Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

The Psychiatric Interview 4th Edition Carlat (Chapter 1-Chapter 3)The Initial Interview: A Preview Chapter 2: Logistic Preparations: What to Do Before the Interview Chapter 3: The Therapeutic Alliance: What It Is, Why It's Important, and How to Establish It MULTIPLE CHOICE 1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will: a. deny suicidal ideation. b. report a sense of well-being. c. take medications as prescribed. d. attend clinic appointments on time.

ANS: B Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness.

The incorrect options focus on the classic medical model rather than recovery.

2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses most caring comment. a. Lets discuss some means of coping other than suicide when you have these feelings. b. I understand why youre so depressed. When I got divorced, I was devastated too. c. You should forget about your marriage and move on with your life. d. How did you get so depressed that hospitalization was necessary?

ANS: A The nurses communication should evidence caring and a commitment to work with the patient.

This commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions.

3. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup.

Which comment by the nurse who receives the report best demonstrates advocacy? a. This is a psychiatric hospital. Craziness is what we are all about. b. Lets all show acceptance of this patient by wearing lots of makeup too.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

c. Your comments are inconsiderate and inappropriate. Keep the report objective. d. Our patients need our help to learn behaviors that will help them get along in society.

ANS: D Accepting patients needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients.

Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other.

4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of attending? a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world. b. Tell me why you felt you had to be hospitalized to receive treatment for your depression. c. You will feel better after we get some antidepressant medication started for you. d. Id like to sit with you a while so you may feel more comfortable talking with me.

ANS: D Attending is a technique that demonstrates the nurses commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are non-therapeutic.

5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web sites address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in .org. b. Address ends in .com. c. Address ends in .gov. d. Address ends in .net.

ANS: B Financial influences on a site are a clue that the information may be biased. .com at the end of the address indicates that the site is a commercial one. .gov indicates that the site is maintained by a government entity. .org indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. .net can have multiple

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

meanings.

6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work.

I plan to stop calling patients by name. Which statement is the best appraisal of this nurses comment? a. One descriptive research study rarely provides enough evidence to change practice. b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into clinical algorithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.

ANS: A Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flow charts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change.

7. Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills. Select the best response by the student interested in psychiatric nursing. a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients problems. b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. Im challenged by those situations. c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. That appeals to me.

ANS: B The practice of psychiatric nursing requires a different set of skills than medical surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation.

Psychosocial pain is real and can cause as much suffering as physical pain.

8. Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for practice b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway ANS: B Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is Level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence.

A critical pathway is not evidence; it incorporates research findings after they have been analyzed.

9. A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice ANS: A An advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do that for himself or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.

10. An informal group of patients discuss their perceptions of nursing care. Which comment best

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

indicates a patients perception that his or her nurse is caring? a. My nurse always asks me which type of juice I want to help me swallow my medication. b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better. c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon. d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone.

ANS: D Caring evidences empathic understanding, as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice.

11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems (ICD) ANS: A A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patients needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases.

12. Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric nursing? a. Abraham Maslow b. Hildegard Peplau c. Kris Martinsen Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

d. Harriet Bailey ANS: B Although all these leaders included science as an important component of practice, Hildegard Peplau most influenced its development in psychiatric nursing. Maslow was not a nurse, but his theories influence how nurses prioritize problems and care. Bailey wrote a textbook in the 1930s on psychiatric nursing interventions. Kris Martinsen emphasized the importance of caring in nursing practice.

13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients.

Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a. distrustful of others. b. connected with others. c. uneasy about the future. d. discouraged with efforts to improve.

ANS: B A patient is likely to respond to caring with a sense of connectedness with others. The absence of caring can make patients feel distrustful, disconnected, uneasy, and discouraged.

MULTIPLE RESPONSE 1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you will instantly know how to take care of psychotic patients. What is the new graduates best analysis of this comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients needs.

ANS: A, B Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.

2. Which patient statements identify qualities of nursing practice with high therapeutic value?

(Select all that apply.) My nurse: a. talks in language I can understand. b. helps me keep track of my medications. c. is willing to go to social activities with me. d. lets me do whatever I choose without interfering. e. looks at me as a whole person with different needs.

ANS: A, B, E Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse, when the nurse should instead provide thoughtful feedback and help patients test alternative solutions or violate boundaries.

1. An example of an environmental factor that would cause a nurse to modify a planned critical interaction occurs when the:

a .

Patient expresses a personal dislike for the nurse

b .

Patient is in total denial about her condition

c .

Nurse lacks the degree of knowledge required for the interaction

d .

Nurse learns that the patients mother has been hospitalized with a stroke

ANS: D Environmental factors include timing. Timing of critical interventions is important. It should occur when the individual can give full attention to the topic. It would be inappropriate to Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

continue with the plan in the face of the patients distress related to her mothers illness. The remaining options reflect other types of factors that influence communication such as attitudes, knowledge, and relationships.

2. The nurse suspects that the patients communication is being negatively influenced by personal attitude when he is heard stating:

a .

They think Im mentally ill but Im not; I just get a little depressed at times.

b .

I cant concentrate on anything besides getting out of here and back to my kids.

c .

Obviously my therapist cant understand where Im coming from because our lives are so different.

d .

There isnt anyone here in this hospital I can trust enough to talk to about why I abuse alcohol and drugs.

ANS: C Attitude determines how one person responds to another. It includes ones biases, past experiences, and openness. People of different socioeconomic backgrounds may have difficulty surmounting this barrier. The remaining options reflect factors that can negatively influence communication but they are environmental, knowledge, and relationship oriented.

3. The nature of the communication characterized in this exchange between a nurse and a chronically depressed patient is: Nurse: Is it true that you enjoy knitting?

Patient: Yes, Ive done it for years and am pretty good at it.

Nurse: Im just a beginner. Do you think you could give me some tips?

Patient: I guess so. What would you like to know?

a .

Therapeutic

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

b .

Collegial

c .

Social

d .

Intrapersonal

ANS: C Although the conversation takes place between the nurse and a patient, it is of a social nature. It is superficial and benefits both parties mutually by encouraging a relationship based on mutual interest. No expectation of help exists. Therapeutic communication promotes patient growth and is patient-focused. Collegial conversation occurs for the purpose of professional collaboration.

Intrapersonal communication takes place within the individual.

4. A patient expresses a sense of genuineness in the nurse providing care when sharing with family members that:

a .

I believe the nurse can feel what Im feeling.

b .

I always know what the nurse expects of me; the explanations are always clear.

c .

I can tell the nurse is sincere because the face supports what the mouth is saying.

d .

I may not always like what the nurse has to say but I can always depend on what Im told.

ANS: C Genuineness is demonstrated by congruence between verbal and nonverbal behavior. Empathy is seeing things from the patients viewpoint. Clearly stating expectations is a characteristic of clarity. Trustworthiness can be described as dependability.

5. When providing discharge teaching to a patient for whom English is a second language, what technique will the nurse use to assess the patients understanding of the information being shared verbally?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

Continuously evaluating the patients nonverbal cues

b .

Periodically asking the patient if they have any questions

c .

Asking the patient to repeat the information they are given

d .

Providing the information in concise, written form

ANS: A Individuals from different cultures or even different generations often misunderstand and misinterpret an unfamiliar language. Being aware of and critically examining cues that result from nonverbal responses is an excellent technique to check their interpretations. Asking if they have questions is an ineffective technique in light of the language barrier. Repeating the information is no guarantee that the patient understands the information. Providing the information in written form reinforces the material but does not ensure understanding especially if the patient has deficiencies related to reading the language.

6. When communicating with a psychotic, schizophrenic patient, the nurse avoids the use of slang phrases most importantly because:

a .

Such phrases have different meanings for different people.

b .

Such phrases will likely trigger anxiety and frustration in the patient.

c .

The use of such phrases is not appropriate when communicating therapeutically with a patient.

d .

This patients altered thought processes will serve to make understanding such phrases very unlikely.

ANS: D Precise verbal communication is important because spoken words often mean different things to different people. Figures of speech, jokes, clichs, colloquialisms, and other terms or special phrases carry a variety of meanings especially to individuals with altered thought processes. A person with schizophrenia interprets concretely and literally whereas psychosis generally brings about loose associations. Although all the options are reasons to avoid the use of slang phrases,

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

the primary reason in this case in to avoid confusing the patient.

7. The nurse is considering the need for both effective means of communication and safety when caring for a patient with impulse control issues and poor social skills. Which nursing intervention is most appropriate to address these needs?

a .

Reminding the patient with each interaction what space boundaries are considered safe and desired

b .

Asking the patient to describe and set space boundaries that feel safe and facilitate effective communication

c .

Clearly setting space boundaries for the patient so both patient and staff feel safe and can communicate more effectively

d .

Discussing the need for space boundaries and how they help both the patient and the staff feel safe and aide in communicating effectively

ANS: D Space as a concept of boundaries and safety is important to understand because the nurse and the patient need to respect the distance that each needs. For successful communication to occur, both parties need to feel safe. Some patients have problems with their boundaries and invade other patients own safe zones; patients who perceive this as threatening react aggressively to such boundary violations. The nurse may need to help the patient understand the need for appropriate distances in order for everyone to feel safe and to communicate effectively. Reminding the patient of what the boundaries are without first discussing the importance of space boundaries is not an effective technique. Having the patient set the boundaries does not take into consideration the needs of others, whereas staff setting the boundaries without patient involvement ignores the needs of the patient and prevents the patient from understanding of the situation.

8. During the termination phase of the nurse-patient relationship with a dependent patient, the nurse evaluates the effectiveness of coping techniques learned by:

a .

Role playing with the patient in order to practice being assertive

b .

Asking the patient to define the difference between being assertive and being aggressive.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

c .

Discussing how her father effectively used both assertiveness and aggressiveness to control her

d .

Asking, When you used assertiveness to deal with your father during his visit, how did it work?

ANS: D Evaluation is a task of the termination phase. Asking such a question encourages patients to evaluate actions and look at the outcomes of behaviors. Role playing to practice the technique, defining the relevant terms, and discussing the effects of the fathers behavior would occur during the working phase of the relationship and does not encourage evaluation of the newly learned skills.

9. The nurse has developed a plan in which nursing interventions are used to reinforce the patients healthy behaviors. Which statement by the nurse will positively reinforce the patients efforts regarding the plan?

a .

How can a stress reduction plan help you at home?

b .

It sounds like you have the incentive to make healthy choices.

c .

When you tried to follow the plan, how well did it work for you?

d .

It sounds as though making healthy choices is very important to you.

ANS: B This answer offers a positive response to a patient who is trying out new behaviors. This nursing response will serve to encourage the patients efforts. The remaining options do not provide positive reinforcement but rather are attempts to gather more information or clarify the patients motivation to change.

10. A patient indicates that he is about to share information about his illness that is shocking and embarrassing. Which nursing intervention has priority in this situation in facilitating the communication process?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

Reassuring the patient that talking will be therapeutic

b .

Assuring the patient the information will be kept confidential

c .

Responding to the patients information in an accepting manner

d .

Providing the patient with a private place for the discussion to occur

ANS: C Responding to the patients information in a nonjudgmental, accepting manner will encourage continued therapeutic communication. The remaining options, although appropriate, will not have the same generalized affect on the communication process as the correct option.

11. A patient whose history includes physically abusing his spouse and children has been admitted to the unit for alcohol and drug dependency. Which nurse will likely experience difficulty establishing a therapeutic relationship with this patient?

a .

The nurse who has experienced physical abuse

b .

The novice nurse who has never cared for an abuser

c .

The experienced nurse who has seen too many abusers

d .

The nurse who has been in treatment for abusing a spouse

ANS: A The therapeutic use of the self begins with knowing yourself. Knowing yourself is a complex and lifelong learning process. At the core of self-knowledge is the nurses ability to correctly identify his or her own negative or unresolved issues including family backgrounds, dynamic cultural and social issues, values, biases, and prejudices. Having been a victim of physical abuse places this nurse in a situation that can be very harmful to the development of an affective nurse-patient relationship. The novice nurse may lack some of the knowledge and experience necessary to be effective but is not a likely to have intruding biases and prejudices. The experienced nurse is more likely to have worked on the ability to provide effective care in spite of such experience with this type of diagnosis whereas, the nurse having been treated for the diagnosis is most likely Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

to show empathy and caring.

12. A novice nurse asks, What is so wrong about being sympathetic with a patient who has also lost a parent like I did? The psychiatric nurse manager responds:

a .

There is a fine line between empathy and sympathy that when crossed makes you less able to be therapeutic.

b .

Rather than discussing the loss of your parent with the patient, you can talk to me about it whenever you need to.

c .

Ill provide you with some excellent materials that Im sure will help you to understand why sympathy is less therapeutic.

d .

Sympathy indicates that you are sharing your personal feelings and that changes the focus of the communication from the patient to you.

ANS: D Empathy should not be confused with sympathy. Sympathy is overinvolvement and sharing your own feelings after hearing about another persons similar experience. It is not objective, and its primary purpose is to decrease ones own personal distress. Although substituting sympathy for empathy does lessen the ability to be therapeutic, that is not the best explanation for avoiding it.

Offering to discuss the nurses loss is a kind gesture but does not address the nurses question.

Providing materials on the subject would be an appropriate reinforcement but does not address the question well.

13. A nurse has for the past 4 weeks been working with a psychotic patient who has been mute and very withdrawn. The patient suddenly encroaches on the nurses personal space by touching inappropriately. What is the most therapeutic response by the nurse to address this behavior?

a .

Ignore it this time because the patient is, at last, responding.

b .

Firmly communicate acceptable boundaries to the patient.

c .

Gently touch the patients head and then observe the reaction.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

d .

Smile while telling the patient that people dont like being touched like that.

ANS: B The therapeutic response is to clearly communicate appropriate boundaries. There are times when patients misinterpret the nurses nurturing as an invitation to an intimate relationship. In these instances, boundaries must be firmly, but neutrally, explained. The behavior should not be ignored since doing so may well result in the patient repeating the behavior with others, perhaps with disastrous results. Touch is often misinterpreted by psychotic patients and in this case has no therapeutic value. Nonverbal communication should always be congruent so as to avoid confusing the patient.

14. Which statement indicates that a novice nurse understands the purpose of therapeutic communication? My goal for communication with any patient is to:

a .

maintain relationships.

b .

mutually share information.

c .

promote growth and change.

d .

offer advice and make suggestions.

ANS: C Therapeutic communication is intended to assist the patient to grow and change. The other options are characteristics of social communication.

15. The expected outcome of conducting a periodic self-evaluation of ones own responses to patients is for the nurse to continue:

a .

Recognizing the nurses need for therapy

b .

Recognizing personal problems and strengths

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

c .

Maintaining distance from the patients problems

d .

Maintaining professional boundaries with the patients

ANS: B Self-evaluation of responses to patients will reveal whether the nurse is responding with objectivity versus subjectivity, acceptance or rejection, calmly or with anger, and with sympathy or anxiety. The goal is not identify the nurses need for therapy or to maintain distance for patient problems, but rather to remain objective about them. The purpose of a self-evaluation is to recognize the nurses responses, not to maintain boundaries.

16. Which nursing response would indicate an empathetic approach to a patient who is depressed over recent losses in her life?

a .

Losing a job isnt always a bad thing.

b .

I lost my parents last year and still feel sad.

c .

Please tell me more about what you are feeling.

d .

Lets not focus on whats sad but rather what is good about life.

ANS: C Empathy or empathic understanding is the nurses ability to see things from the patients viewpoint and to communicate this understanding to the patient. This response focuses on the patients feelings and encourages further discussion. Minimizing the loss or suggesting a change in focus sounds judgmental or patronizing and will likely cut off communication. Although selfdisclosure can be therapeutic, this focuses on the nurses feelings.

17. A nurse is considering the therapeutic value of touch when planning care for an anxious patient. What is the initial question the nurse should answer before initiating this technique?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

How comfortable am I with touching this patient?

b .

Will the patient find therapeutic touch supportive?

c .

Does research support the use of therapeutic touch?

d .

Has therapeutic touch proven to be therapeutic with anxious patients?

ANS: A Touch will only communicate warmth and thus be therapeutic if the nurse is comfortable with it.

Although the other options are all appropriate, they do not have priority in this situation.

18. The nurse mentions, I like to use open-ended questions and statements because they result in fuller, more revealing responses by the patient, and they stimulate discussion. What statement would the nurse ask to best stimulate conversation with a patient about their family?

a .

Where does your family live?

b .

Tell me about your family.

c .

Do you have a family nearby?

d .

Would you like to talk about your family?

ANS: B This broad opening will encourage discussion as well as allow the patient to decide what to include about his or her family. The remaining options can all be answered with a yes or no response and so do not stimulate communication.

19. A patient is struggling to explore and solve a problem. The nurse determines that it would be therapeutic to offer alternatives. Which verbal introduction should the nurse incorporate in order to achieve this objective?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

Have you thought of

b .

You should

c .

Why dont you

d .

I think you need to

ANS: A This encourages the patient to consider alternatives without giving advice. The other options are preludes to giving advice, which is not considered therapeutic.

20. A nurse is contemplating the use of self-disclosure. The expected outcome of this strategy is that the patient will:

a .

be informed about expected behaviors

b .

express previously withheld feelings

c .

foster a mutually supportive relationship with the nurse

d .

recognize that the nurse can empathize through shared experiences

ANS: B Self-disclosure should serve one or more of the following purposes: to model and educate; to build the therapeutic alliance; to provide concrete reflection that encourages reality testing. The nurse does not use self-disclosure foster a interdependent relationship that in any way gives support to the nurse. Empathy does not rely upon shared experiences.

Chapter 4-Chapter 5 : Asking Questions I: How to Approach Threatening Topics Chapter 5: Asking Questions II: Tricks for Improving Patient Recall Chapter 6: Asking Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Questions III: How to Change Topics with Style MULTIPLE CHOICE 1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which response should the nurse use to clarify the patients comment?

a .

It sounds as though you were uncomfortable with the content of your dream.

b .

I understand what youre saying. Bad dreams leave me feeling tired, too.

c .

So you feel as though you did not get enough quality sleep last night?

d .

Can you give me an example of what you mean by stoned?

ANS: D The technique of clarification is therapeutic and helps the nurse examine the meaning of the patients statement. Asking for a definition of stoned directly asks for clarification. Restating that the patient is uncomfortable with the dreams content is parroting, a non-therapeutic technique.

The other responses fail to clarify the meaning of the patients comment.

2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic?

a .

Lets talk about something other than the CIA.

b .

It sounds like youre concerned about your privacy.

c .

The CIA is prohibited from operating in health care facilities.

d .

You have lost touch with reality, which is a symptom of your illness.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

ANS: B It is important not to challenge the patients beliefs, even if they are unrealistic. Challenging undermines the patients trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patients message conveys. The correct response uses the therapeutic technique of reflection. The other comments are non-therapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful, but uncompassionate.

3. The patient says, My marriage is just great. My spouse and I always agree. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patients communication is:

a .

clear.

c .

precise.

b .

mixed.

d .

inadequate.

ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker.

The patients verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self.

a .

Ive also had traumatic life experiences. Maybe it would help if I told you about them.

b .

Why do you think you had so much difficulty adjusting to this change in your life?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

c .

I hope you will feel better after getting accustomed to how this unit operates.

d .

Id like to sit with you for a while to help you get comfortable talking to me.

ANS: D Offering self is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of offering self, helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but is an example of offering hope.

5. Which technique will best communicate to a patient that the nurse is interested in listening?

a .

Restating a feeling or thought the patient has expressed.

b .

Asking a direct question, such as Did you feel angry?

c .

Making a judgment about the patients problem.

d .

Saying, I understand what youre saying.

ANS: A Restating allows the patient to validate the nurses understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as Did you feel angry? ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patients words, the patient has no way of measuring the understanding.

6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

What are the common elements here?

b .

Tell me again about your experiences.

c .

Am I correct in understanding that . . .

d .

Tell me everything from the beginning.

ANS: C Asking, Am I correct in understanding that permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

7. A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most therapeutic response.

a .

Dont talk that way. Of course you will leave here!

b .

Keep up the good work, and you certainly will.

c .

You dont think youre making progress?

d .

Everyone feels that way sometimes.

ANS: C By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are non-therapeutic techniques. Telling the patient not to talk that way is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate?

a .

The patient is giving positive feedback about the nurses communication techniques.

b .

The nurse is viewing the patients behavior through a cultural filter.

c .

The patients verbal and nonverbal messages are incongruent.

d .

The patient is demonstrating psychotic behaviors.

ANS: C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a mixed message. It is inaccurate to say that the patient is giving positive feedback about the nurses communication techniques. The concept of a cultural filter is not relevant to the situation because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 150-151 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed?

a .

Nonverbal communication

c .

A cultural barrier

b .

A message filter

d .

Social skills

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

ANS: A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patients social skills or whether a cultural barrier exists.

10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior.

a .

It shows empathy and compassion. It will encourage the patient to continue to express feelings.

b .

The gesture is premature. The patients cultural and individual interpretation of touch is unknown.

c .

The patient will perceive the gesture as intrusive and overstepping boundaries.

d .

The action is inappropriate. Psychiatric patients should not be touched.

ANS: B Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.

11. During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.

a .

I notice you keep looking toward the door.

b .

This is our time together. No one is going to interrupt us.

c .

It looks as if you are eager to end our discussion for today.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

d .

If you are uncomfortable in this room, we can move someplace else.

ANS: A Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.

12. A black patient says to a white nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to:

a .

explain, Yes, I do understand. Everyone goes through the same experiences.

b .

say, Please give an example of something you think I wouldnt understand.

c .

reassure the patient that nurses interact with people from all cultures.

d .

change the subject to one that is less emotionally disturbing.

ANS: B Having the patient speak in specifics rather than globally will help the nurse understand the patients perspective. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

13. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem, but after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario?

a .

The patients eye contact should have been directly addressed by role-playing to increase comfort with eye contact.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

b .

The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.

c .

The patients poor eye contact is indicative of anger and hostility that were unaddressed.

d .

The nurse should have assessed the patients culture before making this diagnosis and plan.

ANS: D The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

14. When a female Mexican American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate?

a .

The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures.

b .

The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.

c .

The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.

d .

The patient is trying to manipulate the nurse using nonverbal techniques.

ANS: A The most likely answer is that the patients behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

15. A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient: Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

has a histrionic personality disorder.

b .

believes dramatic body language is sexually appealing.

c .

wishes to impress staff with the degree of emotional pain.

d .

belongs to a culture in which dramatic body language is the norm.

ANS: D Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

16. During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:

a .

Why do you keep asking about me?

b .

Nurses direct the interviews with patients.

c .

Do not ask questions about my personal life.

d .

The time we spend together is to discuss your concerns.

ANS: D When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurses personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Why questions are probing and non-therapeutic.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

a .

A nurse is responsible for breaking silences.

b .

Patients withdraw if silences are prolonged.

c .

Silence can provide meaningful moments for reflection.

d .

Silence helps patients know that what they said was understood.

ANS: C Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 151-154 (Table 9-2) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 18. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice:

a .

is rarely helpful.

b .

fosters independence.

c .

lifts the burden of personal decision making.

d .

helps the patient develop feelings of personal adequacy.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

ANS: A Giving advice fosters dependence on the nurse and interferes with the patients right to make personal decisions. It robs patients of the opportunity to weigh alternatives and develop problemsolving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

19. A school age child tells the school nurse, Other kids call me mean names and will not sit with me at lunch. Nobody likes me. Select the nurses most therapeutic response.

a .

Just ignore them and they will leave you alone.

b .

You should make friends with other children.

c .

Call them names if they do that to you.

d .

Tell me more about how you feel.

ANS: D The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.

20. A patient with acute depression states, God is punishing me for my past sins. What is the nurses most therapeutic response?

a .

You sound very upset about this.

b .

God always forgives us for our sins.

c .

Why do you think you are being punished?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

d .

If you feel this way, you should talk to your minister.

ANS: A The nurse reflects the patients comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are non-therapeutic.

MULTIPLE RESPONSE 1. A patient cries as the nurse explores the patients feelings about the death of a close friend. The patient sobs, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse facilitate communication?Select all that apply.

a .

Why do you think you are so upset?

b .

I can see that you feel sad about this situation.

c .

The loss of a close friend is very painful for you.

d .

Crying is a way of expressing the hurt you are experiencing.

e .

Lets talk about something else because this subject is upsetting you.

ANS: B, C, D Reflecting (I can see that you feel sad, This is very painful for you) and giving information (Crying is a way of expressing hurt) are therapeutic techniques. Why questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

2. Which benefits are most associated with use of telehealth technologies? Select all that apply.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

Cost savings for patients

b .

Maximize care management

c .

Access to services for patients in rural areas

d .

Prompt reimbursement by third party payers

e .

Rapid development of trusting relationships with patients

ANS: A, B, C Telehealth has shown it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems. Although telehealths improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third party payers. Telehealth technologies have not shown rapid development of trusting relationships.

3. Which comments by a nurse demonstrate use of therapeutic communication techniques? Select all that apply.

a .

Why do you think these events have happened to you?

b .

There are people with problems much worse than yours.

c .

Im glad you were able to tell me how you felt about your loss.

d .

I noticed your hands trembling when you told me about your accident.

e .

You look very nice today. Im proud you took more time with your appearance.

ANS: C, D Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are non-therapeutic techniques.

4. A nurse is interacting with patients in a psychiatric unit. Which statements reflect use of therapeutic communication? Select all that apply.

a .

Tell me more about that situation.

b .

Lets talk about something else.

c .

I notice you are pacing a lot.

d .

Ill stay with you a while.

e .

Why did you do that?

ANS: A, C, D The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are non-therapeutic techniques.

Chapter 7-Chapter 9 : Techniques for the Reluctant Patient Chapter 8: Techniques for the Overly Talkative Patient Chapter 9: Techniques for the Malingering Patient

1.

A nurse has engaged in self-awareness and has come to understand his own personal beliefs and attitudes and has recognized some prejudicial ideas.

Based on this understanding, which of the following would the nurse now be able to accomplish?

A)

Have a therapeutic relationship with a patient.

B)

Influence patients with certain biases.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

Change learned behaviors.

D)

Formulate values and morals.

2.

When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the nurse to keep in mind?

A)

The nurse should self-disclose when indicated.

B)

The patient is the primary focus of the interaction.

C)

The nurse should have an empathetic relationship with the patient.

D)

The patients conversations should be recorded.

3.

A hospitalized patient diagnosed with depression asks the nurse, Should I go home this weekend? Which response by the nurse uses the technique of reflection?

A)

Should you go home for the weekend?

B)

Home means what to you?

C)

It sounds as if you dont want to go home this weekend.

D)

I doubt that you really should go home this weekend.

4.

A patient who is hospitalized with depression tells the nurse, I dont want to take the medication because Im afraid Ill become suicidal. Which response by the nurse would be most appropriate?

A)

Have you ever thought about hurting yourself?

B)

Its important that you take this medication.

C)

I agree with you. I wouldnt want to take this medication either.

D)

Another patient took that medication, and he really felt better.

5.

A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, Should I break up with my partner? Which response by the nurse would be most effective in building rapport between the patient and nurse?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Of course you should; being a lesbian is just not natural.

B)

Yes, I think you should pursue building a relationship with a man.

C)

It sounds like youre beginning to be uncomfortable in this relationship.

D)

You need to focus on yourself rather than the relationship right now.

6.

A patient is talking to the nurse about the recent death of her grandmother.

She is obviously very sad, and a tear rolls down her cheek as she talks. The nurse remembers how she felt when her own grandmother died the previous summer. The nurse puts her hand on the patients shoulder and says, This must be very difficult for you. The nurse is demonstrating empathy based on which of the following?

A)

The response comment reflects an attempt to communicate understanding of patients feelings.

B)

The nurses response and use of reassuring touch reinforce the nurses concern for the patient.

C)

The nurse demonstrates understanding of how the patient feels because of her own grandmothers death.

D)

The nurses statement expresses compassion and kindness toward the patient.

7.

A nurse engaged in an interaction with a patient recognizes body space zones. Which of the following would the nurse identify as the individuals personal zone?

A)

Beginning at the boundary of the intimate zone and ending at the social zone

B)

Extending outward from the border to the public zone

C)

Surrounding and protecting an individual from others, especially outsiders

D)

The most distant boundary that can be used for recognizing intruders

8.

The nurse is in the orientation phase of the nursepatient relationship with a patient diagnosed with a mental disorder. When interviewing the patient during this first encounter, which information would be most important for the nurse to obtain about the patient?

A)

Known allergies

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

Recent hospitalizations

C)

Perception of the problem

D)

Family history

9.

A patient is a successful insurance salesman; however, because of market changes, his level of sales has dropped. His boss tells him he will consequently be receiving a $2,000 per year cut in his salary. When the patient arrives home from work, the family dog runs to greet him as he always does, barking and jumping up and down and begging for attention.

The patient yells at the dog, Get away from me; I cant take your barking right now. The patients response reflects a defense mechanism because it was which of the following?

A)

An intentional behavior performed to let the dog know his behavior was inappropriate

B)

Automatic, protecting the patient from the anxiety related to his upcoming pay cut

C)

Implemented to keep the patient from having to cope with his upcoming pay cut

D)

Implemented so the patient could rationalize his upcoming pay cut

10 .

Termination takes place during the resolution phase of a nursepatient relationship. During the termination process, a patient brings up resolved problems and presents them as new issues to work toward. The nurse interprets the patients action as indicating which of the following?

A)

The patient is angry that the nurse is abandoning him.

B)

The patient requires additional therapy.

C)

The patient is unhappy that the therapy was ineffective

D)

The patient is attempting to prolong the nursepatient relationship.

11 .

When engaged in a nontherapeutic relationship, which of the following would the nurse identify as occurring first?

A)

Failure to recognize the patient as a person with a need

B)

Patient avoiding the nurse

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

The nurse being perceived as rude

D)

Patient feeling hopeless and frustrated

12 .

While providing care to a patient with a mental disorder, the patient asks the nurse, Does mental illness run in your family? Which response by the nurse would be most inappropriate?

A)

Mental illnesses do run in families, and Ive had a lot of experience caring for people with mental illness.

B)

It sounds like you are concerned that there may be a family connection to your current problem?

C)

Yes, it does. I have a sister who was diagnosed several years ago with severe major depression.

D)

Mental illness can be family related. Lets focus the discussion on you and how youre doing today.

13 .

A nursing instructor is describing the nursepatient relationship to a group of nursing students. Which of the following would the instructor emphasize as crucial for establishing and maintaining the relationship?

A)

Rapport

B)

Empathy

C)

Self-awareness

D)

Values

14 .

A group of students are reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which of the following as the first component of the process?

A)

Formulation of an idea

B)

Message encoding

C)

Transmission of message

D)

Message reception

15 .

A nurse responds to a patients statement with silence based on the rationale that this technique is used primarily to do which of the following?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Allow the nurse to determine an appropriate response

B)

Permit the patient to gather his or her thoughts

C)

Encourage self-reflection by the nurse

D)

Demonstrate passive listening

16 .

A group of nursing students are preparing a class presentation on therapeutic and nontherapeutic techniques of communication. The students demonstrate understanding of the information when they select which techniques to demonstrate as therapeutic? Select all that apply.

A)

Confrontation

B)

Open-ended statements

C)

Reflection

D)

Reassurance

E)

Agreement

F)

Challenges

17 .

When communicating with a patient, which of the following would the nurse use to convey positive body language?

A)

Sitting erect with back against the chair

B)

Crossing the arms over the chest

C)

Sitting at the patients eye level

D)

Keeping the feet flat on the floor with the legs crossed

18 .

During an interview, a patient tells the nurse that he was recently let go from his job. As the interaction continues, the patient states, I was really overqualified for that position anyway. It was definitely below my area of expertise. The nurse interprets this information as reflecting which of the following?

A)

Denial

B)

Intellectualization

C)

Projection

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

D)

19 .

Passive aggression

The nurse is engaged in a therapeutic nursepatient relationship. The relationship is in the working phase. With which of the following would the patient be involved? Select all that apply.

A)

Beginning to identify a need

B)

Testing new ways for problem solving

C)

Testing the relationship

D)

Discussing problems related to needs

E)

Examining personal issues

20 .

A nurse is engaged in active listening. Which of the following would the nurse use? Select all that apply.

A)

Changing the subject to gather more information

B)

Responding indirectly to statements

C)

Using open-ended statements

D)

Concentrating on what patient says

E)

Allowing the patient to talk as he wishes

Answer Key

1.

C

2.

B

3.

A

4.

A

5.

C

6.

A

7.

A

8.

C

9.

B

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

10 .

D

11 .

A

12 .

C

13 .

C

14 .

A

15 .

B

16 .

A, B, C

17 .

C

18 .

B

19 .

B, D, E

20 .

B, C, D

Chapter 10: Techniques for the Adolescent Patient1

1.

While caring for a family who lost a 10-year-old son in a car accident, the nurse should instruct the parents to tell the 4-year-old sister which of the following about her brother?

A)

He died and is not coming back.

B)

He passed on to the other side.

C)

He departed on a long journey.

D)

He has gone to see the Lord above.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

2.

The nurse is counseling a family with a 10-year-old child after the death of a favorite uncle. The nurse provides guidance to the parents, informing them that the child may exhibit which of the following as a response?

A)

Talk about scary, morbid novels all the time.

B)

Complain of aches and pains, stomachaches, that sort of thing.

C)

Suddenly become afraid of leaving home to go to school.

D)

Become obsessed with religious rituals, Bible verses, and prayer.

3.

The nurse is counseling a family with two parents and two children, ages 8 and 10 years. The mother complains that the children are constantly fighting and have intense sibling rivalry. When statement would be most appropriate when advising the parents about how to respond to the sibling rivalry?

A)

Try reacting to each as unique individuals with talents and interests distinctly their own.

B)

Be firm about telling the children they have to cooperate with one another.

C)

Slowly decrease the amount of attention and control shown to the older child.

D)

Make sure they have a quiet, subdued home environment to avoid stimulating conflict.

4.

A 3-year-old child has been admitted to the hospital after an automobile accident. Which statement by the nurse would be most appropriate when discussing the type of behavior the parents can expect their child to display while hospitalized?

A)

Your child may not be able to accept how the injury has changed your childs appearance.

B)

Your child may seem unduly anxious in the presence of strangers.

C)

Your child may experience some guilt feelings associated with the accident.

D)

Your child will exhibit intermittent periodic mood swings, but these should be brief.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

5.

A nurse is providing care to several chronically ill children. Which of the following would the nurse identify as having the greatest risk for developing a psychiatric problem?

A)

12 year-old with diabetes mellitus

B)

5 year-old with cerebral palsy

C)

8 year-old who has chronic renal disease

D)

10 year-old with a heart murmur

6.

The nurse is planning a counseling session with a group of at-risk adolescents on the topic of drug abuse. Which teaching strategy would be most effective?

A)

Handing out educational pamphlets and showing slides of car accidents related to teen drug use.

B)

Showing informational videotapes and providing Internet addresses on the topic of drug addiction.

C)

Giving information by lecturing and using pre- and posttest quizzing about the information.

D)

Involving peers in teaching the effective group problem-solving skills.

7.

The nurse is counseling a family with a child who has been abused by adult family friend in the past. When explaining about the childs needs, which of the following would be most important for the nurse to stress?

A)

A supportive relationship with an adult

B)

Long-term psychotherapy

C)

Antidepressant medications

D)

Short-term separation from the parents

8.

The nurse is planning an initial therapy session with a 20-year-old patient whose parents had alcoholism. The nurse anticipates that the patient would most likely exhibit symptoms of which of the following?

A)

Delusions

B)

Paranoid delusions

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

Low self-concept

D)

Extroversion

9.

A home-health nurse is working with a poverty-stricken family that has two small children, ages 2 and 3 years. The family lives in an isolated rural area.

The familys home has a dirt floor, and there are chickens living in the house with the family. Because of a recent wind storm, there is a sizeable hole in the roof that lets rain and snow into the house. Which nursing intervention would be the highest priority in this situation?

A)

Make immunization appointments for the children in a nearby towns public health clinic.

B)

Help the family find funding and manpower to patch and repair the roof of their home.

C)

Determine the educational readiness of the two children.

D)

Report the family for child abuse because of neglect.

10 .

While engaging in a discussion with a group of teens about risk behaviors, one of the teens says, That will never happen to me. The nurse interprets this as which of the following?

A)

Invincibility fable

B)

Formal operations

C)

Egocentric thinking

D)

Relational aggression

11 .

A nurse is working with a family in which the parents have just gotten divorced. After teaching the parents about measures to reduce the risk of emotional problems for the children, which statement by the parents indicates a need for additional teaching?

A)

We will try to alter their routines so they dont think about the past.

B)

We will make sure that they understand that they did not cause the divorce.

C)

We will develop a regular and consistent schedule for visitation.

D)

We will make sure that we are consistent in the limit that we set.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

12 .

A group of nursing students is reviewing information about the differences that occur with grieving in children, adolescents, and adults. The students demonstrate understanding of this information when they identify which of the following as characteristic of adolescents?

A)

View death as reversible

B)

Mourn by talking about the loss

C)

Need repeated explanations to understand the loss

D)

Express a time limit for socially acceptable grieving

13 .

A nurse is working with a child for which an out-of-home placement has occurred. Which of the following would the nurse anticipate as the childs initial response?

A)

Despair

B)

Withdrawal

C)

Protest

D)

Detachment

14 .

The nurse is working with a child who has engaged in bullying. Which of the following would be most effective for the nurse to implement?

A)

Psychoeducation

B)

Bibliotherapy

C)

Early intervention program

D)

Social skills training

15 .

A nurse is developing a plan of care for a family who is experiencing problems related to their childs chronic illness. The nurse plans to have the family read a group of short stories written by parents of children with chronic illnesses. The nurse will be using which technique?

A)

Psychoeducation

B)

Social skills training

C)

Bibliotherapy

D)

Assertiveness training

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

16 .

After teaching a class about childhood and adolescent mental health, the instructor determines that additional teaching is needed when the class identifies which of the following as promoting mental health in children?

A)

Difficult temperament

B)

Age-appropriate physical development

C)

Secure attachment

D)

Normal psychosocial development

17 .

A nurse is providing teaching to a group of parents with children and adolescents who have experienced losses. The nurse determines that the teaching was successful when the group states which of the following?

A)

Children grieve in similar ways regardless of their age.

B)

Children often use fantasy to fill in their gaps in understanding.

C)

Families tend to grieve at similar times after the loss.

D)

Children and adults grieve much in the same manner.

Answer Key

1.

A

2.

B

3.

A

4.

B

5.

B

6.

D

7.

A

8.

C

9.

B

10 .

A

11 .

A

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

12 .

B

13 .

C

14 .

D

15 .

C

16 .

A

17 .

B

Chapter 11-Chapter 12 : Interviewing Family Members and Other Informants Chapter 12: Techniques for Other Challenging Situations

1.

While caring for a family, the nurse determines that first-order changes have occurred with which of the following?

A)

The children are all in school, and the parent returns to work.

B)

The daughter leaves home to attend college.

C)

The son marries his long-time sweetheart and moves into his own home.

D)

The grandmother who has been living in the household dies.

2.

The nurse is assessing a family system applying the family system framework model. Which assessment would be important for the nurse?

A)

Acceptance of the family rules

B)

Adjustment to the family boundaries

C)

Degree of enmeshment in the system

D)

Interpersonal differentiation

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

3.

While assessing a family system, the nurse uses the structural family system model by Minuchin. The nurse focuses the assessment on which of the following about the family members?

A)

Boundaries

B)

Emotional cutoff

C)

Sibling position

D)

Family projection process

4.

A female patient is an adolescent who recently tried to overdose because her boyfriend broke up with her. Her father is a single parent, and he has been drinking excessively to cope with his stress. The patient tells the nurse that whenever she needs to talk to her father, he is always drunk or away drinking with his drinking buddies. Based on this information, which nursing diagnosis would be most appropriate for this patients family?

A)

Ineffective Family Therapeutic Regimen Management

B)

Compromised Family Coping

C)

Ineffective Denial

D)

Caregiver Role Strain

5.

A family has recently lost all their belongings when their house burned down. They have been living in temporary housing. Although the parents were previously very supportive and able to help their young children with their homework in the evenings, they have been unable to do so under their present circumstances. Based on this information, which nursing diagnosis would be most appropriate for this family?

A)

Interrupted Family Processes

B)

Compromised Family Coping

C)

Ineffective Family Therapeutic Regimen Management

D)

Caregiver Role Strain

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

6.

A male patient has recently been diagnosed with type II diabetes. His family is having trouble incorporating the dietary and exercise regimen prescribed by his physician into their daily routines. They tell the nurse that they are all tired when they return home from school and work and that the last thing any of them want to do is go on a walk. In addition, the patients wife discloses that she is unable to prepare any sugar-free or low-sugar foods that her husband enjoys eating. Based on this information, which nursing diagnosis would be most appropriate for this family?

A)

Interrupted Family Processes

B)

Ineffective Denial

C)

Caregiver Role Strain

D)

Ineffective Family Therapeutic Regimen Management

7.

A couple who have a 7-year-old son have been experiencing growing tension and anxiety in their relationship. However, the tension and anxiety between them lessened when the mother began focusing most of her attention on the son. When applying the family systems therapy model concept of triangulation, which of the following would the nurse expect to assess in the child?

A)

Enjoying his mothers increasing attention and growing even closer to her

B)

Growing distant from his father and blaming him for all of the familys problems

C)

Developing problematic symptoms in response to his mothers increasing attention

D)

Resenting mother for her suffocating attention and his fathers growing distance

8.

A nursing instructor is developing a teaching plan for a class about families.

Which of the following would the instructor be most likely to include?

A)

Families are primarily determined by blood.

B)

New members are added by birth, marriage, or adoption.

C)

In the United States, family size has been on the increase.

D)

Families are less mobile today than in the past.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

9.

A group of nursing students is reviewing information about the changing family structure and its effect on mental health and illness. The students demonstrate understanding of this information when they identify which of the following?

A)

Middle-aged childless adults are more vulnerable to loneliness and depression.

B)

In stepfamilies, caring for the children often is a primary stressor to the marital partners.

C)

Separation because of relocation provides additional support from extended family.

D)

Same-sex families typically demonstrate lower rates for depression and stress.

10 .

A nurse is planning a support group for the families of patients with psychiatric disorders. The nurse integrates knowledge of which of the following as the primary underlying issue related to stress that the families experience?

A)

Severity of the patients symptoms

B)

Barriers faced by the patient

C)

Stigma associated with the diagnosis

D)

Risk for relapse

11 .

A nurse is assessing a family of a patient with a persistent mental disorder.

In comparing this family to one without a member who has a mental disorder, which function would the nurse expect this family to serve? Select all that apply.

A)

Providing support

B)

Providing socialization

C)

Advocating for services

D)

Providing information

E)

Monitoring services

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Test Bank for The Psychiatric Interview 4th Edition

12 .

A nurse is engaged in developing a relationship with a family during a family assessment. Which of the following would be important? Select all that apply.

A)

Demonstrating culturally competent nursing skills

B)

Completing the assessment efficiently in the first meeting

C)

Identifying the familys immediate needs

D)

Exhibiting a professional image

E)

Investigating the adherence to the medication regimen

13 .

A nurse is constructing a genogram of a family. Which of the following would the nurse do?

A)

Use circles to represent the male members.

B)

Use horizontal lines to connect the parents with children.

C)

Use horizontal lines to show marriages.

D)

Use asterisks to denote ages listed at the bottom.

14 .

Assessment of a family reveals that the youngest child has moved out of the family home to live by herself. One of the other two children is married, and the other child has just gotten engaged. The nurse interprets this family to be in which stage of the family life cycle?

A)

Families with adolescents

B)

Launching children and moving on

C)

Families in later life

D)

Leaving home: single young adults

15 .

A nurse is assessing the communication patterns in the family. When observing the interaction, which of the following would be important to keep in mind? Select all that apply.

A)

Who sits next to who?

B)

Which topics are not addressed?

C)

Which situations are identified as stressful?

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Test Bank for The Psychiatric Interview 4th Edition

D)

Who makes the decisions for child care?

E)

How does the family handle conflict?

16 .

A group of nursing students is reviewing system models used in caring for families. The students demonstrate understanding of the information when they identify which of the following as characteristic of the Calgary Family Model?

A)

Differentiation of self

B)

Sibling position

C)

Family development

D)

Subsystems

17 .

A nurse is using a genogram as an intervention strategy based on the understanding of which of the following?

A)

It provides information about appropriate methods for problem solving.

B)

It allows the family to view its evolution over several generations.

C)

It permits a subjective yet factual perspective of family relationships.

D)

It provides a means for identifying the familys beliefs about mental illness.

18 .

A nurse is working with a family and using the Calgary Family Model.

Problems have been identified, and the family being in which stage of the model?

A)

Engagement

B)

Assessment

C)

Intervention

D)

Termination

Answer Key

1.

A

2.

D

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

3.

A

4.

B

5.

A

6.

D

7.

C

8.

B

9.

B

10 .

C

11 .

A, C, D, E

12 .

A, C, D

13 .

C

14 .

B

15 .

A, B

16 .

C

17 .

B

18 .

B

Chapter 13-Chapter 17 : Practical Psychodynamics in the Diagnostic Interview Chapter 14: Obtaining the History of Present Illness Chapter 15: Obtaining the Psychiatric History Chapter 16: Screening for General Medical Conditions Chapter 17: Family Psychiatric History MULTIPLE CHOICE

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

1. A nurse teaching a patient about the effects and side effects of the prescribed medication bases the plan on the knowledge that learning is more effective when:

a .

patients are actively included in the process.

b .

topics are introduced only when the patient expresses an interest.

c .

nurses establish realistic goals for learning on behalf of the patient.

d .

patients have responsibility for directing the teaching-learning process.

ANS: A Learning is more effective when patients participate in the learning experience. By including patients as active participants, the nurse helps restore their sense of control over their life and over their responsibility for their own actions.

2. A nurse interviewed a reluctant patient who answered questions with minimal responses and rarely made eye contact. When documenting baseline data collected in the interview, the nurse should include:

a .

interview content only.

b .

a description of the process of the interview.

c .

both the content and the process of the interview.

d .

both factual data about the patient and the nurses emotional reaction.

ANS: C It is important to document both baseline content and process. In addition to the verbal content of the interview, the patients nonverbal messages and the nurses reactions to the patient give

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

important clues to the patients state.

3. While gathering a baseline history about a patient, a nurse is told by a team social worker that the patient acts weird and has bad hygiene. The nurses responsibility is to:

a .

accept the data without question.

b .

form impressions based on data personally gathered.

c .

document the impression of the team social worker.

d .

discuss the social workers impression with the patient.

ANS: B In using information from secondary sources, nurses should not simply accept the assessment of another health care team member; instead, they should apply the information they obtain to their nursing framework for data collection and formulate their own impressions and diagnoses. This brings another perspective to the work of the health care team and promotes an unbiased receptivity to patients and their problems.

4. To obtain the clearest clinical information about a patient, a nurse who used several secondary sources, including the patients spouse and the report of the admitting psychiatrist, will seek validation from:

a .

the patient.

b .

psychiatric nursing textbooks.

c .

the patients extended family.

d .

the use of psychiatric behavioral rating scales.

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Test Bank for The Psychiatric Interview 4th Edition

ANS: A Patients should be regarded as a source of validation.

5. If physicians wish to understand the nursing equivalent of the medical DSM-IV-TR, they should seek an understanding of the:

a .

nursing diagnoses.

b .

nursing process.

c .

behavioral rating scales.

d .

computerized medical records.

ANS: A A medical diagnosis is the health problem or disease state of the patient. Nursing diagnoses identify patterns of response to actual or potential psychiatric illnesses and mental health problems. Nursing diagnoses proceed from inductive and deductive reasoning, logical decision making, knowledge of normal parameters, and sociocultural sensitivity.

6. Which goal should be given the highest priority?

a .

Reduction of anxiety

b .

Alleviation of depression

c .

Enhancement of self-esteem

d .

Protection from self-destructive impulses

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

ANS: D Patient safety is always of paramount concern. After safety for the patient has been established, other goals of treatment can be effectively addressed.

7. A nurse who is new to the mental health setting is having difficulty writing meaningful outcome criteria. The nurses mentor should suggest which source to best assist the nurse?

a .

Nursing Outcomes Classification (NOC)

b .

Nursing Interventions Classification (NIC)

c .

North American Nursing Diagnosis Association International (NANDA-I)

d .

Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision (DSM-IV-TR)

ANS: A NOC stands for Nursing Outcomes Classification. The outcomes listed can serve as models for nurses.

8. Which is a well-written short-term goal for a socially withdrawn patient who tells a nurse of a wish to reduce social isolation? By day 2, the patient will:

a .

express desire to go shopping.

b .

participate in one unit activity.

c .

become more independent.

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Test Bank for The Psychiatric Interview 4th Edition

d .

be more outgoing.

ANS: B Short-term goal statements should be specific, measurable, attainable, current, adequate, and mutually accepted. The correct option includes a timeframe as well as meeting the existing criteria for a short-term goal. More outgoing and more independent are not measurable.

Expressing a desire to go shopping is a statement rather than an action.

9. A patient is admitted with a diagnosis of bipolar disorder, manic phase, and displays extreme hyperactivity, agitation, talkativeness, and emotional lability. Which is the highest priority nursing diagnosis?

a .

Risk for injury related to extreme hyperactivity

b .

Disturbed thought processes related to manic state

c .

Impaired social interaction related to excessive verbalization

d .

Impaired sensory perception related to biochemical alterations

ANS: A This nursing diagnosis deals with patient safety, a primary concern for the psychiatric nurse caring for a patient exhibiting symptoms of mania.

10. A nurse is working with a patient with depression. To best help the patient translate insight into action, a major nursing challenge will be to:

a .

promote self-care activities.

b .

consult appropriate resources.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

c .

build adequate incentives to change.

d .

identify ineffective behavior patterns.

ANS: C Building adequate incentives to change is critical to translating insight into action. The nurse should help the patient see the consequences of each action and help the patient understand that old patterns do more harm than good. The patient will not learn new patterns until the motivation to acquire them is greater than the motivation to retain the old ones.

11. Nursing interventions that have the greatest validity are those that:

a .

are used by nurse clinicians.

b .

are prescribed by physicians.

c .

have been investigated by nurse researchers.

d .

are based on evidence of the efficacy of the intended treatment.

ANS: D Nursing interventions that have proven successful by research methods (evidence-based psychiatric nursing) should be the ones chosen for use by clinicians.

12. Nursing behaviors associated with the implementation phase of the nursing process are concerned with:

a .

regular, in-depth self-analysis.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

b .

participating in quality improvement activities.

c .

carrying out interventions and generating alternatives.

d .

comparing patient responses and expected outcomes.

ANS: C Nursing behaviors relating to the implementation phase of the nursing process include considering available resources, implementing nursing activities, generating alternatives, and coordinating care with other team members.

13. A nurse clinician is attempting to explain the evaluation phase of the nursing process to a student. Which statement would help the student grasp the essentials?

a .

It is a continuous, active process.

b .

Patient and family participation is optional.

c .

It takes place at the time of termination of services.

d .

It is optional since it is based on the patients readiness.

ANS: A Evaluation is a continuous, active process that begins early in the relationship and continues throughout. It is an activity that requires patient and family participation, because it is based on previously identified goals and level of satisfaction. It should be documented to demonstrate the value of nursing services to consumers.

14. A psychiatric nurse clinician is heard calling nurse educators the experts and frequently refers to nurse administrators and researchers as those who know it all. This nurse can be assessed as having a problem with:

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

ethics.

b .

education.

c .

collegiality.

d .

resource use.

ANS: C Collegiality means regarding other nurses as partners in caregiving who are valued and respected for their unique contributions regardless of educational, experiential, or specialty background. It suggests that nurses view themselves as members of a profession and that nurses trust, remain loyal to, and demonstrate commitment to other nurses.

15. Which action best demonstrates a nurse displaying accountability?

a .

Volunteering to serve on a hospital committee

b .

Notifying the nurse manager when a medication error occurs

c .

Planning patient care strategies for a newly admitted adult patient

d .

Coordinating a patient-centered conference for the health care team

ANS: B Accountability is best demonstrated by taking responsibility for ones own actions.

16. A new psychiatric staff nurse is asked to be a member of the Quality Improvement (QI) Committee. The nurse should be motivated to agree to do this because:

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

QI participation is a requirement stated in the nurses job description.

b .

evaluation of quality of care is a standard of professional performance.

c .

salary increments depend on performance variables like committee work.

d .

QI is an activity mandated by the accrediting agency, The Joint Commission.

ANS: B Professional performance standards state the following: The psychiatric-mental health nurse systematically evaluates the quality of care and effectiveness of psychiatric-mental health practice.

17. A staff nurse is told at orientation that the department has a clinical advancement program in place. On what criterion is advancement usually based?

a .

Desire for professional growth

b .

Acceptance of peer feedback

c .

Advanced application of nursing skills

d .

Attainment of an advanced degree in nursing

ANS: C Clinical advancement programs allow the nurse to be promoted and economically rewarded for providing direct patient care. Such programs identify levels of professional development in nursing based on increased critical thinking and advanced application of nursing skills.

18. What is the major difference between supervision and therapy?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

a .

Therapy is more intensive; supervision is less structured in its focus.

b .

Supervision extends to all aspects of life, whereas therapy is limited to problem areas.

c .

Supervision teaches psychotherapeutic skills, whereas therapy changes personal coping patterns.

d .

Therapy uses transference, whereas supervision focuses on only personal limitations.

ANS: C Despite its intensity, supervision is not therapy; its purposes are different. Supervision aims to teach psychotherapeutic skills, whereas therapy seeks to alter a persons characteristic patterns of coping.

19. A nurse registers for a DSM-IV-TR update workshop. This is an example of adherence to the standard of professional performance that refers to:

a .

education.

b .

ethical standards.

c .

resource utilization.

d .

performance appraisal.

ANS: A The standard about education reads as follows: The psychiatric-mental health nurse acquires and maintains current knowledge in nursing practice. Nursing conditions include intellectual curiosity, desire for professional growth, and access to new information.

20. According to the nursing standard related to research, a novice psychiatric-mental health Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

nurse with an associates degree can be expected to:

a .

engage with other staff in the research process.

b .

use research findings to improve clinical practice.

c .

plan small, independent, data-gathering research projects.

d .

collaborate in proposal development and data collection and analysis.

ANS: B At the beginning level a staff nurse who has no advanced degrees can be expected to use research findings in practice, with supervision.

Chapter 18: Obtaining the Social and Developmental History Section III: Interviewing for Diagnosis: The Psychiatric Review of Symptoms

1.

A nurse is caring for a 76-year-old patient with a hearing deficit caused by presbycusis. Which of the following would be most appropriate for the nurse to do when communicating with the patient?

A)

Use a higher volume of speech.

B)

Address the clients family members.

C)

Ask if the client can use sign language.

D)

Use lower pitched tones.

2.

The nurse is caring for a 78-year-old client who is taking an anticholinergic medication and complains of dry mouth. Which of the following would be most appropriate for the nurse to suggest?

A)

Chew hard candies.

B)

Rinse the mouth with a mouthwash.

C)

Use more seasonings on food.

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Test Bank for The Psychiatric Interview 4th Edition

D)

3.

Drink decaffeinated beverages often.

An elderly client tells the nurse that she had been constipated for the last few days and decided to use an over-the-counter fiber laxative that is dissolved in water. When reviewing the use of this laxative with the client, which of the following would the nurse include as a possible side effect?

A)

Diarrhea

B)

Nausea

C)

Flatus

D)

Stomach pain

4.

An 80-year-old client visits the mental health clinic with her daughter.

During the assessment process, the client tells the nurse that she is taking an antidepressant, an antibiotic, and an occasional aspirin. Which question would be most important for the nurse to ask?

A)

How much grapefruit juice do you drink on a daily basis?

B)

How much orange juice do you drink on a daily basis?

C)

How much tomato juice do you drink on a daily basis?

D)

How much grape juice do you drink on a daily basis?

5.

While caring for an 88-year-old client suspected of having dementia, the nurse assesses the client for a common delusional thought. Which of the following would the nurse interpret as a common delusion?

A)

I am the king of the universe.

B)

Creatures are living in my closet.

C)

The government has people following me.

D)

My roommate keeps stealing my clothes.

6.

A)

The nurse is assessing a 78-year-old client who lives alone in his own home.

To assess the clients instrumental activities of daily living, which question would be most appropriate to ask?

How often do you bathe or shower?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

How many times do you change clothes during the day?

C)

How often do you cook meals for yourself?

D)

How often do you go to the store to buy groceries?

7.

The nurse is assessing a client who has a history of heavy drinking and who lost his wife to cancer during the previous year. He reports that he isnt getting as much sleep as he used to when he was younger. Which question would be most appropriate to ask the client to determine if the change in his sleep pattern is related to normal aging or depression?

A)

How much did you sleep when you were younger?

B)

Is it hard for you to fall asleep or remain asleep during the night?

C)

Why do you think you continue to ingest so much alcohol?

D)

What used to help you go to sleep?

8.

A couple is concerned that the husbands father may be developing depression. In questioning the couple, which of the following statements would support their concern?

A)

Dad has been crying off and on now for over 2 weeks since Mom died.

Hes also still having trouble sleeping.

B)

Dad is agitated and anxious; hes been that way for a month now since Mom died.

C)

Its been over 2 months now since Mom died, and Dad keeps crying; he cant eat or sleep.

D)

Moms funeral was last week, and Dad hasnt been able to eat or sleep since then.

9.

A nurse is providing an in-service educational program for beginning nurses regarding mental health assessment needs of the older adult. One of the topics addressed is the importance of interviewing family members in addition to the older adult client. The nurse tells the audience that family members are sometimes able to give a more accurate history if the client has memory impairment. The nurse also emphasizes that interviewing family members provides which of the following?

A)

A more accurate picture of the social support resources available

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

Evaluation of the familys ability to effectively care for the older client

C)

Determination of the extent of the clients memory impairment

D)

A much needed period of respite and support for the family members

10.

Assessment of an older adult client reveals that the client is receiving psychiatric medications. The client states, I get dizzy periodically and have trouble walking. Which of the following should the nurse do first?

A)

Compare the clients baseline blood pressure with the clients current blood pressure.

B)

Instruct the client to stop taking the psychiatric medications.

C)

Interview the clients family about the clients coping skills and current stress level.

D)

Suggest the client periodically use an alcohol-based mouthwash several times a day.

11.

The nurse is planning to assess a clients anxiety level using the Rating Anxiety in Dementia Scale because the client also has dementia. When using this scale which of the following areas would the nurse assess? Select all that apply.

A)

Apprehension

B)

Motor tension

C)

Life satisfaction

D)

Boredom

E)

Autonomic hyperactivity

F)

Worry

12.

A nurse is preparing a presentation for a group of colleagues about suicide and the older adult population. Which of the following would the nurse include in this presentation? Select all that apply.

A)

Suicide is less of a risk in this population as compared with middle-aged adults.

B)

Married African American men are at the greatest risk for suicide in this group.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

Depression is the greatest risk factor for suicide in this population group.

D)

White women account for the highest number of suicide deaths in this age group.

E)

Recent behavior changes and loss of support are important assessment areas for suicide risk.

13.

A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the information when they identify which of the following as a normal cognitive change?

A)

Disorientation to time

B)

Slowed information processing

C)

Diminished executive functioning

D)

Restricted judgment

14.

A nurse is assessing an older adult client. Which of the following would the nurse interpret as most indicative of mental health and wellness?

A)

Keeping social contacts to a minimum

B)

Interacting with others in the environment

C)

Relying solely on family for assistance

D)

Experiencing bereavement

15.

A nurse is using the Neuropsychiatric Inventory to assess an older adult client who is exhibiting behavior problems related to dementia. When using this tool, which of the following would the nurse assess? Select all that apply.

A)

Dysphoria

B)

Inhibition

C)

Apathy

D)

Level of orientation

E)

Memory

F)

Anxiety

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

16.

A nurse has used the Geriatric Depression Scale (short form) to assess an older adult client for depression. Which score would lead the nurse to suspect that the client is mildly depressed?

A)

3

B)

5

C)

8

D)

13

Answer Key

1.

D

2.

B

3.

C

4.

A

5.

D

6.

D

7.

B

8.

C

9.

B

10.

A

11.

A, B, E, F

12.

C, E

13.

B

14.

B

15.

A, B, C, F

16.

C

Chapter 19- Chaprter 22: How to Memorize the DSM-5 Criteria Chapter 20: Interviewing for Diagnosis: The Art of Hypothesis Testing Chapter 21: Mental Status Examination

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Chapter 22: Assessing Suicidal and Homicidal Ideation

1.

The nurse is caring for a group of hospitalized patients with various psychiatric diagnoses. The nurse identifies which patient as having the greatest risk for a suicide attempt?

A)

Man with bipolar I disorder

B)

Woman with acute stress disorder

C)

Man with major depressive disorder

D)

Woman with somatoform disorder

2.

The nurse is reviewing the medical records of several patients diagnosed with major depression. The nurse identifies which patient as least likely to commit suicide?

A)

Divorced man

B)

Widowed woman

C)

Single woman

D)

Married man

3.

A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, What might predict the possibility of future suicide attempts? Which of the following would the nurse include in the response?

A)

Unemployment

B)

Death of a spouse

C)

Previous suicide attempt

D)

Polydrug use

4.

A)

A nurse is completing an admission assessment of a young adult woman who has a history of depression and who was brought to the hospital by her boyfriend. In response to the nurses question regarding suicidal ideation, the patient discloses that the she is thinking about killing herself. Which question would be most appropriate for the nurse to ask next?

What does your boyfriend think about your desire to kill yourself?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

What are your spiritual beliefs about suicide?

C)

What will killing yourself accomplish?

D)

What thoughts have you had about how you would kill yourself?

5.

A nurse is with an adolescent who tells the nurse that she has nothing to live for and she just wishes she was dead. Which nursing action would be the priority?

A)

Going to the patients psychiatrist to tell him of the girls suicidal ideation

B)

Staying with the patient to explore more of her thoughts about suicide

C)

Putting the patient in seclusion with a staff assigned to watch her at all times

D)

Ascertaining the clients beliefs about what happens when you die

6.

The nurse is caring for a 30-year-old white man whose wife has recently died. The patient has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important?

A)

Refer the patient for long-term psychotherapy.

B)

Determine the patients risk of psychosis.

C)

Determine if anyone in the patients family has had depression.

D)

Ask the patient if he is thinking about killing himself.

7.

The nurse is providing a presentation for a group of health professionals about suicide. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men?

A)

Substance abuse

B)

Media influences

C)

Lack of conflict resolution skills

D)

Parenting practices

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

8.

A nurse has just completed a suicide risk assessment of a 76-year-old widowed man. In addition to documenting the presence or absence of suicidal thoughts, plan, and means, the nurse would also document which of the following?

A)

Use of substances 6 hours before the assessment

B)

Speech patterns

C)

Availability of support resources

D)

Amount of sleep in past 24 hours

9.

A patient was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which nursing intervention would be most appropriate at this time?

A)

Assigning nursing staff to stay with him during his suicidal crisis

B)

Developing a personal plan for managing suicidal thoughts when they occur

C)

Advising the patient that he should consider electroconvulsive therapy treatments

D)

Administering psychotropic drugs that decrease the patients serotonin levels

10 .

A nurse is presenting a discussion for a local community group about suicide. Which comment from an audience member indicates the need to clarify the information?

A)

Warning signs about the persons intention often occur.

B)

People who are suicidal are undecided about living or dying.

C)

Suicides more often occur during the holiday seasons.

D)

People who talk about suicide need to taken seriously.

11 .

A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when they identify which of the following as the probability that a person will successfully complete suicide?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Parasuicide

B)

Suicidal ideation

C)

Suicidality

D)

Lethality

12 .

After teaching a class about factors that enhance the risk of suicide, the instructor determines the need for additional teaching when the class identifies which of the following?

A)

Family member committing suicide

B)

Cautiousness

C)

Delusions

D)

Loss

13 .

A nurse is reviewing the medical record of a patient who has attempted suicide. Which of the following would the nurse identify as relating to a psychological cause?

A)

History of childhood trauma

B)

Cluster B personality disorder

C)

Social isolation

D)

Suicide contagion

14 .

A patient comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being down. When assessing the patient, which statement by the patient would alert the nurse to suspect possible suicide? Select all that apply.

A)

Ive been drinking about three or four more beers every night.

B)

Ive been going out with my friends about once or twice a week.

C)

Im so tired that all I ever want to do is sleep all the time.

D)

Most times, I feel like Im trapped with no way out.

E)

Im looking for a new job because my job is so stressful.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

15 .

The nurse determines that a patient is at imminent risk for suicide. Which of the following would be least appropriate to include in the patients plan of care?

A)

Listening intently and nonjudgmentally

B)

Validating the patients feelings and experience

C)

Instituting strict restriction on the patients activity

D)

Using cognitive interventions to foster hope

16 .

A patient who has attempted suicide has an underlying diagnosis of depression. Which of the following would the nurse anticipate being ordered for the patient?

A)

Selective serotonin reuptake inhibitor

B)

Mood stabilizer

C)

Tricyclic antidepressant

D)

Atypical antipsychotic

17 .

The nurse is working with a patient who will be signing a commitment to treatment statement. After teaching the patient about this statement, the nurse determines the need for additional instruction when the patient states which of the following?

A)

Signing this statement means that I will not commit suicide.

B)

I am agreeing to get emergency treatment if I have suicidal thoughts.

C)

I will be open and honest about my feelings about treatment.

D)

I am agreeing to participate in the necessary treatment for my condition

18 .

A nurse is performing an assessment of a patient with suicidal ideation.

Which question would the nurse most likely ask to determine the degree of planning?

A)

How seriously do you want to die?

B)

Have you attempted suicide before?

C)

Could you stop yourself from killing yourself?

D)

How much do the thoughts distress you?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

19 .

A nurse determines that a patient has poor social skills that have interfered with his ability to engage others, which has contributed to his feelings of purposelessness, hopelessness, and withdrawal. Which of the following would be most important to assist the patient in beginning to social skills?

A)

Self-help group

B)

Recovery group

C)

Nursepatient relationship

D)

Limit setting

20 .

After teaching a group of students about the various concepts involving suicide, the instructor determines that the teaching was successful when the students describe parasuicide as which of the following?

A)

Voluntary act of killing oneself

B)

All suicide related behaviors and suicidal thoughts

C)

Nonfatal act with the intent to die

D)

Voluntary attempt without death as the aim

Answer Key

1.

C

2.

D

3.

C

4.

D

5.

B

6.

D

7.

A

8.

A

9.

B

10 .

C

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

11 .

D

12 .

B

13 .

B

14 .

A, C, D

15 .

C

16 .

A

17 .

A

18 .

C

19 .

C

20 .

D

Chapter 23: Assessing Mood Disorders I: Depressive Disorders

1.

The nurse makes a home visit to a client who has dysthymic disorder. Which of the following would the nurse expect to assess?

A)

Low energy

B)

Intense concentration

C)

Agitation

D)

Normal appetite

2.

A client has been diagnosed with major depression. The client reports that he often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting which of the following?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Initial insomnia

B)

Terminal insomnia

C)

Hypersomnia

D)

Middle insomnia

3.

The nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant, assessment for which of the following would be most important?

A)

Suicide

B)

Hypersomnia

C)

Cardiac arrhythmia

D)

Erectile dysfunction

4.

A client diagnosed with major depression was prescribed imipramine (Tofranil) and has been taking this medication for 1 week. The client took his last dose of imipramine (Tofranil) at 9:00 PM. The client is scheduled to have blood drawn to monitor the medication level the next morning. The nurse should instruct the client to have his blood drawn as close as possible to which time?

A)

6:00 AM

B)

7:00 AM

C)

8:00 AM

D)

9:00 AM

5.

The nurse is caring for a client with major depression. The client tells the nurse that she just isnt sure that life is worth living. The nurse documents which nursing diagnosis as the priority?

A)

Self-esteem, Low, related to depressive episode

B)

Hopelessness related to symptoms of depression

C)

Anxiety related to lack of energy for self-care activities

D)

Thought Processes, Disturbed, related to memory loss and depression

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

6.

A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local caf for lunch with a friend. Which of the following items on the menu would be least appropriate for the client to order?

A)

Roast beef, mashed potatoes, and gravy

B)

A Cobb salad with blue cheese and Roquefort salad dressing

C)

Scrambled eggs, toast, and grape jelly

D)

Medium-well steak, French fries, and broccoli

7.

A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters her room and initiates interaction with the client.

When talking with the client, which approach would be least appropriate?

A)

Quiet and empathetic manner

B)

Animated and cheerful manner

C)

Matter-of-fact manner

D)

Respectful, direct manner

8.

A client is hospitalized on a psychiatric unit secondary to a suicide attempt.

He has been diagnosed with depression. He has been consistently depressed.

When assessing the client, which of the following would alert the nurse that the clients suicidal risk has worsened?

A)

He tells the nurse that he feels more depressed than ever.

B)

He is lethargic, remaining isolated from other clients.

C)

He says he feels better as he interacts more with other clients.

D)

His energy level and degree of depression remain the same.

9.

A group of nursing students is reviewing information about the epidemiology of depressive disorders. The students demonstrate understanding of the information when they identify which of the following as possible risk factors? Select all that apply.

A)

History of substance abuse as a teenager

B)

Little social support

C)

Inadequate coping skills

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

D)

Prior episode of anxiety disorder

E)

Concomitant medical illnesses

10 .

A nursing instructor is preparing a class discussion about major depression.

Which of the following would the instructor expect to include?

A)

Depression in children is manifested in the same manner as in adults.

B)

The risk for suicide is especially high during the mid-adolescent years.

C)

Response to treatment in older adults is slower than that for younger adults.

D)

People older than age 65 years have the lowest suicide rates of any age group.

E)

Episodes of depression tend to occur more frequently over time.

F)

Depressive disorders are most often treated in the primary care setting.

11 .

After teaching a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional teaching when the students identify which neurotransmitter as playing a role?

A)

Gamma-amino butyric acid (GABA)

B)

Norepinephrine

C)

Serotonin

D)

Dopamine

12 .

A nurse is preparing to assess a middle-aged male client who was brought to the emergency department by his wife. She reports that the client has been extremely depressed lately. When assessing this client, which of the following would be a priority assessment?

A)

Changes in sleeping patterns

B)

Thoughts of self-harm

C)

Appetite changes

D)

Level of fatigue

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

13 .

A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. Johns wort to feel better. The nurse assesses the client for which of the following?

A)

Water intoxication

B)

Increased depressive symptoms

C)

Serotonin syndrome

D)

Hypertensive crisis

14 .

A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time?

A)

When did you last have blood drawn to check your drug level?

B)

What have you had to eat or drink today?

C)

Are you having any chest pain?

D)

Do you use any herbal remedies?

15 .

The nurse is developing a teaching plan for a client who is prescribed escitalopram. Which of the following side effects would the nurse include in this plan? Select all that apply.

A)

Weight gain

B)

Decreased sexual interest

C)

Sedation

D)

Blurred vision

E)

Urinary retention

F)

Dry mouth

16 .

A)

The nurse is preparing a client for treatment with repetitive transcranial magnetic stimulation. When teaching the client about this procedure, which of the following would the nurse include? Select all that apply.

You will receive a short-acting anesthetic to relax you.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

You will be awake and alert during the procedure.

C)

You can resume your normal activities right after the treatment.

D)

We will need to shave your scalp at the area where the magnet is placed.

E)

You might feel a moderate amount of stinging at the site.

17 .

When assessing a client with depression, the client states, I just feel so sad and hopeless. I just dont care anymore. I dont even enjoy doing the crossword puzzles like I used to. The nurse documents this finding as indicative of which of the following?

A)

Dysthymic disorder

B)

Anhedonia

C)

Delusion

D)

Psychosis

18 .

The plan of care for a client diagnosed with depression includes cognitive interventions. The nurse would expect to assist with which of the following?

A)

Social skills training

B)

Activity scheduling

C)

Thought stopping

D)

Interpersonal therapy

19 .

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which of the following would the nurse include?

A)

Family members typically can understand how disabling depression can be.

B)

Depression in one family member affects the entire family.

C)

Abuse of the depressed person is a rare occurrence in families.

D)

Families of women older than 55 years of age with depression experience the majority of problems.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

20 .

The nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed mirtazapine. The nurse interprets this information, identifying this agent as which type?

A)

Selective serotonin reuptake inhibitor

B)

Cyclic antidepressant

C)

Norepinephrine dopamine reuptake inhibitor

D)

Alpha-2 antagonist

Answer Key

1.

A

2.

D

3.

A

4.

D

5.

B

6.

B

7.

B

8.

C

9.

B, C, E

10 .

B, C, E, F

11 .

A

12 .

B

13 .

C

14 .

B

15 .

A, B

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

16 .

B, C

17 .

B

18 .

C

19 .

B

20 .

D

Chapter 24: Assessing Mood Disorders II: Bipolar Disorder

1.

A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer?

A)

Lithium carbonate (Lithium)

B)

Haloperidol lactate (Haldol)

C)

Fluoxetine (Prozac)

D)

Paroxetine (Paxil)

2.

A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate?

A)

Increase your salt intake if an activity causes you to perspire heavily.

B)

Wear sunscreen when you are going to be outdoors in the summer time.

C)

Drink less fluid than usual now because you are taking this drug.

D)

No changes are necessary for strenuous activities you do outdoors.

3.

The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, Im just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Irritable

B)

Elevated

C)

Expansive

D)

Euphoric

4.

The nurse is reviewing the medical record of a client with bipolar disorder.

The nurse would most likely expect to find a history of which of the following?

A)

Panic disorder

B)

Schizophrenia

C)

Delusional disorder

D)

Posttraumatic stress disorder

5.

A nurse is developing a presentation for families who have members that have been diagnosed with bipolar disorders. When describing this condition to the group, which of the following would the nurse most likely include?

A)

As the person ages, the episodes tend to decrease over time.

B)

Environmental stressors are a key cause of these disorders.

C)

The risk for suicide is high with either depression or mania.

D)

Risk-taking behaviors are more common with a depressive episode.

6.

A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the clients medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply.

A)

Lisinopril

B)

Hydrochlorothiazide

C)

Indomethacin

D)

Caffeine

E)

Aspirin

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

7.

A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the clients blood level for this drug, which level would alert the nurse to the need to change the dosage?

A)

30 ng/mL

B)

55 ng/mL

C)

75 ng/mL

D)

115 ng/mL

8.

A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following?

A)

I need to notify my physician if I develop a skin rash.

B)

I need to have my blood tested about once a month.

C)

I have to watch how much salt I use every day.

D)

This drug can affect my liver function.

9.

A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do?

A)

Tell the client firmly that she must take her medication.

B)

Allow the client to participate in the treatment decision.

C)

Restrain the client before administering the medication.

D)

Notify the physician about the clients refusal of the medication.

10 .

A client who is receiving lithium comes to the clinic for an evaluation.

During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?

A)

Immediately obtain a specimen to determine the clients blood drug level.

B)

Suggest that the client take the medication with meals or snacks.

C)

Assist the client in minimizing exposure to stressors.

D)

Encourage the client to elevate the affected hand on a pillow.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

11 .

A clients blood level of carbamazepine is increased. When reviewing the clients medication history, which of the following would alert the nurse to a possible interaction?

A)

Phenobarbital

B)

Primidone

C)

Phenytoin

D)

Diltiazem

12 .

A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following?

Select all that apply.

A)

Tachypnea

B)

Bradycardia

C)

Hypotension

D)

Nystagmus

E)

Vomiting

13 .

A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply.

A)

Metallic taste

B)

Ataxia

C)

Diarrhea

D)

Slurred speech

E)

Fasciculations

F)

Muscle weakness

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

14 .

The nurse is preparing a teaching plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the teaching was effective when they identify which of the following as suggesting mania? Select all that apply.

A)

Avoiding people

B)

Sleeping more than usual

C)

Talking faster than usual

D)

Being hungry all the time

E)

Reading several books at once

15 .

A client with bipolar disorder has had a history of multiple episodes and states, Im so frustrated with whats happened because of these episodes.

Which of the following would the nurse encourage to help support this clients recovery?

A)

Codependence

B)

Hope

C)

Self-control

D)

Independent decision making

Answer Key

1.

B

2.

A

3.

C

4.

A

5.

C

6.

A, B, C

7.

A

8.

A

9.

B

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

10 .

C

11 .

D

12 .

C, D, E

13 .

A, C, F

14 .

C, D, E

15 .

B

Chapter 25: Assessing Anxiety, Obsessive, and Trauma Disorders

1.

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which of the following would the nurse include when describing panic disorder?

A)

Individuals may believe they are having a heart attack when a panic attack occurs.

B)

People with panic attacks often have fewer attacks if they also have agoraphobia.

C)

Typically, individuals experience this disorder after the age of 30 years.

D)

Persons rarely have an underlying comorbid condition of depression.

2.

A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to use?

A)

Are you feeling much better now that you are lying down?

B)

What did you experience just before and during the attack?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

Do you think you will be able to drive home?

D)

What do you think caused you to feel this way?

3.

A client with a panic disorder has been prescribed a benzodiazepine medication. Which of the following would the nurse emphasize as a risk associated with using this medication?

A)

Dietary restrictions

B)

Withdrawal symptoms

C)

Agitation

D)

Fecal impaction

4.

A female client is diagnosed with panic disorder. The client tells the nurse that she hasnt left her house in more than a month because she was afraid of another attack. She visited the mental health clinic today only because her son brought her. Which nursing diagnosis would be a priority for this client?

A)

Powerlessness related to symptoms of anxiety

B)

Decisional Conflict related to fear of leaving the house

C)

Ineffective Family Coping related to symptoms of anxiety

D)

Social Isolation related to fear of recurrence of anxiety symptoms

5.

The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack?

A)

I am feeling very nervous right now.

B)

I can handle this anxiety; it will be over shortly.

C)

I am taking medication to eliminate these symptoms.

D)

Relax your muscles, relax your muscles.

6.

A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, Im so nervous. My hands are shaking, and Im sweating. I feel as if Im having a stroke right now.

Which of the following would the nurse do first?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Stay with the client while remaining calm.

B)

Move the client to a safe environment.

C)

Tell the client that the attack will soon pass.

D)

Teach the client deep breathing techniques to calm her.

7.

A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, These pills are making me sick. I think Im getting a brain tumor because of the headaches. Which response by the nurse would be most appropriate?

A)

Lets talk about how often you have been performing the rituals lately.

B)

Tell me how many times you have washed your hands today.

C)

Have you been practicing your deep breathing and relaxation exercises?

D)

These medications have side effects that can cause increased headaches.

8.

A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the clients therapy has been effective when the client states which of the following?

A)

I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital.

B)

When my mother-in-law comes over now, I go out to my workshop and work on one of my projects.

C)

Im still drinking coffee; I cant quit after drinking it all these years.

D)

Ive learned having a beer after I get home from work helps me relax.

9.

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which of the following nursing interventions would be most appropriate?

A)

Demonstrate empathy for the client by trying to mimic the clients state of anxiety.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

Tell the client that you must leave to go report his symptoms to the psychiatrist on duty.

C)

Tell the client this is an acute exacerbation with a positive prognosis and low morbidity.

D)

Stay with the client, emphasizing that he is safe and that you will remain with him.

10 .

A nurse determines that a client who is experiencing anxiety is using relief behaviors. The nurse determines that the client is experiencing which degree of anxiety?

A)

Mild

B)

Moderate

C)

Severe

D)

Panic

11 .

A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state which of the following?

A)

Anxiety disorders rank second to depression in psychiatric illnesses being treated.

B)

Women experience anxiety disorders more often than do men.

C)

Most anxiety disorders tend to be short term with individuals achieving full recovery.

D)

Anxiety disorders are more common in children than in adolescents.

12 .

While interviewing a client, the client reports an intense fear of spiders, stating, I cant be near them. I get so upset. I start to sweat and hyperventilate if I see one. The nurse documents this finding as which of the following?

A)

Algophobia

B)

Entomophobia

C)

Arachnophobia

D)

Cynophobia

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

13 .

After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which neurotransmitter as being implicated?

A)

Dopamine

B)

Serotonin

C)

Norepinephrine

D)

Gamma-aminobutyric acid (GABA)

14 .

A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitivebehavioral concepts associated with panic disorders, which of the following would the nurse expect to address?

A)

Personal losses

B)

Conditioned response

C)

Early separation

D)

Dysfunctional family communication

15 .

A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which of the following would the nurse most likely expect to administer?

A)

Benzodiazepine

B)

Selective serotonin reuptake inhibitor (SSRI)

C)

Monoamine oxidase inhibitor (MAOI)

D)

Tricyclic antidepressant (TCA)

16 .

A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the following would alert the nurse to suspect possible withdrawal? Select all that apply.

A)

Metallic taste

B)

Irritability

C)

Dry, flushed skin

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

D)

Tremor

E)

Muscle flaccidity

17 .

A client with obsessive-compulsive disorder (OCD) is using cue cards to help restructure thought patterns. Which statements would be appropriate to include on a cue card? Select all that apply.

A)

These are the OCD thoughts.

B)

Trust myself.

C)

Keep on checking.

D)

Safety is the key.

E)

I did it right the first time.

18 .

A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? Select all that apply.

A)

Clomipramine

B)

Lithium

C)

Sertraline

D)

Fluvoxamine

E)

Paroxetine

F)

Alprazolam

19 .

A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, Shes always checking and rechecking to make sure that all of the appliances are turned off before we go out. Its nerve-wracking. We can never get out of the house on time.

Isnt checking once enough? An understanding of which of the following would the nurse need to incorporate into the response?

A)

The client is attempting to exert control over the situation.

B)

The client performs the ritual to relieve anxiety temporarily.

C)

The womans behavior reflects a need for safety.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

D)

20 .

The woman is attempting to use thought stopping to decrease her behavior.

A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which of the following as representing the psychoanalytic theory for this disorder?

A)

Inaccurate environmental danger assessment

B)

Exposure to multiple stressful life events

C)

Kindling caused by overstimulation

D)

Unresolved unconscious conflicts

21 .

A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to avoid? Select all that apply.

A)

Coffee

B)

Ginseng

C)

Milk products

D)

Citrus juices

E)

Aged cheese

22 .

The nurse is assessing a client with posttraumatic stress disorder (PTSD).

Which of the following would the nurse categorize as reflecting intrusion?

Select all that apply.

A)

Irritability

B)

Difficulty sleeping

C)

Flashbacks

D)

Short-term memory deficits

E)

Dissociation

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

23 .

A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to include when describing a person with this condition? Select all that apply.

A)

Fear that others will judge them negatively

B)

Openly speak up in crowds to reduce fear

C)

Are insensitive to others criticism

D)

Demonstrate a distorted view of their own strengths

E)

Exaggerate personal flaws

24 .

A group of students is reviewing the signs and symptoms associated with anxiety. The students demonstrate an understanding of the information when they identify which of the following as cognitive symptoms? Select all that apply.

A)

Edginess

B)

Feelings of unreality

C)

Difficulty concentrating

D)

Tunnel vision

E)

Apprehensiveness

F)

Speech dysfluency

25 .

A client is diagnosed with generalized anxiety disorder and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the quickest relief from anxiety symptoms?

A)

Buspirone

B)

Venlafaxine

C)

Alprazolam

D)

Imipramine

Answer Key

1.

A

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

2.

B

3.

B

4.

D

5.

B

6.

A

7.

D

8.

B

9.

D

10 .

C

11 .

B

12 .

C

13 .

A

14 .

B

15 .

B

16 .

A, B, D

17 .

A, B, E

18 .

A, C, D, E

19 .

B

20 .

D

21 .

A, B

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Test Bank for The Psychiatric Interview 4th Edition

22 .

C, D

23 .

A, D, E

24 .

B, C, D

25 .

C

Chapter 26: Assessing Alcohol Use Disorder

1.

A client has been prescribed naltrexone (Trexan) for treatment of alcohol dependence. The nurse has explained the drugs purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which of the following about the drug?

A)

Causes itching if alcohol is consumed

B)

Produces the euphoria of alcohol

C)

Reduces the appeal of alcohol

D)

Improves appetite and nutritional status

2.

An adolescent client tells the nurse that he or she occasionally sniffs airplane glue. When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include?

A)

Tremors and CNS arousal

B)

Enhanced normal heart rhythms

C)

Enhanced attention focus and memory

D)

Brain damage and cognitive abnormalities

3.

A)

A client tells the nurse that he is committed to trying to quit smoking. When teaching the client about smoking cessation, which of the following would the nurse include?

Success usually involves more than one type of intervention.

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Test Bank for The Psychiatric Interview 4th Edition

B)

Relapse is fairly rare within the first year of quitting.

C)

Ear acupressure is a highly proven method for quitting.

D)

Education is key for smoking cessation.

4.

The nurse is completing the admission of a client who is seeking treatment for alcoholism. He tells the nurse that the last time he had any alcohol to drink was at 10:00 AM before he left for the hospital. The nurse closely monitors the client. Which of the following would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome?

Select all that apply.

A)

Slight diaphoresis

B)

Hand tremors

C)

Intermittent confusion

D)

Heart rate of 135 beats/min

E)

Normal blood pressure

5.

A nurse is talking with a 57-year-old client who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5:00 AM, and the client has been having difficulty sleeping. The client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that basically describes how her nursing supervisor came to visit and gave it to her to wear so shed remember to get well. The nurse suspects that the client may be experiencing which of the following?

A)

Wernickes syndrome

B)

Delirium tremens

C)

Korsakoffs psychosis

D)

Malignant hyperthermia

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Test Bank for The Psychiatric Interview 4th Edition

6.

A nurse is using motivational therapy with a female client with alcoholism.

The client, who is unwilling to consider changing her drinking behavior, emphatically states, I am not an alcoholic; you cant make me stop drinking.

Which response by the nurse would be most appropriate?

A)

You have to stop drinking and driving; you could kill someone.

B)

Youre right; youre not an alcoholic.

C)

You should consider what you are doing to your marital relationship.

D)

Youre the only one who can make yourself stop drinking.

7.

A 52-year-old male client who has a history of alcohol dependence is admitted to a detoxification unit. He has tremors, he is anxious, his pulse has risen from 98 to 110 beats/min, his blood pressure has risen from 140/88 to 152/100 mm Hg, and his temperature is six tenths of a degree above normal.

He is slightly diaphoretic. Which nursing diagnosis would be the priority?

A)

Disturbed Thought Processes

B)

Risk for Injury

C)

Ineffective Coping

D)

Ineffective Denial

8.

A nurse is working with a client who is addicted to heroin. The nurse engages in harm reduction by teaching the client about which of the following?

A)

Using bleach solution to disinfect dirty needles

B)

Problem solving

C)

Healthy coping skills

D)

Proper use of naltrexone (Trexan)

9.

A)

A 20-year-old man arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are tracks visible on his arms. The friend who came with him reports that the client had just shot up heroin when he became unconscious. Which medication would the nurse most likely expect to administer?

Naloxone

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Test Bank for The Psychiatric Interview 4th Edition

B)

Naltrexone

C)

Bupropion

D)

Varenicline

10 .

A nurse is obtaining a history from a client who drinks about 6 cups of coffee and several diet cola drinks per day. The client states, I just cut down my coffee and soda intake to one per day. Which of the following would the nurse most likely expect to assess? Select all that apply.

A)

Headache

B)

Fatigue

C)

Yawning

D)

Flushing

E)

Diuresis

11 .

A group of nursing students is reviewing information about substances that are abused. The students demonstrate understanding of the information when they identify which of the following as stimulants? Select all that apply.

A)

Alcohol

B)

Cocaine

C)

Heroin

D)

Nicotine

E)

Phencyclidine

12 .

A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the teaching was successful when the client states which of the following?

A)

I can have a glass of wine with dinner if I choose.

B)

I should eat small frequent meals if I get nauseated.

C)

I should take the drug on an empty stomach.

D)

I might experience diarrhea with this drug.

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Test Bank for The Psychiatric Interview 4th Edition

13 .

A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step two when he states which of the following?

A)

Ive admitted to myself and others the wrongdoings Ive done.

B)

I realize that there is a higher power that can help me.

C)

I know now that I am powerless over alcohol.

D)

I am making amends to all those that Ive harmed.

14 .

A nurse is preparing an inservice program about substance abuse and its etiology. Which of the following would the nurse most likely include in the presentation when discussing possible psychologic etiologies?

A)

Low self-esteem

B)

Genetic predisposition

C)

Dysfunctional family

D)

Peer influence

15 .

A client is brought into the emergency department because he was involved in an automobile accident. His blood alcohol level (BAL) is 0.10 mg %.

Based on this finding, the nurse would expect to assess which of the following?

A)

Difficulty with coordination

B)

Stupor

C)

Emotional lability

D)

Ataxia

16 .

A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess?

A)

Rhinorrhea

B)

Lacrimation

C)

Dilated pupils

D)

Dysphoria

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Test Bank for The Psychiatric Interview 4th Edition

17 .

A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which of the following?

A)

Asking the client questions about alcohol use

B)

Negotiating a conversation with the client to reduce use

C)

Pointing out the inconsistencies in thoughts, feelings, and action

D)

Helping the client change the way he thinks about a situation

18 .

A client with a history of substance abuse is involved in a skills training group. Which of the following would the client be involved with to enhance intrapersonal coping skills? Select all that apply.

A)

Substance refusal skills

B)

Problem solving

C)

Anger awareness

D)

Emergency planning

E)

Social support networking

19 .

A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which of the following would the nurse expect to find? Select all that apply.

A)

Euphoria

B)

Seizures

C)

Cardiac arrhythmia

D)

Paranoia

E)

Dilated pupils

20 .

A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks the nurse, How will this drug help me?

Which response by the nurse would be most appropriate?

A)

It will help to cure your alcoholism.

B)

It can help to prevent you from drinking.

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Test Bank for The Psychiatric Interview 4th Edition

C)

It makes the withdrawal symptoms less troublesome.

D)

It helps to clear the alcohol out of your body.

Answer Key

1.

C

2.

D

3.

A

4.

A, B, E

5.

C

6.

D

7.

B

8.

A

9.

A

10 .

A, B, C

11 .

B, D

12 .

B

13 .

B

14 .

A

15 .

A

16 .

C

17 .

B

18 .

B, C, D

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Test Bank for The Psychiatric Interview 4th Edition

19 .

B, C

20 .

B

Chapter 27: Assessing Psychotic Disorders

1.

The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following?

A)

Echopraxia

B)

Neologisms

C)

Tangentiality

D)

Echolalia

2.

While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following?

A)

Autistic thinking

B)

Concrete thinking

C)

Referential thinking

D)

Illusional thinking

3.

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the clients family voices a desire for the client to live with them when he is discharged.

Based on the assessment findings, which nursing diagnosis would be the priority?

A)

Ineffective Role Performance related to symptoms of schizophrenia.

B)

Social Isolation related to auditory hallucinations.

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Test Bank for The Psychiatric Interview 4th Edition

C)

Dysfunctional Family Processes related to psychosis.

D)

Bathing Self-Care Deficit related to symptoms of schizophrenia.

4.

The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinsons disease. Which agent would the nurse expect the physician to prescribe?

A)

Anticholinergic

B)

Anxiolytic

C)

Benzodiazepine

D)

Beta-blocker

5.

The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the clients eyes are fixed on the ceiling. The nurse interprets this finding as which of the following?

A)

Akathisia

B)

Oculogyric crisis

C)

Retrocollis

D)

Tardive dyskinesia

6.

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?

A)

Diphenhydramine (Benadryl)

B)

Propranolol (Inderal)

C)

Risperidone (Risperdal)

D)

Aripiprazole (Abilify)

7.

The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following?

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Test Bank for The Psychiatric Interview 4th Edition

A)

Weight loss

B)

Torticollis

C)

Hypoglycemia

D)

Tardive dyskinesia

8.

A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following?

A)

Weight loss

B)

Hypertension

C)

Diarrhea

D)

Diabetes

9.

The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the clients vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?

A)

A white blood cell count

B)

Liver function studies

C)

Serum potassium level

D)

Serum sodium level

10 .

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately?

A)

Elevated temperature

B)

Tremor

C)

Decreased blood pressure

D)

Weight gain

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

11 .

A nurse is preparing an in-service program for a group of psychiatricmental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse?

A)

Lack of family support

B)

Accessibility to community resources

C)

Non-adherence to prescribed medications

D)

Stigmatization of mental illness

12 .

While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion?

A)

Grandiose

B)

Nihilistic

C)

Persecutory

D)

Somatic

13 .

The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following?

A)

Clang association

B)

Stilted language

C)

Verbigeration

D)

Neologisms

14 .

A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the clients room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Diabetes mellitus

B)

Disordered water balance

C)

Tardive dyskinesia

D)

Orthostatic hypotension

15 .

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

A)

Dopamine

B)

Serotonin

C)

Norepinephrine

D)

Gamma-amino butyric acid (GABA)

16 .

After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent?

A)

Fluphenazine (Prolixin)

B)

Thiothixene (Navane)

C)

Quetiapine (Seroquel)

D)

Chlorpromazine (Thorazine)

17 .

When assessing a client for possible disordered water balance, the nurse checks the clients urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance?

A)

1.020

B)

1.011

C)

1.005

D)

1.002

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

18 .

A client with schizophrenia tells the nurse, Im being watched constantly by the FBI because of my job. Which response by the nurse would be most appropriate?

A)

Tell me more about how you are being watched.

B)

It must be frightening to feel like youre always been watched.

C)

Youre not being watched; its all in your mind.

D)

You are experiencing a delusion because of your illness.

19 .

A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority?

A)

Improving the quality of life

B)

Instilling hope

C)

Managing psychosis

D)

Preventing relapse

20 .

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following?

A)

He needs to have an electrocardiogram periodically when taking this drug.

B)

Well need to make sure that he has his blood count checked at least weekly.

C)

He might develop toxic levels of the drug if he smokes cigarettes.

D)

We need to watch to make sure that he doesnt lose too much weight.

21 .

Which of the following would be most important for the nurse to keep in mind when establishing the nursepatient relationship with a client with schizophrenia to promote recovery?

A)

The relationship typically develops over a short period of time.

B)

Decisions about care are the responsibility of interdisciplinary team.

C)

Short, time-limited interactions are best for the client experiencing psychosis.

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Test Bank for The Psychiatric Interview 4th Edition

D)

22 .

Typically, clients with schizophrenia readily engage in a therapeutic relationship.

A nurse is developing a teaching plan for a client with schizophrenia. Which method would the nurse use to be most effective?

A)

Engaging the client the trial and error learning

B)

Having the client write down information after directly being given the correct information

C)

Asking the client questions that encourage the client to guess at the correct answer

D)

Using visual aids that are very colorful and full of descriptive graphic images

23 .

Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?

A)

Disturbed thought processes

B)

Risk for self-directed violence

C)

Disturbed sensory perception

D)

Ineffective coping

24 .

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal?

A)

Continuity of care

B)

Shorter in-patient stays

C)

Immediate crisis stabilization

D)

Social engagement

25 .

After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Dilated reactive pupils

B)

Blurred vision

C)

Ataxia

D)

Coherent speech

E)

Facial pallor

F)

Disorientation

Answer Key

1.

D

2.

C

3.

D

4.

A

5.

B

6.

A

7.

D

8.

D

9.

A

10 .

A

11 .

C

12 .

C

13 .

A

14 .

B

15 .

A

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

16 .

C

17 .

D

18 .

B

19 .

C

20 .

B

21 .

C

22 .

B

23 .

C

24 .

A

25 .

B, C, F

Chapter 28: Assessing Neurocognitive Disorders (Dementia and Delirium)

1.

An older adult client is brought to the emergency department after ingesting an unknown substance. The client, who appears to have dementia, has tremors, ataxia of the upper and lower extremities, depression, and confusion.

The nurse suspects ingestion of which of the following?

A)

Lead

B)

Aluminum

C)

Manganese

D)

Mercury

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

2.

An adolescent client is seen in the emergency department with symptoms of dementia, tremors, and ataxia. The client had been sniffing glue with a friend. The nurse suspects the clients symptoms were caused by poisoning with which of the following?

A)

Mercury

B)

Lead.

C)

Toluene

D)

Arsenic

3.

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the clients condition. Which statement by the nurse would be most appropriate?

A)

Basically, this diagnosis is based on the clients inability to talk normally.

B)

Your report of gradually developing confusion over time was the basis for the diagnosis.

C)

His diagnosis is primarily based on the rapid onset of his change in consciousness.

D)

The clients exposure to an infectious agent led us to determine the diagnosis.

4.

As part of a follow-up home visit to an 80-year-old client who has had surgery, the nurse discusses the clients risk for delirium with his family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply.

A)

Urinary tract infection

B)

Hypertension

C)

Acute stress

D)

Bone fractures

E)

Dehydration

F)

Electrolyte balance

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

5.

The nurse is caring for a client diagnosed with delirium who has been brought for treatment by his son. While taking the clients history, which question would be most appropriate for the nurse to ask the clients son?

A)

Has your father taken any medications recently?

B)

Are you aware of your father falling or injuring his head in any way?

C)

Has your father had a recent stroke?

D)

Has your father experienced any major losses recently?

6.

The nurse makes a home visit to a family caring for a client with Alzheimers disease. The clients wife tells the nurse that she hasnt been out of the house for more than 2 weeks because her sister has been unable to help her care for the client. Which nursing diagnosis would the nurse identify as the priority?

A)

Ineffective Family Coping related to care of a client with Alzheimers disease

B)

Risk for Activity Intolerance related to Alzheimers disease

C)

Caregiver Role Strain related to social isolation

D)

Powerlessness related to seclusion and long-term care of client

7.

A daughter brings her mother, who has Alzheimers disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month.

When assessing the client, the nurse would be alert for the possibility of which side effect?

A)

Gastrointestinal distress

B)

Mild headache

C)

Muscle tics

D)

Blurred vision

8.

A son brings his mother to the clinic for an evaluation. The sons mother has moderate Alzheimers disease without delirium. The nurse assesses the client for which of the following as the priority?

A)

Hearing deficits

B)

Mania

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Test Bank for The Psychiatric Interview 4th Edition

C)

Strange verbalizations

D)

Catastrophic reactions

9.

A client is admitted to the hospital with dementia related to Parkinsons disease. The client is being treated for a fractured tibia from a recent fall.

The nurse should assess the clients history for use of which type of medication?

A)

Anticholinergics

B)

Dopamine agonists

C)

Anxiolytics

D)

Benzodiazepines

10 .

While the nurse is caring for a hospitalized client in the advanced stages of Alzheimers disease, the client begins to have a catastrophic reaction to feeding himself. Which of the following should the nurse do first?

A)

Remain calm and reassuring.

B)

Restrain the client temporarily.

C)

Draw the curtains to darken the room.

D)

Offer to feed the client.

11 .

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, the nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

A)

Atypical antipsychotic

B)

Cholinesterase inhibitor

C)

NMDA receptor antagonist

D)

Benzodiazepine

12 .

A)

A group of nursing students is reviewing information about delirium and dementia. The students demonstrate a need for additional review when they identify which of the following as characteristics of dementia?

Fluctuating changes within a 24-hour period

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

Possible hallucinations

C)

Normal psychomotor activity

D)

Globally impaired cognition

13 .

A client is brought to the emergency department by his wife. The wife states that over the past few hours, the client has become disoriented and confused.

He didnt know where he was and didnt seem to recognize me or be able to carry on a coherent conversation. The nurse suspects delirium. When reviewing the clients medication history with the wife, use of which of the following would alert the nurse to a potential cause? Select all that apply.

A)

Propranolol

B)

Acetaminophen

C)

Diphenhydramine

D)

Verapamil

E)

Quinidine

14 .

A nurse is assessing a client diagnosed with Alzheimers disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for which of the following?

A)

Aphasia

B)

Apraxia

C)

Agnosia

D)

Executive functioning

15 .

A nursing instructor is preparing a presentation on the etiology of Alzheimers disease. When discussing the role of neurotransmitters in the course of the disease, which of the following would the instructor most likely emphasize?

A)

Serotonin

B)

Acetylcholine

C)

Dopamine

D)

Norepinephrine

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

16 .

When assessing a client with dementia, the nurse identifies that the client is experiencing hallucinations. Based on the nurses understanding of this disorder, which type of hallucination would the nurse expect as most common?

A)

Auditory

B)

Visual

C)

Gustatory

D)

Olfactory

17 .

A nurse is talking with the husband of a female client diagnosed with Alzheimers disease. During the conversation, the husband tells the nurse that she often begins to scream and curse for no apparent reason. The nurse interprets this as which of the following?

A)

Hypersexuality

B)

Disinhibition

C)

Hypervocalization

D)

Apathy

18 .

After teaching a group of nursing students about Alzheimers disease and appropriate nursing care, the instructor determines that the teaching was successful when the students identify which of the following as the foundation for providing care to the client and family?

A)

Therapeutic relationship

B)

Medication therapy

C)

Injury prevention

D)

Functional independence

19 .

A nurse is providing care to a client with Alzheimers disease who is exhibiting suspiciousness and delusional thinking. Which of the following would be most important for the nurse to do with this client?

A)

Tell the client that he is experiencing delusions.

B)

Confront the client about his distorted thinking.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

C)

Correct the clients interpretation of the situation.

D)

Determine the trigger for the distorted thinking.

20 .

A client with Alzheimers disease is admitted to the acute care facility for treatment of an infection. Assessment reveals that the client is anxious.

When developing the clients plan of care, which of the following would be least appropriate to include?

A)

Frequently provide reality orientation.

B)

Simplify the clients routines.

C)

Limit the number of choices to be made.

D)

Establish predictable routines.

Answer Key

1.

D

2.

C

3.

C

4.

A, C, D, E

5.

A

6.

C

7.

A

8.

D

9.

A

10 .

A

11 .

C

12 .

A

13 .

A, C, E

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

14 .

C

15 .

B

16 .

B

17 .

C

18 .

A

19 .

D

20 .

A

Chapter 29: Assessing Eating Disorders and Somatic Symptom Disorder

1.

While caring for a client with anorexia nervosa, the nurse anticipates that the client would have difficulty making which of the following comments?

A)

Im mad at you because you wont let me go on a pass unless I gain weight!

B)

I need to have everything in its place and perfect.

C)

If I gain a pound, Ill just keep gaining weight.

D)

I am very involved in preparing my food and counting calories.

2.

A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the clients diagnosis?

A)

My father was always very thin.

B)

Ive never really liked myself.

C)

I have a lot of confidence in myself.

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Test Bank for The Psychiatric Interview 4th Edition

D)

3.

I feel really close to my parents and my brother.

A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication?

A)

Closely monitor your fluid intake while taking this medication.

B)

Stop taking this medication if it causes weight gain.

C)

Expect menstrual irregularities, particularly if theyve occurred previously.

D)

Report any weight changes that occur during the first few weeks this medication is taken.

4.

The nurse is caring for several hospitalized clients with anorexia nervosa.

The nurse would be especially alert for which of the following if noted in the clients histories?

A)

Paranoia

B)

Primary insomnia

C)

Depression

D)

Aggression

5.

The nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which of the following would the nurse include in the teaching plan?

A)

Knowing the calorie content of numerous foods

B)

Learning strategies to control impulses

C)

Describing physiologic consequences of anorexia nervosa

D)

Setting realistic goals

6.

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which of the following would the nurse expect to find?

A)

Impulsivity

B)

Panic

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Test Bank for The Psychiatric Interview 4th Edition

C)

Hyperactivity

D)

Delusions

7.

The nurse is planning to explain the purpose of the behavioral therapy technique of self-monitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary to record which of the following?

A)

Feelings of hunger

B)

Efforts at distraction

C)

Environmental stimuli

D)

Rigid rules about eating

8.

A psychiatricmental health nurse working in the community is planning an educational program for fifth and sixth grade teachers. Which of the following would the nurse include?

A)

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

B)

Emphasis on the need for teachers to focus their prevention efforts on female students

C)

Stressing of the need to allow students to eat without undue attention or supervision to prevent inadvertently influencing eating patterns

D)

Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades

9.

The nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, This is a stupid waste of time! Which of the response by the nurse would be most appropriate?

A)

If you feel that way, then you can just leave.

B)

You sound irritated; tell me about what is bothering you.

C)

You were assigned to this group by your therapist, so you must participate.

D)

Sit down and be quiet; your peers would appreciate some peace and quiet.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

10 .

An adolescent is brought to the emergency department by her parents because they were concerned about their daughters appearance. The client appears emaciated and pale. The parents tell the nurse that the client has been diagnosed with anorexia nervosa. A history and physical examination and laboratory testing are completed. Which of the following would lead the nurse to suspect that the client will be admitted to the hospital? Select all that apply.

A)

Blood pressure of 110/60 mm Hg

B)

Elevated serum potassium level

C)

Decreased serum magnesium level

D)

Heart rate of 40 beats/min

E)

Statements of being hopeless

11 .

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge-eating disorder. The students demonstrate understanding when they identify which characteristics as specific to binge-eating disorder? Select all that apply.

A)

Clients typically are obese.

B)

Clients refrain from purging behaviors.

C)

Binge-eating periods are shorter.

D)

Clients engage in overexercising.

E)

Feelings of guilt do not occur after binging.

12 .

A nursing instructor is reviewing the various theories related to anorexia nervosa. Which of the following would the instructor include when describing theories related to the biologic domain? Select all that apply.

A)

Genetic vulnerability

B)

Separationindividuation

C)

Role pressures

D)

Dieting leading to starvation

E)

Pursuit of thinness

F)

Decreased serotonin activity

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

13 .

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which of the following would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply.

A)

Body dissatisfaction

B)

Feelings of control

C)

Obsessiveness

D)

Boundary problems

E)

Sexuality fears

F)

Cognitive distortions

14 .

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

A)

Disturbed Body Image

B)

Anxiety

C)

Imbalanced Nutrition: Less Than Body Requirements

D)

Ineffective Coping

15 .

A nurse is interviewing a client diagnosed with bulimia nervosa about her family and her relationship with her mother. Which statement by the client would the nurse least likely associate with bulimia nervosa?

A)

My mother is my confidante for everything.

B)

My mothers happiness depends on me.

C)

My family basically has very few rules.

D)

My mother and I are close but not joined at the hip.

16 .

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which of the following would the nurse expect to implement in conjunction with pharmacologic therapy?

A)

Behavioral therapy

B)

Cognitive behavioral therapy

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Test Bank for The Psychiatric Interview 4th Edition

C)

Interpersonal therapy

D)

Family therapy

17 .

While talking with a client with an eating disorder, the client states, Ive gained 2 pounds, so soon Ill be over 100 pounds. The nurse interprets this as which of the following?

A)

Magnification

B)

Selective abstraction

C)

Overgeneralization

D)

Dichotomous thinking

Answer Key

1.

A

2.

B

3.

D

4.

C

5.

D

6.

A

7.

C

8.

A

9.

B

10 .

C, D, E

11 .

A, B

12 .

A, D, F

13 .

A, C, F

14 .

C

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

15 .

D

16 .

B

17 .

D

Chapter 30: Assessing Attention Deficit Hyperactivity Disorder 1. After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?

A. The pharmacological action of Ritalin causes a decrease in appetite.

B. Hyperactivity seen in ADHD causes increased caloric expenditure.

C. Side effects of Ritalin cause nausea; therefore, caloric intake is decreased.

D. Increased ability to concentrate allows the client to focus on activities rather than food.

ANS: A The pharmacological action of Ritalin causes a decrease in appetite that often leads to weight loss. Methylphenidate (Ritalin) is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability for clients diagnosed with ADHD. 2. A physician orders methylphenidate (Ritalin) for a child diagnosed with attention deficithyperactivity disorder (ADHD). Which information about this medication should the nurse provide to the parents?

A. If one dose of Ritalin is missed, double the next dose.

B. Administer Ritalin to the child after breakfast.

C. Administer Ritalin to the child just prior to bedtime.

D. A side effect of Ritalin is decreased ability to learn.

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Test Bank for The Psychiatric Interview 4th Edition

ANS: B The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.

3. A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her childs attention deficit-hyperactivity disorder (ADHD). Which nursing reply best addresses the mothers concern?

A. The physician will probably switch from Ritalin to a central nervous system stimulant.

B. The physician may prescribe an antihistamine with the Ritalin to improve effectiveness.

C. Your child has probably developed a tolerance to Ritalin and may need a higher dosage.

D. Your child has developed sensitivity to Ritalin and may be exhibiting an allergy.

ANS: C The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate (Ritalin) is a central nervous system stimulant in which tolerance can develop rapidly. Physical and psychological dependence can also occur.

4. A nurse has taken report for the evening shift on an adolescent inpatient unit. Which client should the nurse address first?

A. A client diagnosed with oppositional defiant disorder being sexually inappropriate with staff B. A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu C. A client diagnosed with conduct disorder who is demanding special attention from staff D. A client diagnosed with attention deficit disorder who has a history of self-mutilation ANS: B A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu presents a potential safety concern that would need to be addressed by the nurse immediately.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

5. A 6-year-old client is prescribed methylphenidate (Ritalin) for a diagnosis of attention deficithyperactivity disorder (ADHD). When teaching the parents about this medication, which nursing statement explains how Ritalin works?

A. Ritalins sedation side effect assists children by decreasing their energy level.

B. How Ritalin works is unknown. Although it is a stimulant, it does combat the symptoms of ADHD. C. Ritalin helps the child focus by decreasing the amount of dopamine in the basal ganglia and neuron synapse.

D. Ritalin decreases hyperactivity by increasing serotonin levels.

ANS: B It is unknown how Ritalin works, but even though it is a stimulant, it does decrease hyperactivity in individuals diagnosed with ADHD.

6. An 8-year-old client diagnosed with attention deficit-hyperactivity disorder (ADHD) was admitted 5 days ago for management of temper tantrums. What would be a priority nursing intervention during the termination phase of the nurseclient relationship?

A. Set a contract with the client to limit acting-out behaviors while hospitalized.

B. Teach the importance of taking fluoxetine (Prozac) consistently, even when feeling better.

C. Discuss behaviors that are and are not acceptable on the unit.

D. Ask the client to demonstrate learned coping skills without direction from the nurse.

ANS: D The priority nursing intervention during the termination phase of the nurseclient relationship should include encouraging the client to demonstrate the coping skills learning during the working phase of the nurseclient relationship.

7. A child diagnosed with attention deficit-hyperactivity disorder (ADHD) is having difficulty Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

completing homework assignments. What information should the nurse include when teaching the parents about task performance improvement?

A. The parents should isolate the child when completing homework to improve focus.

B. The parents should withhold privileges if homework is not completed within a 2-hour period.

C. The parents should divide the homework task into smaller steps and provide an activity break.

D. The parents should administer an extra dose of methylphenidate (Ritalin) prior to homework.

ANS: C By dividing the homework task into smaller steps, the child can remain more focused within a limited about of time. Physical activity can release pent-up energy that would distract from task completion.

8. A nursing instructor is teaching about pharmacological treatments for attention deficithyperactivity disorder (ADHD). Which information about atomoxetine (Strattera) should be included in the lesson plan?

A. Strattera, unlike methylphenidate (Ritalin), is a central nervous system depressant.

B. When taking Strattera, a client should eliminate all red food coloring from the diet.

C. Strattera will be a life-long intervention for clients diagnosed with this disorder.

D. Strattera, unlike methylphenidate (Ritalin), is a selective norepinephrine reuptake inhibitor.

ANS: D Strattera is a selective norepinephrine reuptake inhibitor. Ritalin is classified as a stimulant. The exact mechanism by which these drugs produce a therapeutic effect in ADHD is unknown.

9. Which of the following interventions should a nurse anticipate implementing when planning care for children diagnosed with attention deficit-hyperactivity disorder (ADHD)? Select all that apply.

A. Behavior modification

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B. Antianxiety medications C. Competitive group sports D. Group therapy E. Family therapy ANS: A, D, E The nurse should anticipate that behavior modification, group therapy, and family therapy may be implemented in the management of ADHD in children. These interventions are often used in conjunction with psychopharmacology to reduce impulsive and hyperactive behaviors and to increase attention span.

10. The nurse should recognize which of the following findings contribute to a clients development of attention deficit-hyperactivity disorder (ADHD)? Select all that apply.

A. The clients father was a smoker.

B. The client was born 7 weeks premature.

C. The client is lactose intolerant.

D. The client has a sibling diagnosed with ADHD. E. The client has been diagnosed with dyslexia.

ANS: B, D The nurse should identify that premature birth and having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. Research indicates evidence of genetic influences in the etiology of ADHD. Studies also indicate that environmental influences such as lead exposure and diet can be linked with the development of ADHD.

Chapter 31: Assessing Personality Disorders Section

1.

The nurse is preparing to assess a client with a paranoid personality trait.

The nurse integrates knowledge of this condition, anticipating that the clients affect and behavior will most likely be which of the following?

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

A)

Angry and hostile

B)

Flirtatious and seductive

C)

Fearful and anxious

D)

Friendly and open

2.

The nurse is caring for a client with schizoid personality trait. When developing the plan of care for the client, which of the following would the nurse most likely include?

A)

Social skills training

B)

Anger management training

C)

Relaxation techniques

D)

Coping skills training

3.

A nursing instructor is preparing a teaching plan for a class of nursing students about antisocial personality disorder. Which of the following would the nurse include as a term often used to describe the behaviors associated with this condition? Select all that apply.

A)

Psychopath

B)

Manipulator

C)

Criminality

D)

Sociopath

E)

Psychotic

4.

A nurse is reading a journal article about the various theories associated with the development of antisocial personality disorder. The article mentions difficult temperament as a possible theory. The nurse demonstrates understanding of this concept when identifying which of the following as a key behavior associated with a difficult temperament? Select all that apply.

A)

Aggression

B)

Inattention

C)

Hyperactivity

D)

Impulsivity

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Test Bank for The Psychiatric Interview 4th Edition

E)

Depression

F)

Paranoia

5.

A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit.

Which of the following would the nurse most likely include? Select all that apply.

A)

Developing a therapeutic relationship

B)

Bargaining about the unit rules

C)

Holding the client responsible for behavior

D)

Discouraging client from discussing thoughts

E)

Using a firm, lecture-like approach for teaching

6.

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to focus on when teaching the family about this disorder?

A)

Anger management

B)

Boundary setting

C)

Medication therapy

D)

Self-responsibility

7.

A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state which of the following?

A)

The disorder occurs more frequently in women.

B)

The individual must be at least 18 years of age.

C)

The disorder is found primarily in Asian individuals.

D)

Alcohol abuse disorder rarely accompanies this disorder.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

8.

A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?

A)

It requires the client to develop attachments.

B)

It sets up specific boundaries for the client.

C)

It helps reinforce self-responsibility.

D)

It avoids confrontation about dysfunctional patterns.

9.

The nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify as a priority?

A)

Risk for Other-Directed Violence

B)

Risk for Self-Injury

C)

Risk for Suicide

D)

Risk for Self-Directed Violence

10.

A client is brought into the emergency department because of complaints from the neighbors that the client was acting strangely. The nurse assesses the client and suspects schizotypal personality disorder based on assessment of which of the following? Select all that apply.

A)

Magical beliefs

B)

Hallucinations

C)

Paranoia

D)

Avoidance of eye contact

E)

Meticulous dress

11.

A)

A nurse is assessing a client diagnosed with avoidant personality disorder.

Which of the following would the nurse most likely expect to find? Select all that apply.

Shyness

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

B)

Feelings of inadequacy

C)

Feelings of superiority

D)

Perfectionism

E)

Detail oriented

12.

A group of nursing students is reviewing information about schizoid personality trait. The students demonstrate understanding of the information when they identify which disorder as the most common comorbid disorder?

A)

Depression

B)

Substance abuse

C)

Avoidant personality disorder

D)

Anxiety

13.

A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which client statement would help support the nurses suspicions?

A)

I have a very important position in life; everyone I know wants to be like me.

B)

My wife is poisoning my food so she can get rid of me and marry her boss.

C)

I like to work alone because then I can let my thoughts wander.

D)

Im always the life of the party, making new friends all the time.

14.

A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act?

A)

Remorse

B)

Tension

C)

Regret

D)

Pleasure

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

15.

A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair. The nurse most likely is reading an article about which of the following?

A)

Kleptomania

B)

Trichotillomania

C)

Pyromania

D)

Intermittent explosive disorder

16.

A nurse is working with a client who is a compulsive gambler. Which of the following would the nurse emphasize as crucial for relapse prevention?

Select all that apply

A)

Medication therapy

B)

Family involvement

C)

Identification of triggers

D)

Anger management

E)

Milieu management

17.

A nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as characteristic of negativistic personality traits? Select all that apply.

A)

Anhedonia

B)

Hostility

C)

Pessimism

D)

Oppositionality

E)

Guilt

Answer Key

1.

A

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

2.

A

3.

A, D

4.

A, B, C, D

5.

A, C

6.

B

7.

B

8.

C

9.

A

10.

A, C, D

11.

A, B

12.

C

13.

A

14.

B

15.

B

16.

B, C

17.

B, D, E

Chapter 32-Chapter 34: How to Educate Your Patient Chapter 33: Negotiating a Treatment Plan Chapter 34: Writing Up the Results of the Interview MULTIPLE CHOICE 1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, The patient is like one of my grandparents . . . so helpless. What feelings does the nurse describe? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reaction ANS: B Countertransference is the nurses transference or response to a patient that is based on the nurses unconscious needs, conflicts, problems, or view of the world.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

2. Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. You must have been very upset when you tried to hurt yourself. b. It makes me sad to see you going through such a difficult experience. c. If you tell me what is troubling you, I can help you solve your problems. d. Suicide is a drastic solution to a problem that may not be such a serious matter.

ANS: A Empathy permits the nurse to see an event from the patients perspective, understand the patients feelings, and communicate this to the patient. The incorrect responses are nurse centered (focusing on the nurses feelings rather than the patients), belittling, and sympathetic.

3. After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? a. The patients reactions toward the nurse seem realistic and appropriate. b. The patient states, Talking to you feels like talking to my parents. c. The nurse feels unusually happy when the patients mood begins to lift. d. The nurse develops a trusting relationship with the patient.

ANS: C Strong positive or negative reactions toward a patient or an overidentification with a patient signals possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable.

4. A patient says, Please dont share information about me with the other people. How should the nurse respond? a. I wont share information with others without your permission, but I will share information about you with other staff members. b. A therapeutic relationship is just between the nurse and the patient. Its up to you to tell others what you want them to know. c. It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others. d. I cannot tell anyone about you. It will be as though I am talking about my own problems, and Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

we can help each other by keeping it between us.

ANS: A A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff members need to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse-patient contract is established, and suggest mutual problem solving. The relationship must be patient centered.

5. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent for most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, I really need to talk to you right now. The nurse should: a. say to the interrupting patient, I am not available to talk with you at the present time. b. end the unproductive session with the current patient and spend time with the patient who has just interrupted. c. invite the interrupting patient to join in the session with the current patient. d. tell the patient who interrupted, This session is 5 more minutes; then, I will talk with you.

ANS: D When a specific duration for a session has been set, the nurse must adhere to the schedule.

Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important. The incorrect responses preserve the nurse-patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.

6. Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse: a. avoids upsetting the patient by shifting focus to other patients before the discharge. b. gives the patient a personal telephone number and permission to call after discharge. c. discusses with the patient changes that have happened during the relationship and evaluates the outcomes. d. offers to meet the patient for coffee and conversation three times a week after discharge.

ANS: C Summarizing and evaluating progress help validate the experience for the patient and the nurse Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

and facilitate closure. Termination must be discussed; avoiding the discussion by spending little time with the patient promotes feelings of abandonment. Successful termination requires that the relationship be brought to closure without the possibility of dependency-producing ongoing contact.

7. What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate: a. great sense of independence. b. rapport and trust with the nurse. c. self-responsibility and autonomy. d. resolution of feelings of transference.

ANS: B The development of rapport and trust is necessary before the relationship can progress to the working phase. Behaviors indicating a greater sense of independence, self-responsibility, and resolved transference occur in the working phase.

8. During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved? a. Preorientation b. Orientation c. Working d. Termination ANS: C During the working phase, the nurse strives to assist the patient in making connections among dysfunctional behaviors, thinking, and emotions and offers support while alternative coping behaviors are tried.

9. At what point in the nurse-patient relationship should a nurse plan to first address termination? a. In the orientation phase b. During the working phase c. In the termination phase d. When the patient initially brings up the topic ANS: A The patient has a right to know the conditions of the nurse-patient relationship. If the relationship Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

is to be time limited, then the patient should be informed of the number of sessions. If it is open ended, then the termination date will not be known at the outset and the patient will know that the issue will be negotiated at a later date. The nurse is responsible for bringing up the topic of termination early in the relationship, usually during the orientation phase.

10. A nurse should introduce the matter of a contract during the first session with a new patient because contracts: a. specify what the nurse will do for the patient. b. spell out the participation and responsibilities of each party. c. indicate the feeling tone established between the participants. d. are binding and prevent either party from prematurely ending the relationship.

ANS: B A contract emphasizes that the nurse works with the patient rather than doing something for the patient. Working with is a process that suggests each party is expected to participate and share responsibility for the outcomes. Contracts do not, however, stipulate roles or feeling tone, or that premature termination is forbidden.

11. As a nurse escorts a patient being discharged after treatment for major depressive disorder, the patient gives the nurse a gold necklace with a heart pendant and says, Thank you for helping mend my broken heart. Which is the nurses best response? a. Accepting gifts violates the policies and procedures of the facility. b. Im glad you feel so much better now. Thank you for the beautiful necklace. c. Im glad I could help you, but I cant accept the gift. My reward is seeing you with a renewed sense of hope. d. Helping people is what nursing is all about. Its rewarding to me when patients recognize how hard we work.

ANS: C Accepting a gift creates a social rather than a therapeutic relationship with the patient and blurs the boundaries of the relationship. A caring nurse will acknowledge the patients gesture of appreciation, but the gift should not be accepted.

12. Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse-patient relationship? a. I dont have any problems. b. It is so difficult for me to talk about my problems. c. I dont know how talking about things twice a week can help.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

d. I want to find a way to deal with my anger without becoming violent.

ANS: D Thinking about a more constructive approach to dealing with anger indicates a readiness to make a behavioral change. Behavioral change is associated with the working phase of the relationship.

Denial is often seen in the orientation phase. It is common early in the relationship, before rapport and trust are firmly established, for a patient to express difficulty in talking about problems. Stating skepticism about the effectiveness of the nurse-patient relationship is more typically a reaction during the orientation phase.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 141-144 TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment 13. A nurse explains to the family of a patient who is mentally ill how the nurse-patient relationship differs from social relationships. Which is the best explanation? a. The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient. b. The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented. c. The focus of the relationship is socialization. Mutual needs are met, and feelings are openly shared. d. The focus is the creation of a partnership in which each member is concerned with the growth and satisfaction of the other.

ANS: A Only the correct response describes the elements of a therapeutic relationship. The remaining responses describe events that occur in social or intimate relationships.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 136-138 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 14. A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: a. restate what the patient says. b. use congruent communication strategies. c. use self-disclosure in patient interactions. d. consistently interpret the patients behaviors.

ANS: B Genuineness is a desirable characteristic involving an awareness of ones own feelings as they arise and the ability to communicate them when appropriate. The incorrect options are Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

undesirable in a therapeutic relationship.

15. A nurse caring for a withdrawn, suspicious patient recognizes the development of feelings of anger toward the patient. The nurse should: a. suppress the angry feelings. b. express the anger openly and directly with the patient. c. tell the nurse manager to assign the patient to another nurse. d. discuss the anger with a clinician during a supervisory session.

ANS: D The nurse is accountable for the relationship. Objectivity is threatened by strong positive or negative feelings toward a patient. Supervision is necessary to work through a countertransference of feelings.

16. A nurse wants to enhance the growth of a patient by showing positive regard. The action consistent with this wish is: a. making rounds daily. b. staying with a tearful patient. c. administering daily medication as prescribed. d. examining personal feelings about a patient.

ANS: B Staying with a crying patient offers support and shows positive regard. Administering daily medication and making rounds are tasks that could be part of an assignment and do not necessarily reflect positive regard. Examining feelings regarding a patient addresses the nurses ability to be therapeutic.

17. A patient says, Ive done a lot of cheating and manipulating in my relationships. Select a nonjudgmental response by the nurse. a. How do you feel about that? b. Its good that you realize this. c. Thats not a good way to behave. d. Have you outgrown that type of behavior?

ANS: A

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values. The remaining options offer negative judgments.

18. A patient says, People should be allowed to commit suicide without interference from others.

A nurse replies, Youre wrong. Nothing is bad enough to justify death. What is the best analysis of this interchange? a. The patient is correct. b. The nurse is correct. c. Neither person is totally correct. d. Differing values are reflected in the two statements.

ANS: D Values guide beliefs and actions. The individuals stating their positions place different values on life and autonomy. Nurses must be aware of their own values and be sensitive to the values of others.

19. Which issues should a nurse address during the first interview with a patient diagnosed with a psychiatric disorder? a. Trust, congruence, attitudes, and boundaries b. Goals, resistance, unconscious motivations, and diversion c. Relationship parameters, the contract, confidentiality, and termination d. Transference, countertransference, intimacy, and developing resources ANS: C Relationship parameters, the contract, confidentiality, and termination are issues that should be considered during the orientation phase of the relationship. The remaining options are issues that are dealt with later.

20. During the first interview, a nurse notices that the patient does not make eye contact. The nurse can correctly analyze that: a. the patient is not truthful. b. the patient is feeling sad. c. the patient has a poor self-concept. d. more information is needed to draw a conclusion.

ANS: D Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

The data are insufficient to draw a conclusion. The nurse must continue to assess.

21. Which behavior shows that a nurse values autonomy? The nurse: a. sets limits on a patients romantic overtures toward the nurse. b. suggests one-on-one supervision for a patient who is suicidal. c. informs a patient that the spouse will not be in during visiting hours. d. discusses available alternatives and helps the patient weigh the consequences.

ANS: D A high level of valuing is acting on ones belief. Autonomy is supported when the nurse helps a patient weigh alternatives and their consequences before the patient makes a decision. Autonomy or self-determination is not the issue in any of the other behaviors.

22. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurses best action? a. Recognize the effectiveness of the relationship and patients thoughtfulness. Accept the card. b. Inform the patient that accepting gifts violates the policies of the facility. Decline the card. c. Acknowledge the patients transition through the termination phase but decline the card. d. Accept the card and invite the patient to return to participate in other arts and crafts groups.

ANS: A The nurse must consider the meaning, timing, and value of the gift. In this instance, the nurse should accept the patients expression of gratitude.

23. A patient says, Im still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges? What is the nurses best response? a. Why are you asking me when youre able to speak for yourself? b. I will be glad to address it when I see your doctor later today. c. Thats a good topic for you to take up with your doctor. d. Do you think you cant speak to a doctor?

ANS: C Nurses should encourage patients to work at their optimal level of functioning. A nurse does not act for the patient unless it is necessary. Acting for a patient increases feelings of helplessness and dependency.

24. A community mental health nurse has worked with a patient for 3 years but is moving out of

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

the city and terminates the relationship. A new nurse who begins work with this patient will: a. begin at the orientation phase. b. resume the working relationship. c. enter into a social relationship. d. return to the emotional catharsis phase.

ANS: A After the termination of a long-term relationship, the patient and new nurse usually have to begin at ground zero, the orientation phase, to build a new relationship. If termination is successfully completed, then the orientation phase sometimes progresses quickly to the working phase. Other times, even after successful termination, the orientation phase may be prolonged.

25. As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? a. The invitation facilitates dependency on the nurse. b. The nurses action blurs the boundaries of the therapeutic relationship. c. The invitation is therapeutic for the patients diversional activity deficit. d. The nurses action assists the patients integration into community living.

ANS: B The invitation creates a social relationship rather than a therapeutic relationship.

26. A nurse says, I am the only one who truly understands this patient. Other staff members are too critical. The nurses statement indicates: a. boundary blurring. b. sexual harassment. c. positive regard. d. advocacy.

ANS: A When the role of the nurse and the role of the patient shift, boundary blurring may arise. In this situation, the nurse is becoming overinvolved with the patient as a probable result of unrecognized countertransference. When boundary issues occur, the need for supervision exists.

The situation does not describe sexual harassment. Data are not present to suggest positive regard or advocacy.

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

MULTIPLE RESPONSE 1. Which descriptors exemplify consistency regarding therapeutic nurse-patient relationships?

Select all that apply. a. Having the same nurse care for a patient on a daily basis b. Encouraging a patient to share initial impressions of staff c. Providing a schedule of daily activities to a patient d. Setting a time for regular sessions with a patient e. Offering solutions to a patients problems ANS: A, C, D Consistency implies predictability. Having the same nurse see the patient daily, providing a daily schedule of patient activities, and setting a regular time for sessions help a patient to predict what will happen during each day and to develop a greater degree of security and comfort.

Encouraging a patient to share initial impressions of staff and giving advice are not related to consistency and would not be considered a therapeutic intervention.

2. A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? Select all that apply. a. Focus dialog with the patient on problems that may occur in the future. b. Help the patient express feelings about the relationship with the nurse. c. Help the patient prioritize and modify socially unacceptable behaviors. d. Reinforce expectations regarding the parameters of the relationship. e. Help the patient identify strengths, limitations, and problems.

ANS: A, B The correct actions are part of the termination phase. The other actions are used in the working and orientation phases.

3. A new psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls embarrassing events concerning the parents behavior in the community. Select the best ways for this nurse to cope with these feelings. Select all that apply. a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. b. Recognize that these feelings are unhealthy, and try to suppress them when working with patients. c. Recognize that psychiatric nursing is not an appropriate career choice, and explore other nursing specialties. d. Begin new patient relationships by saying, My own parent had mental illness, so I accept it

Test Bank for The Psychiatric Interview 4th Edition

Test Bank for The Psychiatric Interview 4th Edition

without stigma. e. Recognize that the feelings may add sensitivity to the nurses practice, but supervision is important.

ANS: A, E The nurse needs to explore these feelings. An experienced psychiatric nurse is a resource who may be helpful. The knowledge and experience gained from the nurses relationship with a parent who is mentally ill may contribute sensitivity to a compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories.

4. A new nurse tells a mentor, I want to convey to my patients that I am interested in them and that I want to listen to what they have to say. Which behaviors are helpful in meeting the nurses goal? Select all that apply. a. Sitting behind a desk, facing the patient. b. Introducing self to a patient and identifying own role. c. Using facial expressions that convey interest and encouragement. d. Assuming an open body posture and sometimes mirror imaging. e. Maintaining control of the topic under discussion by asking direct questions.

ANS: B, C, D Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey interest and encouragement support the nurses verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient comfort. A desk would place a physical barrier between the nurse and patient. A face-to-face stance should be avoided when possible, and a less intense, 90- or 120-degree angle is used to permit either party to look away without discomfort. Once introductions have been made, the nurse focuses the interview on the patient by using open-ended questions, such as, Where should we start?

Test Bank for The Psychiatric Interview 4th Edition