workplace.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Hypnotherapy 15. ANS: 2, 3, 4 Page: 141 Integrated Processes: Teaching/Learning Content Area: Mental Health: Complementary and Alternative Therapy Cognitive Level: Knowledge Client Need: Physiological Integrity: Non-Pharmacological Comfort Interventions Chapter 9: Complementary and Alternative Treatment Modalities; Hypnotherapy Feedback 1.

Incorrect. Erickson ignored patients’ histories, preferring instead to focus on their present and future outcomes.

2.

Correct. Erickson ignored patients’ histories, preferring instead to focus on their present and future outcomes.

Copyright © 2019 F. A. Davis Company

3.

Correct. Erickson promoted well-being, and his methods have challenged a new generation of hypnotherapists to do the same.

4.

Correct. Milton H. Erickson (1901–1980) was one of the best-known figures in the development of hypnosis for modern therapeutic purposes.

5.

Incorrect. Traditional hypnotherapy and psychotherapy centered on diagnosing problems and treating symptoms. In contrast, Erickson promoted well-being.

PTS: 1 REF: Chapter 9: Complementary and Alternative Treatment Modalities; Hypnotherapy Chapter 10. Anxiety, Anxiety-Related, and Somatic Symptom Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Which of the following is a priority in dealing with a highly anxious patient?

1. Provide support and a therapeutic milieu.

2. Implement strict limit setting to control behavior.

3. Increase environmental stimuli to distract the patient.

4. Provide more freedom to promote self-expression.

____ 2. Your new patient is admitted to the emergency department after a car accident. She is extremely anxious and experiencing a panic attack. Which intervention is most helpful?

1. Ask her to describe her feelings.

2. Stay with her in the exam room.

3. Set her up in a quiet exam room away from activity and give her privacy.

4. Encourage her to remember what happened in the accident.

Copyright © 2019 F. A. Davis Company

____ 3. Your patient has been taking buspirone (BuSpar) for 1 month. On returning to the clinic for a followup visit, which statement would describe medication effectiveness?

1. Reduction in number of delusions 2. Less depressed 3. Sleeping better 4. Reduced desire for alcohol

____ 4. When working with a female patient experiencing a phobia about spiders, Nurse Toni should anticipate that a problem for this patient would be: 1. Fear when speaking of the item.

2. Depression toward the feared object.

3. Denying the existence of a phobia.

4. Distortion of reality.

____ 5. Helenann, a long-term care nurse educator, noted that one of the staff members was complaining of stress and anxiety. A common physiological response to stress and anxiety is: 1. Urticaria.

2. Light-headiness.

3. Sedation.

4. Palpitations.

____ 6. What type of behavior modification is being used when the patient transforms him/herself into a relaxed state (documented by slowing brain waves)?

1. Biofeedback 2. Massage 3. Aromatherapy 4. Kava

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____ 7. A patient is unwilling to go out of the house for fear of “being outside without a way to get back home” Because of this fear, the patient remains at home, except when accompanied outside by the spouse. The nurse suspects that the patient has: 1. Agoraphobia.

2. Hematophobia.

3. Claustrophobia.

4. Hypochondriasis.

Completion Complete each statement.

8. An irrational fear is known as a _____________.

9. A positive form of stress is called _________________.

10. The most common anxiety disorder is ______________.

11. When you know the cause of the tension, that is an example of ______________ anxiety.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 12. Daria is admitted to the medical-surgical unit, experiencing an anxiety episode. Nurses on the unit are aware of several nursing interventions that can reduce the anxiety that Daria is experiencing, including which of the following (select all that apply)?

1. Attempt to calm the patient by placing an arm around the person.

2. Maintain a calm environment.

3. Promote open communication.

4. Provide the patient with a safe, quiet, and private place.

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5. Document the patient’s behavior.

____ 13. While observing a female patient on the oncology unit who has a secondary diagnosis of panic attacks, the nurse would expect to observe which of the following symptoms (select all that apply)?

1. Nausea 2. Diaphoresis 3. Survivor guilt 4. Increased pulse 5. Reliving the experience

____ 14. Commonly used medications for anxiety disorders include (select all that apply): 1. Alprazolam (Xanax) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Zolpidem (Ambien) 5. Lorazepam (Ativan)

____ 15. The following conditions can be stress related (select all that apply): 1. Asthma 2. Cancer 3. Burnout 4. Hunger 5. Immunity impairment

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Chapter 10. Anxiety, Anxiety-Related, and Somatic Symptom Disorders Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 159 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Anxiety Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; General Interventions Feedback 1

Maintain a calm milieu: Patients who have anxiety disorders need to have a calm, safe treatment area.

2

Implementing strict limit-setting can increase anxiety rather than decrease it.

3

Minimizing, not increasing, environmental stimuli helps the patient remain centered and focused.

4

More freedom can increase anxiety when highly stressed.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; General Interventions 2. ANS: 2 Page: 159 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Anxiety Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Copyright © 2019 F. A. Davis Company

Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-3 Nursing Care for Patient with Anxiety and Related Disorders Feedback 1

Encouraging her to talk about feelings or memories of the accident will probably increase anxiety.

2

When a patient is having a panic attack, stay with the patient.

3

Leaving her alone will increase her sense of abandonment and increase anxiety.

4

Encouraging her to talk about feelings or memories of the accident will probably increase anxiety.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-3 Nursing Care for Patient with Anxiety and Related Disorders 3. ANS: 3 Page: 158 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-2, Commonly Used Anti-Anxiety Medications Feedback 1

Antipsychotics, not BuSpar, reduce the number of delusions.

2

Antidepressants, not BuSpar, make a patient less depressed.

3

BuSpar is used for anxiety disorders. Sleeping better would be an indication of reduction in anxiety.

4

BuSpar is an antianxiety agent, not a deterrent to alcohol.

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PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-2, Commonly Used Anti-Anxiety Medications 4. ANS: 1 Page: 154 Integrated Processes: Caring Content Area: Mental Health: Phobias Cognitive Level: Analysis Client Need: Psychosocial Integrity: Stress Management Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Types of Anxiety and Anxiety-Related Disorders-Phobias Feedback 1

Phobia is defined as an “irrational fear.” The person is very aware of the fear and even of the fact that it is irrational, but the fear continues.

2

The item does not produce depression in a patient with phobias.

3

The person with a phobia is very aware of the fear and even of the fact that it is irrational, but the fear continues.

4

The person with a phobia is very aware of the fear and even of the fact that it is irrational, but the fear continues.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Types of Anxiety and Anxiety-Related Disorders-Phobias 5. ANS: 4 Page: 152 Integrated Processes: Teaching/Learning Content Area: Mental Health, Anxiety Copyright © 2019 F. A. Davis Company

Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Stress Management Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Differential Diagnosis Feedback 1

Urticaria is not a physiological response to stress and anxiety.

2

Hot flashes are physiological responses to stress and anxiety; feeling faint or light-headed is a symptom of a panic attack.

3

Insomnia, not sedation, is a physiological response to stress and anxiety.

4

Palpitations are a common physiological response to stress and anxiety.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Differential Diagnosis 6. ANS: 1 Page: 158 Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Application Client Need: Psychosocial Integrity: Stress Management Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Alternative Interventions for People With Anxiety Disorder Feedback 1

Biofeedback, a form of behavior modification, is a system of progressive relaxation and helps the person slow brain waves.

2

Massage therapies are believed to not only relieve tensions and discomforts in the musculoskeletal system, but also assist with blood and lymph flow.

Copyright © 2019 F. A. Davis Company

3

Essential oils, such as lavender and bergamot, are popular aids in relaxation.

Methods of application include using diffusers, placing a drop on a piece of clothing, or applying directly to the skin, such as the temple area.

4

Kava is a type of herbal supplement for relaxation.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Alternative Interventions for People With Anxiety Disorder 7. ANS: 1 Page: 154 Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Synthesis Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Phobia Feedback 1

Agoraphobia is the irrational fear of being in open spaces and being unable to leave or being very embarrassed if leaving is required.

2

Hematophobia is the fear of blood, rather than open spaces.

3

Claustrophobia is the fear of enclosed places, rather than the fear of open spaces.

4

Hypochondriasis is an old term for somatic symptom disorder, an excessive focus on one’s physical symptoms.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Phobia COMPLETION

Copyright © 2019 F. A. Davis Company

8. ANS: phobia Page: 154 Rationale: Phobia is defined as an “irrational fear.”

Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Anxiety Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Phobia PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Phobia 9. ANS: eustress Page: 150 Rationale: The stress from positive experiences, such as getting married or receiving a promotion at work, is called eustress. It can produce just as much anxiety as negative stressors.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Stress Management Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Anxiety Disorders PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Anxiety Disorders 10. ANS: phobia Page: 154 Rationale: Phobia is the most common of the anxiety disorders and is defined as an “irrational fear.”

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Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders: Phobia PTS: 1

REF: Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders:

Phobia 11. ANS: signal Page: 151 Rationale: Signal anxiety is an uncomfortable feeling in response to a known stressor.

Integrated Process: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorder; Anxiety Disorders PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorder; Anxiety Disorders MULTIPLE RESPONSE 12. ANS: 2, 3, 4, 5 Page: 160 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Anxiety Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Environment

Copyright © 2019 F. A. Davis Company

Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Nursing Care for Patients With Anxiety and Related Disorders-General Interventions

Feedback 1.

Incorrect. Placing an arm around the person will increase anxiety, not reduce the anxiety.

2.

Correct. Patients who have anxiety disorders need to have a calm, safe treatment area.

3.

Correct. Encourage the patient to verbalize all thoughts and feelings. Honesty in dealing with patients helps them learn to trust others and increases their selfesteem.

4.

Correct. Minimizing the stimuli helps the patient to keep centered and focused.

5.

Correct. Document any changes in behavior: Any change, no matter how small, can be significant to the patient’s care.

PTS: 1 REF: Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Nursing Care for Patients With Anxiety and Related Disorders-General Interventions 13. ANS: 1, 2, 4 Page: 159 Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Analysis Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Panic Disorder Feedback

Copyright © 2019 F. A. Davis Company

1.

Correct. Nausea or gastrointestinal upset occurs with panic attacks.

2.

Correct. Diaphoresis is a symptom of panic attacks.

3.

Incorrect. Sometimes, survivors of a traumatic event are haunted by a feeling of guilt that they survived and someone else did not and occurs in posttraumatic stress disorder.

4.

Correct. Increased pulse is a symptom of panic attacks.

5.

Incorrect. Posttraumatic stress disorder (PTSD) is developed in response to an unexpected emotional or physical trauma that could not be controlled. A victim of PTSD will probably have reoccurring, intrusive, disturbing memories of the incident that may last over a period of time.

PTS: 1 REF: Chapter 10 Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Panic Disorder 14. ANS: 1, 2, 4, 5 Page: 158 Integrated Processes: Teaching/Learning Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Expected Actions/Outcomes Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Anxiety Pharmacology Corner; Table 10-2, Commonly Used Anti-Anxiety Medications Feedback 1.

Correct. Xanax is a commonly used antianxiety medication.

2.

Correct. Valium is a commonly used antianxiety medication.

3.

Incorrect. Haldol is an antipsychotic, not an antianxiety medication.

4.

Correct. Ambien is a commonly used antianxiety medication.

5.

Correct. Ativan is a commonly used antianxiety medication.

Copyright © 2019 F. A. Davis Company

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Anxiety Pharmacology Corner; Table 10-2 Commonly Used Anti-Anxiety Medications 15. ANS: 1, 2, 3, 5 Page: 153 Integrated Processes: Teaching/Learning Content Area: Mental Health: Anxiety Cognitive Level: Analysis Client Need: Health Promotion and Maintenance: Health Promotion/Disease Prevention Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-1, Adaptation Responses to Stress and the Outcome of Stress on the Body Feedback 1.

Correct. Asthma can be a stress-related disorder; it may be associated with other stress-related conditions such as allergy and viral infection.

2.

Correct. Cancer can be a stress-related disorder; lowered immunity may allow for overcolonization of opportunistic cancer cells.

3.

Correct. Burnout is a stress-related disorder; it is associated with stress-related depression.

4.

Incorrect. Hunger is not a stress-related disorder; it is a physiological response.

5.

Correct. Immunity impairment is a stress-related disorder; stress interferes with effectiveness of the body’s antibodies, increasing susceptibility to colds, viruses, and other illnesses.

PTS: 1 REF: Chapter 10: Anxiety, Anxiety-Related, and Somatic Symptom Disorders; Table 10-1, Adaptation Responses to Stress and the Outcome of Stress on the Body Chapter 11. Depressive Disorders Copyright © 2019 F. A. Davis Company

Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. In caring for a patient with major depression, the nurse knows that the patient needs: 1. Frequent changes in activities.

2. Introduction to multiple new staff members.

3. Behavior modification that restructures feelings.

4. Well-defined, structured interactions at the beginning of treatment.

____ 2. Patients with major depression commonly display signs of: 1. Energy.

2. Repetitive, compulsive behaviors.

3. Worthlessness.

4. Visual hallucinations.

____ 3. When your patient says, “I am depressed,” what is the best response?

1. “We all feel that way now and then.”

2. “Why do you feel that way?”

3. “Everything will be OK once you snap out of it.”

4. “Tell me more about what is going on with you.”

____ 4. Your patient takes tranylcypromine for depression. Which of the following is most likely to indicate dietary restrictions have not been followed?

1. Hypertensive crisis 2. Syncope 3. Muscle spasms 4. Increased depression Copyright © 2019 F. A. Davis Company

____ 5. Your depressed patient is just started on duloxetine (Cymbalta). Which statement by the spouse tells you that family teaching has been effective?

1. “I can’t wait for him to be back to his old self in the next day or so.”

2. “I realize we can’t expect big changes right away.”

3. “I have to take him for weekly blood tests to monitor the drug dosage.”

4. “I will make sure he doesn’t eat any aged cheese for the next 2 months until the dose is stabilized.”

____ 6. Light therapy has been shown to be effective in treating patients with: 1. Bipolar disorder.

2. Dysthymia.

3. Major depression with seasonal pattern.

4. Schizophrenia.

____ 7. The nurse knows that the two factors that often differentiate major depression from dysthymic disorder are: 1. Amounts of mania and sadness.

2. Presence or absence of anger and guilt.

3. Severity and duration of symptoms.

4. Patient’s gender and age.

____ 8. You are caring for an older adult who is recently widowed. She says, “No one cares if I die.

Everyone I ever loved is dead.” What is the best response?

1. “I am sure that you still have people who care about you.”

2. “You sound like you are feeling all alone.”

3. “Boy, that is depressing.”

Copyright © 2019 F. A. Davis Company

4. “I don’t believe that.”

____ 9. Which of the following meal choices indicates the patient understands the diet restrictions when taking a monoamine oxidase inhibitor (MAOI)?

1. Pepperoni pizza and beer 2. Roast chicken, baked potato, and red wine 3. Fried fish, rice, and cola 4. Smoked herring, eggs, and coffee

____ 10. Your patient with major depression sits in her room for hours staring out the window. Which of the following would be the most appropriate intervention?

1. Sit with the patient and gently offer your availability to help.

2. Keep encouraging the patient to go to exercise class.

3. Offer the class once and then let the patient decide.

4. Sit with the patient and ask her to list reasons for her depression.

____ 11. Some medications such as tricyclics cause blurred vision. What is the cause of this effect?

1. Hyperglycemia 2. Anticholinergic effect 3. Hypoxia 4. Hypertension

____ 12. Your patient has been taking a selective serotonin reuptake inhibitor (SSRI) antidepressant for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication?

1. Patient reports sleeping 12 hours a night.

2. Patient reports sleeping 3 hours a night.

Copyright © 2019 F. A. Davis Company

3. Patient reports difficulty concentrating.

4. Patient arrives neatly dressed.

____ 13. Which of the following would be the most effective intervention for a depressed patient?

1. Establish one small goal to accomplish today.

2. Help the patient develop a goal to complete in the next month.

3. Encourage the patient to talk about recent failures in his or her life.

4. Let the patient guide what is the next best action.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 14. Annie has been diagnosed as having dysthymic disorder. The nurse knows that symptoms of this disorder include (select all that apply): 1. A depressed mood that lasts for most of each day over a 2-year period 2. Low self-esteem 3. Hallucinations 4. Difficulty in making decisions 5. Periods of euphoria 6. Sleep pattern disturbances

____ 15. Which of the following nursing interventions apply to all depressed patients (select all that apply)?

1. Show patience.

2. Monitor lithium levels.

3. Monitor for suicidal ideation.

4. Communicate effectively.

5. Provide meaningful activities.

6. Include alternative therapies in the treatment plan.

Copyright © 2019 F. A. Davis Company

Chapter 11. Depressive Disorders Answer Section MULTIPLE CHOICE 1. ANS: 4 Page: 178 Integrated Processes: Caring Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 11: Depressive Disorders; Table 11-3, Nursing Care Plan for Depressed Patient Feedback 1

Frequent changes can become overwhelming for depressed patients; structure is better.

2

Introduction to multiple new staff can become overwhelming for depressed patients.

3

Cognitive behavioral therapy, not behavior modification, is used to restructure or alter negative thinking.

4

Encourage participation in structured activities, if possible, to reduce pressure on patient to “perform.”

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-3, Nursing Care Plan for Depressed Patient 2. ANS: 3 Page: 171 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 11: Depressive Disorders; Major Depressive Disorders Feedback 1

Patients with depression experience increased fatigue, not energy.

2

Patients with obsessive-compulsive disorders experience repetitive, compulsive behaviors.

3

Feelings of worthlessness are part of the common symptoms of sadness and low self-worth seen in major depression.

4

Visual hallucinations occur in schizophrenia, not depression. Decreased ability to think, remember, or concentrate occurs in depression.

PTS: 1

REF: Chapter 11: Depressive Disorders; Major Depressive Disorders

3. ANS: 4 Page: 177 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 11: Depressive Disorders; General Nursing Interventions Feedback 1

This response minimizes what the patient is experiencing.

2

This response included the word why, which is not therapeutic because it forces the patient to provide a reason for his or her feelings.

3

This response places blame on the patient for being depressed and is not therapeutic.

4

This response gives the patient an opening to share feelings without being pressured to come up with reasons for these feelings.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 11: Depressive Disorders; General Nursing Interventions

4. ANS: 1 Page: 176 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 11: Depressive Disorders; Table 11-2, Antidepressants Feedback 1

Tranylcypromine is a monoamine oxidase inhibitor. A serious, potentially fatal hypertensive crisis may occur in presence of foods high in tyramine.

2

Syncope is not a response if dietary restrictions have not been followed.

3

Muscle spasms are not a response if dietary restrictions have not been followed.

4

Increased depression is not a response if dietary restrictions have not been followed.

PTS: 1

REF: Chapter 11: Depressive Disorders; Table 11-2 Antidepressants

5. ANS: 2 Page: 176 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders and Adult Health: Pharmacology Cognitive Level: Application Client Need: Health Promotion and Maintenance: Principles of Teaching/Learning: Psychosocial Integrity: Mental Health Concepts Chapter 11: Depressive Disorders; Pharmacology Corner Feedback Copyright © 2019 F. A. Davis Company

1

This response indicates the spouse incorrectly thinks the drug will work immediately.

2

This response indicates the spouse understands that antidepressants can take some time before seeing improvements.

3

This response indicates the spouse incorrectly thinks blood tests are needed with this drug.

4

This response indicates the spouse incorrectly thinks food restrictions are needed with this drug. Special food restrictions are needed for monoamine oxidase inhibitors (MAOIs).

PTS: 1

REF: Chapter 11: Depressive Disorders; Pharmacology Corner

6. ANS: 3 Page: 175 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorder Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 11: Depressive Disorders; Alternative Treatment-Light Therapy Feedback 1

Light therapy is not used for bipolar disorder.

2

Light therapy is not used for dysthymia.

3

Light therapy is being prescribed and used successfully in the treatment of depression with seasonal pattern. It consists of special lights to be used for certain amounts of time during the day.

4

Light therapy is not used for schizophrenia.

PTS: 1

REF: Chapter 11: Depressive Disorders; Alternative Treatment-Light Therapy

Copyright © 2019 F. A. Davis Company

7. ANS: 3 Page: 172 Integrated Processes: Nursing Process: Application Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 11: Depressive Disorders; Major Depressive Disorder and Dysthymic Disorder Feedback 1

Mania does not occur in major depression or dysthymic disorder.

2

Presence or absence of anger and guilt are not factors to differentiate the two disorders.

3

Dysthymic disorder is a less severe form of depression that is characterized by its chronic nature. It is sometimes called persistent depressive disorder.

4

Gender and age are not factors to differentiate the two disorders.

PTS: 1 REF: Chapter 11: Depressive Disorders; Major Depressive Disorder and Dysthymic Disorder 8. ANS: 2 Page: 177 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Grief: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 11: Depressive Disorders; General Nursing Interventions Feedback 1

This response minimizes the patient’s feelings.

2

This response helps the patient focus on feelings.

3

This response over dramatizes the patient’s feelings.

Copyright © 2019 F. A. Davis Company

4

This response disrespects the patient and her feelings.

PTS: 1

REF: Chapter 11: Depressive Disorders; General Nursing Interventions

9. ANS: 3 Page: 176 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 11: Depressive Disorders; Pharmacology Corner; Table 11-2, Antidepressants Feedback 1

Pepperoni and beer are high in tyramine and should not be eaten.

2

Red wine is high in tyramine and should not be drunk.

3

This meal is low in tyramine and should be eaten.

4

Smoked herring is high in tyramine and should not be eaten.

PTS: 1 REF: Chapter 11: Depressive Disorders; Pharmacology Corner; Table 11-2 Antidepressants 10. ANS: 1 Page: 178 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication

Copyright © 2019 F. A. Davis Company

Chapter 11: Depressive Disorders; General Nursing Interventions; Table 11-3, Nursing Care Plan for the Depressed Patient Feedback 1

For the patient with depression, spending time with the patient each day without pressure or demands is therapeutic.

2

Although physical activity should be promoted, continuing to encourage the patient who is depressed makes the patient feel like “performance” is required.

3

Although physical activity should be promoted, letting the patient decide places too much pressure on the patient who is depressed. For the depressed patient, it takes too much energy to decide.

4

While sitting with the patient is appropriate, asking questions that require demanding answers should be avoided.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; Table 11-3, Nursing Care Plan for the Depressed Patient 11. ANS: 2 Page: 176 Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Integrated Processes: Nursing Process: Analysis Chapter 11: Depressive Disorders; Table 11-2, Antidepressants Feedback 1

Although hyperglycemia can cause blurred vision from high blood glucose levels, it is not the reason tricyclics cause blurred vision.

2

Anticholinergic effect can create blurred vision, urinary retention, and dry

Copyright © 2019 F. A. Davis Company

mouth caused by the blockage of acetylcholine.

3

Hypoxia causes low oxygen levels and confusion.

4

Although hypertension can cause blurred vision from high blood pressure, it is not the reason tricyclics cause blurred vision.

PTS: 1

REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants

12. ANS: 4 Page: 175 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 11: Depressive Disorders; Pharmacology Corner Feedback 1

Sleeping too much indicates continued depression.

2

An abnormal sleep pattern indicates continued depression.

3

Concentration should increase if the SSRI is working.

4

Attention to personal appearance is an important indicator of improved mood.

PTS: 1

REF: Chapter 11: Depressive Disorders; Pharmacology Corner

13. ANS: 1 Page: 177 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 11: Depressive Disorders; General Nursing Interventions Copyright © 2019 F. A. Davis Company

Feedback 1

Identify small, achievable goals the depressed patient can meet today.

2

A goal to complete in the next month is too far into the future and takes too much energy for a depressed patient. Break down tasks into small parts for the severely depressed patient.

3

Allowing a depressed patient to spend too much time ruminating on negative thoughts is unproductive; the depressed patient is encouraged to challenge negative thoughts.

4

The depressed patient may have no energy to identify the next best action.

PTS: 1

REF: Chapter 11: Depressive Disorders; General Nursing Interventions

MULTIPLE RESPONSE 14. ANS: 1, 2, 4, 6 Page: 172 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 11: Depressive Disorders; Dysthymic Disorder

Feedback 1.

Correct. Dysthymic disorder is characterized by a depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years and 1 year in children.

2.

Correct. Low self-esteem is a symptom of dysthymic disorder.

3.

Incorrect. Hallucinations are not a symptom of dysthymic disorder;

Copyright © 2019 F. A. Davis Company

hallucinations occur in schizophrenia.

4.

Correct. Difficulty making decisions is a symptom of dysthymic disorder.

5.

Incorrect. Periods of euphoria are not symptoms of dysthymic disorder; euphoria occurs in bipolar disorder, manic phase.

6.

Correct. Insomnia or hypersomnia (sleep pattern disturbances) are symptoms of dysthymic disorder.

PTS: 1

REF: Chapter 11: Depressive Disorders; Dysthymic Disorder

15. ANS: 1, 4, 5 Page: 177 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Environment and Communication Chapter 11: Depressive Disorders; General Nursing Interventions Feedback 1.

Correct. Patients that are depressed need patience.

2.

Incorrect. Lithium is usually not a medication for depression; it is for bipolar.

3.

Incorrect. All depressed patients do not need to be monitored for suicidal ideation.

4.

Correct. Communicate effectively is necessary for patients who are depressed.

5.

Correct. Meaningful activities are appropriate for all depressed patients.

6.

Incorrect. Alternate therapies may not be appropriate for some patients.

PTS: 1

REF: Chapter 11: Depressive Disorders; General Nursing Interventions

Chapter 12. Bipolar Disorders

Copyright © 2019 F. A. Davis Company

Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Your new patient admitted to the psychiatric unit is pacing and agitated. Which of the following is the most appropriate intervention?

1. Introduce the patient to all the other patients.

2. Direct him to a group therapy session.

3. Place him in a quiet area away from other patients.

4. Review the unit rules with the patient to distract him.

____ 2. Your patient in the psychiatric unit is still up at midnight playing cards. You tell him, “It’s time to get some sleep now.” What is the purpose of this response?

1. Limit setting 2. Reality testing 3. Controlling patient so other patients will respond the same way 4. Enforcing rules

____ 3. Which statement is most likely to be from a patient in a manic episode?

1. “I don’t need to sleep.”

2. “I am Jesus Christ.”

3. “Leave me alone while I am reading this textbook.”

4. “I am worthless.”

____ 4. Which diversional activity is most appropriate for a patient in a manic phase?

1. A card game 2. Exercise class 3. Cross-stitch 4. Computer game Copyright © 2019 F. A. Davis Company

____ 5. Lithium toxicity is most likely with which of the following patients?

1. An elderly man with diarrhea from food poisoning 2. A teenage girl on oral contraceptives 3. A 40-year-old man who smokes marijuana on the weekend 4. All of the above are at high risk

____ 6. Your 28-year-old patient was admitted to the psychiatric unit with a diagnosis of bipolar disorder in major depression with symptoms of withdrawal and extreme sadness. After 2 weeks on the unit, the patient suddenly becomes more talkative, sleeps only 2 hours a night, and acts seductively with the male patients. What is the most likely explanation for this change?

1. The antidepressants are effective.

2. The patient was diagnosed incorrectly.

3. She is having a manic episode as part of her illness.

4. She is recovering from her depression.

____ 7. You are working with the RN to plan short-term goals for a 28-year-old hospitalized manic patient.

Which is the most important goal?

1. Protection from self-inflicted harm 2. Meals in excess of metabolic requirement 3. Strict participation in unit activities 4. Enforced medication compliance

____ 8. A 30-year-old male patient is admitted to the psychiatric unit with a diagnosis of bipolar disorder.

His family reports that for the past 2 months, he has been in constant motion, sleeping very little, spending lots of money, and has been “full of ideas.” During the initial assessment with the patient, the nurse would expect him to exhibit which of the following?

Copyright © 2019 F. A. Davis Company

1. Short, polite responses to interview questions 2. Introspection related to his present situation 3. Exaggerated self-importance 4. Feelings of helplessness and hopelessness

____ 9. Lithium is most commonly used to treat which of the following disorders?

1. Dysthymia 2. Schizophrenia 3. Generalized anxiety disorder 4. Bipolar disorder

____ 10. Marnie is a 16-year-old patient with bipolar disorder. She is manic right now and is in the hallway naked, making sexual requests of the staff and other patients. What is your best course of action?

1. Quietly approach her, escort her to her room, and assist her in getting dressed.

2. Quietly approach her, escort her to her room, and explain to her the inappropriateness of her actions.

3. Approach her, confront her behavior as it is happening, and escort her to her room.

4. Confront her behavior in the hall, apologize to the other patients, and escort her to her room.

____ 11. Which of the following best describes bipolar I disorder?

1. Full manic cycles with possibility of depression 2. Disturbance in mood that is a direct result of physiological effects of substance abuse 3. Periods of mild mania followed by mild depression 4. Intense depression followed by normal mood

Copyright © 2019 F. A. Davis Company

____ 12. Which of thefollowing would present thegreatest risk of developing bipolar disorder?

1. Use of stimulant medications as a child 2. History of anxiety disorder as a teenager 3. First-degree relative with thebipolar disorder diagnosis 4. History of conduct disorder

____ 13. Toni, diagnosed with bipolar disorder, is currently in themania stage. thestaff noted that Toni has placed her lipstick on in an exaggerated way. She is currently pacing thefloor and is easily angered. thenurse approaches Toni in an attempt to ease some of her behaviors. themost therapeutic response by thenurse would be: 1. “Would you like to watch TV?” 2. “Would you like me to talk with you?”

3. “Let’s walk and talk.”

4. Avoid giving attention to thepatient by not responding to her behavior.

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion. ____ 14. Which of thefollowing are signs of mania (select all that apply)?

1. Pessimistic feelings 2. Increased sexual drive 3. Denial that anything is wrong 4. Decreased energy 5. Decreased need for sleep 6. Thoughts of death or suicide

Copyright © 2019 F. A. Davis Company

____ 15. While assessing your patient, you realize thepatient is experiencing a manic episode. You will most likely expect (select all that apply): 1. Decreased need for sleep 2. Extreme irritability 3. Extreme depression 4. A surge of energy 5. A loss of interest in ordinary activities

Copyright © 2019 F. A. Davis Company

Chapter 12. Bipolar Disorders Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 187 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Behavioral Intervention Chapter 12: Bipolar Disorders; General Nursing Interventions Feedback 1

Introducing thepatient to theother patients increases external stimuli, making thesituation worse.

2

Although a group therapy session may prove beneficial later in treatment, this is not theappropriate time.

3

Reducing external stimulation will help thepatient cope.

4

Reviewing unit rules to distract thepatient is not appropriate. thenurse should take thetime to establish a relationship with thepatient to promote a sense of safety.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

2. ANS: 1 Page: 187 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Copyright © 2019 F. A. Davis Company

Chapter 12: Bipolar Disorders; General Nursing Interventions Feedback 1

Limit setting clearly defines what is expected and what is not allowed. thepatient needs clear, firm limits.

2

Patients that are having problems with hallucinations and delusions need reality testing.

3

Controlling patients is not therapeutic.

4

Enforcing rules may be needed if thepatient is becoming violent or out of control. thepatient is displaying neither of these behaviors.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

3. ANS: 1 Page: 181 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Manic Phase Feedback 1

Manic patients usually have very little need for sleep.

2

This type of delusion is more typical of a patient with schizophrenia rather than a patient who is manic.

3

Manic patients are unable to concentrate on reading.

4

During themanic episode a very elevated mood is present; worthlessness is usually experienced in thedepressive phase of bipolar.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Manic Phase

Copyright © 2019 F. A. Davis Company

4. ANS: 2 Page: 187 Integrated Processes: Nursing Process: Analysis Content Level: Mental Health: Mood Disorders Cognitive Area: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; General Nursing Interventions Feedback 1

Card games are sedentary and require too much concentration, which would be difficult for themanic patient.

2

Physical activity, such as an exercise class, discharges pent-up energy and can be useful for themanic patient.

3

Cross-stitch is sedentary and requires too much concentration, which would be difficult for themanic patient.

4

A computer game is sedentary and requires too much concentration, which would be difficult for themanic patient.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

5. ANS: 1 Page: 185 Integrated Processes: Nursing Process: Analysis Content Area: Adult Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Adverse Effects/Contraindications/Side Effects/Interactions Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders Feedback 1

Diarrhea can precipitate dehydration, which can cause lithium toxicity to

Copyright © 2019 F. A. Davis Company

develop quickly.

2

Although females taking lithium may need to use birth control, birth control does not increase lithium toxicity.

3

Smoking marijuana does not increase lithium toxicity.

4

Taking oral contraceptives and smoking marijuana do not increase lithium toxicity.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders

6. ANS: 3 Page: 181 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Manic Phase Feedback 1

Antidepressants would help thepatient feel less depressed, not rapidly change to mania.

2

Bipolar can cause rapid shifts in behavior.

3

Sudden shifts to manic behavior after depression indicate bipolar disorder.

4

This is unlikely because theshift was rapid and thepatient has bipolar.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Manic Phase

7. ANS: 1 Page: 187 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity Chapter 12: Bipolar Disorders; General Nursing Interventions Feedback 1

Safety is always thepriority. Patients in themanic phase experience reckless behavior and poor judgment.

2

Although meals with extra calories are appropriate, they are not themost important goal.

3

Strict participation in theunit activities is not therapeutic for any patient. Strict participation in unit activities may be too much stimuli for a patient with mania.

4

Although medication compliance is important, enforced is a violation of patient’s rights.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

8. ANS: 3 Page: 182 Integrated Process: Nursing Process: Assessment Content Area: Mental Health: Mood Disorder Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Manic Phase Feedback 1

In themanic phase, thepatient will not give short, polite responses. A manic patient will talk a lot and have racing thoughts and flight of ideas.

2

In themanic phase thepatient will be unable to be introspective; this requires too much concentration.

3

In themanic phase, thepatient will have exaggerated self-importance (false beliefs about self or abilities).

Copyright © 2019 F. A. Davis Company

4

In themanic phase thepatient will not be in touch with feelings of helplessness or hopelessness unless he moves into thedepressive phase.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Manic Phase

9. ANS: 4 Page: 185 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Knowledge Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders Feedback 1

Dysthymia, a depressive disorder, is not treated with lithium.

2

Schizophrenia is treated with antipsychotics, not lithium.

3

Generalized anxiety disorders may be treated with antianxiety agents or antidepressants, not lithium.

4

Lithium is a drug commonly used to treat bipolar disorder.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders

10. ANS: 1 Page: 187 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 12: Bipolar Disorders; General Nursing Interventions

Copyright © 2019 F. A. Davis Company

Feedback 1

With a patient in a manic state, theintervention should be calming with theemphasis on limit setting. Quietly approaching and escorting her to her room is calming and will decrease stimuli. Assisting her in getting dressed sets limits without confrontation.

2

Although quietly approaching thepatient and escorting her to her room are appropriate, explaining behaviors is confrontational and requires too much concentration.

3

Confronting her behavior as it is happening could exacerbate themania and cause thebehavior to escalate.

4

Confronting her behavior in thehall could exacerbate themania and cause thebehavior to escalate.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

11. ANS: 1 Page: 182 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Table 12-1, Forms of Bipolar Disorders Feedback 1

Bipolar I is a full syndrome of manic symptoms and may also have depression.

2

Substance/medication-induced bipolar disorder is a disturbance characterized by elevated, expansive mood with or without depression that is thedirect result of thephysiological effects of a substance, for example, alcohol, amphetamines, cocaine, heavy metals.

3

Cyclothymia is a chronic mood disturbance of at least 2 years’ (1 year in

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children) duration involving numerous episode of hypomania and depressed mood but of less intensity.

4

Intense depression followed by normal mood can describe major depression, not bipolar I.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Table 12-1, Forms of Bipolar Disorders

12. ANS: 3 Page: 184 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Etiology of Bipolar Disorders Feedback 1

Use of stimulants as a child is not associated with development of bipolar disorder.

2

History of anxiety disorder as a teenager is not associated with thedevelopment of bipolar disorder.

3

A genetic link for bipolar has also been demonstrated through family studies.

4

History of conduct disorder is not associated with development of bipolar disorder.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Etiology of Bipolar Disorders

13. ANS: 3 Page: 187 Integrated Processes: Caring Content Area: Mental Health: Therapeutic Communication Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 12: Bipolar Disorders; General Nursing Interventions Feedback 1

Watching TV is a sedentary activity and could exacerbate rather than ease some of Toni’s behaviors.

2

Asking a closed-ended question at this time is nontherapeutic.

3

To reduce thelevel of anger and aggression thepatient may be experiencing, thenurse should encourage thepatient to discharge some energy by physical activity.

4

Ignoring thepatient when pacing and being easily angered is nontherapeutic.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions

MULTIPLE RESPONSE 14. ANS: 2, 3, 5 Page: 181 Integrated Processes: Analysis Content Area: Mental Health: Mood Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorder; Manic Phase

Feedback 1.

Incorrect. Pessimistic feelings occur with depression; a very elevated mood occurs with mania.

2.

Correct. Increased sexual drive occurs with mania.

Copyright © 2019 F. A. Davis Company

3.

Correct. Denial that anything is wrong is typical of mania.

4.

Incorrect. Decreased energy occurs with depression; increased energy occurs with mania.

5.

Correct. Decreased need for sleep occurs with mania.

6.

Incorrect. Thoughts of death or suicide occur with depression, not mania.

PTS: 1

REF: Chapter 12: Bipolar Disorder; Manic Phase

15. ANS: 1, 2, 4 Page: 181 Integrated Processes: Teaching/Learning Content Area: Mental Health: Mood Disorder Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 12: Bipolar Disorders; Manic Phase Feedback 1.

Correct. Decreased need for sleep occurs with mania.

2.

Correct. Extreme irritability occurs with mania.

3.

Incorrect. Extreme depression occurs in thedepressive phase.

4.

Correct. A surge of energy occurs in themanic phase.

5.

Incorrect. A loss of interest in ordinary activities occurs in thedepressive phase.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Manic Phase

Chapter 13. Suicide Multiple Choice Identify thechoice that best completes thestatement or answers thequestion.

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____ 1. Suicide is most likely to occur: 1. On admission to a psychiatric hospital.

2. At thebeginning of psychotherapy.

3. As thedepression begins lifting.

4. When thedepression deepens.

____ 2. Your new patient is admitted after a suicide attempt. She states, “Let me die, I don’t deserve to live.”

What is your best response?

1. “Why do you want to die?”

2. “You have so much to live for.”

3. “How do you think your family feels now?”

4. “You must have been feeling very hopeless. Tell me about it.”

____ 3. Your depressed patient has suddenly changed to being more cheerful and tells you he wants to reduce theclutter at home and give away some prized possessions to friends. What should be your response?

1. “I’m glad you are feeling better.”

2. “I’ll tell thedoctor and maybe he will reduce your dose of antidepressant.”

3. Ask thepatient if he has any thoughts about suicide.

4. Document what thepatient tells you and see another patient.

____ 4. Which of thefollowing statements is true about suicide?

1. There is generally some warning when someone commits suicide.

2. Victims of suicide have a genetic predisposition to it.

3. Suicide can always be prevented.

4. Talking about suicide means theperson is not serious about it.

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____ 5. A patient becomes suicidal and is transferred to thelocked unit of your hospital. Because this patient is actively suicidal you should: 1. Keep thepatient in your line of vision at all times.

2. Perform suicide assessments every half-hour.

3. Inform thedoctor that thepatient is now in a locked seclusion room.

4. Take vital signs every 15 minutes.

____ 6. Patients are most likely to commit suicide when: 1. They are severely depressed.

2. They feel trapped.

3. They are recently discharged from thehospital.

4. They have a significant other who is supportive.

____ 7. As you perform a suicide assessment on your patient, you learn that thepatient has only one person to call in times of need, has been thinking about suicide frequently in past weeks, and has attempted suicide once before 3 years ago. Given this information you believe this patient’s suicide risk is: 1. Low. 2. Moderate.

3. None.

4. Imminent.

____ 8. Which would be most important to find out next about theabove patient?

1. Does he have a suicide plan now?

2. What is his psychiatric diagnosis?

3. Who does he live with?

4. What type of psychiatric therapy has he had recently?

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____ 9. The best approach a nurse can use to gain information relating to a patient’s potential for suicide is to ask: 1. “What do you plan to be doing 5 years from now?”

2. “Does your family know you are considering suicide?”

3. “What have other patients told you about their suicide attempts?”

4. “Are you thinking of killing yourself now?”

____ 10. When planning care for a patient who is suicidal, thenurse knows: 1. Suicide ideations are only gestures.

2. Liquid medication allows thepatient to “cheek” themedication.

3. Teaching new problem-solving skills is a priority of care for suicidal patients.

4. It is necessary to know thereasons why thepatient has suicidal thoughts.

____ 11. You have been consistently caring for a patient who is suicidal. thepatient now tells you, “Nurse, I finally have it all figured out. It’s going to be just fine.” Your best response to this patient is: 1. “I’m so glad to hear that!”

2. “What a relief for you!”

3. “I’m not sure I understand what you mean. Tell me more.”

4. “You are not depressed anymore then?”

____ 12. Of thefollowing patient statements, which do nurses recognize as thehighest risk for a patient to commit suicide?

1. “I’ve been saving my pain medications for when I really need them. Now that my spouse has left me I think I will use them right before theholidays.”

2. “I told my boss if he fires me, I’ll kill myself.”

3. “Nobody appreciates thework I do. They’d miss me if I just killed myself and was gone one day.”

4. “I really admire people who have enough nerve to kill themselves. I’m not that Copyright © 2019 F. A. Davis Company

brave yet.”

____ 13. You are caring for an adolescent patient who has swallowed all of his mother’s sleeping pills and pain pills. thepatient has had a gastric lavage and is able to answer questions. thebest question to ask this patient is: 1. “What are your thoughts right now about hurting yourself?”

2. “Why on earth did you do that?”

3. “Don’t you know how much your family loves you and how much they will miss you if you kill yourself?”

4. “This is a very immature way to get attention.”

____ 14. A suicidal patient has been transferred to your unit from themedical floor and asks you why he “has to be watched every minute. I have a right to my privacy; I’m an adult and can come and go as I please.” thebest response to this patient is: 1. “Why do you think you are being watched?”

2. “We are concerned that you might attempt to seriously hurt yourself.”

3. “It shouldn’t bother you if you have nothing to hide from us.”

4. “This is a direct order from your doctor.”

____ 15. Your 15-year-old neighbor, who knows you are a mental health nurse, informs you that he has “a friend who is talking about suicide.” Your best initial response to theyoung neighbor is: 1. “Who is it? Another neighbor?”

2. “I have some time. Tell me a little about this friend.”

3. “Who else knows? Has this friend told anyone else?”

4. “Your friend needs help right away!”

Copyright © 2019 F. A. Davis Company

Chapter 13. Suicide Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 192 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; Table 13-1, Clearing Up theMyths About Suicide Feedback 1

Upon admission, thedepressed patient usually does not have enough energy to commit suicide; hopelessness prevails.

2

At thebeginning of psychotherapy, thedepressed patient usually does not have enough energy to commit suicide; hopelessness prevails.

3

As thedepression begins to lift, theindividual’s energy level can increase before feelings of hopelessness are relieved. Once theindividual makes thedecision that suicide is an effective solution to theproblems, his or her mood may even elevate.

4

When thedepression deepens, depressed patients usually do not have enough energy to commit suicide; hopelessness prevails.

PTS: 1

REF: Chapter 13: Suicide; Table 13-1 Clearing Up theMyths About Suicide

2. ANS: 4 Page: 197 Integrated Processes: Nursing Process: Implementation Copyright © 2019 F. A. Davis Company

Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; General Nursing Interventions Feedback 1

Asking a patient “why” is nontherapeutic and makes thepatient defensive.

2

This response belittles and minimizes thepatient’s feelings and will make thepatient feel even more isolated.

3

When talking to someone who is suicidal, avoid platitudes such as “Think what this would do to your children.” Often thesuicidal person is so immersed in feelings of hopelessness and isolation that she is unable to identify with how others are feeling. In addition, thepatient may view that thefamily will be better off without her.

4

This response uses empathy and open-ended statements to allow thepatient to talk about feelings. Be prepared to talk to thepatient about her feelings, work to reframe hopelessness, and assist in problem-solving to identify alternative solutions to problems thepatient views as insurmountable.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

3. ANS: 3 Page: 195 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; theWarning Signs of Suicide Feedback 1

Although thepatient looks like he is feeling better, these actions indicate

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thepatient may have made a decision to commit suicide. Therefore, assuming thepatient feels better is inappropriate.

2

Although thepatient looks like he is feeling better, giving away personal items and appearing cheerful indicates thepatient may have made a decision to commit suicide. It would, therefore, be inappropriate to ask thedoctor to reduce thepatient’s dose of antidepressants.

3

Giving away prized possessions often precedes planned suicide. Being direct and asking about suicide intent is important.

4

Giving away personal items and appearing cheerful indicates thepatient may have made a decision to commit suicide. It is important for thenurse to take different action to gain insight into thepatient’s thinking.

PTS: 1

REF: Chapter 13: Suicide; theWarning Signs of Suicide

4. ANS: 1 Page: 194 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Suicide Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; theWarning Signs of Suicide Feedback 1

Most people give some warning about being at risk to commit suicide; 8 out of 10 people considering suicide give some sign of their intentions.

2

Although exposure to thesuicidal behavior of family members may increase risk, there is no indication that suicide is genetic.

3

Suicide cannot always be prevented. Eight out of 10 people considering suicide give some sign of their intentions.

4

Approximately 80% of individuals who attempt or complete suicide give some

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definite verbal or indirect clues. People who talk about suicide, threaten suicide, or call suicide crisis centers are 30 times more likely to kill themselves.

PTS: 1

REF: Chapter 13: Suicide; theWarning Signs of Suicide

5. ANS: 1 Page: 196 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts and Safe and Effective Care Environment Chapter 13: Suicide; General Nursing Interventions Feedback 1

If thepatient is actively suicidal, a psychiatric consultation will be required, and thepatient may be placed on 1:1 precautions until thepatient can be moved to an appropriate treatment setting. On 1:1 precautions, thenurse will be required to accompany thepatient to and remain with thepatient in thebathroom.

2

Every 30 minutes is too long for an actively suicidal patient to be unattended.

3

Placing a patient in a locked seclusion room is a violation of thepatient’s rights.

4

Taking vital signs every 15 minutes is inappropriate.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

6. ANS: 2 Page: 194 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; theWarning Signs of Suicide Feedback 1

Severely depressed patients do not have theenergy to commit suicide.

2

The acronym IS PATH WARM was developed by theAmerican Association of Suicidology to remember thewarning signs of suicide. In this acronym, the“T” stands for “trapped.”

3

Recently discharged patients from thehospital are not high risk for suicide.

4

Patients with supportive significant others are not as prone to suicide as patients with no support group.

PTS: 1

REF: Chapter 13: Suicide; theWarning Signs of Suicide

7. ANS: 2 Page: 194 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; theReality of Suicide and theWarning Signs of Suicide and Treatment of Individuals at Risk for Suicide Feedback 1

This patient is not a low risk because there is evidence of suicidal thoughts, limited support system, and previous history.

2

This patient has suicidal thoughts, a limited support system, and previous history. All of these factors indicate a moderate risk.

3

This does indicate some level of suicide risk because there is evidence of suicidal thoughts, limited support system, and previous history.

4

For imminent risk, thepatient would need to have access to a highly lethal

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method at that time.

PTS: 1 REF: Chapter 13: Suicide; theReality of Suicide and theWarning Signs of Suicide and Treatment of Individuals at Risk for Suicide 8. ANS: 1 Page: 197 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; General Nursing Interventions Feedback 1

Ask outright if thepatient is considering suicide and, if so, how and when.

Asking a patient to talk about suicidal thoughts does not enhance thechance of completing a suicide. Rather, it demonstrates caring and acknowledges his value as a person.

2

Any person can become suicidal even without a psychiatric diagnosis; therefore, this question is not themost important.

3

Although asking whom he lives with can give an indication of support, it is not themost important question to ask.

4

Any person can become suicidal even without psychiatric therapy; therefore, this question is not themost important.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

9. ANS: 4 Page: 197 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; General Nursing Interventions Feedback 1

Often thesuicidal person is so immersed in feelings of hopelessness and isolation that he is unable to identify plans 5 years from now.

2

This is a closed-ended question that does not truly address thepatient’s potential for suicide.

3

Changing thesubject to other patients may block communication and will not address thepatient’s potential for suicide.

4

A direct approach is thebest way to gain this information. Ask outright if thepatient is considering suicide and, if so, how and when. Asking a patient to talk about suicidal thoughts does not enhance thechance of completing a suicide.

Rather, it demonstrates caring and acknowledges his or her value as a person.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

10. ANS: 3 Page: 197 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; General Nursing Interventions Feedback 1

Suicidal ideations are suicidal thoughts, not gestures.

2

Liquid medication decreases thechance that patients will “cheek” themedication.

Copyright © 2019 F. A. Davis Company

3

The nurse should assist in problem solving to identify alternative solutions to problems thepatient views as insurmountable.

4

The patient may not know thereason for these feelings.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

11. ANS: 3 Page: 197 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; General Nursing Interventions Feedback 1

The patient may be happy about thedecision to commit suicide rather than getting better. thenurse should not assume thepatient has decided against suicide.

2

The patient may be happy about thedecision to commit suicide. Therefore, thenurse should not communicate relief.

3

The nurse would want to know themeaning of thepatient’s words, as they could be interpreted as a decision to commit suicide rather than making assumptions about what they mean.

4

The patient may be happy about thedecision to commit suicide rather than getting better. Although thenurse should clarify what thepatient means, a different response is more therapeutic.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

12. ANS: 1 Copyright © 2019 F. A. Davis Company

Page: 198 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 13: Suicide; General Nursing Interventions; Box 13-2, Talking with a Suicidal Patient to Evaluate Lethality Feedback 1

This patient clearly has themeans available and a specific plan along with suicidal intent; thus, this patient is at highest risk.

2

There is no plan just a threat; this patient is not thehighest risk.

3

This patient has no plan, so this is not as lethal as one who has a specific plan.

4

Although thepatient states that he or she admires people who kill themselves, thepatient states that he or she is not that brave. This indicates that there is no plan of suicide.

PTS: 1 REF: Chapter 13: Suicide; General Nursing Interventions; Box 13-2 Talking with a Suicidal Patient to Evaluate Lethality 13. ANS: 1 Page: 197 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; General Nursing Interventions Feedback

Copyright © 2019 F. A. Davis Company

1

This response is an open-ended question to encourage thepatient to talk.

2

Asking a patient “why” is nontherapeutic and places thepatient on thedefensive.

3

This response is judgmental, uses platitudes, and will block communication.

4

This response is judgmental, belittles thepatient, and will block communication.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

14. ANS: 2 Page: 197 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Self-destructive Behaviors Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; General Nursing Interventions Feedback 1

Asking a patient “why” is nontherapeutic and places thepatient on thedefensive.

2

This response communicates clearly and honestly concern for thepatient’s safety.

3

This response belittles thepatient and indicates thepatient is at fault rather than thenurse’s responsibility to provide safety.

4

This response shifts thefocus from thenurse’s responsibility to provide patient safety to thedoctor.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

15. ANS: 2 Page: 197 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Self-destructive Behaviors Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 13: Suicide; General Nursing Interventions Feedback 1

This response might close off communication and is eliciting more information that is not necessary.

2

This response uses open-ended statements to elicit more information rather than jumping to conclusions that might close off communication.

3

This response might close off communication and is eliciting more information that is not necessary.

4

This response is advising. This could close off communication by jumping to conclusions before any information is obtained.

PTS: 1

REF: Chapter 13: Suicide; General Nursing Interventions

Chapter 14. Personality Disorders Multiple Choice Identify thechoice that best completes thestatement or answers thequestion. ____ 1. Patients with antisocial personality disorder: 1. Generally must have immediate gratification.

2. Display a great deal of responsibility toward others.

3. Show a great deal of anxiety.

4. Have obsessive thoughts when in a social situation.

____ 2. Barbara is a new patient on your floor who is being assessed for several disorders, including suicide potential. You learn she attempts suicide every 6 to 12 months because she cannot tolerate living alone. She is unable to see two sides of a situation or an individual; they are either all good or all bad. You consider which of thefollowing as a potential diagnosis for Barbara?

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1. Borderline personality disorder 2. Multiple personality disorder 3. Narcissistic personality disorder 4. Antisocial personality disorder

____ 3. A patient with borderline personality disorder approaches you and voices concern that she is being ignored and feels unimportant. thepatient blames thenursing staff for these feelings because thenurses are “not paying attention” to her. Your best therapeutic response to this patient is: 1. “I will bring it up at our next meeting.”

2. “It’s all in your imagination.”

3. “Tell me more about your feeling of being ignored.”

4. “You need to share your feelings with theindividual nurses you feel are ignoring you.”

____ 4. Nurses understand that a major cause of personality disorders is: 1. Neurochemical imbalance.

2. Genetics.

3. Dysfunctional family relationships.

4. Anoxia.

____ 5. Nurses know that when working with patients who have personality disorders, themost difficult task for these patients will probably be: 1. Following rules.

2. Getting along with others.

3. Hoarding their medications.

4. Participating in care plan meetings.

Copyright © 2019 F. A. Davis Company

____ 6. Nancy has antisocial personality disorder. Which of thefollowing is a goal of treatment for Nancy?

1. Comply with her medication regimen.

2. Participate in long-term therapy.

3. Become a group facilitator.

4. Eliminate her anxiety.

____ 7. Tony is a 25-year-old male patient who is being treated at your hospital day-treatment center. Tony is very charming and seems popular. He has theability to draw crowds around him, but you know he has been in trouble with thelaw several times since adolescence and lies constantly. You realize that Tony’s behavior is most likely which personality disorder?

1. Paranoid personality disorder 2. Schizoid personality disorder 3. Dependent personality disorder 4. Antisocial personality disorder

____ 8. Schizotypal personality disorder may be confused with what other psychiatric disorder?

1. Bipolar 2. Schizophrenia 3. Dual diagnosis 4. Paranoid personality

____ 9. Which characteristic is likely to be present in a patient with avoidant personality?

1. High self-esteem 2. Experiencing pleasure in life 3. Awkward in social situations 4. Very close relationships with family

Copyright © 2019 F. A. Davis Company

____ 10. You know your patient has a personality disorder. He tells you, “You are thebest nurse. I am so glad you are here today and not that mean nurse who was here yesterday.” Which personality disorder would be most associated with this statement?

1. Paranoid 2. Antisocial 3. Schizoid 4. Borderline

____ 11. Personality disorders are organized into three clusters. Which cluster is thediagnosis of schizotypal disorder placed in?

1. Cluster A 2. Cluster 1 3. Cluster B 4. Cluster C

____ 12. Your male patient tells you that he has women “throwing themselves” at him everywhere he goes.

From this statement, what is themost likely personality disorder he is exhibiting?

1. Borderline 2. Narcissistic 3. Paranoid 4. Antisocial

____ 13. Your male patient tells you that he has women “throwing themselves” at him everywhere he goes. thebest nursing response to thepatient is: 1. “Wow, that is impressive. Give me some tips.”

2. “Tell me about a recent relationship.”

3. “Let’s focus on activities for today.”

4. “Let’s go to thedayroom and see what happens.”

Copyright © 2019 F. A. Davis Company

____ 14. Which of thefollowing statements best describes obsessive-compulsive personality disorder?

1. Dramatic, extroverted behaviors with strong emotions.

2. Disregard and violation of therights of others.

3. A pattern of preoccupation with orderliness and perfectionism.

4. Pervasive, submissive, and clinging behavior.

____ 15. You find your patient with antisocial personality disorder smoking in thelounge where smoking is not allowed. Which response is best?

1. Make a general overhead announcement about no smoking.

2. Bring up thesmoking issue at thenext group session.

3. Tell thepatient directly he is not to be smoking here.

4. Encourage thepatient to identify why he has theneed to smoke now.

Copyright © 2019 F. A. Davis Company

Chapter 14. Personality Disorders Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 204 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Antisocial Personality Disorder Feedback 1

Immediate gratification is a symptom of antisocial personality disorder.

2

Showing little concern for therights or feelings of others is a symptom of antisocial personality disorder.

3

Anxiety is not a symptom of antisocial personality; these types of people have no remorse for their behaviors.

4

Despite their inability to feel or show affection, patients with antisocial/sociopathic personality disorder are usually gregarious, intelligent, and likable but can quickly move to aggression if frustrated.

PTS: 1

REF: Chapter 14: Personality Disorders; Antisocial Personality Disorder

2. ANS: 1 Page: 205 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Copyright © 2019 F. A. Davis Company

Chapter 14: Personality Disorders; Borderline Personality Disorder Feedback 1

Individuals with borderline personality disorder (BPD) often exhibit both clinging and distancing behavior as they struggle with fears of separation and abandonment. Splitting in BPD is manifested by a patient who needs to see others as all good or all bad.

2

Multiple personality disorder indicates that theperson has more than one personality.

3

A person with narcissistic personality disorder tends to display an exaggerated impression of self with an inflated sense of self-importance.

4

Sometimes referred to as sociopaths, people with antisocial personality disorder disregard therights of others.

PTS: 1

REF: Chapter 14: Personality Disorders; Borderline Personality Disorder

3. ANS: 4 Page: 205 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Feedback 1

If a patient complains about other staff members, avoid taking sides or acting as intermediary.

2

This response ignores and blames thepatient for feeling ignored and unimportant.

3

This response is less effective with a borderline patient, who may not understand her feelings.

4

If a patient complains about other staff members, never encourage them. Rather,

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point out that thepatient needs to address her concerns with theindividual and not complain about staff members to others.

PTS: 1

REF: Chapter 14: Personality Disorders; Borderline Personality Disorder

4. ANS: 3 Page: 203 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Feedback 1

Neurochemical imbalance is not a major cause of personality disorders.

2

Although genetics may play a role in some, it is not themajor cause.

3

Personality disorders often have their roots in difficult relationships with parental figures. Although each disorder has its own dynamics, this relationship is thethread that runs through all of them.

4

Anoxia is not a major cause of personality disorders.

PTS: 1

REF: Chapter 14: Personality Disorders; Introduction

5. ANS: 2 Page: 202 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Introduction

Copyright © 2019 F. A. Davis Company

Feedback 1

While following rules may be a problem for some personality disorders (antisocial), it is not themost difficult overall.

2

The most common characteristic of personality disorders is dysfunction in interpersonal relationships.

3

Hoarding their medications is not themost difficult task.

4

Participating in care plan meetings is not themost difficult task.

PTS: 1

REF: Chapter 14: Personality Disorders; Introduction

6. ANS: 2 Page: 208 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Psychiatric Treatment of Personality Disorders Feedback 1

Medications are generally not useful for these types of patients.

2

Maintaining a long-standing trusting relationship with a therapist can be advantageous.

3

People with antisocial personality have no regard for others and should not become a group facilitator.

4

Nancy will probably not experience anxiety.

PTS: 1 REF: Chapter 14: Personality Disorders; Psychiatric Treatment of Personality Disorders

Copyright © 2019 F. A. Davis Company

7. ANS: 4 Page: 204 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Antisocial Personality Disorder Feedback 1

Individuals with paranoid personality present with behaviors of suspiciousness and mistrust of other people.

2

People with schizoid personality disorder have a pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. They may appear shy and introverted.

3

Dependent personality is a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors along with fears of separation.

4

People with antisocial personality disorder are usually gregarious, intelligent, and likable, but they often use manipulation to achieve their goals and have been in trouble with thelaw.

PTS: 1

REF: Chapter 14: Personality Disorders; Antisocial Personality Disorder

8. ANS: 2 Page: 204 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Schizotypal Personality Disorder Feedback Copyright © 2019 F. A. Davis Company

1

Bipolar has periods of mania and depression; this does not describe schizotypal.

2

Behavior in this disorder is often odd and eccentric, but not to thelevel of schizophrenia. However, under stress, this person may decompensate with psychotic symptoms such as delusions and hallucinations.

3

A person with a dual diagnosis has two disorders; this does not describe schizotypal.

4

Individuals with paranoid personality present with behaviors of suspiciousness and mistrust of other people; people with schizotypal personality disorder are aloof and isolated and appear to be in their own world.

PTS: 1

REF: Chapter 14: Personality Disorders; Schizotypal Personality Disorder

9. ANS: 3 Page: 207 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Avoidant Personality Disorder Feedback 1

Patients with avoidant personality have low self-esteem.

2

Patients with avoidant personality have anhedonia, a lack of pleasure in life.

3

Patients with avoidant personality are awkward in social situations.

4

Patients with avoidant personality avoid close relationships.

PTS: 1

REF: Chapter 14: Personality Disorders; Avoidant Personality Disorder

10. ANS: 4 Page: 206 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Borderline Personality Disorder Feedback 1

Individuals with paranoid personality present with behaviors of suspiciousness and mistrust of other people.

2

Sometimes referred to as sociopaths, people with antisocial personality disorder disregard therights of others.

3

People with schizoid personality disorder have a pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

4

A common characteristic of borderline personality is to see people as all good and all bad and attempt to pit one against theother to “split” thestaff.

PTS: 1

REF: Chapter 14: Personality Disorders; Borderline Personality Disorder

11. ANS: 1 Page: 203 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Introduction Feedback 1

Schizotypal personality disorder is in theCluster A category because thebehaviors are odd.

2

There is no such category called Cluster 1.

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3

Cluster B category is described as dramatic and includes antisocial and borderline.

4

Cluster C category is described as anxious or fearful and includes avoidant and obsessive-compulsive.

PTS: 1

REF: Chapter 14: Personality Disorders; Introduction

12. ANS: 2 Page: 207 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Narcissistic Personality Disorder Feedback 1

Individuals with borderline personality disorder often exhibit both clinging and distancing behavior as they struggle with fears of separation and abandonment.

They are known for intense and chaotic relationships as well as self-destructive, impulsive, and dramatic coping.

2

Those who have narcissistic personality disorder tend to display an exaggerated impression of self with an inflated sense of self-importance and fantasies of ongoing success (women “throwing themselves” at him).

3

Individuals with paranoid personality present with behaviors of suspiciousness and mistrust of other people.

4

Sometimes referred to as sociopaths, people with antisocial personality disorder disregard therights of others.

PTS: 1

REF: Chapter 14: Personality Disorders; Narcissistic Personality Disorder

Copyright © 2019 F. A. Davis Company

13. ANS: 2 Page: 211 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 14: Personality Disorders; Table 14-1, Nursing Interventions for Personality Disorders Feedback 1

Encouraging thepatient is not therapeutic.

2

Encouraging thepatient to focus on a specific relationship rather than focusing on generalizations is more helpful for thepatient.

3

This response does not encourage thepatient to learn to accept limitation in self and others.

4

Testing thepatient’s belief is not therapeutic.

PTS: 1 REF: Chapter 14: Personality Disorders; Table 14-1 Nursing Interventions for Personality Disorders 14. ANS: 3 Page: 208 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Personality Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 14: Personality Disorders; Obsessive-Compulsive Personality Disorder Feedback 1

Histrionic personality disorder is characterized by dramatic, excessive, extroverted behaviors in someone who has a pattern of strong emotions.

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Excessive attention-seeking, seductive, and provocative behaviors are additionally seen.

2

Disregard and violation of therights of others is characteristic of antisocial personality disorder.

3

Obsessive-compulsive personality disorder is characterized by a pattern of preoccupation with orderliness and perfectionism.

4

Dependent personality disorder is characterized by pervasive submissive and clinging behavior.

PTS: 1

REF: Chapter 14: Personality Disorders; Obsessive-Compulsive Personality

Disorder 15. ANS: 3 Page: 210 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Personality Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 14: Personality Disorders; Antisocial Personality Disorder; Table 14-1, Nursing Interventions for Personality Disorders Feedback 1

This type of patient needs clear, direct limits set; this is indirect.

2

This type of patient needs clear, direct limits set; this is indirect.

3

This patient needs clear limits at thetime of theinfraction and it should be handled directly. This type of patient needs clear expectation that you are not negotiating.

4

This type of patient has no remorse for actions, and focusing on reasons for behavior is usually not effective. Those with antisocial personality disorder are

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difficult to treat because they often have little motivation to change.

PTS: 1 REF: Chapter 14: Personality Disorders; Antisocial Personality Disorder; Table 14-1 Nursing Interventions for Personality Disorders Chapter 15. Schizophrenia Spectrum and Other Psychotic Disorders Multiple Choice Identify thechoice that best completes thestatement or answers thequestion. ____ 1. Your new patient is admitted with a diagnosis of schizophrenia. Which of thefollowing is thepatient most likely to demonstrate?

1. Concrete thinking 2. Effective ego boundaries 3. Inflated self-image 4. Fatigue and loss of appetite

____ 2. Your patient with schizophrenia who is English-speaking says “no acu moona” to you. What is this called?

1. Neologism 2. Echolalia 3. Echopraxia 4. Concretism

____ 3. Which of thefollowing is a positive sign of schizophrenia?

1. Hallucinations 2. Avolition 3. Blunted affect Copyright © 2019 F. A. Davis Company

4. Social withdrawal

____ 4. Your hospitalized schizophrenic patient has been taking clozapine (Clozaril) for several months.

You recognize this medication is effective by which of thefollowing patient reports?

1. He no longer has a memory of past psychotic behavior.

2. He is drowsier, so less bothered by thehallucinations.

3. He no longer hears voices.

4. He is more uncomfortable around others.

____ 5. A schizophrenic patient has been taking fluphenazine (Prolixin) for 6 months. She now is experiencing extrapyramidal symptoms (EPS). Which medication is most likely to be added?

1. Acetaminophen (Tylenol) 2. Alprazolam (Xanax) 3. Benztropine (Cogentin) 4. Amitriptyline (Elavil)

____ 6. You find your schizophrenic patient sitting in a wet bed and singing nursery rhymes. What should you do?

1. Ask why thepatient did not call for help.

2. Help thepatient clean up in a calm manner.

3. Show thepatient again where thebathroom is.

4. Tell thepatient his privileges will be withdrawn if this happens again.

____ 7. Which of thefollowing is themost appropriate nursing intervention for a patient with schizophrenia?

1. Teach thepatient about theillness.

2. Maintain consistency with thepatient’s plan of care.

3. Insist that thepatient participate in all activities provided on theunit.

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4. Allow thepatient time to listen to theradio alone in his or her room.

____ 8. Max says, “Nurse, see that man on thetelevision? He is thereason why I am sick. He told them to make me this way.” thenurse documents this as an episode of: 1. Hallucination.

2. Delusion.

3. Illusion.

4. Loose associations.

____ 9. When discharging a schizophrenic patient who is taking haloperidol (Haldol), it is important for thenurse to advise thepatient to: 1. Keep track of how much salt and water he or she consumes.

2. Avoid strenuous exercise.

3. Report any symptoms of tremors right away.

4. Stop taking themedication if dry mouth develops, and call thedoctor immediately.

____ 10. You are helping with breakfast service in thedining room. A resident begins screaming and hitting her food stating, “There are bugs on my eggs. Bugs! Get them off.” You approach her to see that someone sprinkled pepper on her eggs. An appropriate response is: 1. “No, those aren’t bugs! That is just pepper.”

2. “Don’t eat them then if you believe those are bugs. Eat thetoast instead. There are no bugs on thetoast.”

3. “I see no bugs; only pepper. I will get you a new plate of food.”

4. “There are no bugs! Nobody else sees bugs!”

Completion Complete each statement.

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11. Your patient describes feeling spiders crawling on his skin rather than seeing spiders. This is an example of a(n) ____________________ hallucination.

12. The nurse tells theschizophrenic patient “it’s time to go to bed.” thepatient responds with “it’s time for bed, it’s time for bed, it’s time for bed.” thepatient’s response is an example of ____________________.

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion. ____ 13. Which of thefollowing are true about atypical antipsychotics (select all that apply)?

1. Weak dopamine receptor antagonists 2. Strong dopamine receptor antagonists 3. Higher risk of extrapyramidal symptoms 4. Used to treat negative and positive symptoms of schizophrenia 5. Only available in oral form

____ 14. Which of thefollowing are valid nursing interventions in treating schizophrenic patients (select all that apply)?

1. Do not reinforce hallucinations, delusions, or illusions.

2. Provide a stimulating environment for thepatient to provide distraction.

3. Keep communication simple.

4. Whisper when thepatient is around.

5. Emphasize behavior that is appropriate to thesituation.

6. Encourage thepatient to confront stressful situations.

____ 15. Antipsychotics are used to treat schizophrenia and other acute psychotic behavior. Typical antipsychotic agents treat these symptoms (select all that apply): Copyright © 2019 F. A. Davis Company

1. The negative symptoms of schizophrenia 2. Hallucinations 3. Delusions 4. Social withdrawal 5. Suspiciousness

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Chapter 15. Schizophrenia Spectrum and Other Psychotic Disorders Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 219 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Psychotic Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms Feedback 1

Concrete thinking (literal interpretation of theenvironment) is a positive symptom of schizophrenia.

2

People with schizophrenia do not have effective ego boundaries.

3

People with schizophrenia do not have inflated self-images.

4

People with schizophrenia do not have fatigue and loss of appetite; these occur in depression.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders;

Symptoms 2. ANS: 1 Page: 219 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorder Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms Copyright © 2019 F. A. Davis Company

Feedback 1

Neologisms are invented new words that only have meaning to theindividual.

2

Echolalia is parrot-like repeating of words spoken by others.

3

Echopraxia is repeating themovements of others.

4

Concretism is concrete thinking, or literal interpretation of theenvironment.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders;

Symptoms 3. ANS: 1 Page: 218 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorders Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms Feedback 1

Positive symptoms are those that are found among people with schizophrenia but not present among those who do not have thedisorder. They reflect an excess or distortion of normal functions such as delusions, thought disorders, and hallucinations.

2

Avolition, a lack of desire or motivation to accomplish goals, is a negative symptom. Negative symptoms are those found among people who do not have thedisorder but are missing or lacking among individuals with schizophrenia and reflect a lessening or loss of normal functions.

3

Blunted affect is a negative symptom. Negative symptoms are those found among people who do not have thedisorder but are missing or lacking among individuals with schizophrenia and reflect a lessening or loss of normal functions.

Copyright © 2019 F. A. Davis Company

4

Social withdrawal is a negative symptom. Negative symptoms are those found among people who do not have thedisorder but are missing or lacking among individuals with schizophrenia and reflect a lessening or loss of normal functions.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders;

Symptoms 4. ANS: 3 Page: 220 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Expected Actions/Outcomes Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia Feedback 1

Antipsychotics, like clozapine, do not erase memory.

2

Drowsiness may be a side effect of antipsychotics but does not reflect effectiveness.

3

Reduction in hallucinations is a target symptom that atypical antipsychotics, such as Clozaril, treat.

4

Being uncomfortable around others is not an indication of effectiveness.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia

Copyright © 2019 F. A. Davis Company

5. ANS: 3 Page: 222 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorders: Adult Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Expected Actions/Outcomes Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia Feedback 1

Acetaminophen is given for fever and pain, not for EPS.

2

Alprazolam is an antianxiety agent, not an agent for EPS.

3

Extrapyramidal symptoms are generally managed with anticholinergic drugs such as benztropine, biperiden, trihexyphenidyl, dopaminergic agonists such as amantadine, or antihistamines such as diphenhydramine.

4

Amitriptyline is an antidepressant, not a drug for EPS.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia 6. ANS: 2 Page: 223 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Feedback 1

This response blames thepatient and is nontherapeutic. Avoid overreacting to

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thepatient’s abnormal behavior.

2

This response offers reassurance and assistance.

3

This response blames thepatient and is nontherapeutic. thepatient cannot necessarily control behavior.

4

This response blames thepatient and is nontherapeutic. thepatient cannot necessarily control behavior.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Nursing Care of theSchizophrenic Patient 7. ANS: 2 Page: 223 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions Feedback 1

Teaching may be too demanding for this patient; teaching of thefamily about theillness is recommended.

2

Consistency is therapeutic for a schizophrenic patient. Maintain a calm, consistent environment with a regular routine.

3

Insisting on participation in all activities is not therapeutic for a schizophrenic patient.

4

Too much time alone can reinforce hallucinations and delusions, especially with theradio playing.

PTS: 1 Copyright © 2019 F. A. Davis Company

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions 8. ANS: 2 Page: 219 Integrated Processes: Communication and Documentation Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-2, Common Delusions Feedback 1

Hallucinations refer to altered sensory perceptions, like seeing someone who is not there or hearing voices.

2

This is an example of reference delusion. A delusion is a fixed, false belief.

3

Illusions are misinterpretations of real stimuli.

4

Ideas that shift from one unrelated thought to another are loose associations.

Loose associations would not be as organized as this delusion.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-2 Common Delusions 9. ANS: 3 Page: 222 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Application

Copyright © 2019 F. A. Davis Company

Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Adverse Effects/Contraindications/Side Effects/Interactions Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1, Extrapyramidal Side Effects Feedback 1

Lithium, not haloperidol, requires monitoring of salt and water intake.

2

Haloperidol has no restrictions on exercise.

3

Tremors could be a sign of extrapyramidal symptoms. Medications need to be added to treat this to prevent further complications.

4

Dry mouth, an anticholinergic side effect, is common and would not be a reason to stop taking this drug. Sugarless candy, good oral hygiene, and saliva substitute are possible solutions to this side effect.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1 Extrapyramidal Side Effects 10. ANS: 3 Page: 223 | Page: 225 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; Table 15-7, Suggested Interventions for Patients with Schizophrenia Who Are Hallucinating Feedback 1

There is a difference in meaning between “I see no bugs” and “no, those aren’t

Copyright © 2019 F. A. Davis Company

bugs.” thepatient may perceive you are arguing with her.

2

This response reinforces thehallucination or illusion and is nontherapeutic.

3

This response is reality-based, lets thepatient know you heard her, and then directs attention to a new plate of food. This acknowledges thepatient experience rather than denying it and then moves her into thehere and now (getting a plate of food).

4

This response pulls more people into themisinterpretation of reality and is nontherapeutic. thepatient may perceive you as arguing with her and overreacting.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; Table 15-7 Suggested Interventions for Patients with Schizophrenia Who Are Hallucinating COMPLETION 11. ANS: tactile Page: 220 Rationale: Tactile hallucination involves thesense of touch, crawling on skin.

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-3, Recognizing Hallucinations PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-3 Recognizing Copyright © 2019 F. A. Davis Company

Hallucinations 12. ANS: echolalia Page: 219 Rationale: This is a symptom seen in schizophrenia where thepatient repeats over and over words spoken by others.

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders;

Symptoms MULTIPLE RESPONSE 13. ANS: 1, 4 Page: 220 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Adverse Effects/Contraindications/Side Effects/Interactions Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia

Feedback 1.

Correct. Atypical antipsychotics are weaker dopamine receptor antagonists.

Copyright © 2019 F. A. Davis Company

2.

Incorrect. Typical antipsychotics are stronger dopamine receptor antagonists.

3.

Incorrect. Typical antipsychotics have more side effects; atypical antipsychotics generally have fewer side effects.

4.

Correct. Atypical antipsychotics treat both positive and negative symptoms.

5.

Incorrect. Some formulations are available in long-acting injections.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia 14. ANS: 1, 3, 5 Page: 223 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication

Feedback 1.

Correct. Never reinforce hallucinations, delusions, or illusions. An example of an inappropriate response from thenurse is, “Jesus wants you to take these pills.” That response reinforces thedelusion about Jesus.

2.

Incorrect. Maintain a calm, consistent environment with a regular routine.

3.

Correct. Remember that schizophrenic patients are often very concrete thinkers, so it is important to speak clearly and plainly.

4.

Incorrect. Avoid whispering or laughing when thepatient cannot hear thewhole conversation; such behavior can promote paranoia.

5.

Correct. This reinforces reality without creating more stress for thepatient.

6.

Incorrect. This could make thesituation worse by increasing stress and anxiety

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for thepatient.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions 15. ANS: 2, 3, 5 Page: 218 | Page: 220 Integrated Processes: Teaching/Learning Content Area: Mental Health: Psychotic Disorders Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies; Expected Actions/Outcomes Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; Psychiatric Treatment of Schizophrenia

Feedback 1.

Incorrect. Typical antipsychotic agents treat thepositive symptoms of schizophrenia; atypical antipsychotic agents treat both positive and negative symptoms.

2.

Correct. Typical antipsychotic agents treat thepositive symptoms of schizophrenia; hallucinations are positive symptoms.

3.

Correct. Typical antipsychotic agents treat thepositive symptoms of schizophrenia; delusions are positive symptoms.

4.

Incorrect. Typical antipsychotic agents treat thepositive symptoms of schizophrenia; social withdrawal is a negative symptom.

5.

Correct. Typical antipsychotic agents treat thepositive symptoms of schizophrenia; suspiciousness is a positive symptom.

Copyright © 2019 F. A. Davis Company

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; Psychiatric Treatment of Schizophrenia Chapter 16. Neurocognitive Disorders: Delirium and Dementia Multiple Choice Identify thechoice that best completes thestatement or answers thequestion. ____ 1. Your patient with advanced Alzheimer’s disease keeps searching theunit for her mother who died many years ago. How should you respond?

1. “Your mother isn’t here—she died long ago.”

2. “Let’s go to theactivity room and see what’s going on.”

3. “You must be upset that you can’t find her.”

4. “What makes you keep looking for your mother?”

____ 2. Your patient is on donepezil (Aricept). This tells you your patient has which disorder?

1. Dementia 2. Obsessive-compulsive disorder 3. Major depression 4. Delirium

____ 3. Team members working with patients who have dementia need to have a common, unified approach because this type of patient requires: 1. Sameness and consistency in their lives.

2. Strict rules and regulations.

3. Behavior modification at all times.

4. Staff who cannot be manipulated.

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____ 4. The best way to assist a patient who has mild Alzheimer’s disease is to: 1. Ask thephysician to keep thepatient sedated to avoid “acting-out” behaviors.

2. Provide strict, one-on-one behavior modification techniques to prevent further cognitive deterioration.

3. Encourage thefamily to begin preparations to move theperson to a skilled nursing facility.

4. Provide a stable, safe, and consistent environment.

____ 5. A person who is receiving tests to confirm a diagnosis of Alzheimer’s disease is preparing for a computerized tomography (CT) test. thepatient becomes restless and is unable to follow thepreexamination directions given by thepersonnel. As thenurse who is assisting thepatient, your best action at this time is to: 1. Tell thepatient that refusing to cooperate will require having to return another day.

2. Give thepatient thewritten instructions.

3. Take thepatient to a quiet waiting area until it is time for theCT scan.

4. Make certain that thepatient is tightly strapped to theexamination table during thetest.

____ 6. Your new patient is admitted to your nursing home with a diagnosis of vascular dementia. You know that this type of dementia differs from Alzheimer’s dementia in what way?

1. The progression of symptoms is predictable based on theperson’s heart disease.

2. The progression of symptoms is more variable than Alzheimer’s disease.

3. Vascular dementia can be treated successfully with surgery compared with Alzheimer’s disease for which there is no surgical treatment.

4. Vascular dementia is temporary and Alzheimer’s dementia is permanent.

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____ 7. Mavis Brown is a 75-year-old patient in your nursing home. She has Alzheimer’s disease. Mavis comes to you at thedesk one day and is crying. She says, “You all hate me. Everyone hates me!”

Your most therapeutic reply is: 1. “Nobody here hates you, Mavis.”

2. “Why do you feel hated, Mavis?”

3. “You seem upset, Mavis. Let’s go for a walk and talk.”

4. “It’s time for your medication, Mavis.”

____ 8. Henry Smith is 88 years old and has been having periods of disorientation and confusion that worsen at night. He has been given a diagnosis of Alzheimer’s disease. When you pick up Henry’s tray after supper, you observe that he has not touched any of thefood. As his nurse, you understand that themost likely cause of his not eating is: 1. He is too depressed to eat.

2. He sees ants in his food.

3. He is too forgetful to remember to eat.

4. He is deliberately obstinate.

____ 9. A patient may be suffering from sundowning. What is thealternate name for this condition?

1. Nocturnal delirium 2. Vascular dementia 3. Pseudodementia 4. Neurocognitive confusion

____ 10. Which of thefollowing activities would be most appropriate for a patient who is in themoderate stage of Alzheimer’s disease?

1. A large jigsaw puzzle 2. Trivial Pursuit 3. A scavenger hunt Copyright © 2019 F. A. Davis Company

4. Playing a game of catch with a soft ball

____ 11. Pharmacological treatment of delirium is most likely to include which medication?

1. Antidepressants 2. Tranquilizers 3. Antipsychotics 4. Stimulants

____ 12. Andrea’s mother has been becoming more and more forgetful. It seems to have gotten worse over thepast 15 years. Her most likely diagnosis could be: 1. Depression.

2. Alzheimer’s disease.

3. Hyperthyroidism.

4. Delirium.

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion. ____ 13. Of thefollowing, which interventions are part of an effective care plan for someone with advanced dementia (Select all that apply)?

1. Keep thepatient busy with structured activities.

2. Keep televisions and radios on whenever possible to encourage patient interaction.

3. Allow more time for performing care.

4. Emphasize “reality orientation.”

5. Encourage independent decision making.

6. Provide group therapy opportunities to share feelings and problems.

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____ 14. Which of thefollowing are characteristics of delirium? (Select all that apply) 1. Slow onset 2. Sudden onset 3. Fluctuating mental status 4. Treatment is focused on finding thecause 5. Progressive decline common despite treatment 6. Can be caused by psychological stress 7. Treatment thesame no matter what thecause 8. Consistent pattern of decline

True/False Indicate whether thestatement is true or false. ____ 15. All dementias are a form of Alzheimer’s disease.

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Chapter 16. Neurocognitive Disorders: Delirium and Dementia Answer Section MULTIPLE CHOICE 1. ANS: 2 Page: 238 Integrated Processes: Implementation Content Area: Mental Health: Cognitive Disorder Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Feedback 1

Changes in thebrain will not allow thememory to function successfully and may, in fact, cause thepatient to experience frustration, feel agitation, and increase acting-out behaviors if reality orientation is emphasized.

2

This response is themost helpful. Distraction can be helpful in some cases because it refocuses thepatient’s attention to thehere and now.

3

This makes assumptions and may cause more agitation with theword “upset.”

4

Open-ended questions are less effective with advanced Alzheimer’s disease.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; General Nursing Interventions 2. ANS: 1 Page: 236 Integrated Processes: Nursing Process: Analysis Content Area: Geriatrics: Pharmacology Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Feedback 1

Donepezil, a cholinesterase inhibitor, is a major treatment for dementia. theU.S. Food and Drug Administration (FDA) has approved two types of medications— cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda)—to treat thecognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer’s disease.

2

Donepezil is not approved for obsessive-compulsive disorder.

3

Donepezil is not approved for major depression.

4

Donepezil is not approved for delirium.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders; Pharmacology Corner; Table 16-4 Cholinesterase Inhibitors 3. ANS: 1 Page: 239 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Cognitive Disorder Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts: Therapeutic Environment Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions Feedback 1

Consistency is important when short-term memory is limited. thepatient can count on that approach even when he or she can’t remember details.

2

Strict rules and regulations aren’t useful when short-term memory is impaired.

3

Behavior modification is not useful when short-term memory is impaired.

Copyright © 2019 F. A. Davis Company

4

Patients with dementia are not using manipulation; their short-term memory is impaired.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions 4. ANS: 4 Page: 239 Integrate Process: Nursing Process: Implementation Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts: Therapeutic Environment Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions Feedback 1

Keeping thepatient sedated is considered chemical restraint, and it is inappropriate.

2

In Alzheimer’s disease preventing further cognitive deterioration is not possible; Alzheimer’s is irreversible. Behavior medication is generally ineffective with cognitive deterioration if theperson cannot remember therewards.

3

A person with mild Alzheimer’s is usually still functioning independently; it is too early to begin moving thepatient to a skilled nursing facility.

4

A stable, consistent environment will give thepatient with Alzheimer’s disease cues to maintain participation and orientation.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions Copyright © 2019 F. A. Davis Company

5. ANS: 3 Page: 238 Integrated Processes: Nursing Process: Analysis/Implementation Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Environment and Communication Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions Feedback 1

The patient is not refusing to cooperate; thepatient with Alzheimer’s becomes overwhelmed when in a new environment.

2

The patient with Alzheimer’s will not be able to comprehend thewritten information.

3

Rather than flood thepatient with a lot of information or demands, it is more important to create a calm environment to reduce thepatient’s fear of theunknown.

4

Tightly strapped to theexamination table is physically restraining thepatient and inappropriate. This will likely increase agitation and confusion.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; General Nursing Interventions 6. ANS: 2 Page: 237 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Cognitive Disorders Copyright © 2019 F. A. Davis Company

Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Other Forms of Dementia Feedback 1

The progression is not predictable and is not based on heart disease.

2

Vascular dementia’s progression depends on therecurrence of new strokes. It can be stable for long periods if there are no strokes.

3

There is no surgical treatment for this type of dementia nor for Alzheimer’s.

4

The damage from vascular is permanent just like it is in Alzheimer’s.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Other Forms of Dementia 7. ANS: 3 Page: 238 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia Feedback 1

This invalidates thepatient’s feeling and is nontherapeutic; an Alzheimer’s patient could perceive this as arguing.

2

Asking “why” is nontherapeutic because it causes Mavis to focus on analyzing thecause of her feelings, which she does not know.

3

This response acknowledges her feelings but uses an activity to distract her rather than focus on analyzing thecause, which she does not know.

4

While changing thesubject can be useful with some Alzheimer’s patients, it is

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not themost therapeutic for this situation.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia 8. ANS: 3 Page: 230 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimer’s Disease Feedback 1

Although Henry has Alzheimer’s, he is not necessarily depressed.

2

Seeing ants in his food would indicate hallucination. Because Henry has Alzheimer’s, themost probable cause is forgetting, not hallucinating.

3

Memory loss can lead to forgetting to perform daily, routine functions like eating. This is themost likely cause of Henry not eating.

4

Henry is not manipulative; he most likely cannot remember to perform routine functions, such as eating, because of theAlzheimer’s.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimer’s Disease 9. ANS: 1 Page: 229 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Cognitive Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium Feedback 1

The patient may exhibit nocturnal delirium, known as sundowning, when confusion and agitation increase at dusk.

2

Vascular dementia is sometimes referred to as multi-infarct dementia or vascular neurocognitive disease.

3

Sometimes depression can mimic dementia; in that case, it is referred to as pseudodementia.

4

While neurocognitive confusion may lead to sundowning, this is not theterm for sundowning.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium

10. ANS: 4 Page: 234 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication and Environment Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; Box 16-3, theStages of Alzheimer’s Disease Feedback 1

A large jigsaw puzzle requires too much concentration. A patient in themoderate stage of Alzheimer’s has damage to nerve cells in thebrain that make it difficult

Copyright © 2019 F. A. Davis Company

to express thoughts or concentrate.

2

Trivial Pursuit requires too much concentration and memory. A patient in themoderate stage of Alzheimer’s has damage to nerve cells in thebrain that make it difficult to express thoughts or concentrate.

3

A scavenger hunt requires too much concentration and problem-solving. A patient in themoderate stage of Alzheimer’s has damage to nerve cells in thebrain that make it difficult to express thoughts or concentrate.

4

Physical activity can improve mood and does not put stress on thepatient to concentrate.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; Box 16-3 theStages of Alzheimer’s Disease 11. ANS: 3 Page: 231 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Treatment of Delirium; Pharmacology Corner Feedback 1

Antidepressants are used for depression, not delirium.

2

Tranquilizers are not used to treat delirium.

3

Prescribing medications to control delirium symptoms is risky because these medications can mask or compound theconfusion and agitation. However, at times, low-dose antipsychotic medications such as haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa) may be needed to address

Copyright © 2019 F. A. Davis Company

agitation.

4

Stimulants are not used to treat delirium.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Treatment of Delirium; Pharmacology Corner 12. ANS: 2 Page: 231 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Cognitive Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 16: Neurocognitive Disorders; Dementia Feedback 1

Depression is extreme sadness with a negative outlook, not forgetfulness.

2

Alzheimer’s is a slow, progressive form of dementia where deterioration is expected consistently over many years.

3

Hyperthyroidism is an overactive thyroid gland, not forgetfulness.

4

Delirium is an acute reaction to underlying physiological (e.g., toxins, drugs, illness) or psychological (e.g., sensory overload) stress.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders; Dementia

MULTIPLE RESPONSE 13. ANS: 1, 3 Page: 238 Integrated Processes: Nursing Process: Implementation Copyright © 2019 F. A. Davis Company

Content Area: Mental Health: Cognitive Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication and Environment Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia

Feedback 1.

Correct. It is as detrimental to understimulate people with cognitive disorders as it is to overload them. The brain needs some encouragement to activate.

2.

Incorrect. Keep televisions and radios off or at a very low volume.

3.

Correct. The ability to function cognitively and physically is diminished when a person has dementia. Nurses and other health-care workers must remember to allow more time for performing care.

4.

Incorrect. With dementia patients, nurses should not emphasize “reality orientation” by asking or reminding the patient of his or her name, the year, and current location—especially in later stages of the disease. Changes in the brain will not allow the memory to function successfully and may, in fact, cause the patient to experience frustration, feel agitation, and increase acting-out behaviors if reality orientation is emphasized.

5.

Incorrect. As the dementia progresses, independent decision-making is lost.

6.

Incorrect. Group therapy is added stimulation that can increase the stress level of a patient with impaired memory.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia 14. ANS: 2, 3, 4, 6 Page: 237 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Cognitive Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium; Table 16-5, Characteristics of Delirium and Dementia

Feedback 1.

Incorrect. Dementia has a slow onset; delirium has a sudden onset.

2.

Correct. Delirium has a sudden onset.

3.

Correct. Delirium has fluctuating levels of awareness and symptoms.

4.

Correct. Treatment is focused on finding the cause because reversibility is possible with correct treatment.

5.

Incorrect. Dementia has a progressive decline despite treatment; delirium can be reversible with correct treatment.

6.

Correct. Delirium can be caused by psychological stress.

7.

Incorrect. Treatment for delirium depends on the cause.

8.

Incorrect. Delirium is fluctuating.

PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium; Table 16-5 Characteristics of Delirium and Dementia TRUE/FALSE 15. ANS: F Page: 237 Rationale: Alzheimer’s disease is a specific type of dementia. There are several other types not considered to be Alzheimer’s disease.

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Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Cognitive Disorders Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; Other Forms of Dementia PTS: 1 REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; Other Forms of Dementia Chapter 17. Substance Use and Addictive Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A new patient with a history of alcoholism is in the emergency department (ED) with agitation, vomiting, and tremors. He tells you he had his last drink 24 hours ago. Which medication would most likely be ordered?

1. Chlordiazepoxide 2. Disulfiram 3. Chlorpromazine 4. Naloxone hydrochloride

____ 2. Your patient has a long history of alcohol abuse. You know that denial is a frequently used defense mechanism. Which statement is indicative of denial?

1. “My father was a drinker, so I guess that led me to this.”

2. “I can stop anytime I want, I just don’t feel like it now.”

3. “Drinking calms my nerves.”

4. “I drink when my kids upset me.”

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____ 3. Which of the following statements from an alcoholic patient reflects a good understanding of his or her condition?

1. “I will stick to wine or beer from now on.”

2. “I’ll be OK if my wife will just stop nagging me.”

3. “I plan to take my sobriety one day at a time.”

4. “I won’t need alcoholics anonymous (AA) after I am sober for 1 year.”

____ 4. A teenager admits to you that he has been smoking marijuana. The nurse knows that marijuana is a(n): 1. Cannabis.

2. Amphetamine.

3. Hallucinogen.

4. Narcotic.

____ 5. Which drug cannot be given if the patient reports alcohol intake in the past 24 hours?

1. Chlorpromazine 2. Chlordiazepoxide 3. Disulfiram 4. Risperidone

____ 6. Your patient tells you her husband has a serious drinking problem. Which statement tells you she may be in a codependent relationship?

1. “I’ve reached my limit with his drinking.”

2. “I called his job and told them he was sick when he couldn’t go to work.”

3. “The kids are ashamed of their father. I feel bad about that.”

4. “He is drinking less this week.”

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____ 7. What should be your response to the wife who says, “I should get out of this bad situation with his drinking”?

1. “That happened to me. It’s best to get out while you can.”

2. “Tell me more about the bad situation.”

3. “Why don’t you talk to your husband about his drinking?”

4. “You’ll do what’s right.”

____ 8. Your new patient is at risk for alcohol withdrawal. You know that alcohol withdrawal tends to develop within what period after the last drink?

1. 1 week 2. 24 to 48 hours 3. 1 hour 4. More than 1 week

____ 9. The wife of your alcoholic patient has been attending Al-Anon meetings for the past 2 weeks. Which statement tells you the wife is benefitting from the meetings?

1. “I can tolerate his destructive behavior now that I see how bad other women have it.”

2. “I realize that I provoke his drinking when I go out with my friends.”

3. “I no longer feel that I have to tolerate his berating me.”

4. “It is great to get out of the house and away from the tension.”

____ 10. Which of the following are signs of withdrawal from heroin?

1. Insomnia, muscle cramps, vomiting 2. Excessive sleeping, low blood pressure, depression 3. Seizures, brain damage, excessive sleeping 4. Lethargy, panic disorder, increased appetite Copyright © 2019 F. A. Davis Company

____ 11. You are caring for a patient who has a long history of alcohol abuse. Recently, this patient went on a 5-day drinking binge, of which she has no memory. This is an example of: 1. Selective memory.

2. Wernicke’s syndrome.

3. Blackout.

4. Denial.

____ 12. Randi is a young model. She had been taking high doses of amphetamines to keep her weight down.

She recently decided to cut back on the drugs and she is now experiencing amphetamine withdrawal.

Which of the following sets of symptoms of amphetamine withdrawal is Randi likely experiencing?

1. Chest pain, palpitations, and diaphoresis 2. Depression, vivid dreams, and confusion 3. Euphoria, hyperactivity, and hyperalertness 4. Diaphoresis, clammy palms, and diarrhea

____ 13. A young adult arrives in the after-hours clinic with dilated pupils, an elevated heart rate, extreme sensitivity to sounds around him, sense of being outside of his body, and fine tremors of the hands.

The patient admits to recent use of an illegal street drug. As the nurse collecting this data, you suspect: 1. LSD. 2. “Crack” cocaine.

3. Amphetamines.

4. Sedatives.

Completion Complete each statement.

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14. You are completing the discharge plan for an alcoholic patient. Which support group for the patient should be included in the plan? _______________ _________________ Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 15. You find out that your schizophrenic patient is also using opioids to counteract the frightening hallucinations. What terms are used to describe this (Select all that apply)?

1. Dual diagnosis 2. Bipolar schizophrenia 3. Co-occurring disorder 4. Opioid-related schizophrenia 5. Schizophrenia: Addiction type

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Chapter 17. Substance Use and Addictive Disorders Answer Section MULTIPLE CHOICE 1. ANS: 1 Page: 253 Integrated Processes: Nursing Process: Assessment Content Area: Substance Abuse Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Alcohol Withdrawal; Table 17-2, Commonly Used Medications for Withdrawal Management of Alcohol and Other Substances Feedback 1

Generally, withdrawal is managed with longer-acting central nervous system depressants such as diazepam and chlordiazepoxide, which have anticonvulsant actions and are relatively safe. These are administered routinely and tapered down over several days.

2

Disulfiram was the first medicine approved for the treatment of alcohol abuse and alcohol dependence, but not for alcohol withdrawal. It works by causing a severe adverse reaction when someone taking the medication consumes alcohol.

3

Chlorpromazine is an antipsychotic used for treatment of schizophrenia, not withdrawal.

4

Naloxone hydrochloride is used for opioid addiction, not withdrawal. Naloxone can reduce cravings by interacting with the drug’s receptor system in the brain.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol Withdrawal; Table 17-2 Commonly Used Medications for Withdrawal Management of Alcohol and Other Substances Copyright © 2019 F. A. Davis Company

2. ANS: 2 Page: 262 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 17: Substance Use and Addictive Disorders; Table 17-4, Common Coping Styles of Substance Abusers Feedback 1

Noting that one’s own behavior is due to someone else’s represents rationalization, not denial.

2

This response indicates denial by minimizing or not acknowledging that he or she has a problem even when strong evidence is presented.

3

This response represents rationalization, not denial.

4

This response represents projection, not denial.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-4 Common Coping Styles of Substance Abusers 3. ANS: 3 Page: 262 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 17: Substance Use and Addictive Disorders; Treatment of Alcoholism; Table 17-4, Common Coping Styles of Substance Abusers Copyright © 2019 F. A. Davis Company

Feedback 1

This represents ineffective coping by substituting wine or beer.

2

This represents rationalization and projection, ineffective defense mechanisms.

3

The represents understanding of the disease as a lifelong struggle.

4

This represents ineffective coping. Membership in AA is a lifelong endeavor.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Treatment of Alcoholism; Table 17-4 Common Coping Styles of Substance Abusers 4. ANS: 1 Page: 254 Integrated Processes: Nursing Process: Analysis Content Area: Adolescent: Substance Abuse Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances Feedback 1

Marijuana is cannabis.

2

Marijuana is not an amphetamine; methamphetamine and Dexedrine are examples of amphetamines.

3

Marijuana is not a hallucinogen; LSD and mescaline are examples of hallucinogens.

4

Marijuana is not a narcotic; opioids like heroin and morphine are examples of narcotics.

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PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3 Comparing Commonly Abused Substances 5. ANS: 3 Page: 253 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse: Adult Health: Pharmacology Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration and Adverse Effects/Contraindications/Side Effects/Interactions Chapter 17: Substance Use and Addictive Disorders; Pharmacology Corner for Alcohol Feedback 1

Chlorpromazine is an antipsychotic used to treat schizophrenia.

2

Chlordiazepoxide is used to treat alcohol withdrawal.

3

Disulfiram (Antabuse) is used to treat alcoholism by producing severe adverse effects in the presence of alcohol. Any patient on disulfiram must be advised to avoid taking any substance with an alcohol base, including cough syrups and mouthwashes.

4

Risperidone is an antipsychotic used to treat schizophrenia.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Pharmacology Corner for Alcohol 6. ANS: 2 Page: 264 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Family Dynamics: Chemical and Other Dependencies Copyright © 2019 F. A. Davis Company

Chapter 17: Substance Use and Addictive Disorders; Impact on the Family; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions Feedback 1

This response indicates the reality of the situation.

2

This response shows that the wife is covering for her husband so he doesn’t have to take responsibility for his actions (codependency).

3

This response indicates the reality of the situation.

4

This response indicates denial.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Impact on the Family; Table 17-5 Problems With Substance Abuse: Symptoms and Nursing Interventions 7. ANS: 2 Page: 264 Integrated Processes: Nursing Process: Analysis/Implementation Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions Feedback 1

This response is giving advice and is nontherapeutic.

2

Using a general lead allows the wife to explain what is meant by “bad situation.” Supporting problem solving and helping her express herself is most important.

Copyright © 2019 F. A. Davis Company

3

Using “why” is nontherapeutic.

4

This response is assuming too much. The focus should be on allowing the wife to express her feelings.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5 Problems With Substance Abuse: Symptoms and Nursing Interventions 8. ANS: 2 Page: 250 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Knowledge Client Need: Physiological Integrity: Reduction of Risk Potential: Potential for Alterations in Body Systems Chapter 17: Substance Use and Addictive Disorders; Alcohol Withdrawal Feedback 1

This is too long.

2

Withdrawal symptoms are generally most intense on the second day of abstinence; however, they can occur as early as 8 hours after the last drink in a heavy drinker.

3

This is too short.

4

This is too long.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol Withdrawal

9. ANS: 3 Page: 264 Integrated Processes: Nursing Process: Analysis Copyright © 2019 F. A. Davis Company

Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Chemical and Other Dependencies: Coping Mechanisms Chapter 17: Substance Use and Addictive Disorders; Impact on the Family; Table 17-5, Problems with Substance Abuse: Symptoms and Nursing Interventions Feedback 1

This response indicates the wife continues to accept his bad behavior by rationalizing.

2

This response indicates the wife is taking responsibility for the husband’s drinking and enabling the husband’s behavior (codependent).

3

This response indicates she is not accepting a codependent role or enabling the husband’s behaviors.

4

This response indicates the wife is using the meetings as escape rather than a place to work on issues.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Impact on the Family; Table 17-5 Problems with Substance Abuse: Symptoms and Nursing Interventions 10. ANS: 1 Page: 257 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Comprehension Client Needs: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances Feedback Copyright © 2019 F. A. Davis Company

1

Insomnia, muscle cramps, and vomiting, along with yawning, rhinorrhea, and chills, are signs of withdrawal from heroin.

2

Insomnia, not excessive sleeping, occurs with heroin withdrawal. Low blood pressure and depression also do not occur.

3

Insomnia, not excessive sleeping, occurs with heroin withdrawal. Seizures and brain damage also do not occur.

4

Lethargy, panic disorder, and increased appetite do not occur in heroin withdrawal.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3 Comparing Commonly Abused Substances 11. ANS: 3 Page: 248 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Comprehension Client Need: Physiological Integrity: Physiological Adaptation: Illness Management Chapter 17: Substance Use and Addictive Disorders; Alcohol Feedback 1

This does not describe selective memory, the ability to remember some facts but not others.

2

This does not describe Wernicke’s syndrome, a neurological disorder from excessive drinking.

3

This does describe blackouts, lapses in memory resulting from persistent heavy drinking.

4

This does not describe denial, a refusal to accept reality.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol

12. ANS: 2 Page: 254 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances Feedback 1

Chest pain, palpitations, and diaphoresis do not typically occur in amphetamine withdrawal.

2

Depression, vivid dreams, and confusion along with insomnia and lethargy often occur in amphetamine withdrawal.

3

Euphoria, hyperactivity, and hyperalertness do not typically occur in amphetamine withdrawal.

4

Diaphoresis, clammy palms, and diarrhea do not typically occur in amphetamine withdrawal.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3 Comparing Commonly Abused Substances 13. ANS: 1 Page: 255 Integrated Processes: Nursing Process: Analysis Content Area: Substance Abuse Cognitive Level: Application Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances Feedback 1

Hallucinogens, like LSD, produce tremors, dilated pupils, palpitations, and a sense of enhanced perception of the environment, which can contribute to a sense of depersonalization and panic.

2

Euphoria, grandiosity, sexual excitement, and impaired judgment occur with “crack” cocaine.

3

Euphoria, high energy, impaired judgment, weight loss, aggressive behavior and panic occur with amphetamine intoxication.

4

Sedatives and hypnotics produce relaxation, slurred speech, labile mood, inappropriate sexual behavior, and drowsiness.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3 Comparing Commonly Abused Substances COMPLETION 14. ANS: Alcoholics Anonymous Page: 251 Rationale: Alcoholics Anonymous (AA) provides a treatment approach for rehabilitation and is based on the Twelve Steps. It is known internationally, and the person can reach out to any group when away from home.

Integrated Processes: Teaching/Learning Content Area: Substance Abuse Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Chemical and Other Dependencies Chapter 17: Substance Use and Addictive Disorders; Treatment of Alcoholism PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Treatment of

Alcoholism MULTIPLE RESPONSE 15. ANS: 1, 3 Page: 245 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Psychotic Disorders and Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Coping Mechanisms and Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 17: Substance Use and Addictive Disorders; Introduction

Feedback 1.

Correct. People with psychiatric disorders commonly abuse drugs and alcohol as a way to self-medicate to reduce feelings of anxiety, insomnia, depression, loneliness, rapid thoughts, frightening hallucinations, and other distressing symptoms and is commonly referred to as a co-occurring disorder (also called dual diagnosis).

2.

Incorrect. This is not bipolar schizophrenia.

3.

Correct. People with psychiatric disorders commonly abuse drugs and alcohol as a way to self-medicate to reduce feelings of anxiety, insomnia, depression, loneliness, rapid thoughts, frightening hallucinations, and other distressing symptoms and is commonly referred to as a co-occurring disorder (also called dual diagnosis).

4.

Incorrect. This is not opioid-related schizophrenia.

Copyright © 2019 F. A. Davis Company

5.

Incorrect. This is not schizophrenia: Addiction type.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Introduction

Chapter 18. Eating Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Which statement is most true about anorexia nervosa?

1. It is only found in females.

2. A major symptom is loss of appetite.

3. Overuse of laxatives is a common symptom.

4. Onset occurs in young adults.

____ 2. Your patient with anorexia nervosa is in the bathroom running in place at a rapid rate. What is the most likely reason for this behavior?

1. She recently ate and wants to work off the calories to avoid gaining weight.

2. She wants her heart rate increased so you will think she is having heart problems.

3. She is a regular exerciser for good health.

4. She is depressed and hopes this will make her feel more alert.

____ 3. Your patient with anorexia nervosa is in the bathroom running in place at a rapid rate. How should you respond to the patient?

1. Encourage her to finish her exercise session.

2. Interrupt her and have her weighed immediately.

3. Tell her she is not allowed to exercise.

4. Interrupt her and encourage her to take a walk with you.

Copyright © 2019 F. A. Davis Company

____ 4. Which of the following would NOT be a potential characteristic of a patient with anorexia nervosa?

1. Male 2. Slightly overweight 3. Anxious 4. Perfectionistic

____ 5. Your first goal in the care of a patient with an eating disorder is: 1. Reassure the patient that he or she is attractive.

2. Teach the patient nutrition requirements for his or her age and height.

3. Establish a trusting relationship with the patient.

4. Ask the patient to explain why he or she will not eat.

____ 6. An appropriate goal for a patient who is on behavior modification for anorexia nervosa is: 1. Gain 2 pounds per week.

2. Eat all food at each meal.

3. Discuss the meaning of food to the patient for 1 hour every day.

4. Gain as much weight as possible in the first month of treatment to prevent serious complications of starvation.

____ 7. Mark is a male model who has been admitted for dehydration. Mark tells you, “I can eat anything I want and I don’t gain weight. Isn’t that great?” After dinner you hear a noise and you observe Mark vomiting in the bathroom. You document this and suspect: 1. Food poisoning.

2. Anorexia nervosa.

3. Bulimia nervosa.

4. Bipolar disorder.

Copyright © 2019 F. A. Davis Company

____ 8. Nurses know that the main difference between anorexia nervosa and bulimia nervosa is that the patient with bulimia nervosa: 1. Is morbidly obese.

2. Eats and purges in secret to keep the problem hidden.

3. Gets pleasure from being able to control the urge to eat.

4. Believes mealtime is stressful.

____ 9. Rob, a 15-year-old, has lost 30 pounds in 3 months. Rob is 6 feet tall and weighs 110 pounds. He tells you that he is fat: “Just look at how puffy my feet and arms still are. I have to get rid of the fat there.” The nursing diagnosis based on this information is: 1. Body image disturbance: distorted perception.

2. Knowledge deficit: nutritional requirements.

3. Altered nutrition, more than body requirements.

4. Potential for suicide.

____ 10. Nurses realize the importance of family relationships in the life of a patient with anorexia nervosa.

As a nurse, you would expect which of the following attitudes or behaviors in the parents of an adolescent with anorexia nervosa?

1. Indifferent and inattentive 2. Permissive and providing loose boundaries 3. Immature and concerned with themselves 4. Perfectionistic and overly demanding

____ 11. In addition to gastrointestinal disorders associated with eating disorders, nurses must be aware of and assess for other medical complications including: 1. Electrolyte imbalances.

2. Cardiac irregularities.

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3. Dehydration.

4. All of the above.

____ 12. As a nurse, you understand that anorexia nervosa in adolescents may be related to: 1. Depression.

2. Fear of moving into adulthood.

3. Family history of alcoholism.

4. A desire to die.

____ 13. Morbid obesity is defined as: 1. Body weight over 200 pounds no matter how tall the person is.

2. Body mass index (BMI) over 30.

3. Whatever is determined by the individual’s physician.

4. 100 pounds above established norms for a person’s height and sex.

____ 14. Bariatric surgery is now an accepted treatment for people with which of the following?

1. Poor body image 2. BMI over 40 3. Untreatable bulimia 4. BMI of 25 with diabetes

____ 15. Of the following observations, which is the most objective measure of improvement in your patient with anorexia nervosa?

1. She eats all of her food on the tray at lunch.

2. She gains 2 pounds from last week.

3. She weighs herself daily.

4. She tells you her friends are bringing her special foods.

Copyright © 2019 F. A. Davis Company

Chapter 18. Eating Disorders Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 270 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Anorexia Nervosa Feedback 1

The disorder is found in men but not as often as in females.

2

Loss of appetite is not the major symptom; in fact, patients are often hungry while denying themselves food.

3

Laxative abuse is often part of purging behaviors to promote weight loss.

4

Onset generally peaks in the early to late teens. Bulimia usually occurs in young adults.

PTS: 1

REF: Chapter 18: Eating Disorders; Anorexia Nervosa

2. ANS: 1 Page: 271 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Anorexia Nervosa; Box 18-1, Behaviors, Signs and Symptoms of Anorexia Nervosa Copyright © 2019 F. A. Davis Company

Feedback 1

Patients with anorexia will go to great extremes to deprive themselves of food, including use of methods such as excess exercise and purging to rid themselves of calories.

2

Patients with anorexia nervosa struggle with body image and fear of being fat, but they are not primarily concerned with convincing others they have a heart problem.

3

Patients with anorexia nervosa are concerned with getting rid of calories through excessive exercise, not to stay healthy.

4

Patients with anorexia are primarily concerned with body image and a fear of being fat, rather than coping with depression.

PTS: 1 REF: Chapter 18: Eating Disorders; Anorexia Nervosa; Box 18-1 Behaviors, Signs and Symptoms of Anorexia Nervosa 3. ANS: 4 Page: 278 Integrated Processes: Nursing Process: Analysis/Implementation Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 18: Eating Disorders; General Nursing Interventions; Table 18-2, Nursing Interventions for Eating Disorders Feedback 1

Encouraging her to continue this behavior reinforces inappropriate coping.

2

While interrupting her may be therapeutic, weighing her immediately may cause

Copyright © 2019 F. A. Davis Company

further issues with body image.

3

Control is a major issue in patients with anorexia nervosa. This response could escalate the problem.

4

Excessive exercise is not healthy in this patient. By encouraging her to walk with you, you are distracting her from this compulsion to exercise.

PTS: 1 REF: Chapter 18: Eating Disorders; General Nursing Interventions; Table 18-2 Nursing Interventions for Eating Disorders 4. ANS: 2 Page: 271 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Anorexia Nervosa Feedback 1

Being male could be a characteristic of a patient with anorexia nervosa, as anorexia nervosa affects both male and female.

2

Slightly overweight is not a characteristic of a patient with anorexia nervosa.

Patients with anorexia are generally severely underweight.

3

Anxious is a characteristic of a patient with anorexia nervosa; no amount of weight loss can relieve the anxiety.

4

Perfectionistic is a characteristic of a patient with anorexia nervosa.

PTS: 1

REF: Chapter 18: Eating Disorders; Anorexia Nervosa

Copyright © 2019 F. A. Davis Company

5. ANS: 3 Page: 277 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Safe and Effective Care Environment: Establishing Priorities Chapter 18: Eating Disorders; General Nursing Interventions Feedback 1

This response is false reassurance and is nontherapeutic.

2

This response does not relate to the emotional issues that underlie the eating disorder.

3

Establishing trust is key to the ongoing relationship. Gaining the patient’s trust and giving positive reinforcement for the progress the patient makes will help the patient learn to change his or her lifestyle.

4

This response assumes that the patient knows the etiology and reasons for the disorder. The focus should not be on food.

PTS: 1

REF: Chapter 18: Eating Disorders; General Nursing Interventions

6. ANS: 1 Page: 271 Integrated Processes: Nursing Process: Analysis/Planning Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Safe and Effective Care Environment: Coordinated Care: Establishing Priorities Chapter 18: Eating Disorders; Treatment for Anorexia Nervosa Feedback 1

The recommended dietary regimen generally promotes slow, steady weight gain of no more than 3 pounds per week.

Copyright © 2019 F. A. Davis Company

2

Eating all food at each meal is unrealistic.

3

Avoid focusing on food when dealing with patients with anorexia nervosa.

4

Slow, steady weight gain is associated with good outcomes physically and emotionally; rapid weight gain is not healthy emotionally or physically.

PTS: 1

REF: Chapter 18: Eating Disorders; Treatment for Anorexia Nervosa

7. ANS: 3 Page: 273 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Bulimia Feedback 1

These signs and symptoms are not typical of food poisoning.

2

While anorexia nervosa can include purging, Mark is not severely underweight.

3

Bulimia nervosa is known to be common in men and women who feel pressure to keep their weight at a certain level. Self-induced vomiting is a frequent method of purging food.

4

Bipolar disorder is a mood disorder, not an eating disorder.

PTS: 1

REF: Chapter 18: Eating Disorders; Bulimia

8. ANS: 2 Page: 272 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Comprehension Copyright © 2019 F. A. Davis Company

Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Bulimia Feedback 1

Patients with bulimia nervosa are often of normal weight or slightly overweight, not morbidly obese.

2

Bulimia nervosa is a secretive disorder where the individual is often of normal weight or slightly overweight and binges and purges in secret.

3

Patients with bulimia cannot control the urge to eat, they binge. Pleasure from controlling the urge to eat is associated with anorexia nervosa.

4

This is not a difference between anorexia nervosa and bulimia nervosa. Eating is stressful for both.

PTS: 1

REF: Chapter 18: Eating Disorders; Bulimia

9. ANS: 1 Page: 276 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Nursing Care of Patients with Eating Disorders Feedback 1

The patient’s view of self as fat indicates a distorted body image.

2

This has nothing to do with knowledge about nutrition.

3

At 6 feet tall and weight at 110 pounds, Rob does not have more than body requirements, he has less than body requirements.

4

Suicide is generally not viewed as a motivation in self-starvation for patients with anorexia nervosa.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 18: Eating Disorders; Nursing Care of Patients with Eating

Disorders 10. ANS: 4 Page: 271 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Etiology of Anorexia Nervosa Feedback 1

Parents of patients with anorexia nervosa are usually overprotective, not indifferent and inattentive.

2

Parents of patients with anorexia nervosa are usually demanding, not permissive and providing loose boundaries.

3

Parents of patients with anorexia nervosa are usually demanding, not immature and concerned with themselves.

4

Parents of patients with anorexia nervosa are usually demanding and overprotective.

PTS: 1

REF: Chapter 18: Eating Disorders; Etiology of Anorexia Nervosa

11. ANS: 4 Page: 271, 273 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Comprehension Client Need: Physiological Integrity: Physiological Adaptation: Illness Management Chapter 18: Eating Disorders; Treatment of Anorexia Nervosa; Treatment of Bulimia Feedback Copyright © 2019 F. A. Davis Company

1

While electrolyte imbalances can occur, there are other complications associated with eating disorders.

2

While cardiac irregularities can occur, there are other complications associated with eating disorders.

3

While dehydration can occur, there are other complications associated with eating disorders.

4

All of these complications can occur with eating disorders, especially anorexia nervosa and bulimia.

PTS: 1 REF: Chapter 18: Eating Disorders; Treatment of Anorexia Nervosa; Treatment of Bulimia 12. ANS: 2 Page: 271 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Etiology of Anorexia Nervosa Feedback 1

Depression is not the underlying cause of anorexia nervosa. Depression has close ties to bulimia.

2

By not eating, the person forestalls sexual development and remains a child in the family.

3

Alcoholism is not an underlying cause of anorexia nervosa. A family history of alcoholism may be present in a patient with bulimia.

4

A desire to die is not the underlying cause of anorexia nervosa.

PTS: 1

REF: Chapter 18: Eating Disorders; Etiology of Anorexia Nervosa

Copyright © 2019 F. A. Davis Company

13. ANS: 4 Page: 275 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Eating Disorders: Child, Adolescent, Adult Health Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance Chapter 18: Eating Disorders; Morbid Obesity Feedback 1

Depending upon height, a body weight over 200 pounds may be normal.

2

Obesity, not morbid obesity, is defined as a body mass index (BMI) >30.

3

There are standards to determine morbid obesity.

4

Morbid obesity refers to body weight more than 100 pounds above established norms for a person’s height and sex.

PTS: 1

REF: Chapter 18: Eating Disorders; Morbid Obesity

14. ANS: 2 Page: 276 Integrated Processes: Nursing Process: Analysis Content Area: Child, Adolescent, Adult Health Cognitive Level: Comprehension Client Need: Health Promotion and Maintenance Chapter 18: Eating Disorders; Treatment of Morbid Obesity Feedback 1

Poor body image is not treated by bariatric surgery.

2

Generally, bariatric surgery is considered only for people with a BMI >40 or for those with a BMI >35 with serious medical complications related to the excess weight, such as diabetes.

Copyright © 2019 F. A. Davis Company

3

Untreatable bulimia is not a recommendation for bariatric surgery.

4

The BMI must be >35, not 25, for a patient with diabetes.

PTS: 1

REF: Chapter 18: Eating Disorders; Treatment of Morbid Obesity

15. ANS: 2 Page: 271 Integrated Processes: Nursing Process: Planning Content Area: Mental Health: Eating Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 18: Eating Disorders; Treatment of Anorexia Nervosa Feedback 1

This only indicates a one-time observation.

2

This is the most objective finding to indicate improvement with a patient who has anorexia nervosa.

3

This does not indicate improvement because the patient is still obsessed with weight gain.

4

This is subjective data, not objective, and could have many meanings.

PTS: 1

REF: Chapter 18: Eating Disorders; Treatment of Anorexia Nervosa

Chapter 19. Childhood and Adolescent Mental Health Issues Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A boy with a conduct disorder diagnosis would be most likely to have which symptom?

1. Withdrawal

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2. Ritualistic behavior 3. Class bully 4. Class clown

____ 2. Suzanne is a 10-year-old girl who has been diagnosed as experiencing depression. What is likely to be the most effective way to help Suzanne express her feelings?

1. Have her participate in a group therapy session with other young children who are depressed.

2. Ask her to draw some pictures about things that she’s been thinking about.

3. Arrange for individual psychotherapy sessions with a psychiatrist.

4. Observe her actions but don’t seek to draw her into conversation.

____ 3. Which of the following is the most common childhood mental disorder?

1. Attention-deficit/hyperactivity disorder (ADHD) 2. Asperger’s syndrome 3. Conduct disorder 4. Enuresis

____ 4. Marty is a 15-year-old boy whose parents have brought him to a mental health clinic for evaluation.

They are concerned because his grades have fallen and he has become angry and sometimes even violent. He spends long periods of time alone and does not want to see his friends. The parents report that he has never been a “bad” boy nor had problems in school. They are worried about the changes in his behavior. Which of the following is the most likely cause?

1. Depression 2. Running around with a tough crowd 3. Normal adolescent phase 4. Attention-deficit/hyperactivity disorder (ADHD)

Copyright © 2019 F. A. Davis Company

____ 5. Joey is a 5-year-old who is causing his parents a lot of concern. His mother reports that “he bounces off the walls all the time” and can’t focus on any one thing for very long. He is impulsive and recently ran out into the street in front of the family’s home. His teacher has told his parents that he has done similar things at school. The nurse understands that: 1. Joey shows all the signs of having ADHD and should probably be placed on Ritalin as soon as possible.

2. Joey is just an active, healthy child who needs to be disciplined more effectively.

3. Joey could be autistic, and additional testing will have to be done to confirm the diagnosis.

4. Joey shows signs of having ADHD but is too young for that diagnosis to be made definitively now.

____ 6. Marie is 16 years old. She has been referred to the clinic by the nurse at her school because she started a fight with a younger girl and hurt her badly. The school nurse reports that Marie has been troublesome before—skipping school, bullying, and smoking on school grounds on several occasions. Of the following, which diagnosis is most likely?

1. Bipolar depression 2. Paranoid schizophrenia 3. Conduct disorder 4. Dysthymic disorder

____ 7. The single most common symptom of autism spectrum disorder is: 1. Inability to grasp reality.

2. Impaired social interaction.

3. “Acting-out” behaviors.

4. Diminished affect.

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____ 8. Which of the following would be the first priority for nurses caring for autistic children?

1. Assist the psychiatrist and mental health team in providing treatments to cure the disorder.

2. Determine which of the two types of autism the child has.

3. Discourage and prevent self-destructive behavior.

4. Provide behavior modification tools, specifically limit setting and reward systems.

____ 9. Which of the following statements is true about the differences in mental health problems between children and adults?

1. Children are affected by the same stressors as adults, but to different degrees and with different manifestations.

2. Children’s mental health disorders are generally much less severe and resolve more quickly than do those of adults.

3. Children’s mental health problems are different from those of adults because their brains are “wired” differently.

4. Children have better means of “working off” stresses than do adults.

____ 10. The nurse knows that stimulant medication for attention-deficit/hyperactivity disorder (ADHD) should be administered: 1. At bedtime, to coincide with rising cortisol levels.

2. Only on school days to improve performance.

3. On an empty stomach.

4. With breakfast and lunch.

____ 11. Which of the following statements by your attention-deficit/hyperactivity disorder (ADHD) child’s parents indicate they need further teaching?

1. “We will establish firm but reasonable limits on his behavior.”

2. “We will give him his medication at night so it won’t decrease his appetite.”

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3. “We will set him up in a special program at his school so he will get extra attention.”

4. “We will work to ensure he gets 8 hours of sleep a night.”

____ 12. You are caring for a 13-year-old boy with a diagnosis of conduct disorder. Which of the following would you be most likely to expect given this diagnosis?

1. Severe separation anxiety from parents 2. Making up stories to make him appear more important 3. History of cruelty to schoolmates and pets 4. Insomnia and anorexia nervosa

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 13. Which of the following statements about attention-deficit/hyperactivity disorder (ADHD) are true (select all that apply)?

1. ADHD is more common in boys than in girls.

2. Children with ADHD tend to be of below-average intelligence.

3. ADHD can be caused by a chaotic family life.

4. Children with ADHD are often treated with the use of stimulants.

5. Children with ADHD often benefit from behavior modification tools like limit setting, reward systems, and positive reinforcement.

6. Even though we think of ADHD as a disorder in children, adults can also have it.

____ 14. Which symptoms are typical of depression in younger children (select all that apply)?

1. Social isolation 2. Boredom 3. Rapid mood swings Copyright © 2019 F. A. Davis Company

4. Poor concentration 5. Grandiose delusions 6. Rapid speech/racing thoughts

____ 15. A girl with suicidal thoughts would be most likely to have which symptoms (select all that apply)?

1. Asking questions about death 2. Losing interest in sports 3. Showing evidence of substance abuse 4. Exhibiting delayed speech skills 5. Experiencing echolalia 6. Having poor sleep habits

Copyright © 2019 F. A. Davis Company

Chapter 19. Childhood and Adolescent Mental Health Issues Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 297 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Child Health Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct Disorders Feedback 1

Withdrawal is a sign of autism, not conduct disorder.

2

Ritualistic behavior may reflect autism, not conduct disorder.

3

Some behavior patterns for conduct disorder might be bullying, displaying or using a weapon, arson, lying, fighting, animal abuse, truancy from school, chronic rule breaking, and running away from home.

4

Being a class clown is not a sign of conduct disorder.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct Disorders 2. ANS: 2 Page: 289 Content Area: Mental Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Behavioral Interventions Chapter 19: Childhood and Adolescent Mental Health Issues; Nursing Care of Children and Adolescents With Depression, Bipolar Disorder, and Suicidal Behavior Copyright © 2019 F. A. Davis Company

Feedback 1

Having a group therapy session with other young children is not as effective as another intervention.

2

Young children especially can benefit from art therapy to express their feelings.

3

While individual therapy may be helpful, it is not the most effective.

4

Communication is essential for a depressed child.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Nursing Care of Children and Adolescents With Depression, Bipolar Disorder, and Suicidal Behavior 3. ANS: 1 Page: 284 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Introduction Feedback 1

Attention-deficit/hyperactivity disorder (ADHD) is the most common disorder among children and teens, which affects 6.8% of children aged 3 to 17 years.

2

Asperger’s syndrome is not the most common childhood mental disorder.

Autism spectrum disorder is a neurodevelopmental disorder that includes classic autism and Asperger’s syndrome.

3

Conduct disorder is now categorized under Disruptive, Impulse Control, and Conduct Disorders in DSM-5 and is not the most common childhood mental disorder.

4

Enuresis is not the most common childhood mental disorder.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues;

Introduction 4. ANS: 1 Page: 285 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health: Mood Disorders Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Depression, Bipolar Disorders, and Suicide in Children and Adolescents Feedback 1

In addition to classic symptoms of depression, adolescents often display irritability, rage, and problems in school performance.

2

This not the most likely cause for the change in behavior.

3

This is not normal teen behavior.

4

Because Marty has been functioning well in school up until now, it is unlikely that ADHD would be exhibited at this point.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Depression, Bipolar Disorders, and Suicide in Children and Adolescents 5. ANS: 4 Page: 290 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts

Copyright © 2019 F. A. Davis Company

Chapter 19: Childhood and Adolescent Mental Health Issues; Attention-Deficit/Hyperactivity Disorder Feedback 1

Joey is too young to have a definitive diagnosis of ADHD and started on medication.

2

Although Joey may be active, discipline is not the issue.

3

These are not behaviors that describe autism.

4

A definitive diagnosis of ADHD should not be made before age 7 because developmentally the child has a shorter attention span.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Attention-Deficit/Hyperactivity Disorder 6. ANS: 3 Page: 297 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct Disorder Feedback 1

Marie is not displaying bipolar depression symptoms, which are hyperactivity, grandiose delusions, and rapid mood swings.

2

Marie is not displaying paranoid schizophrenia symptoms.

3

Marie is displaying conduct disorder symptoms, a pattern of aggressive behavior and violating the rights of others, including defiance and rule-breaking.

4

Marie is not displaying dysthymic disorder.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct

Disorder 7. ANS: 2 Page: 294 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Autism Spectrum Disorder Feedback 1

Inability to grasp reality is not the most common symptom.

2

The single most common symptom or manifestation of autism spectrum disorder is impaired social interaction. Autism is characterized by persistent difficulties in social communication and social interaction, problems in maintaining relationships, and repetitive patterns of behavior.

3

“Acting-out” behaviors are not the most common symptom.

4

Diminished affect is not the most common symptom.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Autism Spectrum Disorder 8. ANS: 3 Page: 295 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts

Copyright © 2019 F. A. Davis Company

Chapter 19: Childhood and Adolescent Mental Health Issues; Autism Spectrum Disorder; General Nursing Interventions Feedback 1

Autism at this point is not curable.

2

Determining the type of autism is not a nursing goal. This is a medical goal.

3

Safety is the primary nursing intervention. Therapists may prescribe special equipment or even special clothing, such as helmets and arm covers, to help maintain safety. The goal of this intervention is to discourage and prevent selfdestructive behavior.

4

Behavior modification tools are important, but safety comes first.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Autism Spectrum Disorder; General Nursing Interventions 9. ANS: 1 Page: 284 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concept Chapter 19: Childhood and Adolescent Mental Health Issues; Introduction Feedback 1

Stresses on children today are much different than in previous generations. The fast pace of life, the Internet, social media, continuous exposure to news, and exposure to violence at a young age all lead to children growing up more quickly and having to deal with many issues that previous generations never addressed until they were much older.

2

Mental disorders in children can lead to a lifetime of problems, including poor

Copyright © 2019 F. A. Davis Company

peer relationships, problems in school, substance use, and risk-taking behaviors as well as being more likely to develop a chronic psychiatric illness.

3

Children and adolescents are at risk for developing many of the same mental health disorders as adults.

4

Children may not have the mental capacity or life experiences to “work off” stress better than adults.

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues;

Introduction 10. ANS: 4 Page: 292 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Medication Administration Chapter 19: Childhood and Adolescent Mental Health Issues; Pharmacology Corner: AttentionDeficit/Hyperactivity Disorder Feedback 1

Generally, administer stimulant medication no later than 6 hours before bedtime to avoid interference with sleep.

2

Stress the importance of daily compliance with the regimen to the child and parents.

3

Administer drugs after eating or with meals to reduce the effect on the child’s appetite.

4

Administer drugs after eating or with meals to reduce the effect on the child’s appetite.

PTS: 1 Copyright © 2019 F. A. Davis Company

REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Pharmacology Corner: Attention-Deficit/Hyperactivity Disorder 11. ANS: 2 Page: 292 Integrated Processes: Teaching/Learning Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Health Promotion and Maintenance: Principles of Teaching/Learning Chapter 19: Childhood and Adolescent Mental Health Issues; Pharmacology Corner: AttentionDeficit/Hyperactivity Disorder Feedback 1

The parents should use firm, reasonable limits, so this response indicates an understanding of teaching.

2

This is a misconception that would require further teaching. Stimulant medications are given for treatment of ADHD. These can cause insomnia if given later in the day.

3

The parents should use special programs, so this response indicates an understanding of teaching.

4

The parents should ensure 8 hours of sleep, so this response indicates an understanding of teaching.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Pharmacology Corner: Attention-Deficit/Hyperactivity Disorder 12. ANS: 3 Page: 297 Integrated Processes: Nursing Process: Analysis Content Area: Adolescent: Mental Health: Child Health Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct Disorder Feedback 1

Severe separation anxiety does not occur in conduct disorder.

2

Making up stories for importance is not a characteristic of conduct disorder.

3

The diagnosis of conduct disorder is based on the presence of a pattern of aggressive behavior to people and/or animals, destruction of property, deceitfulness, or theft and/or serious violation of rules. Conduct disorder is associated with long-term problems with defiance, rule-breaking, and violating the basic rights of others.

4

Insomnia and anorexia nervosa are not associated with conduct disorder.

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Conduct

Disorder MULTIPLE RESPONSE 13. ANS: 1, 3, 4, 5, 6 Page: 290–291 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Attention-Deficit/Hyperactivity Disorder

Feedback

Copyright © 2019 F. A. Davis Company

1.

Correct. The diagnosis is much more common among boys than among girls.

2.

Incorrect. Children with this disorder are generally of average or above-average intelligence but do not always perform at their level of intelligence.

3.

Correct. Chaotic family life is also a factor for ADHD.

4.

Correct. Psychostimulants (also known as stimulants) are the most commonly used ADHD drugs.

5.

Correct. Interventions include behavior-modification tools, limit setting, and positive reinforcement to promote self-esteem.

6.

Correct. ADHD can also occur in adults.

PTS: 1 REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Attention-Deficit/Hyperactivity Disorder 14. ANS: 1, 2, 4 Page: 285 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Mood Disorders: Child Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Depression

Feedback 1.

Correct. Social isolation is a symptom of depression in the younger age-group.

2.

Correct. Boredom is a symptom of depression in the younger age-group.

3.

Incorrect. Rapid mood swings occur in bipolar disorder.

4.

Correct. Poor concentration is a symptom of depression in the younger agegroup.

Copyright © 2019 F. A. Davis Company

5.

Incorrect. Grandiose delusions are symptoms of bipolar disorder.

6.

Incorrect. Rapid speech/racing thoughts are symptoms of bipolar disorder.

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Depression

15. ANS: 1, 2, 3, 6 Page: 287 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Mood Disorders: Child Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 19: Childhood and Adolescent Mental Health Issues; Suicide Feedback 1.

Correct. Asking questions about death is a sign of suicide.

2.

Correct. Losing interest in sports is a sign of suicide.

3.

Correct. Showing evidence of substance abuse is a sign of suicide.

4.

Incorrect. Delayed speech and language skills occur in autism spectrum disorders, not suicide.

5.

Incorrect. Echolalia occurs in autism spectrum disorders, not suicide.

6.

Correct. Having poor sleep habits is a sign of suicide.

PTS: 1

REF: Chapter 19: Childhood and Adolescent Mental Health Issues; Suicide

Chapter 20. Postpartum Issues in Mental Health Multiple Choice Identify the choice that best completes the statement or answers the question.

Copyright © 2019 F. A. Davis Company

____ 1. You are caring for the patient who is 4 weeks postdelivery in the obstetrics follow-up clinic. She tells you she is sleeping for long hours, wants to avoid taking care of the baby, and wishes she had never had the baby. What would be your first response?

1. “It’s normal to feel overwhelmed at first.”

2. “Tell me more about these feelings.”

3. Report her to Child Protective Services.

4. “I’ll call your husband right away to get you back home to rest.”

____ 2. Which statement best describes postpartum blues?

1. A rare condition that affects bonding between mother and baby.

2. A transient, self-limiting period of sadness after the birth of the baby.

3. A psychiatric diagnosis similar to dysthymia.

4. A period of sadness that usually moves quickly into postpartum psychosis.

____ 3. Which is NOT a contributing factor to postpartum blues?

1. Hormone shifts 2. Lack of sleep 3. Stress 4. History of depression

____ 4. Which of the following combines the best treatments for postpartum blues?

1. Antidepressants, sleep, crisis intervention 2. Rest, support, compassion 3. Mother–baby bonding session, family education, antidepressants 4. Analgesics for postdelivery pain, rest, longer hospital stay

____ 5. Which statement by the nurse indicates a good understanding of postpartum blues?

Copyright © 2019 F. A. Davis Company

1. “You need to get involved with taking care of this baby.”

2. “You are lucky to have a healthy baby. The patient in the next room would give anything to be in your place.”

3. “You look tired. Why don’t you rest for a bit and I will come back later to start some teaching.”

4. “I will call the social worker to check into alternate caregiving for the new baby.”

____ 6. In addition to antidepressants, which of the following is a common treatment for postpartum depression?

1. Antipsychotics 2. Psychotherapy 3. Hormone replacement 4. Temporary removal of the baby from the home

____ 7. Your pregnant patient has a history of major depression. Which of the following is she most likely to be at risk for?

1. She is at risk for development of manic episodes.

2. She is at risk for postpartum depression after the birth of the baby.

3. She is more likely to have an autistic child.

4. She has no higher risk for emotional problems than other patients.

____ 8. Which of the following is true about postpartum issues in mental health?

1. Postpartum blues is a serious, major postpartum psychiatric disorder.

2. Pregnancy is thought to be a protectant against postpartum mental disorders.

3. Postpartum depression is a common and normal reaction postdelivery.

4. Postpartum mental disorders cross all cultures.

Copyright © 2019 F. A. Davis Company

____ 9. Marie is admitted with postpartum depression. Which symptom should the nurse expect to observe?

1. Impaired ability to care for the baby 2. Delusions of grandeur 3. Extreme impulsivity 4. Disorganized speech

____ 10. Which patient is most prone to postpartum depression (PPD)?

1. A mother 2 months postdelivery 2. A mother 4 months postdelivery 3. A mother 6 months postdelivery 4. A mother 8 months postdelivery

____ 11. Ann has a diagnosis of postpartum psychosis. Which finding would you expect to find in her history?

1. This is her third pregnancy.

2. She has bipolar disorder.

3. She delivered 5 months ago.

4. There are no prior mental health disorders.

____ 12. What is a priority when caring for a patient with postpartum psychosis?

1. Education for infant care 2. Safety of the infant 3. Proper bathing techniques for the infant 4. Supplements for infant nourishment

Multiple Response Identify one or more choices that best complete the statement or answer the question.

Copyright © 2019 F. A. Davis Company

____ 13. Which of the following are early signs of postpartum psychosis (select all that apply)?

1. Restlessness 2. Hallucinations 3. Irritability 4. Delusions of persecution 5. Insomnia

____ 14. Which information should the nurse consider when administering medications for patients with postpartum depression (PPD) and postpartum psychosis (select all that apply)?

1. Starting antidepressants during pregnancy is absolutely safe for the infant.

2. Women with bipolar disorder and postpartum mental problems should be encouraged to breastfeed.

3. Antidepressants are generally to be avoided in patients with bipolar disorder.

4. Antipsychotics are often needed to treat postpartum psychosis.

5. Antianxiety medications can be used to treat postpartum depression.

____ 15. Which of the following interventions would you contribute to the plan of care for a patient with postpartum mental disorders (select all that apply)?

1. Suggest the use of support groups.

2. Closely observe patients with substance abuse.

3. Arrange home-health visits.

4. Provide support and education to the family.

5. Keep the mother active, especially when the baby is sleeping.

Copyright © 2019 F. A. Davis Company

Chapter 20. Postpartum Issues in Mental Health Answer Section MULTIPLE CHOICE 1. ANS: 2 Page: 304 Integrated Processes: Nursing Process: Assessment Content Area: Maternity: Postpartum: Mental Health: Mood Disorder Cognitive Level: Analysis Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Depression Feedback 1

This behavior is not normal at 4 weeks postdelivery.

2

Talking about her feelings is helpful if a mother is experiencing early signs of postpartum depression. The open-ended statement will give you more information and be less judgmental to this patient.

3

You would need a lot more information before reporting this as neglect.

4

More rest is probably not adequate treatment.

PTS: 1 REF: Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Depression 2. ANS: 2 Page: 302 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Blues Copyright © 2019 F. A. Davis Company

Feedback 1

Postpartum blues does not affect the quality of care the mother is able to provide to the new baby, and it is common.

2

Postpartum blues (sometimes called transient depressive symptoms) are an extremely common response to the sudden changes immediately after childbirth.

The disorder is generally self-limiting, does not reflect psychopathology, and does not affect the quality of care the mother is able to provide to the new baby.

3

Postpartum blues is not the same thing as dysthymia.

4

The presence of postpartum blues does increase the risk for postpartum major depression, but not postpartum psychosis.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Blues

3. ANS: 4 Page: 302 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Blues Feedback 1

Hormones shifts are significant contributing factors to postpartum blues.

2

Lack of sleep can be a significant contributing factor to postpartum blues.

3

Stress can be a significant contributing factor to postpartum blues.

4

History of depression is a contributing factor to postpartum depression or postpartum psychosis, not postpartum blues.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Blues

Copyright © 2019 F. A. Davis Company

4. ANS: 2 Page: 303 Integrated Processes: Nursing Process: Implementation Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Blues Feedback 1

Antidepressants and crisis intervention are not used for postpartum blues; however, sleep is beneficial for postpartum blues.

2

Emotional support, compassion, and rest generally help resolve this problem in a matter of days.

3

Postpartum blues require no psychiatric treatment, like antidepressants; however, family education is recommended.

4

While rest is advocated for postpartum blues, a longer hospital stay is not.

PTS: 1 REF: Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Blues 5. ANS: 3 Page: 303 Integrated Processes: Nursing Process: Implementation Content Area: Women’s Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Blues Feedback 1

This statement is judgmental. Postpartum blues does not affect the quality of care the mother is able to provide to the new baby.

Copyright © 2019 F. A. Davis Company

2

This statement is judgmental because it invalidates and belittles the woman’s feelings.

3

This response indicates understanding that postpartum blues is transient and that time and rest are major healers.

4

This response is inappropriate at this time; it is too early for this intervention.

PTS: 1 REF: Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Blues 6. ANS: 2 Page: 304 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Depression Feedback 1

Antipsychotics are not needed in postpartum depression but may be needed for postpartum psychosis.

2

When the diagnosis of postpartum depression is made, the mother is usually placed on antidepressants and begins some form of psychotherapy.

3

Hormone replacement is not indicated and would be inappropriate for postpartum depression.

4

Mother and baby should be kept together with added support from the family to ensure the baby is well cared for.

PTS: 1 REF: Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Depression

Copyright © 2019 F. A. Davis Company

7. ANS: 2 Page: 303 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression Feedback 1

Manic episodes occur in bipolar, but not postpartum depression.

2

The strongest risk factor for postpartum depression (PPD) is depression during a previous pregnancy or in the previous postpartum period.

3

This does not place the pregnant patient at risk for an autistic child.

4

A history of major depression places a pregnant patient at a higher risk for emotional problems.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression

8. ANS: 4 Page: 302 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Introduction Feedback 1

The major psychiatric disorders of postpartum depression and postpartum psychosis are much rarer and much more serious than postpartum blues.

2

In the past, pregnancy was thought to be a protectant against mental disorders, but current research has proved this is not the case.

Copyright © 2019 F. A. Davis Company

3

Postpartum blues, not postpartum depression, is a common and normal reaction related to an abrupt change in hormone levels when a pregnancy ends, whether from birth, miscarriage, or abortion.

4

Postpartum mental disorders cross all cultures. Each culture has expected behaviors of new mothers, and knowledge of these cultural expectations can make for more accurate screening of possible psychiatric disorders.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Introduction

9. ANS: 1 Page: 303 Integrated Processes: Nursing Process: Assessment Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression Feedback 1

The symptoms of postpartum depression are the ones typically seen in depression with the addition of impaired ability to care for the baby.

2

Delusions of grandeur occur with postpartum psychosis.

3

Extreme impulsivity occurs with postpartum psychosis.

4

Disorganized speech occurs with postpartum psychosis.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression

10. ANS: 1 Page: 303 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Copyright © 2019 F. A. Davis Company

Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression Feedback 1

Most of the time, PPD occurs within the first 3 months after delivery.

2

Although this mother may be prone to PPD, PPD usually occurs sooner than 4 months postdelivery.

3

Although this mother may be prone to PPD, PPD usually occurs sooner than 6 months postdelivery.

4

Although this mother may be prone to PPD, PPD usually occurs sooner than 8 months postdelivery.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Depression

11. ANS: 2 Page: 305 Integrated Processes: Nursing Process: Assessment Content Area: Women’s Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis Feedback 1

Postpartum psychosis is most common in first pregnancies.

2

Postpartum psychosis occurs most frequently in women with a history of bipolar disorder prepregnancy.

3

Postpartum psychosis is generally evident within a few weeks of delivery.

4

The majority of women with this disorder have had symptoms of mental illness before pregnancy.

Copyright © 2019 F. A. Davis Company

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis

12. ANS: 2 Page: 305 Integrated Processes: Nursing Process: Implementation Content Area: Women’s Health Cognitive Level: Application Client Need: Coordinated Care: Establishing Priorities Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Psychosis Feedback 1

Although education is important, it is not the priority in this instance.

2

Immediate medical and psychiatric treatment must be instituted when postpartum psychosis is diagnosed. Safety of the infant must be a priority.

3

Bathing techniques are important; however, they are not the priority in this situation.

4

Although infant nourishment is important, it is not the priority in this situation.

PTS: 1 REF: Chapter 20: Postpartum Issues in Mental Health; Treatment of Postpartum Psychosis MULTIPLE RESPONSE 13. ANS: 1, 3, 5 Page: 305 Integrated Processes: Nursing Process: Assessment Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis

Copyright © 2019 F. A. Davis Company

Feedback 1.

Correct. Restlessness is an early sign of postpartum psychosis.

2.

Incorrect. Hallucinations are not early signs of postpartum psychosis.

3.

Correct. Irritability is an early sign of postpartum psychosis.

4.

Incorrect. Delusions of persecution are not early signs of postpartum psychosis.

5.

Correct. Insomnia is an early sign of postpartum psychosis.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis

14. ANS: 3, 4, 5 Page: 304–307 Integrated Processes: Nursing Process: Planning Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Pharmacological Therapies: Medication Administration Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis

Feedback A.

Incorrect. Some studies report the fetus is at increased risk for complications when exposed to antidepressants during pregnancy. Therefore, starting antidepressants during pregnancy or during subsequent pregnancies must be discussed in detail with the health-care provider.

B.

Incorrect. For women with bipolar disorder, breastfeeding may be problematic for a number of reasons.

C.

Correct. Antidepressants are generally to be avoided in patients with bipolar disorder as they can trigger a manic episode. Thus, these medications should be avoided in any patient with a history of bipolar disorder who is pregnant or has

Copyright © 2019 F. A. Davis Company

just given birth.

D.

Correct. Antipsychotic medications are often needed to treat postpartum psychosis as well as PPD. The psychiatrist will identify those medications with less risk to the mother and the breastfeeding infant. Antipsychotics are generally viewed as having less risk to both mother and infant.

E.

Correct. Antianxiety medications are often needed to treat postpartum psychosis as well as PPD. The psychiatrist will identify those medications with less risk to the mother and the breastfeeding infant.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; Postpartum Psychosis

15. ANS: 1, 2, 3, 4 Page: 307 Integrated Processes: Nursing Process: Planning Content Area: Women’s Health Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts

Feedback 1.

Correct. Support groups are an appropriate intervention for patients with postpartum mental disorders.

2.

Correct. Ongoing monitoring for high-risk patients. Be aware that patients with any history of mental disorders, substance abuse, and family conflict are at higher risk for postpartum mental disorders.

3.

Correct. Home-health visits should be arranged for any mother at high risk for postpartum psychiatric disorders.

4.

Correct. The new family needs education about the stresses of pregnancy and childbirth.

Copyright © 2019 F. A. Davis Company

5.

Incorrect. The new mother needs rest, not activity.

PTS: 1

REF: Chapter 20: Postpartum Issues in Mental Health; General Nursing

Interventions Chapter 21. Aging Population Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. An 85-year-old patient is admitted to the hospital with the diagnosis of cerebrovascular accident and depression. The symptom that is unrelated to depression would be?

1. Crying and refusing to perform tasks 2. Answering “I forgot” to questions 3. Having positive self-esteem 4. Neglecting activities of daily living (ADLs)

____ 2. The Omnibus Budget Reconciliation Act (OBRA) provides standards of care for which of the following?

1. Very young 2. Older adults 3. Those who have certain intellectual communication difficulties 4. Those without medical insurance

____ 3. In the elderly, administering medication is a great concern for the nurse because these patients are more prone to side effects. The primary cause of this is: 1. Altered circulatory and renal function.

2. Accelerated gastrointestinal system.

3. Enlarged lymph nodes.

Copyright © 2019 F. A. Davis Company

4. Musculoskeletal system weakness.

____ 4. Which health-care team member is responsible for the initial assessment of elderly individuals?

1. RN 2. LPN 3. Certified nurse aide 4. Social worker

____ 5. Which elderly patient is most prone to suicide?

1. Female, 55 years old 2. Female, 60 years old 3. Male, 64 years old 4. Male, 87 years old

____ 6. How should you address Carl Jones, the newly admitted elderly patient, to your mental health unit?

1. “Hello, Carl.”

2. “Hi, Mr. Jones.”

3. “Good morning, Gramps.”

4. “Honey, glad you are here.”

____ 7. An elderly patient has aphasia from a cerebrovascular accident (CVA). Which need is priority?

1. Sleep 2. Nutrition 3. Elimination 4. Communication

Copyright © 2019 F. A. Davis Company

____ 8. You are caring for Eliza. She has dementia and is recovering from knee surgery. You are working with a nursing assistant and physical therapy to achieve optimal functioning for her. Which type of nursing care are you providing?

1. Restorative 2. Palliative 3. Hospice 4. Intraoperative

____ 9. You are caring for Tom, an older adult, who has paranoid thinking. Which action should you take?

1. Teach relaxation methods.

2. Speak in terms of the future.

3. Provide aids for hearing and vision loss.

4. Discourage daytime napping.

Completion Complete each statement.

10. The federal act that establishes the standards of care for older adults residing in long-term facilities is known as the Omnibus Budget ______________ Act. 11. _______________, the study of older adults, is a specialty area within nursing.

12. A phenomenon called ______________ is discrimination against people based on how old they are.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

Copyright © 2019 F. A. Davis Company

____ 13. When assessing the elderly for depression, the nurse may find that a depressed person over 70 years of age without a medical diagnosis may have the following symptoms of depression (select all that apply): 1. Aches 2. Pains 3. Constipation 4. One-sided weakness 5. Confusion

____ 14. Which interventions should the nurse contribute to the plan of care for an elderly patient (select all that apply)?

1. Do as much as possible for the elderly patient.

2. Allow time for the elderly patient to complete tasks.

3. Restrict dietary fiber.

4. Praise successes of the elderly patient.

5. Focus on the elderly patient’s strengths.

____ 15. You are monitoring for common drug side effects in an elderly patient. Which side effects are common (select all that apply)?

1. Excessive drooling 2. Orthostatic hypotension 3. Fatigue 4. Irritability 5. Urinary complications

Copyright © 2019 F. A. Davis Company

Chapter 21. Aging Population Answer Section MULTIPLE CHOICE 1. ANS: 3 Page: 316 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Aging Population Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Coping Mechanisms Chapter 21: Aging Population; Cerebrovascular Accident; Depression Associated With CVA Feedback 1

Crying is related to depression. Nurses may see the patient crying and refusing to perform tasks that he or she could do effortlessly before the stroke.

2

Answering “I forgot” to questions is related to depression.

3

Having positive self-esteem is not related to depression. Self-esteem decreases as they realize they may be incontinent, unable to eat independently, or unable to communicate with their families.

4

Neglecting ADLs is related to depression.

PTS: 1 REF: Chapter 21: Aging Population; Cerebrovascular Accident; Depression Associated With CVA 2. ANS: 2 Page: 314 Integrated Processes: Nursing Process: Implementation Content Area: Legal Cognitive Level: Analysis Client Need: Coordinated Care: Client Rights Copyright © 2019 F. A. Davis Company

Chapter 21: Aging Population; Introduction Feedback 1

OBRA does not address the standards of care for the very young.

2

The OBRA is a federal act that provides standards of care for older adults residing in a long-term care facility.

3

OBRA does not address the standards of care for those who have intellectual communication difficulties.

4

OBRA does not address the standards of care for those without medical insurance.

PTS: 1

REF: Chapter 21: Aging Population; Introduction

3. ANS: 1 Page: 324 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Feedback 1

The process of pharmacokinetics (drug metabolism) is slower and less complete in older people. Because circulatory, hepatic, and renal function start to decrease normally with age, it is easier for medication levels in elderly patients to become toxic.

2

Constipation, not accelerated gastrointestinal system, is a common drug side effect.

3

Enlarged lymph nodes do not make the elderly more prone to side effects.

Copyright © 2019 F. A. Davis Company

Enlarged lymph nodes occur in an infection.

4

Although musculoskeletal system weakness does occur in the older patient and can lead to falls, it does not make the older adult prone to side effects.

PTS: 1 REF: Chapter 21: Aging Population; Medication Concerns; Table 21-2 Concerns of Aging Adults and Helping Techniques 4. ANS: 1 Page: 314 Integrated Processes: Nursing Process: Assessment Content Area: Legal Cognitive Level: Comprehension Client Need: Coordinated Care: Legal Responsibilities Feedback 1

Only the RN may conduct or coordinate initial assessments of elderly individuals, the same standard that applies to hospitals, acute care, and most other health-care facilities.

2

The LPN/LVN role is to assist the registered nurse through active listening and competent observation.

3

Certified nurse aides are not responsible for the initial assessment of elderly individuals.

4

Social workers are not responsible for the initial assessment of elderly individuals.

PTS: 1

REF: Chapter 21: Aging Population; Introduction

5. ANS: 4 Page: 320 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Aging Population Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 21: Aging Population; End-of-Life Issues Feedback 1

According to the National Institute of Mental Health (2012), the rate of suicide was higher for another group of individuals.

2

The national average rate of suicide was higher than all age-groups in another population.

3

According to the National Institute of Mental Health (2012), the rate of suicide for persons age 65 and older is higher than the national average for all other agegroups.

4

The highest suicide rate was found in white men aged 85 and older.

PTS: 1

REF: Chapter 21: Aging Population; End-of-Life Issues

6. ANS: 2 Page: 321 Integrated Processes: Communication and Documentation Content Area: Mental Health: Aging Population Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 21: Aging Population; Nursing Skills for Working With Older Adults Feedback 1

If the patient prefers, the nurse may call him by the first name or the name that the person is called socially. Nurses should not do this until invited to do so, however.

Copyright © 2019 F. A. Davis Company

2

Using the proper name of the patient shows respect for that person. “Mr. Washington” or “Ms. Jones” is the best way to address the patient.

3

It is not acceptable to assign nicknames such as “gramps” arbitrarily to patients.

4

It is not acceptable to assign nicknames such as “honey” arbitrarily to patients.

PTS: 1

REF: Chapter 21: Aging Population; Nursing Skills for Working With Older

Adults 7. ANS: 4 Page: 316 Integrated Processes: Communication and Documentation Content Area: Mental Health: Aging Population Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 21: Aging Population; Aphasia Feedback 1

Sleep is a priority for insomnia, not aphasia.

2

Nutrition is a priority for dysphagia, not aphasia.

3

Elimination is a priority for kidney and bowel issues, not aphasia.

4

Communication is a priority for aphasia, a speech disorder that may be found in patients who have had a CVA. Communication is such a basic human need that the nurse and the patient must find a way to communicate.

PTS: 1

REF: Chapter 21: Aging Population; Aphasia

8. ANS: 1 Page: 323 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health Copyright © 2019 F. A. Davis Company

Cognitive Level: Analysis Client Need: Coordinated Care: Continuity of Care Chapter 21: Aging Population; Restorative Nursing Feedback 1

Restorative nursing is part of rehabilitation and focuses on maintaining dignity and achieving optimal function for patients and residents.

2

Palliative care is specialized care for people with serious illness that focuses on addressing management of uncomfortable symptoms and the stress of advanced illness.

3

Hospice is end-of-life care.

4

Intraoperative is during surgery; this is after surgery.

PTS: 1

REF: Chapter 21: Aging Population; Restorative Nursing

9. ANS: 3 Page: 324 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health; Aging Population Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 21: Aging Population; Table 21-2, Concerns of Aging Adults and Helping Techniques Feedback 1

Relaxation methods are used for insomnia, not paranoid thinking.

2

When speaking to an adult who has paranoid thinking, it is therapeutic to speak in terms of the “here and now,” not the future.

3

Provide aids for hearing and vision loss for Tom. Age-related hearing loss (presbycusis) and vision loss as well as early onset of dementia can all contribute to paranoid thinking.

Copyright © 2019 F. A. Davis Company

4

Daytime napping is discouraged in insomnia, not for paranoid thinking.

PTS: 1 REF: Chapter 21: Aging Population; Table 21-2 Concerns of Aging Adults and Helping Techniques COMPLETION 10. ANS: Reconciliation Page: 314 Rationale: The Omnibus Budget Reconciliation Act (OBRA) is a federal act that provides standards of care for older adults residing in a long-term care facility. One of the provisions of OBRA is ensuring proper care and assessment of each resident and providing him or her with a plan of care.

Another provision of OBRA is to provide training especially for those caring for residents.

Integrated Processes: Caring Content Area: Legal Cognitive Level: Knowledge Client Need: Safe and Effective Care Environment: Client Rights Chapter 21: Aging Population; Introduction PTS: 1

REF: Chapter 21: Aging Population; Introduction

11. ANS: Gerontology Page: 312 Rationale: Gerontology, the study of older adults, is a specialty area within nursing. Geriatrics is the branch of medicine that focuses on caring for older adults.

Integrated Processes: Caring Content Area: Mental Health: Aging Population Cognitive Level: Knowledge Copyright © 2019 F. A. Davis Company

Client Need: Health Promotion and Maintenance: Aging Process Chapter 21: Aging Population; Introduction PTS: 1

REF: Chapter 21: Aging Population; Introduction

12. ANS: ageism Page: 313 Rationale: A phenomenon called ageism, which commonly occurs in the United States, is discrimination against people on the basis of their age. Ageism assumes that most older people are incapable of functioning in and contributing to society. Ageism is a misguided and hurtful prejudice toward a group of people, similar to sexism or racism.

Integrated Processes: Caring Content Area: Mental Health: Aging Population Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance: Aging Process Chapter 21: Aging Population; Introduction PTS: 1

REF: Chapter 21: Aging Population; Introduction

MULTIPLE RESPONSE 13. ANS: 1, 2, 3, 5 Page: 316 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Aging Population Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 21: Aging Population; Depression in the Elderly

Copyright © 2019 F. A. Davis Company

Feedback 1.

Correct. Body aches can be a sign of depression in the elderly.

2.

Correct. Body aches (pain) can be a sign of depression in the elderly.

3.

Correct. Constipation can be a sign of depression in the elderly.

4.

Incorrect. One-sided weakness can be a sign of a stroke, not depression.

5.

Correct. Confusion can be a sign of depression in the elderly.

PTS: 1

REF: Chapter 21: Aging Population; Depression in the Elderly

14. ANS: 2, 4, 5 Page: 321–323 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Aging Population Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 21: Aging Population; Nursing Skills for Working With Older Adults

Feedback 1.

Incorrect. Independence should be maintained and promoted for the elderly patient. Too much focus is placed on the staff to provide care by a specific time and not on promoting independence.

2.

Correct. Be patient and recognize that care may take longer than expected. Plan for this. Nurses should convey the message that they have plenty of time (even though they may not).

3.

Incorrect. Constipation can be an issue in the older adult. Fiber should be encouraged to decrease the chance of constipation.

4.

Correct. Self-esteem and pride in one’s accomplishments are as important when one is 80 years old as they were when one was 20. Success breeds success, and

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meeting small goals is an encouragement to the older person to attempt bigger goals.

5.

Correct. The focus should be on the residents’ strengths, not their weaknesses.

PTS: 1

REF: Chapter 21: Aging Population; Nursing Skills for Working With Older

Adults 15. ANS: 2, 3, 4, 5 Page: 317–319 Integrated Processes: Nursing Process: Assessment Content Area: Mental Health: Pharmacology Cognitive Level: Comprehension Client Need: Pharmacological Therapies: Adverse Effects/Contraindications/Side Effects/Interactions Chapter 21: Aging Population; Box 21-2, Common Drug Side Effects for Elderly Patients; Table 211, Common Drug Side Effects and Nursing Actions for Elderly Patients Feedback 1.

Incorrect. Dry mouth, not excessive drooling, is a common drug side effect for elderly patients.

2.

Correct. Orthostatic hypotension is a common drug side effect for elderly patients.

3.

Correct. Fatigue is a common drug side effect for elderly patients.

4.

Correct. Irritability is a common drug side effect for elderly patients.

5.

Correct. Urinary complications are common drug side effects for elderly patients.

PTS: 1 REF: Chapter 21: Aging Population; Box 21-2 Common Drug Side Effects for Elderly Patients; Copyright © 2019 F. A. Davis Company

Table 21-1 Common Drug Side Effects and Nursing Actions for Elderly Patients Chapter 22. Victims of Abuse and Violence Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Your new patient in the emergency department states that she was been beaten and raped. What should you do first?

1. Ask for a psychiatric consult.

2. Stay with her and provide support.

3. Wash and dress her wounds before the “rape kit” is performed.

4. Encourage her to tell you the details of what happened.

____ 2. Who is the most likely perpetrator of child abuse?

1. Parent 2. Other relative 3. Hired babysitter 4. Teacher

____ 3. Which of the following is NOT a risk factor for becoming a child abuser?

1. Abused as a child 2. Having a chronic disease 3. Heavy drinker 4. Poor coping mechanisms to deal with frustration

____ 4. A 90-year-old patient is admitted with a broken wrist and multiple bruises. The caregiver reports the patient falls when she wanders. Which of the following would lead you to suspect elder abuse?

1. Inconsistent explanations about the details of the falls.

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2. The patient tells you she doesn’t like the caregiver.

3. The patient begins crying when her daughter arrives.

4. The patient has a urinary tract infection (UTI).

____ 5. Because a woman who is being hurt by her partner may try to keep the abuse private, which of the following is known to be an indirect source to identify the abuse?

1. Pediatric clinics 2. Emergency departments 3. Women’s shelters 4. Mental health clinics

____ 6. A battered woman in the women’s shelter states that she “is afraid to go home because he drinks.

That’s when he gets violent and he beats me.” Which of the following reflects accurate knowledge about domestic violence and alcohol use?

1. “If you can get him to quit drinking, the beating will stop.”

2. “Alcohol use can increase the chances of abuse.”

3. “People who use alcohol almost always end up as abusers.”

4. “He’s just using the alcohol as an excuse to beat you.”

____ 7. You are caring for a middle-aged man who is under medical and psychiatric care for molesting a 7year-old girl. You inform him that dinner is being served in the dining room. He tells you to leave and that he does not want anyone to see him or “know what I did.” You respond: 1. “You will need to face people sooner or later.”

2. “You are here for treatment of an illness, not judgment of an action.”

3. “I guess I wouldn’t want to been seen either. You may stay here.”

4. “Only the staff knows the reason for your admission.”

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____ 8. You are caring for a 6-year-old boy who allegedly has been abused by his mother. During his mother’s visits, which of the following is most associated with her being an abuser?

1. A strong and loving relationship with her parents 2. Single-parent home 3. A history of being abused as a child 4. Unemployed

____ 9. Your patient, who has reported domestic violence, now tells you she is going home with her husband because he has apologized and says he is taking her to Hawaii on a romantic vacation. Which statement best helps you understand her actions?

1. Her husband has received treatment for anger management.

2. This is the honeymoon phase of the abuse cycle.

3. This is the resolution phase of the family crisis.

4. She mistakenly reported domestic violence.

____ 10. The difference between child abuse and child neglect is: 1. Abuse is done on purpose; neglect is accidental.

2. Abuse is an act of commission; neglect is an act of omission.

3. Abuse is a crime; neglect is not.

4. Children are often afraid to report abuse, but are willing to report neglect.

____ 11. Annie is a 5-year-old who has been the victim of sexual abuse by a family member. Which of the following therapeutic techniques would be especially useful in helping Annie express her feelings?

1. Individual psychotherapy 2. Behavior modification 3. Family therapy sessions 4. Drawing

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Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 12. Which of the following are actions the nurse can take to help adult victims of abuse (select all that apply)?

1. Reassure the patient that everything possible is being done to ensure his or her safety.

2. Don’t show empathy to the abuser.

3. Know your own thoughts and feelings about abuse.

4. Take the burden of deciding about notifying authorities off the patient and do it yourself.

5. Remain nonjudgmental.

6. Know and follow agency policies.

____ 13. Which of the following statements about sexual abuse of children are true (select all that apply)?

1. The abuser is most often someone the child knows and trusts.

2. The nurse must confront the abuse victim to make him or her admit to the abuse.

3. Abused children often act out the abuse in their own play behaviors.

4. The abused child is confused about whether the acts are right but believes the abuser would not do anything wrong.

5. Because children are resilient, they tend to get over acts of sexual abuse fairly easily with minimal intervention.

6. One thing the nurse must do is reinforce that the child is not to blame for the abuse.

True/False Indicate whether the statement is true or false.

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____ 14. Purposely hurting a family pet is a warning sign of other types of abuse in the home.

True False Completion Complete each statement.

15. _______________ abuse can include verbal abuse, humiliation, and excessive criticism.

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Chapter 22. Victims of Abuse and Violence Answer Section MULTIPLE CHOICE 1. ANS: 2 Page: 339 Integrated Processes: Nursing Process: Implementation Content Area: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 22: Victims of Abuse and Violence; General Nursing Interventions Feedback 1

This may be needed later but it is not the first action you should take.

2

Providing security and support are the best initial interventions. The survivor of abuse will be confused and fearful. The nurse needs to reassure the patient that everything possible is being done to ensure her safety.

3

One of the victim’s first instincts is to “wash away” the incident both physically and psychologically by showering. Nurses should discourage that activity until evidence can be collected.

4

Gathering information about the incident will come later. The nurse’s first action should be to provide security and support.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; General Nursing

Interventions 2. ANS: 1 Page: 332 Integrated Processes: Nursing Process: Analysis Copyright © 2019 F. A. Davis Company

Content Area: Mental Health: Child Abuse Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; Child Abuse Feedback 1

Parents are the most common abusers of children.

2

Other relatives are not the most common perpetrators of child abuse.

3

Hired babysitters are not the most common perpetrators of child abuse.

4

Teachers are not the most common perpetrators of child abuse.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; Child Abuse

3. ANS: 2 Page: 330 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; The Abuser Feedback 1

Being abused as a child is a risk factor for becoming a child abuser. Children who grow up witnessing violence in the home and perhaps their community are sensitized to believe that this is the right behavior, and they may continue such actions into adulthood.

2

Having a chronic disease is not a risk factor for becoming a child abuser.

Healthy and ill individuals can be abusers; it crosses all socioeconomic levels.

3

Being a heavy drinker is a risk factor for becoming a child abuser. Being under the influence of a substance is a major contributor to violence.

Copyright © 2019 F. A. Davis Company

4

Poor coping mechanisms to deal with frustration is a risk factor for becoming a child abuser.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; The Abuser

4. ANS: 1 Page: 332 Integrated Processes: Nursing Process: Analysis Content Area: Geriatrics: Elder Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; The Abuser; Box 22-1, Common Warning Signs of Abuse Feedback 1

Inconsistent explanations of injuries are a common indicator of abuse.

2

Liking or not liking the caregiver is not as strong an indicator of abuse as inconsistent explanations about the injury.

3

Beginning to cry when the daughter arrives does not indicate abuse; it may mean the patient is relieved to have someone present.

4

The presence of a UTI does not indicate abuse; there needs to be a pattern of UTIs.

PTS: 1 REF: Chapter 22: Victims of Abuse and Violence; The Abuser; Box 22-1 Common Warning Signs of Abuse 5. ANS: 1 Page: 335 Copyright © 2019 F. A. Davis Company

Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; Domestic Violence Feedback 1

Pediatricians and veterinarians are trained to identify signs of domestic violence because they may observe clues of a troubled family when examining children and pets.

2

Although the emergency department may be a source to identify the abuse, it is a direct source.

3

Women’s shelters are used as safe places for women who are abused to stay.

4

Mental health clinics are not usually an indirect source to identify the abuse.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; Domestic Violence

6. ANS: 2 Page: 330 Integrated Processes: Nursing Process: Implementation Content Area: Substance Abuse Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect: Chemical and Other Dependencies Chapter 22: Victims of Abuse and Violence; The Abuser Feedback 1

This invalidates the patient’s feelings and safety. Telling the patient she has to get him to stop is inappropriate.

2

Being under the influence of a substance is a major contributor to violence.

When a person’s judgment is impaired and his or her ability to control impulses

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is altered, a person who is prone to these acts may abuse others.

3

This is an inaccurate statement. Although it increases the chances, it does not mean it will occur.

4

There are many reasons a person may abuse others.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; The Abuser

7. ANS: 2 Page: 339 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health: Therapeutic Communication Cognitive Level: Application Client Need: Psychosocial Integrity: Therapeutic Communication Chapter 22: Victims of Abuse and Violence; General Nursing Interventions Feedback 1

This response is judgmental and critical. Nurses are responsible to help all patients.

2

This response is professional and communicates support to this patient. Nurses are responsible to help all patients.

3

This response is judgmental. Nurses are responsible to help all patients.

4

Although this response is true, it is not as supportive. Nurses are responsible to help all patients.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; General Nursing

Interventions 8. ANS: 3 Page: 330 Integrated Processes: Nursing Process: Analysis Copyright © 2019 F. A. Davis Company

Content Area: Mental Health: Child Abuse Cognitive Level: Comprehension Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; The Abuser Feedback 1

This type of relationship usually decreases the chance of abuse.

2

Being a single parent does not indicate abuse. Abuse occurs with all types of people.

3

Continuing of the abuse cycle into adulthood remains a frequent pattern.

4

Being unemployed does not indicate abuse. Abuse crosses all socioeconomic levels.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; The Abuser

9. ANS: 2 Page: 335 Integrated Processes: Nursing Process: Analysis Content Area: Women’s Health Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; Domestic Violence Feedback 1

This is not behavior that the husband received anger management treatment for.

The couple is still in the abuse cycle.

2

During the honeymoon phase, the perpetrator is contrite, loving, and very sad about the incident of abuse that has occurred. He or she may well try to make amends with gifts. The victim believes that love will conquer all and that, this time, the abuse will stop.

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3

This is not behavior of the resolution phase of a family crisis. The couple is still in the abuse cycle.

4

This is not behavior of mistakenly reporting domestic violence. The couple is still in the abuse cycle.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; Domestic Violence

10. ANS: 2 Page: 342 Integrated Processes: Nursing Process: Analysis Content Area: Child Health: Abuse Cognitive Level: Analysis Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; Introduction; Table 22-3, Nursing Interventions for Victims of Abuse Feedback 1

Both can be done on purpose.

2

Abuse is purposeful mistreatment of another (therefore commission), and neglect is failure to provide for the basic needs of someone (that is an omission of needed care).

3

Both can be a crime.

4

Children are often afraid to report either abuse or neglect.

PTS: 1 REF: Chapter 22: Victims of Abuse and Violence; Introduction; Table 22-3 Nursing Interventions for Victims of Abuse 11. ANS: 4 Copyright © 2019 F. A. Davis Company

Page: 338 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concept Chapter 22: Victims of Abuse and Violence; Treatment of Abuse Feedback 1

Because she is so young, Annie may have great difficulties expressing her feelings in words.

2

Because she is so young, Annie may have great difficulties expressing her experiences in words.

3

Because she is so young, another form of therapy may better help Annie express her feelings and experiences.

4

Drawing allows her self-expression in an age-appropriate manner. Play and art therapy can be important tools for children to communicate their feelings.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; Treatment of Abuse

MULTIPLE RESPONSE 12. ANS: 1, 3, 5, 6 Page: 339 Integrated Processes: Nursing Process: Implementation Content Area: Mental Health Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect: Therapeutic Communication Chapter 22: Victims of Abuse and Violence; General Nursing Interventions

Feedback Copyright © 2019 F. A. Davis Company

1.

Correct. The survivor of abuse will be confused and fearful. The nurse needs to reassure the patient that everything possible is being done to ensure his or her safety.

2.

Incorrect. Nurses should remember that they may be treating the survivor as well as the abuser. Nurses are responsible to help all patients.

3.

Correct. Know your own thoughts and feelings about abuse: a nurse who has been abused or who has been an abuser may find it difficult to be therapeutic for the patient.

4.

Incorrect. In adults with capacity to make their own decisions, the patient needs to consent to reporting abuse.

5.

Correct. The responsibility and professionalism of the nurse is to remain nonjudgmental.

6.

Correct. Know your agency policy and use your resources: Every health-care agency has its own policies and procedures for dealing with victims of abuse and violence. Familiarity with these policies and procedures will help save time and convey confidence.

PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; General Nursing

Interventions 13. ANS: 1, 3, 4, 6 Page: 333–334, 341 Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Child Health Cognitive Level: Application Client Need: Psychosocial Integrity: Mental Health Concepts Chapter 22: Victims of Abuse and Violence; Sexual Abuse; Table 22-3, Nursing Interventions for Victims of Abuse

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Feedback 1.

Correct. The abuser is most often someone the child knows and trusts.

2.

Incorrect. It is not the nurse’s role to have the abuser admit to the abuse.

3.

Correct. Play and drawings may reflect the child’s abuse and are good tools to help children deal with the effects of abuse.

4.

Correct. Children may feel threatened, be confused about their feelings, and question whether the activity is right.

5.

Incorrect. Although children are often resilient, sexual abuse is traumatic and requires treatment. It may not be revealed until later in life.

6.

Correct. Nurses should reinforce that victims should not blame themselves for the abuse.

PTS: 1 REF: Chapter 22: Victims of Abuse and Violence; Sexual Abuse; Table 22-3 Nursing Interventions for Victims of Abuse TRUE/FALSE 14. ANS: T Page: 330, 333 Rationale: Abuse of family pets can be an indicator of family violence as the abuser demonstrates his or her power and control. Children may try to deal with their own abuse by controlling another being or seeking an outlet for their anger through a more vulnerable victim, such as a pet.

Integrated Processes: Nursing Process: Analysis Content Area: Mental Health: Coping Cognitive Level: Application Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; The Abuser; Child Abuse PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; The Abuser; Child Abuse

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COMPLETION 15. ANS: Emotional Page: 330 Rationale: Emotional abuse can include verbal abuse, humiliation, excessive criticism, and lack of emotional support. Physical abuse includes any action that causes physical harm to another person.

Sexual abuse can include rape as well as any inappropriate sexual contact without consent.

Integrated Processes: Teaching/Learning Content Area: Mental Health: Abuse Cognitive Level: Knowledge Client Need: Psychosocial Integrity: Abuse/Neglect Chapter 22: Victims of Abuse and Violence; Introduction PTS: 1

REF: Chapter 22: Victims of Abuse and Violence; Introduction

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