Test Bank for Foundations of Mental Health Care 6th Edition by Morrison-Valfre

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Chapter 01: The History of Mental Health Care Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The belief of the ancient Greek philosopher Plato that the rational soul controlled the

irrational soul could be compared with the belief of the more recent psychological theorist: a. Freud b. Pinel c. Fisher d. Rush ANS: A

Sigmund Freud believed that mental illness was, in part, caused by forces both within and outside the personality. Philippe Pinel advocated acceptance of mentally ill individuals as human beings in need of medical assistance. Alice Fisher was a Florence Nightingale nurse who cared for the mentally ill, and Dr. Benjamin Rush was the author of the book Diseases of the Mind.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 4 OBJ: 2 TOP: Early Years of Mental Health KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. During the mid-1500s, behaviors associated with mental illness were more accurately

recorded by professionals. This practice led to ______________ for different abnormal behaviors. a. Classifications b. Diagnosing c. Treatment d. Education ANS: A

Classification of abnormal behaviors did not begin until this time, after the practice of more accurate recording of behaviors was begun. Diagnoses, treatment guidelines, and any education regarding mental health disorders were not available during this period.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 5 OBJ: 3 TOP: Mental Illness During the Renaissance KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. During the latter part of the eighteenth century, psychiatry became a separate branch of

medicine, and inhumane treatment was greatly diminished by the French hospital director: a. Dix b. Beers c. Pinel d. Carter ANS: C

Philippe Pinel advocated acceptance of the mentally ill, as well as proper treatment. Dorothea Dix crusaded for construction of mental health hospitals. Clifford Beers wrote the book A Mind That Found Itself. President Jimmy Carter established the President’s Commission on Mental Health in 1978.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 5 OBJ: 4 TOP: Mental Illness in the Eighteenth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. In 1841, _______________ surveyed asylums, jails, and almshouses throughout the United

States, Canada, and Scotland and is credited with bringing about public awareness and reform for the care of the mentally ill. a. Sigmund Freud b. John Cade c. Florence Nightingale d. Dorothea Dix ANS: D

Dorothea Dix spent 20 years surveying facilities that housed mentally ill individuals and is credited with major changes in the care of the mentally ill. Sigmund Freud introduced the concept of psychoanalysis, John Cade discovered lithium carbonate for the treatment of bipolar disorder, and Florence Nightingale trained nurses in England in the 1800s.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 4 TOP: Mental Illness in the Nineteenth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. As a direct result of Clifford Beers’ work and book, A Mind That Found Itself, the Committee

for Mental Hygiene was formed in 1909 with a focus on prevention of mental illness and: a. Early detection of symptoms of mental illness b. Education of caregivers c. Current treatment options d. Removing the stigma attached to mental illness ANS: D

Clifford Beers’ book reflected on his attempt at suicide followed by the deplorable care he received for the next 3 years in mental hospitals. Beers’ work and book raised the consciousness of people throughout the country regarding prevention and removal of the stigma of having a mental illness. Early detection of symptoms, education of caregivers, and current treatment options regarding mental illness were not the focus of his book, nor were they a priority for the Committee for Mental Hygiene.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 4 TOP: Mental Illness in the Twentieth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma

that could last as long as 50 hours? a. Electroconvulsive therapy b. Insulin therapy c. Humoral therapy

d. Amphetamine therapy ANS: B

Insulin therapy was believed to successfully treat schizophrenia in the early 1900s.

Amphetamines were used to treat depression, and electroconvulsive therapy was used for severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a belief that mental illness resulted from an imbalance of the humors of air, fire, water, and earth.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often

used to treat? a. Schizophrenia b. Bipolar disorder c. Severe depression d. Violent behavior ANS: C

ECT was found to be an effective treatment for severe depression in the 1930s. During this period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. In the early twentieth century, a frontal lobotomy was a common treatment for violent

behaviors. Which description of this procedure is accurate? a. A procedure that delivers an electrical stimulus to the frontal lobes of the brain b. A surgical procedure that drills holes in the front of the skull to drain fluid c. A surgical procedure that severs the frontal lobes of the brain from the thalamus d. A surgical procedure that inserts implants into the frontal lobes of the brain ANS: C

A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed from the thalamus.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which class of drugs was introduced in the 1930s for the treatment of depression? a. SSRIs b. Tricyclic antidepressants c. MAOIs d. Amphetamines ANS: D

In the 1930s, amphetamines were found to boost the spirits of depressed people. SSRIs, tricyclic antidepressants, and MAOIs are antidepressant agents, but they were not discovered until much later.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of

mental health because it funded: a. Research on drugs for the treatment of mental health disorders b. Training of mental health professionals c. Construction of psychiatric units in facilities throughout North America d. Development of community mental health clinics ANS: C

The Hill-Burton Act provided money for the construction of psychiatric units in the United States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health professionals was funded by the National Mental Health Act of 1946, and community mental health centers were not instituted until the 1960s.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The National Mental Health Act of 1946 provided a means for funding of programs that

promote research on mental health and: a. Development of mental health clinics in the community b. Training of mental health professionals c. Treatment for veterans suffering from mental health disorders d. Educating the public about mental illness ANS: B

The National Mental Health Act of 1946 provided much needed training for individuals who cared for patients with mental health disorders. Community mental health clinics were initiated in the 1960s, treatment for veterans was not funded by this act, and education of the public occurred later.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which of the following best describes the disorder that was first recognized in veterans

following the Korean and Vietnam Wars? a. Depression b. Bipolar disorder c. Post-traumatic stress disorder d. Paranoid schizophrenic disorder ANS: C

Posttraumatic stress disorder was initially discovered in veterans who had been involved in armed conflicts. The other disorders also occur in veterans but were not first recognized in soldiers who were fighting wars.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. The introduction of ___________ in the 1950s led to the deinstitutionalization of many

mentally ill individuals. a. Psychotherapeutic drugs b. Community mental health clinics c. Residential treatment centers d. State mental health facilities ANS: A

Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone during the 1950s. Patients were being released from state mental health facilities as a result of psychotherapeutic drug therapy. Community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 6 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. In 1949, an Australian physician discovered which therapy to be an effective treatment for

bipolar (manic-depressive) illness? a. Insulin therapy b. Water/ice therapy c. Lithium carbonate therapy d. Electroconvulsive therapy ANS: C

To this day, lithium is a treatment that is used to effectively balance the manic states and depressive states of bipolar disorder. None of the other therapies listed are effective for bipolar disorder.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 6 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. In the early 1960s, a committee appointed by President John F. Kennedy recommended the

development of a new approach to the way mental health care was administered, with an emphasis on the introduction of: a. Psychotherapeutic drugs b. State mental health care systems c. Community mental health centers d. Deinstitutionalization of patients ANS: C

The emergence of community mental health centers was necessary, in part because of the massive deinstitutionalization of patients from state mental health care facilities after the introduction of psychotherapeutic drugs in the 1950s.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 7 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The Mental Health Systems Act of 1980 was one of the most progressive mental health bills

in the history of the United States, but its enactment was interrupted by the: a. Election of a new president b. Appointment of a new Surgeon General c. Rapid expansion of community centers d. National Alliance on Mental Illness (NAMI) surveys ANS: A

The election of a new president and his administration led to drastic cuts in federal funding for mental health programs. None of the other three choices were a part of the Mental Health Systems Act of 1980.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with

chronic mental illness in: a. Nursing homes b. State mental health facilities c. Residential treatment centers d. Homeless shelters ANS: A

Many mentally ill, especially elderly, people were inappropriately placed in nursing homes with personnel who were not trained to care for these people. OBRA prevented this practice.

State mental health facilities, residential treatment centers, and homeless shelters were not addressed in the OBRA of 1987.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. In the late 1980s, government funding for mental health care dwindled, and most insurance

companies __________ coverage for psychiatric care. a. Withdrew b. Increased c. Decreased d. Added ANS: A

Unfortunately, insurance companies followed the trend of the national government to the point of actually dropping coverage for psychiatric care.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey

and grading of state mental health care for adults and learned that the overall grade for care was: a. “A” b. “B” c. “C” d. “D” ANS: D

The NAMI gave a grade of “D” to the mental health care system based on poor funding, limited availability of care, and patients’ lack of access to mental health care.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 20. Which of the following persons has the greatest risk for developing ineffective coping

behaviors? a. The middle-aged man whose diet is high in saturated fat and who has a 20-year history of tobacco use b. The single 30-year-old female facing the death of her father c. The 19-year-old college student with a family history of schizophrenia d. The 9-year-old whose parents are nurturing but provide chores and responsibilities ANS: C

Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 2 TOP: Introduction KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 21. In the early 1900s the first theory of mental illness that showed behavior could be changed is

attributed to: a. Beers b. Dix c. Freud d. Pinel ANS: C

Freud was the first person who succeeded in explaining human behavior in psychological terms and in demonstrating that behavior can be changed under the proper circumstances.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 5 TOP: Psychoanalysis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE 1. The humoral theory of disease embraced by Hippocrates required a balance of which

elements? (Select all that apply.) a. Fire b. Water c. Light d. Air e. Earth ANS: A, B, D, E

Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental elements of air, fire, water, and earth. Each basic element had a related humor or part in the body.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 2 TOP: Greece and Rome KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which aspects of adult mental health care systems did the National Alliance on Mental Illness

survey focus on? (Select all that apply.) a. Availability of care b. Access to care c. Regulation of medications d. Increased funding ANS: A, B, D

In 2006, the National Alliance on Mental Illness (NAMI) conducted the “first comprehensive survey and grading of state adult mental health care systems conducted in more than 15 years” (NAMI, 2006). Their results revealed a fragmented system with an overall grade of D. Recommendations focused on increased funding, availability of care, access to care, and greater involvement of consumers and their families.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 9 TOP: Twenty-first century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Mental health is said to be influenced by which of the following factors? (Select all that

apply.) a. Diet and nutritional intake b. Inherited characteristics c. Activities of daily living d. Childhood nurturing e. Life circumstances ANS: B, D, E

Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas.

PTS: 1 OBJ: 2

DIF: Cognitive Level: Knowledge TOP: Congressional Actions

REF: p. 7

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

COMPLETION 1. During the middle ages, mentally ill patients often were burned at the stake and were greatly

mistreated. In an attempt to treat mentally ill people more humanely, Bethlehem Hospital, more commonly called ___________, was created.

ANS:

Bedlam Bedlam was the nickname for Bethlehem Hospital, which prevented burning of mentally ill people at the stake but provided poor care for the mentally ill.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 3 OBJ: 3 TOP: Mental Illness in the Middle Ages KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

b. Insulin therapy c. Humoral therapy d. Amphetamine therapy ANS: B Insulin therapy was believed to successfully treat schizophrenia in the early 1900s.

Amphetamines were used to treat depression, and electroconvulsive therapy was used for severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a belief that mental illness resulted from an imbalance of the humors of air, fire, water, and earth.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often used to treat? a. Schizophrenia b. Bipolar disorder c. Severe depression d. Violent behavior ANS: C ECT was found to be an effective treatment for severe depression in the 1930s. During this period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. In the early 20th century, a frontal lobotomy was a common treatment for violent behaviors.

Which description of this procedure is accurate? a. A procedure that delivers an electrical stimulus to the frontal lobes of the brain. b. A surgical procedure that drills holes in the front of the skull to drain fluid. c. A surgical procedure that severs the frontal lobes of the brain from the thalamus. d. A surgical procedure that inserts implants into the frontal lobes of the brain.

ANS: C A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed from the thalamus.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of mental health because it funded: a. research on drugs for the treatment of mental health disorders.

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b. training of mental health professionals. c. construction of psychiatric units in facilities throughout North America. d. development of community mental health clinics.

ANS: C The Hill-Burton Act provided money for the construction of psychiatric units in the United States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health professionals was funded by the National Mental Health Act of 1946, and community mental health centers were not instituted until the 1960s.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. The National Mental Health Act of 1946 provided a means for funding of programs that promote research on mental health and: a. development of mental health clinics in the community. b. training of mental health professionals. c. treatment for veterans suffering from mental health disorders. d. educating the public about mental illness.

ANS: B The National Mental Health Act of 1946 provided much needed training for individuals who cared for patients with mental health disorders. Community mental health clinics were initiated in the 1960s, treatment for veterans was not funded by this act, and education of the public occurred later.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. Which of the following best describes the disorder that was first recognized in veterans following the Korean and Vietnam Wars? a. Depression b. Bipolar disorder c. Post-traumatic stress disorder d. Paranoid schizophrenic disorder ANS: C Post-traumatic stress disorder was initially discovered in veterans who had been involved in armed conflicts. The other disorders also occur in veterans but were not first recognized in soldiers who were fighting wars.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. The introduction of mentally ill individuals. a. psychotherapeutic drugs

in the 1950s led to the deinstitutionalization of many

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b. community mental health clinics c. residential treatment centers d. state mental health facilities ANS: A Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone during the 1950s. Patients were being released from state mental health facilities as a result of psychotherapeutic drug therapy. Community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 6 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. In 1949, an Australian physician discovered which therapy to be an effective treatment for bipolar (manic-depressive) illness? a. Insulin therapy b. Water/ice therapy c. Lithium carbonate therapy d. Electroconvulsive therapy ANS: C To this day, lithium is a treatment that is used to effectively balance the manic states and depressive states of bipolar disorder. None of the other therapies listed are effective for bipolar disorder.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 6 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. In the early 1960s, a committee appointed by President John F. Kennedy recommended the development of a new approach to the way mental health care was administered, with an emphasis on the introduction of: a. psychotherapeutic drugs. b. state mental health care systems. c. community mental health centers. d. deinstitutionalization of patients.

ANS: C The emergence of community mental health centers was necessary, in part because of the massive deinstitutionalization of patients from state mental health care facilities after the introduction of psychotherapeutic drugs in the 1950s.

DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 7 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. The Mental Health Systems Act of 1980 was one of the most progressive mental health bills in the history of the United States, but its enactment was interrupted by the: a. election of a new president.

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b. appointment of a new Surgeon General. c. rapid expansion of community centers. d. National Alliance on Mental Illness (NAMI) surveys.

ANS: A The election of a new president and his administration led to drastic cuts in federal funding for mental health programs. None of the other three choices were a part of the Mental Health Systems Act of 1980.

DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with chronic mental illness in: a. nursing homes. b. state mental health facilities. c. residential treatment centers. d. homeless shelters.

ANS: A Many mentally ill, especially elderly, people were inappropriately placed in nursing homes with personnel who were not trained to care for these people. OBRA prevented this practice.

State mental health facilities, residential treatment centers, and homeless shelters were not addressed in the OBRA of 1987.

DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. In the late 1980s, government funding for mental health care dwindled, and most insurance companies coverage for psychiatric care. a. withdrew b. increased c. decreased d. added ANS: A Unfortunately, insurance companies followed the trend of the national government to the point of actually dropping coverage for psychiatric care.

DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey and grading of state mental health care for adults and learned that the overall grade for care was: a. “A.” b. “B.”

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c. “C.” d. “D.” ANS: D The NAMI gave a grade of “D” to the mental health care system based on poor funding, limited availability of care, and patients’ lack of access to mental health care.

DIF: Cognitive Level: Knowledge REF: p. 8 OBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. In the early 1900s, the first theory of mental illness that showed behavior could be changed is attributed to: a. Beers. b. Dix. c. Freud. d. Pinel.

ANS: C Freud was the first person who succeeded in explaining human behavior in psychological terms and in demonstrating that behavior can be changed under the proper circumstances.

DIF: Cognitive Level: Knowledge REF: p. 6 OBJ: 5 TOP: Psychoanalysis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The humoral theory of disease embraced by Hippocrates required a balance of which elements? (Select all that apply.) a. Fire b. Water c. Light d. Air e. Earth ANS: A, B, D, E Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental elements of air, fire, water, and earth. Each basic element had a related humor or part in the body.

DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 2 TOP: Greece and Rome KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which aspects of adult mental health care systems did the National Alliance on Mental Illness survey focus on? (Select all that apply.) a. Availability of care b. Access to care c. Regulation of medications

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d. Increased funding ANS: A, B, D In 2006, the National Alliance on Mental Illness (NAMI) conducted the “first comprehensive survey and grading of state adult mental health care systems conducted in more than 15 years” (NAMI, 2006). Their results revealed a fragmented system with an overall grade of D. Recommendations focused on increased funding, availability of care, access to care, and greater involvement of consumers and their families.

DIF: Cognitive Level: Knowledge REF: p. 8 TOP: 21st Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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OBJ: 9

Chapter 02: Current Mental Health Care Systems Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Mental health care is available under the universal health care system in Britain, which is funded primarily by: a. employers. b. private donations. c. small businesses. d. tax revenues.

ANS: D Tax revenues are the primary funding source for Britain’s universal health care system. All aspects of health care, except for eye care and limited dental care, are covered under the standard benefit package for citizens of Britain.

DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 1 TOP: Mental Health Care in Britain KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. The model views clients holistically with the goal of creating a support system designed to encourage independence in the client with a mental health disorder. a. community support systems b. case management c. multidisciplinary health care team d. client population ANS: A The community support systems (CSS) model works by coordinating social, medical, and psychiatric services. Case management refers to individual management of clients and takes into consideration psychosocial rehabilitation, consults, referrals, therapy, and crisis intervention. A multidisciplinary health care team is made up of all of the professionals who work within a mental health care system, and client population simply refers to individuals who may potentially seek mental health care.

DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 3 TOP: Outpatient Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. The home mental health nurse visits a female client to assess her ability to care for herself at home after discharge from an inpatient setting. Which component of the case management system does this demonstrate? a. Consultation b. Crisis intervention c. Resource linkage d. Psychosocial rehabilitation ANS: D

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Psychosocial rehabilitation assists clients in gaining independence in activities of daily living to the best of their individual capabilities. Consultation refers to assistance obtained from specialists, such as a psychiatrist; crisis intervention refers to care provided during a crisis event; and resource linkage indicates referral to community resources.

DIF: Cognitive Level: Comprehension REF: p. 14 OBJ: 5 TOP: Case Management Systems KEY: Nursing Process Step: Intervention MSC: Client Needs: Health Promotion and Maintenance 4. A client with a severe, treatment-resistant mental illness has been assigned to an assertive community treatment (ACT) team. An ACT treatment strategy that helps to prevent recurrent hospitalizations for mental health reasons is to meet with the client in the community setting: a. once per week. b. two to four times per week. c. five to six times per week. d. seven to eight times per week.

ANS: B The continuous care team that meets with a client two to four times per week has been found to be effective in directing the client’s treatment on a more continuous basis, resulting in greater stability for the client who is living in the community with the help of appropriate systems.

DIF: Cognitive Level: Knowledge REF: p. 15 | Table 2.2 OBJ: 5 TOP: Case Management Systems KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 5. Which member of the multidisciplinary mental health care team is primarily responsible for evaluating the family of the client, as well as the environmental and social surroundings of the client, and plays a major role in the admission of new clients? a. Psychiatric nurse b. Clinical psychologist c. Psychiatrist d. Psychiatric social worker ANS: D These are the primary responsibilities of the psychiatric social worker. The psychiatric nurse’s primary responsibilities include assisting with the client’s activities of daily living and managing individual, family, and group psychotherapy. The clinical psychologist is involved in the planning of treatment and diagnostic processes, and the psychiatrist is the leader of the team.

DIF: Cognitive Level: Comprehension REF: p. 16 | Table 2.3 OBJ: 6 TOP: Multidisciplinary Mental Health Care Team KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment

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6. It is estimated that approximately form of mental or emotional disorder. a. 35.5 b. 61.5 c. 28.2 d. 59

million adults in the United States experience some

ANS: B Although exact statistics are unavailable, it is estimated that at any given time at least 61.5 million adults in the United States suffer from mental-emotional disorders. “Approximately 18.1% of American adults—about 42 million people—live with anxiety disorders” (National Alliance on Mental Illness, 2014).

DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 7 TOP: Impact of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. A male client with a diagnosis of bipolar disorder is admitted to an inpatient unit during a severe manic episode. As a result of guidelines implemented by the Health Care Financing Administration in 1983, the client’s Medicare will pay for his stay in this unit for: a. the length of time necessary for his condition to be stabilized. b. up to 6 months with appropriate documentation. c. a pre-determined length of time based on the diagnosis. d. 2 to 4 weeks.

ANS: C Medicare payment guidelines are based on the diagnosis, which is classified under a diagnosis-related group (DRG), and specify a pre-determined payment for a particular diagnosis. This cost containment strategy has also been adopted by some private insurance companies. After the pre-determined time, the facility is responsible for additional costs incurred by the client’s stay.

DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 1 TOP: Economic Issues of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 8. A female client was given the diagnosis of schizophrenia and recently has lost her job. She tells the nurse that she has enough money for only two more house payments, and if she does not find a job, she fears she will become homeless. The nurse knows that this client falls into the group of nearly of U.S. citizens who live below the poverty level. a. 1% b. 6% c. 12% d. 25% ANS: C Approximately 12% of Americans (or 45 million people) live below the poverty level.

Living in poverty often precipitates mental disorders, or mental disorders may occur while an individual is living in poverty.

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DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 7 TOP: Social Issues of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with: a. permanent psychotic states. b. bipolar disorder. c. generalized anxiety disorder. d. obsessive-compulsive disorder.

ANS: A Permanent psychotic states are occurring in mental health clients who combine their psychotherapeutic medications with the abuse of recreational drugs. The combination of these two types of drugs is not commonly associated with bipolar disorder, generalized anxiety disorder, or obsessive-compulsive disorder.

DIF: Cognitive Level: Knowledge REF: p. 19 OBJ: 7 TOP: Social Issues of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. A 9-year-old girl is given the diagnosis of depression. She has low self-esteem, does not enjoy group therapy, and does not show her emotions. The nurse has had difficulty establishing rapport with this client and decides to ask for assistance from another treatment team member. Which team member would best assist in this situation? a. Psychiatric assistant b. Dietitian c. Occupational therapist d. Expressive therapist ANS: D Expressive therapists work well with children who have difficulty expressing their thoughts and feelings. Expressive therapists use creative methods that appeal to children. The dietitian would not be the best team member to meet the needs of the client at this time. The psychiatric assistant, or technician, assists the nurse with daily activities and in monitoring clients during leisure activities. The occupational therapist works primarily with rehabilitation therapy, such as socialization and vocational retraining.

DIF: Cognitive Level: Application REF: p. 16 | Table 2.3 OBJ: 6 TOP: Multidisciplinary Mental Health Care Team KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 11. Nearly of all countries in the world have no clear governmental policy that addresses mental health issues. a. 7% b. 26% c. 50% d. 75%

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ANS: C In addition to nearly half of the countries in the world that have no policy on mental health issues, approximately one-third have no program for coping with the increasing numbers of mental health disabilities.

DIF: Cognitive Level: Knowledge REF: p. 10 OBJ: 1 TOP: Current Mental Health Care Systems KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose.

The primary rationale for her admission is to: a. have limited supervision by health care personnel. b. maintain responsibility for her own behavior. c. receive treatment in the least restrictive manner. d. provide her with a safe and secure environment.

ANS: D The most important advantage of inpatient psychiatric care is that it provides clients with a safe and secure environment where they can focus on and work with the problems that brought them there.

DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 2 TOP: Inpatient Care KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 13. A 35-year-old client with a long history of schizophrenia who often forgets to take his medication is admitted to an inpatient unit after police find him threatening passengers on a bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example of: a. recidivism. b. symptom exacerbation. c. noncompliance. d. rejection.

ANS: A Unable to cope in the community setting, people with chronic psychiatric problems often return to institutions or use community services on a revolving-door basis. This behavior pattern is known as recidivism and means a relapse (return) of a symptom, disease, or behavior.

DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 4 TOP: Outpatient Care KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which principles characterize mental health care in Canada? (Select all that apply.) a. Portability b. Universality

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c. d. e. f.

Accessibility Comprehensiveness Private insurance models Public administration

ANS: A, B, C, D, F Portability refers to retaining services in the event of moving; universality means that everyone in the nation of Canada is covered; accessibility indicates that everyone has access to health care; comprehensiveness means that all necessary treatment is covered; and public administration reveals that the health care system is publicly run and accountable. Private insurance models are the types of insurance provided in the United States.

DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 1 TOP: Mental Health Care in Canada KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 2. In the United States, which factors determine whether a client requires inpatient rather than outpatient care? (Select all that apply.) a. Severity of the illness b. Level of dysfunction c. Suitability of the setting for treating the problem d. Anticipated diagnosis e. Level of client cooperation f. Ability to pay ANS: A, B, C, E, F These options are the determining factors for inpatient mental health care. If a client meets the criteria, the diagnosis does not matter in the determination of whether the client requires inpatient or outpatient care.

DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 2 TOP: Care Settings KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 3. Which client populations are at greater risk for the development of mental health disorders?

(Select all that apply.) a. Homeless b. Clients infected with HIV or AIDS c. Those in crisis d. Nurses e. Clients living in rural areas f. Older adults g. Psychiatrists h. Children ANS: A, B, C, E, F, H These individuals are considered to be at high risk for various reasons. Nurses and psychiatrists are not considered at high risk for developing mental health disorders.

DIF:

Cognitive Level: Knowledge

REF: p. 18

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OBJ: 7

TOP: Client Populations KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The case management for a client requiring community mental health services would include which of the following? (Select all that apply.) a. Advocacy b. Crisis intervention c. Provision of referrals to a shelter d. Administration of psychotropic medications e. Developing a client’s plan of care ANS: A, B, C Case management is a system of interventions designed to support mentally ill clients living in the community. The major components of case management are psychosocial rehabilitation, consultation, resource linkage (referral), advocacy, therapy, and crisis intervention. Administration of medications is performed by an individual, not a system, and clients are involved in planning their care.

DIF: Cognitive Level: Knowledge REF: p. 15 OBJ: 5 TOP: Case Management KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 03: Ethical and Legal Issues Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this client’s particular value was formed? a. Moralizing b. Modeling c. Reward-punishment d. Laissez-faire ANS: B Modeling best describes how the teenage client developed this value because his parents not only discussed this issue but also behaved in a way for the teen to copy. Moralizing sets standards of right and wrong with no choices allowed; the reward-punishment model rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices.

DIF: Cognitive Level: Application REF: p. 22 | Table 3.1 OBJ: 1 TOP: Acquiring Values KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications.

What process best describes how the nurse decided on the course of action taken? a. Values clarification b. Nurse’s rights c. Beliefs d. Morals ANS: A Values clarification consists of the steps of choosing, prizing, and acting. This most accurately describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed the choice, and then enacted the choice. The nurse’s rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred.

DIF: Cognitive Level: Application REF: p. 22 OBJ: 1 TOP: Values Clarification KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 3. Twenty-three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to: a. include coverage for mental illness.

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b. include coverage for substance abuse treatment. c. include coverage for mental illness that is equal to coverage for physical illness. d. include coverage for outpatient therapy for individuals with substance abuse.

ANS: C The mental health parity laws require insurance companies to include coverage for mental illness that is equal to coverage for physical illness. Only nine states include treatment for substance abuse in their parity laws.

DIF: Cognitive Level: Knowledge REF: p. 23 OBJ: 2 TOP: Client Rights KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 4. The client is feeling very anxious and has requested that a prn. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate? a. Fidelity b. Veracity c. Confidentiality d. Justice ANS: A Fidelity refers to the obligation to keep one’s word. The nurse violated this principle in this situation, which leads to mistrust from the client. Veracity is the duty to tell the truth, confidentiality is the duty of keeping the client’s information private, and justice indicates that all clients must be treated fairly, equally, and respectfully.

DIF: Cognitive Level: Application REF: p. 24 OBJ: 3 TOP: Ethical Principles KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 5. A male client is seeking help in a mental health clinic for anger management problems. He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do “whatever it takes” to control his anger. Later in the week, the client’s wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing: a. a moral dilemma. b. value clarification. c. an ethical conflict (or dilemma). d. a breach of confidentiality.

ANS: C This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both clients but must maintain confidentiality for each. Use of guidelines for ethical decision-making can assist the nurse in making an ethical decision. A moral dilemma is simply a dilemma associated with making a decision between right and wrong. Value clarification is a process that helps to identify an individual’s values.

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DIF: Cognitive Level: Application REF: p. 24 OBJ: 3 TOP: Ethical Conflict KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 6. The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question? a. National nurse practice act b. State nurse practice act c. Regional nurse practice act d. Community nurse practice act ANS: B Each state’s board of nursing determines the scope of practice in that state through a series of regulations that are called nurse practice acts. It is the nurse’s responsibility to know his or her scope of practice. The other options do not exist.

DIF: Cognitive Level: Comprehension REF: p. 26 OBJ: 4 TOP: Legal Concepts in Health Care KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 7. Standards of nursing practice for mental health can best be described as helping to ensure: a. that certain clients receive care. b. quality and effectiveness of care. c. proper documentation. d. proper medication administration.

ANS: B Most health care disciplines have standards of practice documented as guidelines with measurable criteria that can be used to evaluate the quality and effectiveness of care provided. All clients have the right to receive care, so standards of nursing practice would not address who receives care. Although proper documentation and proper medication administration might be part of the evaluation process, they do not provide complete evaluation of quality and effectiveness of care.

DIF: Cognitive Level: Comprehension REF: p. 23 OBJ: 4 TOP: Legal Concepts in Health Care KEY: Nursing Process Step: Evaluation MSC: Client Needs: Safe and Effective Care Environment 8. If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every: a. 3 months. b. 6 months. c. 12 months. d. 15 months.

ANS: C Although the case is being reviewed constantly by the mental health care team, the court must review the indefinite commitment on a yearly basis.

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DIF: Cognitive Level: Knowledge REF: p. 27 OBJ: 5 TOP: Adult Psychiatric Admissions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 9. A male client is being argumentative during a group therapy session. The psychiatric technician warns the client that if he does not cooperate with the nurse, he will be physically restrained and taken to his room for the remainder of the day. For which action could the technician be held liable? a. Assault b. Battery c. Privacy d. Fraud ANS: A The technician is engaging in assault, which is any act that threatens a client. Battery of a client occurs when any physical act of touching occurs without the client’s permission.

Privacy refers to issues related to the body and confidentiality, and fraud is giving false information.

DIF: Cognitive Level: Application REF: p. 27 OBJ: 6 TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 10. Which of the following circumstances, when it occurs on an inpatient mental health unit, would be considered false imprisonment? a. An alert and oriented client is confined to his room after being loud and argumentative with another client in the recreation area. b. Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission. c. A client is housed in a private room with visual monitors after attempting suicide at home on the previous day. d. An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission.

ANS: A The client cannot be confined to his room if he did not pose a threat to himself or others, or if no contract was made with the client regarding consequences for inappropriate behavior.

All of the other options are appropriate because they follow guidelines for client safety.

DIF: Cognitive Level: Analysis REF: p. 28 OBJ: 6 TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 11. The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent? a. Social worker b. Nurse c. Physician d. Facility’s legal representative

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ANS: C The physician is responsible for providing the client with the information necessary to give informed consent, including expectations and risks involved. The nurse can assist by obtaining the written documentation necessary for informed consent.

DIF: Cognitive Level: Knowledge REF: p. 24 OBJ: 8 TOP: Care Providers’ Responsibilities KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 12. An important responsibility of the nurse in a mental health facility is to ensure that clients do not from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions. a. escape b. abandon c. flee d. elope ANS: D The appropriate terminology used when a client runs away from a facility without a discharge order is elopement. In the event of elopement, the caregiver can be held liable if a client becomes injured.

DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 8 TOP: Care Providers’ Responsibilities KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 13. If a female client tells the nurse of extensive plans, she has to harm the girlfriend of her ex-husband, what is the nurse’s best action? a. Try to talk with the client to convince her not to harm the girlfriend. b. Have the client sign a contract with you stating that she will not harm the girlfriend. c. Inform the ex-husband of the intentions of the client. d. Inform the girlfriend of the intentions of the client.

ANS: D Health care providers have a duty to warn others when serious harm may occur as the result of actions taken by the client. This does not breach confidentiality because providers have an obligation to protect the public as well as the client. In addition to warning the client, the nurse should inform the client’s physician and the nursing supervisor and must document the situation and actions taken. The other options are not adequate to meet the duty to warn or to prevent harm to the girlfriend.

DIF: Cognitive Level: Application REF: p. 28 OBJ: 8 TOP: Care Providers’ Responsibilities KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment

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14. The nurse encounters a client crying in her room. Upon talking to the client, it is discovered that she is upset because a new nursing assistant made her go out for a walk with the group even though the client informed her that she waits for her daughter to go for her walk. This is a potential violation of which ethical principle? a. Beneficence b. Autonomy c. Confidentiality d. Nonmaleficence ANS: B Autonomy refers to the right of people to act for themselves and make personal choices. The principle of beneficence refers to actively doing good, and maleficence refers to doing no harm. Confidentiality is not violated in this situation.

DIF: Cognitive Level: Application REF: p. 24 OBJ: 1 TOP: Ethical Principles KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 15. A client preparing for discharge from an inpatient unit asks a nurse which psychiatrist she would recommend to use for follow-up as an outpatient. The nurse responds, “There are several good physicians on your list. Make sure you do not use Dr. Smith. I have heard some terrible things about his methods of treatment.” This is an example of which type of potential liability? a. Slander b. Invasion of privacy c. Assault d. Libel ANS: A Slander is verbal defamation, which is false communication, and can result in harm to the psychiatrist’s practice. Libel is written defamation, and assault is threat of bodily harm.

Invasion of privacy pertains to confidential information and is not pertinent in this case.

DIF: Cognitive Level: Application REF: p. 27 OBJ: 6 TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 16. A client frequently wanders around the unit, and the staff frequently needs to reorient the client to the environment and remind her not to walk into the rooms of other clients on the unit. Due to short staffing, the decision is made to use a restraint device to prevent this from occurring. This action may constitute: a. assault. b. defamation. c. false imprisonment. d. negligence.

ANS: C The application of protective devices and restraints may constitute false imprisonment.

Restraints must be used only to protect the client, not for staff convenience. All less restrictive measures should first be attempted and documented.

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DIF: Cognitive Level: Application REF: p. 26 OBJ: 6 TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. If a person is perceived to be a threat to himself or others, who can implement an involuntary commitment to a mental health facility? (Select all that apply.) a. Family members b. Police c. Physicians d. Social workers e. Representatives of a county administrator ANS: B, C, E Police, physicians, and representatives of a county administrator are the only individuals who can implement an involuntary admission to a mental health facility. An involuntary admission can last from days to years, depending on the need. A court order is necessary for extended involuntary admissions.

DIF: Cognitive Level: Knowledge REF: p. 26 OBJ: 5 TOP: Adult Psychiatric Admissions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 2. For a nurse or health care provider to be found negligent, what requirements must the provider’s misconduct meet? (Select all that apply.) a. The provider owed a duty to the client. b. The provider breached a duty to the client. c. The provider had intent to harm the client. d. The provider caused injury to the client by action or inaction. e. The provider caused loss or damage through his or her actions.

ANS: A, B, D, E These four criteria must be present for an act of a health care provider to be considered negligent. Intent to harm would be considered a criminal action rather than an action of negligence.

DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 7 TOP: Areas of Potential Liability KEY: Nursing Process Step: Evaluation MSC: Client Needs: Safe and Effective Care Environment

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Chapter 04: Sociocultural Issues Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. An older Asian female with a diagnosis of depression is cared for by her granddaughter. Her granddaughter is very attentive to the client’s needs, attends every therapy session, and is active in the planning and implementing of the treatment plan. The granddaughter’s valuing of her grandmother is most likely due to her: a. ethnicity. b. cultural beliefs. c. religion. d. stereotype.

ANS: B Cultural beliefs develop over many generations and are a learned set of values, beliefs, and behaviors. Asian cultures commonly value their elderly family members. Ethnicity and religion do not explain the granddaughter’s behavior in that ethnicity describes customs and socialization patterns, and religion refers to an organized form of worship. Stereotyping is a preconceived belief about another cultural group, so it does not apply to this situation.

DIF: Cognitive Level: Application REF: p. 32 OBJ: 1 TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Disease is defined as: a. social dysfunction. b. emotional dysfunction. c. physical dysfunction. d. intellectual dysfunction.

ANS: C Disease differs from illness in that disease is an abnormal physical function, whereas illness refers to social, emotional, and intellectual dysfunction. Illness is affected by culture, but disease is not.

DIF: Cognitive Level: Knowledge REF: p. 34 OBJ: 4 TOP: Health and Illness Beliefs KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity 3. The nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks English, but she is accompanied by her mother, who does not. The client has a history of mental illness, and through the interpreter, the nurse learns that the mother, who has traditional Puerto Rican cultural beliefs, believes that the client’s mental illness is caused by: a. witchcraft. b. stress. c. chemical imbalances. d. a trance.

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ANS: A It is a common traditional Puerto Rican cultural belief that mental illness is caused by witchcraft, magic, or evil spells, as opposed to more traditional Western medicine, which believes that stress and chemical imbalances play a role in mental illness. A trance is considered a state of consciousness in some cultures.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 4 TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. A client is continually late for his appointment at the mental health clinic. What is a likely reason for his lack of punctuality? a. Need for environmental control b. Time orientation c. Space comfort zone d. Territorial needs ANS: B Mental dysfunction can lead to incorrect perception of time, causing the client to be continually late. In addition, some cultures do not see schedules and specific appointment times as important, causing the client to be continually late in the eyes of the caregiver.

Environmental control refers to an individual’s need to control his or her perception of the environment. Comfort zones are highly culture based, meaning that individual interpretation of personal space varies among cultures. Territorial needs provide a sense of identity and security for some clients.

DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 5 TOP: Space, Territory, and Time in Cultural Assessment KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 5. Which client communication problem can the nurse most easily correct? a. Age differences b. Altered cognition c. Cultural differences d. Gender differences ANS: C The nurse can easily correct communication problems caused by cultural differences in a number of ways, including learning what cultural beliefs and practices are important to the client and being accepting of those beliefs. Communication problems due to age and gender differences and altered cognition cannot be corrected by the nurse.

DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5 TOP: Communication in Cultural Assessment KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. What is the social orientation among most middle-class American families? a. Extended b. Friends c. Significant others

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d. Nuclear ANS: D The nuclear family is the social orientation of family that is seen most frequently in this group. The extended family is seen as the social orientation for cultures such as some Alaskan, traditional Chinese, and Mexican cultures. Friends and significant others are not identified as a social orientation of family.

DIF: Cognitive Level: Knowledge REF: p. 37 OBJ: 5 TOP: Social Organization in Cultural Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. It is important for the nurse to be familiar with the religious practices of clients cared for most often in a particular region because attitudes toward health and illness, death and burial, food, and procreation have a strong impact on a client’s beliefs and practices. The nurse knows that the religion practiced most often around the world is: a. Buddhism. b. Jehovah’s Witness. c. Christianity. d. Ahmadiyya.

ANS: C More than 2 billion individuals throughout the world are practicing Christians. Although these religions are seen in large numbers worldwide, it is important for the nurse to be familiar with the religions most frequently seen in the client populations with whom he works within his own area.

DIF: Cognitive Level: Knowledge REF: p. 37 | Table 4.3 OBJ: 6 TOP: Social Organization in Cultural Assessment KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 8. The metabolism of psychotropic medications is most likely to be affected by: a. ethnicity. b. religion. c. culture. d. values.

ANS: A Ethnicity is a determining factor in a person’s genetic makeup. Religious and cultural practices could play a role in the metabolism of medications as a result of food or alternative treatment interactions with medications, but the metabolism is more closely related to the genetic makeup. Values have little to do with the metabolism of medications.

DIF: Cognitive Level: Knowledge REF: p. 38 | Drug Alert OBJ: 5 TOP: Biological Factors in Cultural Assessment KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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9. A Hmong man from Laos is a client at an outpatient mental health clinic and is being seen for his diagnosis of bipolar disorder. The importance of lithium testing was stressed in his discharge plans; however, it is discovered that he has had his lithium level checked only once, rather than the three scheduled times. What is the nurse’s best action? a. Remind the client about the importance of lithium level testing. b. Make scheduled appointments for the client to get his lithium level tested. c. Give the client written information regarding the importance of lithium level testing and written instructions on how to make appointments for testing. d. Talk with the client to see if there is a reason that he is not getting his lithium levels checked as outlined in his discharge plans.

ANS: D In the Hmong culture, it is believed that loss of blood leads to decreased body strength, which can cause the soul to leave the body, resulting in death. If the nurse did not discuss why the client was not getting his blood levels tested and gave him additional instructions as listed in the other options, the nurse would not understand and would not be able to incorporate the client’s cultural beliefs into the plan of care. The nurse and the client can now make revisions that will be acceptable while meeting the needs of the client.

DIF: Cognitive Level: Application REF: p. 38 OBJ: 5 TOP: Biological Factors in Cultural Assessment KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. Culture includes common beliefs and practices in areas such as religion, economics, diet, health, and: a. genetics. b. occupations. c. patterns of communication. d. stereotypes.

ANS: C In addition to shared beliefs and practices in religion, economics, diet, and health, a person’s cultural integration consists of patterns of communication, politics, art, and kinship. The other three options are not part of a person’s culture.

DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 3 TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. What is the usual approach to care for individuals who practice folk medicine? a. Fragmented b. Impersonal c. Disjointed d. Personalized ANS: D Folk medicine is highly personalized; the descriptors fragmented, impersonal, and disjointed more often are associated with the Western medicine approach to health care.

DIF:

Cognitive Level: Knowledge

REF: p. 33

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OBJ: 4

TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. A client seen in the mental health clinic feels her depression is the result of being “punished” due to becoming pregnant as an adolescent and giving the infant up for adoption against her family’s wishes. This view of her depression is considered: a. exaggerated. b. naturalistic. c. personalistic. d. stress.

ANS: C Naturalistic illnesses are caused by impersonal factors without regard for the individual.

Forces that exist outside the individual cause mental illness. Personalistic illnesses are seen as aggression or punishment directed toward a specific person.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 4 TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. The nurse in the emergency department finds a woman collapsed on the floor and crying loudly. The woman’s husband was in a car accident and is being attended to by the medical staff. Which statement by the nurse best demonstrates acting in a culturally competent manner? a. “You need to control yourself. Your husband was not injured that badly.” b. “Let me take you to a room with more privacy so we can talk.” c. “I am concerned about how you are acting right now. No one else here is acting like this.” d. “We will call the psychiatrist to see if medication can be ordered for you.”

ANS: B The nurse is demonstrating cultural competence and using cross-cultural therapeutic health care skills by offering to allow the client to express herself. The nurse is imposing personal beliefs on expected behavior in the other options.

DIF: Cognitive Level: Application REF: p. 35 OBJ: 2 TOP: Cultural Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. A 45-year-old married man comes to the community mental health center after he is suspended from his job for fighting. Upon talking to him, the nurse discovers he and his wife recently moved to the United States and his wife needs to work to pay bills. He is angry and embarrassed that he cannot be the sole provider for his family. His behavior may be the result of: a. cultural stereotyping. b. gender role conflict. c. religious beliefs. d. territoriality conflicts.

ANS: B

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Traditional roles for men and women are in conflict with societal expectations of Western society in this situation. Men tend to demonstrate more violent and abusive behaviors as mental health problems with this conflict. Cultural stereotyping is imposed by someone outside the culture, and religious and territoriality conflicts do not apply to this circumstance.

DIF: Cognitive Level: Application REF: p. 37 OBJ: 4 TOP: Social Organization: Gender Roles KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A nurse preparing to interview a client in the client’s room begins to move newspapers off a chair to sit down. The client requests that the nurse sit in another chair and leave the newspapers where they were. The client is demonstrating: a. personal space. b. paranoia. c. manipulation. d. territoriality.

ANS: D Territoriality is the need to gain control over an area of space and claim it for oneself, as it helps to provide a sense of identity, security, autonomy, and control over the environment.

Personal space is the distance maintained between people. Manipulation and paranoia are not demonstrated in this case.

DIF: Cognitive Level: Application REF: p. 37 OBJ: 5 TOP: Cultural Assessment: Space, Territoriality, and Time KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. A male client is visiting his family in the United States and experiences what his family describes as a “breakdown.” His family takes him to a stress treatment center at a local mental health clinic. The client is a follower of traditional folk medicine practices and is agitated when he learns that he must see a licensed psychiatrist. Which care provider is this client most likely accustomed to? (Select all that apply.) a. Healers b. Shamans c. Nurse practitioners d. Spiritualists e. Lay unlicensed therapists ANS: A, B, D, E Individuals who practice folk medicine for care typically do not see licensed health care providers, such as nurse practitioners and physicians. Folk medicine beliefs regarding the causes of disorders and treatments are different from Western medicine beliefs.

DIF: Cognitive Level: Knowledge REF: p. 34 | Table 4.2 OBJ: 4 TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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2. Refugees frequently experience depression, anxiety, and stress-related disorders caused by their particular circumstances. Therefore, in addition to a cultural assessment, what is important for the nurse to assess? (Select all that apply.) a. Immigration history b. History of arrival in the new country c. How long the refugee has been in the new country? d. Whether anyone or anything was lost in coming to the new country e. What type of medical insurance the refugee will be seeking to obtain?

ANS: A, B, C, D A refugee is a person who flees from his or her home or country, usually because of war or persecution in the homeland. The refugee has experienced trauma not only in his life experiences, but also in the process of fleeing from home. Therefore, a more accurate assessment can be performed if these questions are answered. The type of medical insurance obtained is of little concern to this person at this time.

DIF: Cognitive Level: Comprehension REF: p. 38 OBJ: 7 TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Cultural assessments allow the health care provider to understand the unique beliefs a client may have regarding mental illness and how they cope. Key areas to assess include which of the following? (Select all that apply.) a. Communication b. Space and territory c. Biological orientation d. Defense mechanisms e. Social orientation ANS: A, B, C, E The six areas of cultural assessment on various tools include: communication, environmental control, space and territory, time, social orientation, and biological factors.

Defense mechanisms do not pertain to cultural assessments.

DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5 TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 05: Theories and Therapies Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. A male client who has a diagnosis of generalized anxiety disorder (GAD) is seen in the emergency department with complaints of chest pain, shortness of breath, and inability to concentrate, along with feelings of overwhelming anxiety. The nurse uses Maslow’s theory to triage the client’s complaints, knowing that which complaint must be addressed first? a. Inability to concentrate b. Shortness of breath c. Overwhelming anxiety d. Chest pain ANS: B According to Maslow’s hierarchy of needs, the nurse first must address shortness of breath, followed by chest pain, and then feelings of overwhelming anxiety and inability to concentrate. Even though, based on his diagnostic history, this client may be having a panic attack, the nurse cannot ignore basic needs that are not being met first.

DIF: Cognitive Level: Application REF: p. 46 TOP: Humanistic Theories and Therapies KEY: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity

OBJ: 4

2. According to Freud’s theory, a baby who is crying in response to wanting to be held by his mother is an example of which part of the personality’s control over behavior? a. Id b. Ego c. Superego d. Self-control ANS: A According to Freud, the id is the pleasure center of the brain that seeks immediate pleasure or avoids pain, without regard for possible outcomes. The ego is reality based and has more control than the id; the superego is not developed in early childhood because it includes a conscience. Self-control is not a component of Freud’s theory of personality.

DIF: Cognitive Level: Application REF: p. 41 OBJ: 2 TOP: Psychoanalytical Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. According to the theorist Erik Erikson, an individual strives to actualize his identity, is most productive, and demonstrates guidance of and concern for others with a core task of caring during which stage of psychosocial development? a. Young adulthood (18–25 years) b. Maturity (65 years to death) c. Middle adulthood (25–65 years) d. Puberty (12–18 years)

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ANS: C The characteristics of striving to actualize identity, being most productive, and demonstrating guidance of and concern for others, according to Erikson, are seen during middle adulthood. Individuals who do not achieve the core task of caring become stagnant, self-indulgent, and absorbed in themselves. The core task of young adulthood is love; the core task of maturity is wisdom; and the core task of puberty is fidelity.

DIF: Cognitive Level: Comprehension REF: p. 45 TOP: Developmental Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

OBJ: 3

4. During a therapy session, a client is asked to respond to a word with the first word or phrase that comes to mind. What term is commonly used to refer to this technique? a. Transference relationship b. Dream analysis c. Free association d. Psychoanalysis ANS: C Free association is a technique that is used to interpret the real meaning behind word association. Dream analysis is a technique that is used to interpret the meaning of an individual’s dreams as they relate to their unconscious conflicts. Psychoanalysis is the form of therapy developed by Freud, and transference relationship is the technique used during therapy when the client transfers to the therapist emotions associated with significant people in his life.

DIF: Cognitive Level: Knowledge REF: p. 42 OBJ: 2 TOP: Psychoanalytical Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Carl Jung was the founder of analytical psychotherapy; he differed from Freud in that he believed that the mind was divided into three levels: the conscious ego, the personal unconscious, and the: a. extroverted personality. b. introverted personality. c. psyche. d. collective unconscious.

ANS: D The collective unconscious stores experiences from the person’s ancestral past and is part of what Jung believed was the third level of the mind. Extroversion and introversion were parts of the personality that Jung identified. Psyche is the mental or spiritual part of a person.

DIF: Cognitive Level: Knowledge REF: p. 43 OBJ: 2 TOP: Analytical Psychotherapy KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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6. Jean Piaget’s theory of cognitive development identifies an interrelationship between the and the functions in the development of one’s personality. a. id; ego b. intellectual; emotional c. anxiety; affective d. personified; cognitive ANS: B Piaget believed that growth and development occurred as a result of the interrelationship between intellectual (cognitive) and emotional (affective) development. The id and the ego are part of Freud’s beliefs regarding personality development. Anxiety is a vague feeling of uneasiness. Personification is a term developed by the theorist Sullivan to describe distorted images of certain relationships that occur in development of the personality.

DIF: Cognitive Level: Comprehension REF: p. 44 TOP: Developmental Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

OBJ: 3

7. How many stages of the human life cycle did Erik Erikson identify? a. Two b. Four c. Six d. Eight ANS: D Erik Erikson identified eight stages of the human life cycle that form one’s personality; each stage is marked by a developmental task that must be confronted and resolved. Erikson’s theory is commonly used in health care today.

DIF: Cognitive Level: Knowledge REF: p. 44 TOP: Developmental Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

OBJ: 3

8. A 4-year-old client in a pediatric unit is imitating the actions of the nurse. The nurse knows, according to Erik Erikson’s theory, that this child is displaying a characteristic seen during which developmental stage? a. Genital-locomotor b. Latency c. Oral-sensory d. Anal-muscular ANS: A The genital-locomotor stage (preschool years) is characterized by exploration of the environment, cooperative play, fantasy, and imitation of adults. Initiative and guilt are core tasks of this stage. The latency stage occurs during the school-age years (6–12 years old), the oral-sensory stage occurs from birth to 1 year of age, and the anal-muscular stage occurs during early childhood.

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DIF: Cognitive Level: Application REF: p. 44 | Table 5.2 OBJ: 3 TOP: Developmental Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. Humanistic theories are important to health care because these theories serve as the foundation for the concept of: a. assertiveness training. b. behaviorism. c. holistic care. d. behavior modification.

ANS: C Humanistic theories emphasize the total person, which serves as the basis of holistic care.

Assertiveness training refers to teaching a person to express his needs in nonaggressive ways. Behaviorism is the belief that all behavior is learned, and behavior modification is a therapy that teaches clients new behaviors that can be used to replace dysfunctional behavior.

DIF: Cognitive Level: Comprehension REF: p. 46 OBJ: 3 TOP: Humanistic Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. During a conversation with a male client, he voices that he really appreciates his family, likes his job, and enjoys groups in which he volunteers. According to Maslow’s theory, what is this client experiencing? a. Symbolization b. Self-actualization c. Equilibrium d. Identification ANS: B In Maslow’s hierarchy of needs theory, a person is said to have reached the highest human need of self-actualization when all basic needs are met, the individual is self-directed, and the individual has reached the highest potential. Symbolization and identification are common defense mechanisms, and equilibrium is a state wherein all body systems are in balance.

DIF: Cognitive Level: Application REF: p. 47 OBJ: 4 TOP: Humanistic Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The nurse knows that the major concept of the systems theory is that individuals are viewed as functioning: a. within a set of interacting and related units. b. according to activities of attention, language, and imagery. c. according to unmet needs. d. within accepted social aspects of behavior.

ANS: A

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The interacting and related units are called systems, and both open and closed systems have been identified. Activities of attention, language, and imagery are components of cognitive theories. Met and unmet needs correspond to Maslow’s hierarchy of needs theory, and social aspects of behavior are seen in sociocultural theories.

DIF: Cognitive Level: Knowledge REF: p. 48 OBJ: 5 TOP: Systems Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. Group therapy, which assists in relieving emotional distress and encourages psychological and behavioral changes, was developed following World War II as a result of a: a. study of the benefits of group therapy. b. decreasing number of mental health facilities. c. shortage of psychiatrists. d. grant from the federal government.

ANS: C A shortage of psychiatrists prompted the need for group therapy in the 1940s. Mental health facilities did not begin to decrease in number until psychotherapeutic drugs were introduced in the 1950s. No federal grant was provided for group therapy.

DIF: Cognitive Level: Knowledge REF: p. 53 OBJ: 10 TOP: Group Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. Betty Neuman developed the nursing theory that promotes nursing interventions to assist individuals in reaching and maintaining the highest level of wellness possible. What is this theory known as? a. Adaptation model b. Interpersonal model c. Systems model d. Self-care deficit model ANS: C Betty Neuman developed this model with a focus on reducing stress as a means of assisting in reaching high-level wellness. The adaptation model was developed by Myra Levine.

Peplau developed the interpersonal model, and Orem developed the self-care deficit models.

DIF: Cognitive Level: Knowledge REF: p. 52 | Table 5.4 OBJ: 9 TOP: Nursing Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. Following an argument with his daughter, a father takes away her phone privileges. He later feels guilty about the argument and asks her if she would like to go shopping for new clothes. What is this defense mechanism known as? a. Compensation b. Displacement c. Rationalization d. Restitution

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ANS: D Restitution involves engaging in an activity that helps to resolve feelings of guilt.

Compensation is an attempt to overcome feelings of inferiority. Displacement involves redirecting energy to another person or object, and rationalization is a way of explaining something in a good, although not true, way.

DIF: Cognitive Level: Application REF: p. 42 | Table 5.1 OBJ: 2 TOP: Psychoanalytical Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A female client with low self-esteem tries to dress and act like the nurse who cares for her in an outpatient clinic setting. This behavior is an example of which defense mechanism? a. Identification b. Symbolization c. Displacement d. Projection ANS: A Identification occurs when an individual takes on personal characteristics of someone she admires, especially when she has low self-esteem or poor self-concept. Symbolization involves the use of unrelated objects to represent a hidden idea. Displacement involves the redirecting of energies to another person or object; projection occurs when an individual projects onto another person his or her unacceptable thoughts or emotions.

DIF: Cognitive Level: Application REF: p. 42 | Table 5.1 OBJ: 2 TOP: Psychoanalytical Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. During group therapy, certain group change mechanisms may be observed. When an individual engages in helping others, resulting in improvement in his or her own self-esteem, which group change mechanism has the individual experienced? a. Altruism b. Feedback c. Expressiveness d. Communion ANS: A Altruism occurs when not only recipients benefit from assistance, but the individual who is giving assistance also benefits through improvement in his own self-esteem. Feedback refers to receipt of information about how one is perceived by others. Expressiveness is a group change mechanism in which group members share positive and negative emotions, and communion occurs in a group when members feel a sense of belonging.

DIF: Cognitive Level: Comprehension REF: p. 53 | Table 5.5 OBJ: 10 TOP: Group Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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17. A client is granted permission to watch a favorite television show in the evening because she participated in an occupational therapy activity. Her therapist bases this on theory. a. psychoanalytic b. humanistic c. behavioral d. developmental ANS: C Behavioral theory believes behavior is a result of rewards to enforce desired behaviors.

Psychoanalytic theory explores the unconscious, humanistic theory deals with the whole person, not just behavior, and developmental theory focuses more on life tasks at particular points.

DIF: Cognitive Level: Comprehension REF: p. 45 OBJ: 3 TOP: Behavioral Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. A client does not participate in group sessions due to feeling inferior to others in the group.

Based on cognitive theory, he would be directed to: a. review his previous relationship with his parents. b. participate in group to receive extra privileges. c. suppress negative thoughts about the group. d. recognize and change his negative thoughts.

ANS: D Cognitive theory and therapy stress self-regulation and control to change behavior.

Reviewing relationships with parents is indicative of psychoanalysis. Behavior change for reward is based on behavioral theory, and suppression of thoughts is a negative means of coping.

DIF: Cognitive Level: Comprehension REF: p. 48 OBJ: 5 TOP: Cognitive Theories and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. Which of the following assessment parameters is a priority in a biobehavioral model of practice? a. Blood chemistry b. Physiologic needs c. Coping mechanisms d. Psychosocial level ANS: A Biobehavioral theories follow the medical model, which states that illness is the result of abnormalities in the structure, function, or chemistry of the body. A history, physical examination, laboratory tests, imaging techniques, and electroencephalograms (EEGs; brain wave recordings) are used to assist in diagnosis. Blood chemistry is the only option providing for this structure, function, or chemical abnormality.

DIF:

Cognitive Level: Comprehension

REF: p. 49

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OBJ: 8

TOP: Biobehavioral Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 20. The nurse who feels the most beneficial part of the client’s inpatient stay is the establishment of an interpersonal relationship with the nurse is an example of which nursing theorist? a. Orem b. Watson c. Peplau d. Roy ANS: C Peplau’s goal of nursing is to develop interpersonal interaction between the client and nurse.

Orem’s goal is to help the client attain self-care, Watson’s goal is to promote and restore health, and Roy’s goal is to identify demands on clients and adaptation.

DIF: Cognitive Level: Comprehension REF: p. 52 | Table 5.4 OBJ: 9 TOP: Nursing Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Freud’s psychoanalytical theory states that an adult is more likely to be mentally healthy if there is a balance between which parts of the mind? (Select all that apply.) a. Id b. Ego c. Superego d. Conscience ANS: A, B, C Freud believed that if there was a dynamic balance between the id, the ego, and the superego, an adult’s personality would develop in a healthy manner. The conscience is part of the superego.

DIF: Cognitive Level: Knowledge REF: p. 41 OBJ: 1 TOP: Psychoanalytical Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Psychobiology theory considers the causes of mental illness to be which of the following?

(Select all that apply.) a. Genetics b. Neurotransmitter activity c. Immune system dysfunction d. Social setting e. Unmet needs ANS: A, B, C Psychobiological theories about the causes of mental illness relate to genetics, neurotransmitter activity, viruses, fetal development, and immune system dysfunction.

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DIF: Cognitive Level: Knowledge REF: p. 49 OBJ: 8 TOP: Psychobiological Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 06: Complementary and Alternative Therapies Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. For a client with a sleep disorder, which CAM therapy could be used safely without interference with any allopathic methods of treatment? a. Progressive relaxation b. Dietary supplements c. Herbal supplements d. Aromatherapy ANS: A Progressive relaxation is noninvasive in that it uses deep breathing and conscious muscle relaxation and therefore would not interfere with allopathic methods of treatment. Dietary and herbal supplements can interfere with other medications (allopathic therapy) that may be taken by this client. Aromatherapy could interfere with this client’s allopathic treatment if he is being treated for allergies.

DIF: Cognitive Level: Application REF: p. 63 OBJ: 8 TOP: CAM Approaches to Mental Health Care KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 2. A female client would like to use biofield therapy for her addiction to nicotine. Which form of therapy would she most likely choose? a. Aromatherapy b. Acupuncture c. Nicotine patches d. Group therapy ANS: B Acupuncture is a form of biofield therapy, which is a form of energy medicine.

Aromatherapy is a CAM that is a biologically based practice. Nicotine patches would be considered allopathic, and group therapy is socioculturally based therapy.

DIF: Cognitive Level: Application REF: p. 61 OBJ: 7 TOP: Energy Medicine KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity 3. A male client experiences a phobia of enclosed spaces (claustrophobia) and is seeking an energy-based therapy that he can practice and initiate on his own when he experiences symptoms. Which therapy will the nurse recommend? a. Music and sound therapy b. Relaxation and visualization c. Hypnosis therapy d. Spiritual healing ANS: B

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Although all of these therapies are considered energy-based, the one that would be best suited for these circumstances is relaxation and visualization. The other choices would be difficult to initiate in a claustrophobic situation.

DIF: Cognitive Level: Application REF: p. 61 OBJ: 6 TOP: Mind-Body Medicine KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 4. Which theory best describes energy medicine? a. There is a harmony within the body, nature, and the world. b. The body has a natural ability to heal itself. c. There is a vital, life-force energy that flows through an individual’s body. d. The mind and spirit affect body functions and influence illness.

ANS: C Energy medicine is best described as the belief that there is a vital energy that flows through an individual’s body. The theory that there is harmony within the body, nature, and the world describes holistic care. The theory that the body has a natural ability to heal itself describes body-based CAM therapies, and mind-body medicine followers believe that the mind and spirit affect body functions and influence illness.

DIF: Cognitive Level: Comprehension REF: p. 61 OBJ: 7 TOP: Energy Medicine KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. A female client is receiving therapy for severe depression that consists of repetitive transcranial magnetic stimulation. This form of therapy is considered to be: a. energy medicine. b. illegal according to FDA regulations. c. a form of expressive therapy. d. a biofield therapy.

ANS: A Repetitive transcranial magnetic stimulation is a form of energy medicine in the category of electromagnetic field therapies. This therapy is not considered to be illegal. Expressive therapy is the use of creative activities such as dance and music to express emotions, and biofield therapy is another form of energy medicine.

DIF: Cognitive Level: Comprehension REF: p. 63 OBJ: 7 TOP: Energy Medicine KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. A 70-year-old male client tells the nurse that he is using chelation therapy to prevent Alzheimer’s disease. Which adverse effect is the client most likely to experience? a. Allergic reactions b. Low potassium levels c. Elevated blood glucose levels d. Interactions with other medications ANS: B

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Although adverse effects of CAM therapy cannot be predicted in any individual, the most likely adverse effect of chelation therapy is a low potassium level because EDTA binds with heavy metals, causing potassium depletion. This therapy is controversial, and its effectiveness has not been proved scientifically.

DIF: Cognitive Level: Comprehension REF: p. 64 OBJ: 10 TOP: Adverse Effects KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity 7. A male client of Indian origin practices meditation and yoga, uses herbs and follows specific diet practices, and practices controlled breathing and exposure to sunlight. Which type of CAM therapy is this individual practicing? a. Traditional Chinese medicine b. Homeopathy c. Ayurveda d. Reiki ANS: C Ayurveda is a body-based CAM therapy that often is practiced by Indian cultures with a central focus on being knowledgeable of how to live. Homeopathy uses natural substances to heal, and traditional Chinese medicine deals with a balance between yin and yang, “laying on of hands” to promote relaxation and healing.

DIF: Cognitive Level: Application REF: p. 57 OBJ: 4 TOP: Whole Medical Systems KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. What is the main function of the National Center for Complementary and Alternative Medicine (NCCAM)? a. To seek scientific validation of and be a resource for the public for CAM therapies b. To investigate and develop new CAM therapies c. To produce a monthly newsletter on new CAM therapies d. To monitor the production of dietary and herbal supplements used in CAM therapies ANS: A The function of the NCCAM is to seek scientific validation of and be a resource for the public for CAM therapies. The other options are not representative of the functions of NCCAM. DIF: Cognitive Level: Knowledge REF: p. 57 OBJ: 3 TOP: National Center for Complementary and Alternative Medicine KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. The Food and Drug Administration (FDA) does not impose the same guidelines on as it does on prescription drugs. a. chiropractic treatment b. dietary supplements c. homeopathic treatments

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d. hypnotic therapy ANS: B The Dietary Supplement Health and Education Act of 1994 (DSHEA) addresses dietary supplements but does not include the same guidelines that govern prescription drugs.

Guidelines are less stringent for dietary supplements; therefore, the safety of use of these products with prescription drugs is one of the concerns associated with such supplements.

Dietary supplements include, but are not limited to, vitamins, minerals, and herbs. The FDA does not govern chiropractic treatment, homeopathic treatment, or hypnotic therapy.

DIF: Cognitive Level: Knowledge REF: p. 59 OBJ: 5 TOP: Biologically Based Practices KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 10. A 45-year-old male client uses a treatment method that focuses on the relationship between an individual’s body structure and its function. This mode of treatment is: a. naturopathic. b. homeopathic. c. chiropractic. d. acupuncture.

ANS: C Chiropractors use manipulation therapy of the spine to improve the relationship of the body structure (spine) to its function, which is thought to aid the body in healing various conditions, such as migraine headache. Naturopathic therapy, homeopathic therapy, and acupuncture do not have this focus.

DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: N/A TOP: Body-Based Practices KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. Massage therapy manipulates muscles and connective tissue and has been found to be very successful as a CAM method in the treatment of which disorder(s)? a. Schizophrenia b. Bipolar disorder c. PTSD and OCD d. Depression and anxiety ANS: D Massage therapy has been frequently reported to assist in the relaxation of clients with a diagnosis of depression and anxiety disorder. No documentation of massage therapy for schizophrenia, bipolar disorder, or PTSD and OCD is available.

DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: N/A TOP: Body-Based Practices KEY: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity 12. Which type of therapy has yielded positive results for psychological functioning and is considered one of the safest treatment modalities? a. Mind-body medicine

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b. Chiropractic treatment c. Dietary supplements d. Herbal therapy ANS: A Mind-body medicine (music and dance therapy, expressive therapy, meditation) has been found effective in improving psychological functioning. It is considered safe because it is noninvasive. Chiropractic treatment, herbal therapy, and dietary supplements are more invasive and can interfere with medicines and cause alterations in body systems.

DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: 6 TOP: Mind-Body Medicine KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. A therapy that once was denounced by the scientific community but now is being used to successfully treat victims of the events of 9/11, Hurricane Katrina, and the South Asian tsunami of 2004 and that helps the rational left side of the brain bond with a traumatic memory from the emotional right side of the brain is known as: a. hypnosis therapy. b. eye movement desensitization and reprocessing (EMDR). c. Shiatsu. d. doshas.

ANS: B EMDR is thought to help clients who have experienced a horrific trauma to process the event so they can deal with their emotions. The other therapies are not being used widely for treatment following these events.

DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: N/A TOP: Body-Based Practices KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 14.

is a form of therapy that has been used for over 2000 years to successfully treat clients with drug addiction; it is believed to restore the energy balance in the body and to stimulate the release of certain neurotransmitters and hormones. a. Yoga b. Meditation c. Therapeutic touch d. Acupuncture ANS: D Acupuncture is of oriental origin and has been used for over 2000 years. It has been found to be successful as adjunctive therapy for drug addiction. Yoga, meditation, and therapeutic touch are also forms of energy medicine, but they are more focused on relaxation and on understanding of the inner self.

DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 7 TOP: Energy Medicine KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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15. Color therapy has been found to be especially effective in the treatment of: a. seasonal affective disorder. b. bipolar disorder. c. drug addiction. d. generalized anxiety disorder.

ANS: A Color therapy involves the use of high-intensity light therapy and is highly effective in improving the symptoms of seasonal affective disorder. Color therapy is not an effective therapy for bipolar disorder, drug addiction, or generalized anxiety disorder.

DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 7 TOP: Energy Medicine KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 16. A client experiencing symptoms of anxiety would benefit from which therapy? a. Chelation b. Phototherapy c. Therapeutic touch d. Magnetic therapy ANS: C Therapeutic touch is effective in stress-related conditions such as migraine headaches and anxiety. Chelation is effective against atherosclerosis, phototherapy is used in depression, and magnetic therapy is used primarily for pain.

DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 8 TOP: Energy Medicine: Stress reduction and relaxation KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 17. A child who is the victim of domestic violence refuses to talk about the experience. He is doing poorly in school and having trouble sleeping. Which therapy would he benefit from? a. Massage b. Biofeedback c. Aromatherapy d. Art therapy ANS: D Art, or expressive, therapy is indicated to release inner conflicts and repressed emotions.

Massage uses manipulation to relax muscles, biofeedback monitors physical responses during relaxation, and aromatherapy uses scents to promote well-being. None of these provide for the expression of repressed emotions.

DIF: Cognitive Level: Knowledge REF: p. 61 OBJ: 6 TOP: Mind-Body Medicine: Expression Therapy KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 18. Which CAM therapy would a nurse be most concerned about if used by a client being treated with antipsychotic medications? a. Biologically based practices

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b. Body-based practices c. Mind-body practices d. Technology-based practices ANS: A Biologically based practices include dietary supplements and herbal therapies that may have adverse or unwanted effects in combination with pharmacotherapy. None of the other practices have the potential to interact with pharmacologic agents.

DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 10 TOP: Biologically Based Practices KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 19. An allopathic mental health practitioner would most likely recommend which treatment for a client suffering from anxiety? a. Expressive therapy b. Acupuncture c. Antianxiety agents d. Dietary supplements ANS: C Allopathic practitioners use medical and surgical methods to treat disease and injury. The other therapies are CAM agents.

DIF: Cognitive Level: Comprehension REF: p. 56 OBJ: 10 TOP: Biologically Based Practices KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which treatments are used in biologically based practice? (Select all that apply.) a. Dietary supplements b. Aromatherapy c. Herbal supplements d. EDTA ANS: A, B, C Dietary supplements, aromatherapy, and herbal supplements fit the category of biologically based practice. EDTA is a body-based practice that involves moving the body into an improved state of function.

DIF: Cognitive Level: Knowledge REF: p. 59 OBJ: 5 TOP: Biologically Based Practices KEY: Nursing Process Step: Implementation MSC: Client Needs: Physiological Integrity 2. Self-help groups provide support to individuals who are dealing with or who have had similar experiences. Which of the following are characteristics of self-help groups? (Select all that apply.) a. Groups are informal, nonprofit, and free of charge. b. Membership requires referral from a physician or counselor.

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c. Meetings are facilitated by trained counselors. d. Groups provide support, education, and encouragement to members. e. Groups benefit individuals who are dealing with life-altering events such as addiction.

ANS: A, D, E Self-help groups are informal, nonprofit, and free of charge; provide support, education, and encouragement to members; and benefit individuals who are dealing with life-altering events. Membership is voluntary, and meetings usually are facilitated by a survivor or someone with experiences similar to those of the group.

DIF: Cognitive Level: Comprehension REF: p. 64 | Box 6.2 OBJ: 9 TOP: CAM Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 07: Psychotherapeutic Drug Therapy Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to: a. 5 days. b. 2 to 3 weeks. c. 4 to 5 weeks. d. 6 weeks.

ANS: B It is important that the client understand that TCAs typically take 2 to 3 weeks to take effect so he will not become discouraged when he does not see immediate results.

DIF: Cognitive Level: Comprehension REF: p. 70 | Table 7.2 OBJ: 4 TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 2. A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan? a. Avoid foods high in sodium content. b. Avoid alcoholic beverages. c. Ensure that protein intake is 60 g/day. d. Take a potassium supplement.

ANS: B This client should be given a list of foods and beverages that are restricted when taking MAOIs, such as some alcoholic beverages, sausage and bologna, and some cheeses.

Sodium, protein, and potassium are not factors when MAOIs are taken.

DIF: Cognitive Level: Application REF: p. 72 | Box 7.2 OBJ: 4 TOP: Antidepressant Medications KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity 3. A female client is 3-days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission.

What signs and symptoms should the nurse look for in case of reaction between these two medications? a. Increased pulse and respirations b. Hyperactivity and difficulty concentrating c. Increased tearing and increased urinary output d. Sedation, disorientation, and hallucinations ANS: D

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Nardil is a monoamine oxidase inhibitor; therefore, symptoms of CNS depression such as sedation, disorientation, and hallucinations, rather than increased vital signs, hyperactivity and difficulty concentrating, and increased tearing and urination, most likely would occur as a reaction between these two medications.

DIF: Cognitive Level: Application REF: p. 71 OBJ: 4 TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 4. The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating: a. depression. b. psychotic episodes. c. neuropathic pain. d. bipolar disorder.

ANS: C Pregabalin (Lyrica) has been found to be effective for the treatment of neuropathic pain, as well as seizure disorders. This medication is not used for any of the other options listed.

DIF: Cognitive Level: Knowledge REF: p. 71 OBJ: 3 TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 5. Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice for the treatment of depression because: a. the side effects are more manageable than with other antidepressants. b. they are the only class safe for long-term therapy. c. this is the oldest class of antidepressants. d. they are fast-acting medications.

ANS: A The side effect most commonly reported, gastrointestinal (GI) upset, usually can be avoided if the client takes the medication with food. SSRIs can be used for both short- and long-term therapy; they are not the oldest class of antidepressants; and they usually take a few weeks before onset of effect.

DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 4 TOP: Antidepressant Medications KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 6. In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of: a. potassium. b. carbohydrates. c. protein. d. sodium.

ANS: D

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Lithium is a salt that is absorbed into the bloodstream and is excreted by the kidneys at a faster rate than sodium. Therefore, clients must monitor their sodium and fluid intake, as well as their activity level. The other options are not a concern when lithium is taken.

DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 5 TOP: Antimanic Medications KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity 7. A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client? a. Take the dose immediately, and then take the second dose 3 hours late. b. Take half of a dose now, and then take the second dose at the normal time. c. Eliminate the dose missed, and take the second dose at the normal time. d. Immediately take the missed dose, and take the second dose at the normal time.

ANS: C Because lithium should be taken at the same time each day and the therapeutic range is narrow, 5 hours after the first dose was missed would be too close to take the second dose to try to make it up. Altering the schedule for one missed dose could cause more problems with future doses.

DIF: Cognitive Level: Analysis REF: p. 72 OBJ: 5 TOP: Antimanic Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 8. A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered: a. depressed. b. noncompliant. c. suffering from an anxiety disorder. d. possessing obsessive-compulsive tendencies.

ANS: B Noncompliance occurs with many individuals with mental health disorders because of the ways the side effects of the medication affect an individual as well as other factors. It is important to work with clients to prevent noncompliance. Depression, anxiety disorder, and obsessive-compulsive tendencies are not indicated in the situation described.

DIF: Cognitive Level: Application REF: p. 77 OBJ: 9 TOP: Noncompliance KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 9. A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team? a. Try to coerce him into taking his medication.

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b. Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client. c. Crush his antipsychotic medications and put them in his food to stop the process of his withdrawal from reality. d. Speak to his family about seeking an involuntary emergency hold in a mental health facility to get him back on his medications.

ANS: B The Patient Self-Determination Act states that individuals who are not in an emergency or safety-threatening situation cannot be coerced, forced, or talked into following a suggested course, such as taking medication against their will. All three remaining options go against the Act. In addition, an involuntary emergency hold in a mental facility is not reasonable because the client is not a threat to himself or others.

DIF: Cognitive Level: Analysis REF: p. 78 OBJ: 9 TOP: Informed Consent KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of: a. informed consent. b. noncompliance. c. client education. d. right to privacy.

ANS: A Informed consent most accurately describes the situation because all aspects of taking the medication were discussed with the client before she made the decision to not take the medication. If she had already been in agreement with the regimen rather than seeking other alternatives, she would have been considered noncompliant. Client teaching, such as how and when to take the medication, would occur if she decided to take the medication. The client’s right to privacy is not addressed in this scenario.

DIF: Cognitive Level: Application REF: p. 78 OBJ: 9 TOP: Informed Consent KEY: Nursing Process Step: Evaluation MSC: Client Needs: Safe and Effective Care Environment 11. The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client? a. Lithium b. Depakene c. Neurontin d. Risperdal ANS: D Risperdal is an antipsychotic medication that is used for schizophrenia. The other options are all antimanic medications.

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DIF: Cognitive Level: Comprehension REF: p. 73 OBJ: 2 TOP: Antipsychotic (Neuroleptic) Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 12. Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response? a. Pupil dilation b. Increased saliva production c. Decreased heart rate d. Constricted airway ANS: A Pupil dilation is a sympathetic response. All the other options are examples of a parasympathetic response.

DIF: Cognitive Level: Comprehension REF: p. 69 | Table 7.1 OBJ: 1 TOP: How Psychotherapeutic Drug Therapy Works KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 13. While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands and then sits back down. The nurse knows that this client most likely is experiencing the side effect of: a. drug-induced parkinsonism. b. dystonia. c. akathisia. d. akinesia.

ANS: C Akathisia is an extrapyramidal side effect (EPSE) of antipsychotic drugs that causes an individual to be unable to sit still. The other options are also EPSEs but are not evident in the scenario.

DIF: Cognitive Level: Knowledge REF: p. 74 | Table 7.7 OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 14.

is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation. a. Drug-induced parkinsonism b. Neuroleptic malignant syndrome (NMS) c. Tardive dyskinesia d. Dystonia ANS: B

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NMS is a very serious side effect of antipsychotic drugs that can lead to coma and death.

Muscle rigidity is usually the first symptom, with symptoms progressing rapidly after the onset and reaching peak intensity in 3 days. The other options are also side effects of antipsychotics but do not describe NMS. DIF: Cognitive Level: Knowledge REF: p. 74 | Table 7.7 OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 15. The constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias. a. benzodiazepines b. tricyclics c. azaspirones d. beta-blockers ANS: D In the past, beta-blockers were strictly cardiac drugs, but new research has found this class of drugs to be successful as adjunctive treatment for social phobias. The other options are antianxiety and antidepressant medications; they are not used for cardiac arrhythmias.

DIF: Cognitive Level: Knowledge REF: p. 70 | Table 7.2 OBJ: 3 TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 16. When educating a client being treated with lithium, which item(s) in his or her diet should be monitored or avoided? a. Fresh fruit b. Whole milk c. Hot dogs and ham d. Fresh vegetables ANS: C Lithium and sodium compete for elimination from the body through the kidneys. An increase or decrease in salt affects proper elimination of lithium from the body. Processed foods like hot dogs and ham contain larger amounts of sodium.

DIF: Cognitive Level: Knowledge REF: p. 72 OBJ: 5 TOP: Guidelines for clients taking lithium KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 17. The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team? a. Nurse b. CMA c. Physician d. Therapist ANS: A

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While all care providers should be aware of the actions and side effects of the client’s medication, the nurse remains responsible for monitoring drug effectiveness and adverse reactions.

DIF: Cognitive Level: Knowledge REF: p. 75 OBJ: 7 TOP: Drug administration KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.) a. Monitoring and evaluating the client’s response to the medication b. Continually assessing the client’s condition c. Adjusting medication dosages according to therapeutic levels d. Assisting in the coordination of the client’s care e. Teaching clients about their medications f. Administering prescribed medications ANS: A, B, D, E, F These responsibilities require nurses to be cognizant of all aspects of medication administration. Adjusting medication dosages is not within the nurse’s scope of practice.

DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 7 TOP: Client Care Guidelines KEY: Nursing Process Step: Implementation MSC: Client Needs: Physiological Integrity 2. The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.) a. Teach signs and symptoms of side effects and what to do if these occur. b. Provide written information regarding the purpose, dosage, route, and dosing schedule. c. Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur. d. Provide written information regarding how the client should decrease dosages in response to side effects or improvement in symptoms.

ANS: A, B, C The nurse should teach signs and symptoms of side effects, provide information about the drug, and have the client and significant other verbally explain when it is necessary to call the physician. The nurse should never provide written information about decreasing dosages without contacting the physician. The physician will determine whether side effects can be controlled, or if dosage adjustments are necessary. In addition, improvement in symptoms is most likely the desired effect of the medication and ensures that the dosage and medications are correct.

DIF:

Cognitive Level: Application

REF: p. 75

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OBJ: 8

TOP: Client Teaching KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity 3. Clients diagnosed with Type I-Positive Schizophrenia symptoms respond better to antipsychotic medications. Manifestations of Type I Schizophrenia include which of the following? (Select all that apply.) a. Delusions b. Hallucinations c. Apathy d. Anhedonia e. Illusions ANS: A, B, E Type I: Positive symptoms include delusions, illusions, and hallucinations and have a good response to medications. Type II: Negative symptoms include anhedonia, apathy, and flat affect and usually do not respond well to antipsychotic medications.

DIF: Cognitive Level: Application REF: p. 74 OBJ: 6 TOP: Positive and Negative Symptoms of Schizophrenia KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity

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Chapter 08: Principles and Skills of Mental Health Care Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. An adult female client becomes combative with the nurse during routine medication administration. What is the nurse’s primary responsibility in this situation? a. To ensure that the client takes her medications b. To ensure that the client is placed in physical restraints to protect the safety of the staff and other clients c. To ensure that chemical restraints are used in the future until the client displays more appropriate and compliant behavior d. To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior ANS: D The “Do no harm” principle of mental health care applies to this situation. Client and staff safety are imperative. Ensuring that the client takes her medications is not of greatest concern in this situation because this most likely would cause increased combativeness.

Physical restraints and chemical restraints are not reasonable options in the care of this patient.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 2 TOP: Do No Harm KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 2. A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship? a. At the beginning of the shift, the nurse promises to play a game of cards with the client at some point during that day and does so before the end of the shift. b. The nurse promises to play a game of cards with the client on the following day. c. The nurse leads a group discussion with clients about ways to develop trust in a relationship. d. The nurse gives the client written information about the medications he is taking.

ANS: A Developing mutual trust is one of the principles of mental health care. The nurse most likely would be able to carry out plans on a daily basis rather than trying to make plans for the next day. Making plans with the client is a very effective way to develop trust, as long as the plans can be carried out. Leading a group discussion and giving written information are helpful to clients but are not going to promote development of trust in the same way that making plans and carrying them out would do.

DIF: Cognitive Level: Application REF: p. 82 OBJ: 3 TOP: Develop Mutual Trust KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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3. An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurse’s best action? a. Continue to monitor the client’s behavior and document it as anger directed toward another client. b. Talk with the client about the observations made, and ask whether she was displaying anger toward the other client. c. Ask the other client if she felt that the client was angry at her. d. Ask the client to write in a journal the emotions she was feeling at that time.

ANS: B Asking the client is an effective way of understanding the meaning of her behavior and is one of the principles of mental health care. Documentation of the nurse’s interpretations without clarification would not be appropriate, nor would involving another client by asking for her interpretation of the situation. Asking the client to write in a journal is fine, but not in this circumstance.

DIF: Cognitive Level: Application REF: p. 83 OBJ: 3 TOP: Explore Behaviors and Emotions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. A nurse and an adolescent female client develop a plan of care together that addresses the client’s difficult relationship with her parents. The client says that her parents just don’t understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurse’s best action? a. Talk with the client about how important it is that she carry through with actions that her parents feel are important. b. Identify two priority responsibilities that are agreed upon between the client and her parents, and monitor her ability to comply with the plan for 1 week. c. Discuss with the parents what responsibilities they feel are important, to determine what actions should be planned with the client. d. Identify what the client feels are reasonable responsibilities.

ANS: B Responsibility is one of the principles of mental health care that should be fostered. It is important to work in conjunction with all involved parties to set a realistic goal and plan of action. Remaining options do not include all parties and do not set a realistic goal or plan.

DIF: Cognitive Level: Application REF: p. 81 OBJ: 3 TOP: Encourage Responsibility KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 5.

coping mechanisms are means of successfully solving a problem or reducing one’s stress level. a. Defensive b. Maladaptive c. Constructive d. Individual ANS: C

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Constructive, or adaptive, coping mechanisms are effective because they deal with the problem to attempt to solve it and in turn reduce stress. Defensive and maladaptive mechanisms do not deal with the problem effectively. Individual coping mechanisms may or may not be effective.

DIF: Cognitive Level: Knowledge REF: p. 85 OBJ: 3 TOP: Encourage Effective Adaptation KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. A married woman, who is the mother of two children, has been in an abusive relationship for 4 years. She decides to leave her husband after suffering an episode of severe physical abuse. She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurse’s priority intervention? a. Offer immediate emotional support. b. Refer her to a woman’s domestic abuse center. c. Begin to develop a treatment plan for the client and her children. d. Thoroughly assess the situation from the most recent abusive episode to 2 weeks prior to this incident.

ANS: A All of the options are steps in the crisis intervention process, but emotional support is the first priority for helping to reduce high anxiety levels.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 5 TOP: Crisis Intervention KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 7. A male client with the diagnosis of depression has not attended his last two group meetings.

The nurse provides a printed schedule of meeting dates and times to the client the next time she sees him. The nurse’s actions can be described as: a. insight. b. self-awareness. c. empathy. d. client advocacy.

ANS: D Advocacy is when the nurse works on behalf of the client by providing him with the tools needed to make decisions. It is especially important to be an advocate for clients with mental health disorders because it often is difficult for them to make informed decisions.

Insight refers to the ability to see intuitively, self-awareness is looking into and analyzing oneself, and empathy encompasses the ability to understand and enter into another person’s emotions. All of the options listed are skills needed if mental health care workers are to practice effectively.

DIF: Cognitive Level: Application REF: p. 82 TOP: Caring KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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OBJ: 9

8. An adolescent female client continually displays a negative attitude toward everyone she comes into contact with and toward life in general. Which action should the nurse implement first that will be helpful in assisting this client to develop a more positive attitude? a. Helping the client recognize negative thoughts, emotions, and attitudes b. Pointing out every negative behavior that the client displays c. Assisting the client to replace negative thoughts by frequently repeating positive statements d. Praising positive behavior exhibited by the client ANS: A The nurse must help the client to identify negative thoughts, emotions, and attitudes before the client can concentrate on changing this behavior. Pointing out every negative behavior would not be therapeutic, and assisting the client to replace negative thoughts and praising positive behavior promote development of a positive attitude but do not constitute the first step.

DIF: Cognitive Level: Application REF: p. 84 OBJ: 10 TOP: Positive Outlook KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 9. A caregiver is said to be practicing care not only when she takes into consideration the client’s actual or potential problems but also when she considers the client’s family, work responsibilities, and social aspects of life. Which of the following best describes this caregiving concept? a. competent b. complete c. holistic d. crisis ANS: C Holistic care encompasses all aspects of an individual. Competent care and complete care are essential, but neither is the best choice to answer the description in this question. Crisis intervention components are not addressed in this scenario.

DIF: Cognitive Level: Comprehension REF: p. 81 OBJ: 3 TOP: Accept Each Client as a Whole Person KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 10. A client is believed to have adapted to a situation when he or she exhibits which characteristic? a. The client has become accustomed to his or her surroundings. b. The client has shown improvement in behavior as evidenced by the ability to carry out activities normal to his or her life. c. The client has accepted his or her current behavior patterns. d. The client has established a trusting relationship with the caregivers who are providing care.

ANS: B

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Adaptation, in mental health terms, is best shown in the client’s improved behavior and ability to carry out activities normal to his or her life; this displays effective coping skills.

The other options do not show complete adaptation.

DIF: Cognitive Level: Application REF: p. 84 OBJ: 5 TOP: Crisis Intervention KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 11. One of the goals of therapy established with a client on a mental health unit who has been given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of stability in his environment. Much of his OCD behavior manifests as cleanliness and control of germs. Which nursing intervention most likely would help this client to feel more stable in his environment? a. Encouraging visits from family members and friends b. Rewarding him for acceptable behavior by increasing the number of times he is allowed to clean his bathroom daily c. Encouraging him to participate in group activities d. Allowing him to wash his hands only for an agreed upon number of times daily ANS: D Setting limits for clients with mental health disorders helps them to feel more stable in their environment because these clients often are incapable of setting limits on their own.

Encouraging family visits may be beneficial for needs of comfort and love but not for stability. Rewarding this client by allowing him to increase the number of times he may clean the bathroom does not provide for stability because it fosters inconsistency in rules and routines. Encouraging group activities is beneficial for diversional purposes and love and belonging needs but does not best address the stability issue.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 6 TOP: Provide Consistency KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. Which is the best way that a nursing unit manager can assist his or her staff in maintaining a professional commitment to their job and profession? a. Frequently offering and requiring a specific number of hours of in-service training on new care modalities within the facility b. Requiring out-of-facility continuing education hours twice a year c. Encouraging staff to subscribe to nursing journals to keep up-to-date on new information d. Keeping nursing journals on the unit for easy access to staff ANS: A Professional commitment is accomplished by keeping current with developments within one’s profession, improving therapeutic effectiveness, and seeking out new knowledge.

Offering and requiring in-service training is the easiest way to seek new knowledge and remain current in the profession, while at the same time making the staff accountable to attend a certain number of sessions.

DIF: Cognitive Level: Application TOP: Commitment

REF: p. 90 OBJ: 9 KEY: Nursing Process Step: Intervention

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MSC: Client Needs: Safe and Effective Care Environment 13. The nurse is working with a male client to instill a feeling of self-commitment, to improve his self-esteem. From which of the following interventions would the client most benefit? a. Having the client promise himself that he will do the best he can in a particular situation, knowing that failure is a possibility b. Encouraging the client to do the best he can in any given situation, while reminding him that failure is a possibility c. Ensuring that the client limits activities to those in which he is sure to be successful d. Allowing the client to set goals that are nearly impossible to achieve but giving him the opportunity to try his best to meet these goals ANS: A Having the client promise himself, with the knowledge that failure is a possibility, is the most beneficial option because it is making the client active in the process and is also the most realistic approach. Simply encouraging the client does not make the client active in the situation. Ensuring that the client limits activities to those in which he will be successful is too protective. Allowing the client to set nearly impossible goals is setting him up for failure.

DIF: Cognitive Level: Application REF: p. 90 OBJ: 7 TOP: Risk Taking and Failure KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 14. The nurse is working with a health care team with the philosophy of reality therapy. The nurse is aware that the team’s belief is centered around: a. reorientation of the client to his or her environment. b. describing clients as irresponsible rather than mentally ill. c. looking at the client’s past in determining how it has affected present behavior. d. accepting the client’s perceptions of right and wrong behavior in the development of his treatment plan.

ANS: B Reality therapy focuses on responsibility and does not accept the premise of mental illness.

Reality therapists look at the present and future and do not look to the past for excuses for behavior. Reality therapy also emphasizes the morality of behavior and does not allow the client’s own interpretation of right and wrong.

DIF: Cognitive Level: Comprehension REF: p. 84 OBJ: 6 TOP: Encourage Responsibility KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 15. A busy community mental health center treats a client who is in crisis. The client is provided with instruction on relaxation exercises, but throws them away. Two weeks later, the staff is dismayed when the client returns with her condition worsened. This lack of success after the previous visit is due to which of the following factors? a. Disorganization b. Pseudoresolution c. Self-awareness

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d. Lack of commitment ANS: B The client and health care provider did not address the cause and opportunity for growth.

This is termed pseudoresolution. Disorganization is preoccupation with the crisis situation.

Self-awareness and lack of commitment are not considered in crisis.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 5 TOP: Crisis Intervention KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 16. A client is monopolizing a group session, not allowing other members to participate. What is the most appropriate way to address the client? a. “You are not allowed to speak for the remainder of the session.” b. “You are selfish and must leave now.” c. “You are very rude when you act this way.” d. “You need to stop this behavior. Let’s see what others have to say.”

ANS: D Accepting the client does not mean accepting the behavior. Communication must focus on correcting the behavior and not the person. The other options focus on the person and not the behavior.

DIF: Cognitive Level: Application REF: p. 83 OBJ: 3 TOP: Skills for Mental Health Care: Acceptance KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 17. The night before her final exam, the nursing student cannot sleep and is convinced she will fail. Which of the following actions will help to promote a more positive outlook? a. Continue to study rather than attempting to sleep. b. Accept the possibility of failure and plan to repeat the course. c. Use the negative thoughts as motivation. d. Visualize staying relaxed during the exam and successfully passing.

ANS: D One of the actions in maintaining a positive attitude is to visualize a positive image. Actual level of confidence grows each time an image of self-assurance is projected. The other options do not project positive self-image.

DIF: Cognitive Level: Application REF: p. 91 OBJ: 10 TOP: Positive Outlook: Develop a Positive Attitude KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 18. A client with frequent re-admissions to the inpatient unit refuses to eat or participate in activities. The nurse functions as the client advocate by which of the following actions? a. Respecting the client’s wishes by taking food away and leaving the room door closed b. Scolding the client as a way to motivate a change in behavior c. Providing consistent encouragement to attend activities and having food available d. Ignoring the client and encouraging other health care team members to do the same

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ANS: C Advocacy is the process of providing the client with information, support, and feedback needed to make a decision, and the obligation to act in the best interest of the client. The other options do not demonstrate advocacy and caring behaviors.

DIF: Cognitive Level: Application REF: p. 82 OBJ: 3 TOP: Skills for Mental Health Care: Caring KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Identify the stages experienced by a person in a crisis. (Select all that apply.) a. Recovery b. Adaptation c. Disorganization d. Crisis e. Denial f. Reorganization g. Perception h. Exhaustion ANS: A, C, D, E, F, G These are the typical stages that a person in crisis experiences. The stages usually occur in the order of perception, denial, crisis, disorganization, recovery, and reorganization.

DIF: Cognitive Level: Knowledge REF: p. 85 OBJ: 5 TOP: Crisis Intervention KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which of the following are signs that indicate that the mental health nurse is becoming overly involved with a client’s care? (Select all that apply.) a. Knowing when to help and when not to help a client b. Showing greater levels of concern for one client over all other clients c. Feeling that the nurse is the only caregiver who understands the client d. Being committed to providing competent health care at all times ANS: B, C Showing greater levels of concern for one client over all other clients and the nurse’s feeling that he or she is the only caregiver who understands the client are signs that indicate the development of a co-dependency with a client that can result from overinvolvement of the practitioner with a particular client. The other options describe qualities needed to provide effective health care.

DIF: Cognitive Level: Analysis REF: p. 89 OBJ: 8 TOP: Boundaries and Overinvolvement KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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3. An important component of providing good care is for health caregivers to take care of, or nurture, themselves. Which of the following are ways that effectively assist health caregivers to nurture themselves? (Select all that apply.) a. Be supportive of colleagues. b. Recognize and accept one’s own limitations, and strive to improve. c. Take pride in oneself. d. Accept all challenges presented. e. Be responsible and accountable for one’s own actions.

ANS: A, B, C, E Caregivers are constantly serving as client advocates, but they must be careful to avoid expending their energies without renewing energy. A caregiver cannot provide quality health care unless he first takes care of himself. One does not have to take on all challenges presented to him because this can be exhausting to an individual.

DIF: Cognitive Level: Application REF: p. 91 OBJ: 10 TOP: Principles and Practices for Caregivers KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. A recently widowed 74-year-old male is seen in the mental health clinic for sleep disorders and depression. Which of the following nursing actions demonstrate caring? (Select all that apply.) a. Providing a private place to interview the client b. Delegating other tasks to a colleague while speaking to the client c. Addressing the client as “honey” to provide comfort d. Asking about the client’s daily activities and hobbies during the interview e. Listening intently to the client’s responses and not being distracted by his nonverbal communication ANS: A, B, D Providing a private place to talk and making oneself available with no distractions are ways of demonstrating caring. In addition, showing interest in the whole person, not only the diagnosis, is a therapeutic action. Addressing the client as “honey” without being instructed to by the client does not convey respect and caring. Watching for nonverbal messages, not ignoring them, is also therapeutic.

DIF: Cognitive Level: Application REF: p. 87 OBJ: 3 TOP: Principles and Practices for Caregivers: Caring KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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Chapter 09: Mental Health Assessment Skills Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The nurse asks the client a series of questions upon entry into a mental health care system.

This action is an example of which phase of the nursing process? a. Evaluation b. Assessment c. Intervention d. Planning ANS: B Assessment is the phase of the nursing process during which data collection occurs. It is performed not only upon admission into a facility but also throughout the care of the client.

Evaluation is the phase during which goals are evaluated to determine whether they have been met, partially met, or not met at all; intervention is the phase of the nursing process when planned interventions are actually implemented; planning is the phase of the nursing process when client goals are set and interventions are planned.

DIF: Cognitive Level: Comprehension REF: p. 95 OBJ: 2 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. A nurse administers antidepressant medication to a client in an assisted-living facility. This is an example of which phase of the nursing process? a. Intervention b. Assessment c. Planning d. Diagnosis ANS: A Intervention is the phase of the nursing process during which planned interventions are actually implemented. Assessment is the phase of the nursing process when data collection occurs. Planning is the phase of the nursing process when client goals are set and interventions are planned. Diagnosis is the phase of the nursing process following assessment when the client’s problem is identified.

DIF: Cognitive Level: Comprehension REF: p. 94 OBJ: 2 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 3. Following completion of a male client’s series of group therapy sessions, the nurse periodically talks with the client to determine whether he has any signs of relapse of his previous problems. This action by the nurse is an example of: a. planning. b. assessment. c. intervention. d. diagnosing.

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ANS: B In this situation, the nurse is assessing for any signs of relapse. Assessment is a continuous process. Planning is the phase of the nursing process when client goals are set and interventions are planned; intervention is the phase of the nursing process when planned interventions are actually implemented; and diagnosis is the phase of the nursing process following assessment when the client’s problem is identified.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 2 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. During a session with a female client with a diagnosis of social phobia, she talks about how proud she is of herself because she was finally able to shop at the grocery store. The nurse documents the events and knows that this would be considered which phase of the nursing process? a. Assessment b. Planning c. Intervention d. Evaluation ANS: D This client has accomplished a goal; therefore, this would be considered evaluation.

Assessment is the phase of the nursing process when data collection occurs; planning is the phase of the nursing process when client goals are set and interventions are planned; and intervention is the phase of the nursing process when planned interventions are actually implemented.

DIF: Cognitive Level: Comprehension REF: p. 94 OBJ: 2 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance 5. The treatment team meets with a client for the first time and determines, with the client’s input, a nursing diagnosis, goal, and steps to reach this goal. In addition to a nursing diagnosis, the treatment team has completed which phase of the nursing process? a. Evaluation b. Intervention c. Planning d. Assessment ANS: C During the planning phase, goals are established and a plan is developed. Evaluation is the phase in which goals are evaluated to determine whether they have been met, partially met, or not met at all; intervention is the phase of the nursing process when planned interventions are actually implemented; and data collection occurs during the assessment phase.

DIF: Cognitive Level: Comprehension REF: p. 94 OBJ: 2 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

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6. Without assessment of six specific aspects of an individual’s being, the mental health nurse’s scope of care is narrow and limited in effectiveness. These aspects include social, physical, cultural, intellectual, emotional, and spiritual areas of a person’s life, known as a assessment. a. complete b. accurate c. holistic d. psychiatric ANS: C Although the other options do address some of these aspects, holistic more accurately describes these six aspects of an individual’s life. The psychiatric assessment tool specifically addresses the problems that are being experienced, coping mechanisms, and resources of the client.

DIF: Cognitive Level: Knowledge REF: p. 96 OBJ: 4 TOP: About Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The nurse is reviewing information regarding a female client that was obtained with the psychiatric assessment tool. The client’s ability to provide food and shelter for herself is included in which area of the assessment? a. Appraisal of health and illness b. Coping responses, discharge planning needs c. Knowledge deficits d. Previous psychiatric treatment ANS: B The client’s ability to care for herself outside of the facility would be considered when her discharge planning needs are assessed, to determine whether other resources will be necessary. The other options are included in the psychiatric assessment tool but do not focus on discharge planning. Appraisal of health and illness focuses on the client’s perception of health care and identification of problems and goals; knowledge deficits focus on areas such as medications and coping skills; and previous psychiatric treatment focuses on the client’s psychiatric history, including family history.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 4 TOP: Assessment Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. During an interview with a 15-year-old female client admitted for depression, the nurse is disappointed to learn that the client recently became pregnant and had an abortion. The nurse is contradicting the effective interview guideline of: a. paying close attention to the client’s nonverbal communication. b. avoiding making assumptions. c. avoiding one’s personal values that may cloud professional judgment. d. setting clear client goals.

ANS: C

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This is an example of the nurse allowing his or her personal values to cloud professional judgment and is an ineffective interview technique that leads to a negative nurse-client relationship. The other options are good interview techniques but do not represent this situation.

DIF: Cognitive Level: Comprehension REF: p. 96 OBJ: 5 TOP: Effective Interviews KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. A male client with a history of schizophrenia was admitted to the mental health facility after he was found on the street confused and uncooperative when approached by the police. One of the first assessments that should be performed on this client upon admission is a: a. physical assessment. b. sociocultural assessment. c. psychosocial assessment. d. psychiatric assessment.

ANS: A Physical problems frequently are overlooked when someone has a diagnosed mental health disorder. These physical problems often can be the cause of symptoms and may be easily treated. For example, low blood sugar, rather than schizophrenia, could be a cause of the symptoms described in this scenario. For this reason, physical examinations are always performed on admission to a mental health facility, followed by the other options listed.

DIF: Cognitive Level: Application REF: p. 98 OBJ: 6 TOP: Physical Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 10. During the mental status examination, the nurse observes that the client rapidly changes from one idea to another related thought. Which disordered thinking process is the client displaying? a. Delusions b. Perseveration c. Confabulation d. Flight of ideas ANS: D It is difficult to follow a conversation with an individual who is experiencing flight of ideas because the conversation follows his rapidly changing thought pattern. Delusions result in false beliefs that cannot be corrected by logical explanations or reasoning; perseveration occurs when the client repeats the same word response to different questions; and with confabulation, the client uses untrue statements to fill in gaps of memory loss.

DIF: Cognitive Level: Comprehension REF: p. 100 TOP: Thinking KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 9

11. When reviewing the nursing notes from the previous shift, the nurse notices notations indicating that the client was experiencing a somnolent level of consciousness. The client’s behavior would be described as:

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a. b. c. d.

“Falling asleep easily and only awakening with strong verbal stimuli.”

“Frequently sleeping and awakening only to strong physical stimuli.”

“Unresponsive to any verbal or painful stimuli.”

“Having alternating periods of excitability and drowsiness.”

ANS: A Falling asleep easily and waking only to strong verbal stimuli describes the level of consciousness known as somnolent, which also can be called a state of drowsiness.

Frequently sleeping and waking only to strong physical stimuli describes a stuporous state, unresponsiveness to verbal or painful stimuli is a comatose state or unconsciousness, and alternating periods of excitability and drowsiness describe a lethargic state.

DIF: Cognitive Level: Application REF: p. 100 | Table 9.6 OBJ: 9 TOP: Sensorium and Cognition KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. During the mental status assessment, the nurse hands the client a piece of paper that reads “Please raise your left hand.” If the client follows the command, the nurse has just assessed which ability of the client? a. Abstract thinking b. Reading c. General knowledge d. Memory ANS: B This is an easy method of assessing the client’s reading ability and is less anxiety provoking than having the client read aloud. Abstract thinking is assessed by methods such as assessing the ability of the client to understand similarities; general knowledge can be assessed by asking questions such as how many months are in a year or discussing current events; and memory can be assessed by testing immediate, recent, and remote memory.

DIF: Cognitive Level: Application REF: p. 101 OBJ: 9 TOP: Sensorium and Cognition KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. A nurse educates a client on medication side effects and verbal feedback of understanding is given by the client. Which phase of the nursing process is being described? a. Planning b. Intervention c. Assessment d. Evaluation ANS: D This phase determines the effectiveness of the care. Clients are encouraged to become partners in their care.

DIF: Cognitive Level: Application REF: p. 95 OBJ: 1 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

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14. Components of the sociocultural assessment include a history interview for the purpose of obtaining information about a client’s background and: a. observing the client’s appearance, behaviors, and attitudes. b. eliciting answers related to general health, past illnesses, and hospitalizations. c. encouraging description of lifestyle and activities of daily living. d. reviewing physical assessment data and various diagnostic examinations.

ANS: A The sociocultural assessment focuses on the cultural, social, and spiritual aspects of an individual. During the history interview, the care provider obtains information about a client’s background and observes the client’s appearance, behaviors, and attitudes.

DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: 1 TOP: Sociocultural Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 15. A client with a history of delusions demonstrates which of the following behaviors? a. Shifts from laughing to crying with no apparent cause. b. Insists the government is out to harm him. c. Has trouble remembering what he had for breakfast. d. Expresses a constant fear of dying.

ANS: B Delusions are false beliefs that cannot be corrected by reasoning or explanation. A constant fear of dying is an example of an obsession, shifting from laughing to crying for no reason demonstrates the inappropriate response of being labile, while having trouble remembering is indicative of amnesia.

DIF: Cognitive Level: Comprehension REF: p. 99 | p. 100 | Table 9.5 OBJ: 8 TOP: Disorders of Thinking KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The nurse suspects the client is experiencing a manic episode based on which of the following observations? a. Clothing is very colorful and mismatched, and client cannot sit in chair during interview. b. Hair is not combed, clothing is dirty, and client has no interest in surroundings. c. Client repeatedly washes her hands and picks at a button on her shirt. d. Client expresses fear that someone is waiting outside the room to harm her.

ANS: A It is not uncommon for manic clients to dress in colorful clothing and have excessive body movement. Clients who look unkempt and neglected are more common in depression.

Repeated behaviors and picking at clothing are often seen in obsessive-compulsive disorders.

DIF: Cognitive Level: Comprehension REF: p. 98 OBJ: 8 TOP: Mental Status Assessment: General Appearance KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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MULTIPLE RESPONSE 1. Upon entrance into a mental health care system, clients are thoroughly assessed, and this is followed by the development of a mental health treatment plan. Which of the following are purposes of the treatment plan? (Select all that apply.) a. Proof of care for insurance reimbursement purposes b. A means of monitoring the client’s progress c. An instrument for communication and coordination of care d. A guide for planning and implementation of care e. Evaluating the effectiveness of interventions ANS: B, C, D, E Purposes of the treatment plan include serving as a means of monitoring the client’s progress, acting as an instrument for communication and coordination of care, serving as a guide for planning and implementation of care, and providing a way to evaluate the effectiveness of interventions. Documentation for reimbursement purposes is not a primary goal of the treatment plan.

DIF: Cognitive Level: Comprehension REF: p. 93 OBJ: 1 TOP: Mental Health Treatment Plan KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 2. The assessment phase of the nursing process refers to the phase when data collection occurs.

Which methods does the nurse use to collect data? (Select all that apply.) a. Interpreting client behaviors b. Interviewing the client and significant others c. Observing client behavior d. Performing physical assessment e. Reviewing diagnostic testing results ANS: B, C, D, E Interviewing the client and significant others, observing client behavior, performing a physical assessment, and reviewing diagnostic testing results are effective ways of collecting data. Interpreting a client’s behavior should never occur without clarification because interpretation often is incorrect.

DIF: Cognitive Level: Application REF: p. 94 | p. 95 OBJ: 3 TOP: Data Collection KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. During the sociocultural assessment of a client who is entering a mental health program, the nurse focuses on which information related to the client? (Select all that apply.) a. Education b. Income c. Ethnicity d. Age e. Gender f. Medications g. Previous diagnoses h. Belief system

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ANS: A, B, C, D, E, H Medications and previous diagnoses are not part of the sociocultural assessment.

DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: 4 TOP: Sociocultural Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. Short-term memory loss is seen in which of the following disorders? (Select all that apply.) a. Depression b. Dissociative disorder c. Conversion disorder d. Alzheimer’s e. Anxiety ANS: A, D, E Loss of recent memory is seen in persons with Alzheimer’s disease, anxiety, and depression.

Dissociative and conversion disorders cause long-term memory loss.

DIF: Cognitive Level: Comprehension REF: p. 100 OBJ: 4 TOP: Sociocultural Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 10: Therapeutic Communication Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Ruesch’s theory of communication, this unsuccessful interaction is called: a. disturbed communication. b. nontherapeutic communication. c. blocked communication. d. therapeutic communication.

ANS: A Ruesch called this type of interrupted communication is disturbed communication. In addition to interference with receiving a message, as in the case of this client, the term applies to interference with the sending of messages, problems in language between people, insufficient information, and lack of the opportunity for feedback. Ruesch’s theory did not coin the term nontherapeutic or blocked communication, and this interaction would not be considered therapeutic.

DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: 1 TOP: Ruesch’s Theory KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 2. The theorist Eric Berne theorized that an individual’s three ego states of parent, child, and adult make up one’s: a. conscience. b. personality. c. thought processes. d. ability to communicate.

ANS: B The three ego states, according to Berne, make up an individual’s personality. The parent ego focuses on rules and values, the child ego focuses on emotions and desires, and the focal point of the adult ego is previous observations. He did not address any of the other three options.

DIF: Cognitive Level: Knowledge REF: p. 105 OBJ: 1 TOP: Transactional Analysis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique? a. “I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something.” b. “Can you tell me more about how you feel when you are arguing with your

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daughter?” c. “I would like to talk with you about your plan of care.” d. “Tell me if I understand you correctly.”

ANS: A Sharing perceptions lets the client know that you are listening and ensures that you understand what he or she is communicating. Asking the client to describe how he or she feels when arguing with his or her daughter describes focusing. Speaking to the client about the plan of care describes informing, and the nursing student is using clarification when asking whether he or she understands the client correctly.

DIF: Cognitive Level: Application REF: p. 104 OBJ: 7 TOP: Interacting Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification? a. “You said that the fight you had with your wife caused you to start drinking again?” b. “Let’s discuss what made you feel the need to drink.” c. “Could you tell me again when and what happened that you feel caused you to start drinking again?” d. “Tell me what your childhood was like.”

ANS: C Clarification helps to confirm feelings, ideas, and perceptions. The other options are examples of restating, focusing, and changing the topic.

DIF: Cognitive Level: Application REF: p. 104 OBJ: 7 TOP: Interacting Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 5. A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response? a. “Tell me more about the feelings you have regarding their relationship.” b. “I think that you should tell them how you feel.” c. “Let’s not talk about that right now.” d. “Don’t you think that you should be thankful that your daughter has a good relationship with her grandmother?”

ANS: D

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Defensive, challenging statements such as this one will block communication with the client because she will feel that she needs to respond defensively and answer to the nurse for her feelings. The therapeutic communication response that includes a broad opening statement is used when the nurse asks the client to tell more about her feelings. When the nurse tells the client that she should tell the mother and daughter how she feels, it describes giving advice. The nurse uses the nontherapeutic technique of belittling the client when the nurse states that the client’s feelings are childish.

DIF: Cognitive Level: Application REF: p. 112 OBJ: 7 TOP: Nontherapeutic Messages KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just can’t find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique? a. “I can’t believe that you would want your daughter to grow up in this environment.” b. “I understand your concern. Let me give you some information on our local council for domestic abuse.” c. “I’m sure it won’t be that bad to be out on your own. I know you can do it.” d. “I think you should not think about leaving and should just do it.”

ANS: C This is an example of the nontherapeutic technique of falsely reassuring the client. It dismisses the client’s concerns and does not support her. The nurse is showing disapproval in stating that she “can’t believe” that the client would want her daughter to grow up in such an environment. The nurse gives an appropriate therapeutic statement when she acknowledges the client’s concern and then provides the client with helpful information.

The nurse is giving advice in offering her thoughts that the client should just leave.

DIF: Cognitive Level: Application REF: p. 112 OBJ: 7 TOP: Nontherapeutic Messages KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 7. Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client? a. Broad openings, restating, and advising b. Clarification, focusing, and confrontation c. Listening, silence, and reflection d. Humor, informing, and reassuring ANS: C The techniques of listening, silence, and reflection are all therapeutic. Advising, confronting, and reassuring are all examples of nontherapeutic techniques.

DIF: Cognitive Level: Comprehension REF: p. 111 | Box 10.5 OBJ: 7 TOP: Interacting Skills

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KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

8. While the nurse is talking with a female client, the client becomes silent for several seconds.

Which is the nurse’s best response? a. To interpret this action as an indication that the client is finished with the conversation b. To ask the client a question so the interaction can continue c. To remain silent and be attentive to the client’s nonverbal communication d. To tell the client that help can be more effective if she shares her feelings ANS: C This is an example of the therapeutic communication technique of silence. It allows the client time to collect her thoughts. Although most people want to talk away the silence, it is important for the caregiver to become comfortable with the effective technique of silence.

The three incorrect options prevent silence from occurring.

DIF: Cognitive Level: Application REF: p. 111 | Box 10.5 OBJ: 7 TOP: Interacting Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 9. A client who usually is very active in her therapy group tells the nurse that she really does “not feel well today” and would “rather not attend the group therapy session.” Which is the nurse’s most appropriate response? a. “You don’t feel like attending the group therapy today?” b. “I will just stay with you for a while.” c. “It’s okay to skip a session every once in a while.” d. “Why don’t you want to attend group therapy?”

ANS: A The nurse is restating what the client said, which verifies what the client communicated and lets the client know that the nurse listened and understood her. The client did not ask the nurse to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session is giving advice and is not conveying an understanding of what the client really said.

Asking the client why she doesn’t want to attend group therapy clearly conveys that the nurse did not listen to what the client communicated.

DIF: Cognitive Level: Application REF: p. 111 | Box 10.5 OBJ: 7 TOP: Interacting Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should: a. sit with the client and encourage him to not verbalize. b. do most of the talking. c. discuss several different topics to keep the client’s attention. d. use simple, concrete language.

ANS: D

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Because this client has been given the diagnosis of schizophrenia and frequently has auditory hallucinations, his perception of the communication must be considered. Use of simple, concrete language will assist the client in following the conversation without having to interpret what the nurse means during the interaction. Encouraging the client not to verbalize and doing most of the talking do not allow the client to express himself, and discussing several different topics will be confusing and may cause the client undue stress during the interaction.

DIF: Cognitive Level: Application REF: p. 109 OBJ: 8 TOP: Verbal Communication KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. The nurse’s ability to interpret communication effectively in the mental health setting depends mostly on: a. How well the client communicates? b. the nurse’s relationship with the client. c. the nurse’s understanding of mental health disorders. d. the nurse’s ability to listen to and observe the client’s verbal and nonverbal messages.

ANS: D Accurate interpretation of the client’s communication cannot occur if the nurse does not listen to and observe the client. It is not dependent on how well the client communicates because the nurse has no control over the client. The nurse’s relationship with the client and understanding of mental health disorders are important but will not supersede good observation and listening.

DIF: Cognitive Level: Comprehension REF: p. 115 | Sample Client Care Plan 10-1 OBJ: 6 TOP: Therapeutic Communication Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. Which nurse response is the best example of the therapeutic principle of respect? a. “I’m interested in what you have to say.” b. “Describe how you are feeling for me.” c. “I hear how worried you are about your future and can imagine how you feel.” d. “You signed a contract stating that you would let me know when you have those thoughts.”

ANS: C Although all of these responses are examples of therapeutic principles, this option best describes respect because it shows consideration and acceptance. The other options convey interest, the principle of concreteness, and honesty.

DIF: Cognitive Level: Application REF: p. 114 OBJ: 6 TOP: Therapeutic Communication Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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13. A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of: a. permission. b. respect. c. interest. d. protection.

ANS: D A protective response, such as “Let’s look together again at what we have planned for you when you go home,” will help the client feel more confident in her ability to do well once she is discharged. The other options are examples of therapeutic principles but do not address the needs of this client at this time.

DIF: Cognitive Level: Application REF: p. 110 | Table 10.1 OBJ: 6 TOP: Therapeutic Communication Skills KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 14. A nurse has just graduated from nursing school and has been hired on a mental health unit.

The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves: a. focusing. b. parroting. c. restating. d. clarifying.

ANS: B Parroting is the extreme form of the therapeutic communication skill of restating. It becomes very annoying to clients when the nurse continually repeats the client’s statements in an attempt to show understanding of the client’s message. The other options are therapeutic communication skills.

DIF: Cognitive Level: Knowledge REF: p. 112 | p. 113 | Table 10.2 OBJ: 7 TOP: Nontherapeutic Messages KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 15. A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating? a. Aphasia b. Dyslexia c. Speech cluttering d. Incongruent communications ANS: C

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Rapid, confusing delivery of speech patterns is called speech cluttering and can result in the client’s inability to focus on verbal communication as the main form of interaction. Aphasia refers to the inability to speak, dyslexia refers to the mixing of letters when reading that sometimes results in the mixing of syllables when speaking, and incongruent communications occur when verbal messages do not match nonverbal messages.

DIF: Cognitive Level: Knowledge REF: p. 112 OBJ: 8 TOP: Problems With Communication KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills? a. Finishing the client’s sentences to indicate listening b. Not clarifying messages to avoid interrupting c. Avoiding taking notes to detract from listening d. Changing the environment to decrease distractions ANS: D Effective listening improves the ability to meet client needs. Changing the environment to decrease distractions is a practice important to listening skills. Finishing the client’s sentences, not clarifying messages, and avoiding taking notes are barriers to listening and may prevent the nurse from picking up hidden messages, minimizing misunderstandings.

DIF: Cognitive Level: Knowledge REF: p. 110 | Box 10.4 OBJ: 7 TOP: Problems With Communication KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of: a. echolalia. b. circumstantiality. c. neologism. d. perseveration.

ANS: B Circumstantiality is a speech pattern in which the client describes in too much detail and cannot be selective. Echolalia is repeating the last word heard, neologism is the coining of new words or expressions, and perseveration is the repeating of a single activity and the inability to shift from one topic to another.

DIF: Cognitive Level: Knowledge REF: p. 114 | Box 10.3 OBJ: 8 TOP: Speech Patterns Associated With Psychiatric Problems KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. The client tells the nurse that she believes there is no improvement in her manic episodes.

Her clothing matches and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate? a. Verbal communication takes priority. b. Verbal communication is not congruent with nonverbal communication. c. Nonverbal communication indicates the client is lying.

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d. Nonverbal communication should take priority.

ANS: B Verbal and nonverbal communications send and receive messages on every interaction.

Neither verbal nor nonverbal communication takes priority over the other. In this case the verbal communication of the client that her episodes are not improving is belied by the obvious improvement in her dress and behavior (nonverbal communication).

DIF: Cognitive Level: Knowledge REF: p. 112 OBJ: 8 TOP: Levels of Communication KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. When asking the adolescent client about the magazine she is reading, she responds, “It’s an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night.” Which speech pattern is this an example of? a. Echolalia b. Flight of ideas c. Loose association d. Neologism ANS: C Loose association is a pattern in which the speaker shifts between loosely related topics such as a movie star, stars in the sky at night, and darkness at night.

DIF: Cognitive Level: Knowledge REF: p. 114 | Table 10.3 OBJ: 8 TOP: Speech Patterns Associated With Psychiatric Problems KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which elements must be present for communication to occur? (Select all that apply.) a. Feedback b. Transmission c. Sender d. Clarification e. Receiver f. Focusing g. Context ANS: A, B, C, E, G Feedback, transmission, sender, receiver, and context are the five elements that must be in place for communication to occur. The sender transmits the message to the receiver, resulting in feedback between them. The context, or setting, is where the communication takes place. Clarification and focusing are types of therapeutic communication.

DIF: Cognitive Level: Knowledge REF: p. 104 OBJ: 3 TOP: Process of Communication KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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2. Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.) a. The nurse adapts his or her behavior to accommodate the difference in communication styles. b. The nurse identifies and clarifies confusion during the interaction. c. The nurse recognizes the difference between communication styles and assists the client to change to the nurse’s communication style. d. The nurse uses a limited number of slang terms when communicating with the client.

ANS: A, B Adaptation of behavior to accommodate differences in communication is effective because it is less difficult for the nurse to adapt to differences in communication, as with the use of an interpreter. Identifying and clarifying confusion prevents misinterpretation during the interaction. Recognizing differences in communication style is correct, but assisting the client to change to the communication style of the nurse is incorrect. Using a limited number of slang words indicates that some slang terms are acceptable; however, no slang terms should be used because these may block communication.

DIF: Cognitive Level: Application REF: p. 107 OBJ: 5 TOP: Intercultural Difference KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 3. Which nurse responses could block effective communication with a client? (Select all that apply.) a. “This is what I think you should say…” b. “Don’t stress over it. Everything will turn out fine.” c. “Why did you do that?” d. “Most people in your circumstance…”

ANS: A, B, C, D All of these options are nontherapeutic and should be avoided. When the nurse offers what she thinks the client should say, she is giving the client advice. Telling the client not to stress is giving the client false reassurance. Asking the question “Why did you do that?” will make the client defensive. When the nurse says “Most people in your circumstance…,” she is generalizing.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 7 TOP: Nontherapeutic Messages KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 4. In order to be therapeutic when communicating with a client living in a homeless shelter, it is important to apply which techniques? (Select all that apply.) a. Show acceptance and respect. b. Avoid clarifying terms. c. Use medical terminology to avoid talking down. d. Consider the client’s environment. e. Assess the client’s pattern of verbal and nonverbal communication.

ANS: A, D, E

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Showing acceptance and respect, considering the client’s environment, and assessing verbal and nonverbal patterns of communication are effective ways of communicating with clients of different social classes. Avoiding clarifying terms and using medical terminology provide barriers to communication.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 6 TOP: Communicating With Clients of Different Social Classes KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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Chapter 11: The Therapeutic Relationship Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is currently administering medications to all clients on the unit. The newly admitted client asks the nurse to sit and talk with her for a while. What is the nurse’s best response? a. “I am busy right now, but I will come back later.” b. “Give me just a few more minutes to finish passing medication to the other clients.” c. “I will return in 20 minutes so we can talk.” d. “I have to finish giving all the clients their medications, but I will then come back so we can talk.”

ANS: D This is an honest statement that lets the client know exactly what the nurse is doing and helps to build trust in that the nurse is not making up excuses or making false promises. The nurse’s statement that she is busy right now would make the client feel unimportant. The nurse would be making false promises if she were to say that she will be back in only a few minutes or even in 20 minutes, because most likely it will take more than this amount of time to finish giving out medications.

DIF: Cognitive Level: Application REF: p. 118 TOP: Trust KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 2

2. A nurse is working with a male client in a mental health outpatient clinic. The client voices a desire to become more autonomous. Which goal will assist the client in becoming more autonomous? a. The client will check his calendar each night to plan for commitments scheduled on the following day. b. The nurse will remind the client weekly of his appointment at the clinic for the following week. c. The client will ask the nurse to call him to remind him of his appointment. d. The nurse will complete the client’s calendar of daily commitments scheduled for the week.

ANS: A Autonomy refers to the ability to direct and control one’s activities and destiny. Working toward this goal is a simple way to begin to develop control over one’s life. Reminding the client and completing the client’s calendar are nursing goals rather than client goals. If the client asks the nurse to call him to remind him, no responsibility is placed on the client.

DIF: Cognitive Level: Application REF: p. 118 TOP: Autonomy KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

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OBJ: 2

3. An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by: a. telling a client several times a day that he or she cares about him or her. b. asking a client what his or her favorite movie is and then showing that movie during a movie night on the unit. c. giving a client a card that has a sentiment that says the nurse cares about him or her. d. telling a client that he or she is the favorite client.

ANS: B Showing a favorite movie is a safe way of showing the client that you are aware of him or her as an individual, rather than as just another client. If the nurse only tells the client that she cares about him or her, it does not prove to the client that the nurse cares. Giving a client a card or telling the client that he or she is a favorite is too personal and may mislead the client regarding the development of a social relationship.

DIF: Cognitive Level: Application REF: p. 119 TOP: Caring KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 2

4. The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope? a. “You need to take your lithium unless you want to relapse.” b. “You are doing so well that there is nothing you can’t do if you put your mind to it.” c. “You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication.” d. “A lot of people are much worse off than you are, so you should be thankful that you are doing as well as you are.”

ANS: C This option is realistic and provides hope without providing false hope. Stating that the client will relapse if she discontinues medication suggests that the nurse is threatening the client, which provides no hope. Telling the client that “there is nothing that you can’t do” may be providing false hope. Reminding the client that others are worse off is disregarding the client’s feelings.

DIF: Cognitive Level: Application REF: p. 119 TOP: Hope KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 2

5. A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The client’s current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope? a. Affective b. Contextual

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c. Temporal d. Affiliative ANS: B Although all the dimensions of hope listed in these options may be difficult for this client, the dimension that is representative of the living and job situation for this client is contextual, because this refers to inadequate physical, financial, and emotional resources.

DIF: Cognitive Level: Comprehension REF: p. 119 TOP: Hope KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

OBJ: 2

6. A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient setting and is attending group therapy sessions. She is working on controlling the compulsion of touching her head three times every time she talks. To maintain the therapeutic relationship established with the client, by which action can the nurse show acceptance? a. Ignoring the compulsion during the group therapy session and talking with the client privately about the behavior b. Asking the group to remind the client every time she touches her head to help her consciously stop the compulsion c. Pointing out the compulsion to the group each time the client exhibits the behavior d. Asking the client to stop talking during the group session until she has learned to control her compulsion ANS: A Ignoring the behavior in group therapy shows acceptance of the behavior because the nurse does not embarrass the client in front of the group. Talking with her privately shows compassion for the client. Asking the group to remind the client of the compulsion and pointing out the compulsion to the group could belittle the client. Asking the client to stop talking would defeat the purpose of the support of belonging to a therapeutic group.

DIF: Cognitive Level: Application REF: p. 120 TOP: Acceptance KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 4

7. The characteristic of genuineness helps in establishing a therapeutic relationship with a client. Which nurse response is the best example of a display of genuineness to a client who is going through a difficult divorce? a. “I know exactly how you feel. My husband and I divorced 2 years ago because of his infidelity.” b. “Divorcing my husband was the best thing I ever did.” c. “I have friends who have gone through a divorce. It must be difficult for you.” d. “I am sorry that you have to go through this difficult time.”

ANS: C This response shows the client sincerity and honesty, which are components of being genuine. The nurse should not offer too much personal information, such as providing information about her own divorce. When the nurse says that she is sorry that the client is experiencing the difficult time, it is an example of a sympathetic response.

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DIF: Cognitive Level: Application REF: p. 121 TOP: Genuineness KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 4

8. During the preparation phase of a therapeutic relationship with a client, what is the main task to be completed by the nurse? a. To establish with the client the purpose of the relationship b. To gather and review all possible information regarding the client c. To build trust with the client d. To obtain agreement from the client to work in conjunction with the nurse ANS: B The main task during the preparation phase is to gather and review all possible information regarding the client; this can be accomplished by obtaining data from past and current medical records and from the client’s significant others. The other options are tasks that occur during the orientation phase.

DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 9. When should the nurse begin preparations for the termination phase of a therapeutic relationship? a. During the orientation phase b. Prior to the last meeting c. During the last meeting d. After all goals have been met ANS: B Preparing for termination of the relationship should begin prior to the last meeting to allow for review of whether goals have been met and to prepare for client independence. The orientation phase is too early in the relationship to prepare for termination, and the last meeting is too late. Unfortunately, not all goals are always met, so preparing for termination of the relationship after goals have been met may not be a possibility.

DIF: Cognitive Level: Comprehension REF: p. 123 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 10. The nurse is preparing an adult male client, who has been successfully treated for a social phobia, for the termination phase of the therapeutic relationship. During their last meeting, the client told the nurse that he noticed he has developed a nervous habit that started a few days ago of checking his door at home several times a day to be sure it is locked. This client is exhibiting the client response to termination known as: a. continuation. b. regression. c. withdrawal. d. confabulation.

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ANS: A Continuation sometimes occurs when a client is fearful of ending the therapeutic relationship. This response is characterized by a client’s trying to continue the relationship by bringing up new problems or having the caregiver solve his problems. Regression and withdrawal are also client responses to termination, but they do not fit the description in this situation. Confabulation is not a response to termination. It refers to the making up of answers by a client who is experiencing a memory loss.

DIF: Cognitive Level: Comprehension REF: p. 123 | Table 11.3 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 11. When a caregiver becomes a role model for a client during a therapeutic relationship, the caregiver is functioning in the role of a: a. teacher. b. therapist. c. technician. d. change agent.

ANS: D Serving as a role model is one of the many functions of a change agent. The role of a change agent also includes promoting a climate of anticipation of positive change for the client and serving as a socializing agent. The other options are roles of the caregiver, but role model is not included in those roles.

DIF: Cognitive Level: Comprehension REF: p. 123 OBJ: 7 TOP: Roles of the Care Giver KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. A male client is being discharged from a mental health facility and is worried about what to tell his friends and coworkers regarding his time away. The nurse helps the client plan what to say to others about his disease. The nurse is functioning in the role of: a. change agent. b. teacher. c. therapist. d. technician.

ANS: B This is an example of a teaching opportunity that the nurse is involved in during a therapeutic relationship. Other teaching opportunities include teaching the client how to cope with stressors, early signs of relapse, and effects of medications and providing public education regarding mental illness. The other options do not incorporate the teaching role as a function.

DIF: Cognitive Level: Comprehension REF: p. 123 OBJ: 7 TOP: Roles of the Care Giver KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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13. A female client is admitted with suicidal tendencies. The client is placed in suicide precautions for the first 24 hours of her stay. Ensuring client safety is included in the therapeutic role of: a. change agent. b. teacher. c. therapist. d. technician.

ANS: D In addition to ensuring safety, the role of technician includes medication management, management of medical problems in the mental health environment, and management of environmental factors. These responsibilities are not a function of the other roles.

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: 7 TOP: Roles of the Care Giver KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 14. The nurse who is caring for a client begins to have very protective feelings toward the client that are interfering with the therapeutic relationship between the nurse, the client, and the client’s family. This is an example of a problem that is encountered in some therapeutic relationships and is known as: a. an environmental problem. b. resistance. c. transference. d. countertransference.

ANS: D Countertransference, the inappropriate emotional response of a caregiver to a client, is occurring in this relationship. Environmental problems refer to items such as privacy and noise levels, resistance is a behavior of the client that demonstrates unwillingness to change or accept the need for change, and transference is the client’s inappropriate feelings or behaviors directed toward the caregiver.

DIF: Cognitive Level: Comprehension REF: p. 125 OBJ: 8 TOP: Problems With Care Providers KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 15. A 19-year-old male client is being treated for a drug addiction. He continually voices his dread of being discharged because he knows he will have to live with his parents and follow their rules until he can earn enough money to live on his own. He is showing increasing resistance to treatment measures, such as attending group sessions, and is refusing to acknowledge that he has an addiction or that he needs treatment. Which behavior is the client demonstrating? a. Transference b. Primary resistance c. Secondary resistance d. Tertiary resistance ANS: C

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This is an example of secondary resistance in view of the fact that the client is displaying behaviors that will prolong his discharge from the facility, in an attempt to avoid his perception of the unpleasant living situation that awaits him upon discharge. Transference is a client’s emotional response, based on earlier relationships, to the care provider. Primary resistance refers to simple avoidance of change or admitting the need for change. Tertiary resistance is not a used term.

DIF: Cognitive Level: Comprehension REF: p. 125 OBJ: 8 TOP: Problems With Clients KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 16. A client response to the termination phase of the therapeutic relationship is withdrawal. This response most often is manifested by client behaviors such as: a. bringing up new problems. b. being absent from appointments. c. returning to maladaptive behavior. d. having increased anxiety.

ANS: B Being absent from appointments is a behavior that is commonly seen when clients are withdrawing from the termination phase of the relationship. It actually is a response that occurs because the client does not want the therapeutic relationship to end. Bringing up new problems refers to the continuation response, and returning to maladaptive behavior and having increased anxiety refer to the regression response.

DIF: Cognitive Level: Comprehension REF: p. 125 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. A 22-year-old woman with depression misses her scheduled meeting with the nurse.

Although they have established a contract to meet on an agreed upon schedule, the nurse understands that the client is still testing the relationship and working on trusting her care provider. This behavior usually manifests itself during which phase of the therapeutic relationship? a. Termination b. Orientation c. Working d. Preparation ANS: B Testing is an important step during the orientation phase in establishing trust in the therapeutic relationship. Although clients may not appear for scheduled appointments, may use profane language, or may resist sharing their feelings, the caregiver must demonstrate a willingness to continue the therapeutic relationship.

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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18. The new nurse confides to his supervisor, “I am feeling frustrated. Mr. J has been doing so well in dealing with his issues over the last month, and today he refused to discuss anything productive in our session.” What is the most appropriate response? a. “You are still in the preparation phase and need to check the medical record for information.” b. “The orientation phase is a time where the client is building trust and testing you.” c. “During the working phase, the client may have growth and resistance.” d. “The termination phase is a difficult one for both nurse and client.”

ANS: C The working phase of the therapeutic relationship has periods of growth accompanied by episodes of resistance. Changing one’s behavior is very hard work. It requires energy and self-disclosure. Clients often feel self-conscious, shameful, and vulnerable during this time.

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: 6 TOP: Phases of the Therapeutic Relationship KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. As the nurse begins to discuss discharge plans for a 45-year-old female client hospitalized for anxiety, the client states, “You never really cared whether I get better! Why not stop this charade?” The nurse recognizes this to be: a. transference. b. secondary gain. c. countertransference. d. insecurity.

ANS: A Transference is a client’s emotional response based on earlier relationships.

The most outstanding characteristic of transference is the inappropriateness of the client’s responses. Secondary gain occurs when clients profit or avoid unpleasant situations by remaining ill. Countertransference is based on a caregiver’s inappropriate response.

DIF: Cognitive Level: Comprehension REF: p. 125 OBJ: 8 TOP: Problems With Clients KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. For which roles are the caregiver responsible in a therapeutic relationship? (Select all that apply.) a. Teacher b. Therapist c. Technician d. Friend e. Change agent f. Confidante ANS: A, B, C, E

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These are the typical roles of the caregiver in mental health services. The caregiver should avoid becoming friends with clients because this can cause strain on the professional relationship. The caregiver also should avoid becoming a confidante of the client because this term usually describes someone whom a person trusts with secret or private matters.

This is not a role that the caregiver can play, given that caregivers have a responsibility to share with other team members information pertinent to the client’s care.

DIF: Cognitive Level: Knowledge REF: p. 123 | p. 124 OBJ: 7 TOP: Roles of the Care Providers KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 2. Which of the following are characteristics of a therapeutic relationship? (Select all that apply.) a. Acceptance b. Rapport c. Problem-solving d. Genuineness e. Therapeutic use of self f. Mutual support ANS: A, B, D, E The focus of the therapeutic relationship is on the client. It is consciously directed as the care provider establishes a connection with the client to help him or her cope with life demands. Acceptance, rapport, genuineness, and therapeutic use of self are the characteristics used to accomplish this. Problem-solving on the part of the care provider does not help the client to cope. Support is provided for the client; it is not mutual.

DIF: Cognitive Level: Knowledge REF: p. 120 OBJ: 4 TOP: Roles of the Care Providers KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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Chapter 12: The Therapeutic Environment Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Crisis stabilization provides care to clients in treatment settings with the purpose of reestablishing homeostasis; it usually lasts for: a. 1 to 2 days. b. 2 to 4 days. c. 4 to 6 days. d. 6 to 8 days.

ANS: A Intensive counseling is given to assist clients with the immediate problem that is causing the crisis. This usually is accomplished within 1 to 2 days, and the client is discharged with follow-up care.

DIF: Cognitive Level: Knowledge REF: p. 129 OBJ: 1 TOP: Crisis Stabilization KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 2. Which is an accepted criterion for inpatient admission to a mental health facility? a. The client likes the security and comfort of the mental health facility. b. The client feels that he is no longer able to cope with life stressors or maintain control of his behavior. c. A client’s behavior becomes unusual. d. The client suffers from depression.

ANS: B This situation meets the criteria for an inpatient admission. Other criteria include being a threat to one’s safety or the safety of others and having people who are a part of the client’s environment who are not willing or able to support him. The other options do not meet the criteria.

DIF: Cognitive Level: Comprehension REF: p. 129 OBJ: 1 TOP: Use of the Inpatient Setting KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 3. A male client with a diagnosis of schizophrenia refuses to take his medication because of his paranoia that the medication may be poisoned. Frequent inpatient readmissions to the facility occur as a result. Which term is given to repeated inpatient admissions? a. Milieu b. Chronicity c. Noncompliance d. Recidivism ANS: D

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Recidivism often occurs as a result of noncompliance with prescribed therapy, as in the case of this client who is not taking his medications. Adequate community resources help to prevent recidivism. Milieu refers to the mental health care environment; chronicity refers to a long duration, such as occurs with a chronic illness like schizophrenia; and noncompliance describes a situation in which the client does not follow the prescribed plan of care, often resulting in recidivism.

DIF: Cognitive Level: Comprehension REF: p. 130 OBJ: 2 TOP: The Chronically Mentally Ill Population KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 4. An adult female inpatient client with a diagnosis of paranoid schizophrenia will not take her medications from the nurse. She states, “I know you are poisoning that medicine.” Which nursing action is most appropriate? a. Promise the client that the staff would not do anything to harm her. b. Let the client watch the medication preparation process. c. Administer medications to the client in unit dose packages so that she can open the packages herself. d. Allow the client to retrieve the medications out of the medication cart with supervision.

ANS: C Administering medications in unit dose packages would help to prevent the client from thinking that the nurse is poisoning the medications. The client would be allowed to open the packages herself. Promising the client that the staff would not harm her will not alleviate her paranoia. Letting the client watch the medication preparation process may help, but if she feels that the poisoning is happening when the nurse is placing the medication in the cup, the client will remain paranoid. Allowing the client to retrieve medications from the medication cart would go against facility policy.

DIF: Cognitive Level: Application REF: p. 131 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 5. A male inpatient client who is experiencing depression has no interest in eating. He skips meals frequently and has been losing weight. What is the best nursing action in this situation? a. Ask the client to “Please eat one meal for me.” b. Leave food with the client at mealtime and offer snacks frequently. c. Give the client information on the benefits of good nutrition. d. Remove client privileges every time the client doesn’t eat.

ANS: B Trying not to make an ordeal out of mealtime and food may allow the client to choose to eat, especially as his condition improves. Asking the client to “please eat one meal for me” is not an appropriate request and does not focus on the need to discover which, if any, medications are effecting a desire to eat as well as how the client’s mood may be affecting the interest in eating. Giving the client information about nutrition is not important to this client; his refusal to eat is not related to good or bad nutrition. Removing client privileges each time the client doesn’t eat goes against the client’s rights.

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DIF: Cognitive Level: Application REF: p. 131 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. Encouragement for clients to practice good hygiene habits not only meets basic physiological needs, but it also meets the hierarchal need of: a. love and belonging. b. safety and security. c. infection control. d. self-care.

ANS: A Good hygiene meets the need for love and belonging by conveying to others a willingness for social interaction. Safety and security needs relate more to the client’s feeling secure in his environment and providing measures to keep clients safe; infection control and self-care are not actually needs, but the concepts fall into the category of physiological needs.

DIF: Cognitive Level: Comprehension REF: p. 131 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 7. With regard to the environment, it is important for the nurse to be aware of lighting for some clients. Clients with a diagnosis of schizophrenia may be bothered by lights that are flickering because this may trigger: a. overstimulation. b. hallucinations. c. aggressive behaviors. d. photophobia.

ANS: B The flickering of a lightbulb can trigger hallucinations and delusions; therefore, it is important for the nurse to monitor the physical environment. Overstimulation, aggressive behaviors, and photophobia usually occur when light is too bright.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 8. A female client on the mental health unit experiences periods of psychosis at intervals. She often asks what day she came to the facility and what day it is now, and she seems never to be aware of the time. Which nursing intervention would help this client the most? a. Remind her of the time of day every time she asks. b. Assist her to keep a written schedule, including her day of admission, on a calendar posted in her room and a clock beside the calendar. c. Tell her it doesn’t really matter what day she came to the facility; what matters is what day and time it is now. d. Instruct the staff to not answer her repetitive questions because she has been told numerous times her day of admission, and there is a clock on the wall.

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ANS: B A written schedule in her room and a clock will assist her in learning to monitor this information on her own, and this will help to keep her oriented and will foster independence. Reminding her of the time will not help the client monitor the time on her own; it allows the ineffective cycle to continue. Telling the client that it doesn’t matter when she entered the facility and instructing the staff not to answer her questions are belittling to the client.

DIF: Cognitive Level: Application REF: p. 130 OBJ: 3 TOP: Safety and Security Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 9. A 15-year-old female client is noted to often sit alone in the activity room of the facility while watching television. She often begins to join in activities on the unit but then retreats back to her room. Which intervention is most appropriate in this situation? a. Encourage her to join in on a group activity and actively participate in the activity with her until she feels more comfortable on her own. b. Keep encouraging her to participate in the group activity. c. Offer her rewards, such as extended television privileges, for joining in a group activity. d. Offer her support as she tries to become more involved in activities.

ANS: A Encouraging the client to join the activity and participating with her will offer her security and will help her to meet others in the group and feel less alone. Love and belonging needs are met by socializing with others. Offering encouragement to participate in the group activity and supporting her as she tries to become more involved are helpful, but these actions do not give her the same sense of security as she receives with encouragement and participation in the group activity until she is comfortable. Offering her rewards defeats the purpose of instilling motivation and the improvement in self-esteem that results from participating according to her own desire.

DIF: Cognitive Level: Application REF: p. 131 OBJ: 6 TOP: Love and Belonging Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. The nurse can assist a client best in meeting his or her needs for self-esteem and/or self-actualization by: a. setting rules and regulations. b. allowing the client to set rules and regulations for the inpatient unit. c. informing the client what the treatment team has decided regarding the plan of care. d. allowing the client to make choices involving his or her care when appropriate.

ANS: D

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Self-esteem needs must be met before self-actualization can occur, but this is also a part of self-actualization. This intervention allows the client to practice decision-making skills and assists in improving his or her self-esteem. Rules and regulations are necessary for limit-setting, but the nurse can include the client and improve his or her self-esteem by informing the client of the rules and regulations, so the client is able to follow them.

Allowing the client to set rules is difficult in that the ability for limit-setting often is lacking in clients with mental health disorders. Sharing with the client should reflect a combined effort between the client and the treatment team.

DIF: Cognitive Level: Application REF: p. 134 OBJ: 3 TOP: Self-Esteem Needs KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. The nurse is aware that during the admission process to a mental health facility, the anxious client: a. is acutely aware of his or her surroundings. b. often forgets some of what is said in the unfamiliar surroundings. c. has a keen memory in his or her heightened state of awareness. d. frequently has no recollection of what is said by the staff during admission.

ANS: B High levels of anxiety can prevent an individual from remembering things that he has been told. It is helpful to limit the amount of information thrust on a client during the early admission process. Written information about rules, regulations, and expectations on the unit is often helpful. The anxious client is not acutely aware of his or her surroundings and does not have a keen memory during this time. Having no recollection of what the staff has said is an extreme reaction.

DIF: Cognitive Level: Comprehension REF: p. 135 OBJ: 7 TOP: Admission and Discharge KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 12. Bright colors in the environment of the client are often: a. depressing. b. stimulating. c. calming. d. frightening.

ANS: B Colors are important to consider, depending on the needs of the client. Bright colors can be stimulating to clients. Mental health settings often have warm, more neutral colors because these colors promote calm emotions and behavior. Dark colors are considered more depressing. Color usually is not associated with eliciting fright.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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13. The nurse should monitor the temperature of the environment of a client who becomes easily agitated, with awareness that increased temperatures sometimes may cause the client to become: a. calm. b. confused. c. cooperative. d. more distressed.

ANS: D Increased environmental temperatures often cause easily agitated clients to become more agitated. It is important for the nurse to monitor a client’s individual response to his or her environment.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 3 TOP: Physiological Needs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. A male client is in the process of being admitted to a mental health facility. He is sure that the nurse is the administrator of the hospital, despite the nurse’s insistence that he is a staff nurse on the unit. This client is experiencing: a. acute confusion. b. visual hallucinations. c. delusions. d. auditory hallucinations.

ANS: C Delusions are thoughts or beliefs that cannot be changed by rational explanations. Acute confusion is seen as disorientation to person, place, time, or purpose. A visual hallucination involves seeing something that is not there, and an auditory hallucination is hearing something that is not present.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: N/A TOP: Admission and Discharge KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. When establishing a client’s level of consciousness, the nurse is aware that this is determined by assessing the client’s: a. level of awareness. b. ability to tell the nurse where he or she is at any given time. c. accuracy in expressing the current month, date, or year. d. capability to explain why he or she is in the facility.

ANS: A Level of awareness determines the client’s level of consciousness. The other options refer to other aspects of the client’s level of orientation.

DIF: Cognitive Level: Comprehension REF: p. 136 | Box 12.3 OBJ: N/A TOP: Admission and Discharge KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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16. A 16-year-old client is in the lounge with other clients on the inpatient unit when he suddenly becomes agitated. Which action by the nurse would be most appropriate in this situation? a. Turn up the volume on the television to distract the client. b. Bring him to sit at the nurses’ station while the staff is doing shift report. c. Keep him in the lounge and attempt to converse with him. d. Accompany him to a room where soft music is playing.

ANS: D High noise levels can lead to distorted perceptions, altered thinking, and sensory overload.

Calm music, the sound of ocean waves, or a light rain can produce relaxation. When noise levels become too intense, clients tend to become distracted and agitated. Turning up the volume on the television, bringing the client to a crowded nurses’ station, and keeping the client in the lounge do not decrease noise levels and may increase the client’s agitation.

DIF: Cognitive Level: Comprehension REF: p. 132 OBJ: 4 TOP: Therapeutic Environment and Client Needs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. The goal in treating a client with a chronic mental illness is to prevent recidivism. Which factor is crucial in this effort? a. Increased use of psychotherapeutic medications b. Increased lengths of stay on the inpatient unit c. Increased commitment to the plan of care by the client d. Group residential homes with vocational training ANS: D One of the most important factors in preventing recidivism is adequate community resources where clients receive support and educational and vocational opportunities. With the focus on the “least restrictive environment,” many chronically mentally ill clients now live in small, homelike, sheltered group settings within the community.

DIF: Cognitive Level: Comprehension REF: p. 130 OBJ: 2 TOP: The Chronically Mentally Ill Population KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. The use of therapeutic touch as a relaxation technique in the mental health setting is beneficial for clients displaying which symptoms? a. Aggression b. Paranoia c. Depression d. Anxiety ANS: C People with suspicious feelings usually feel more comfortable when caregivers are outside their intimate space. Depressed persons may need touch and physical contact—an excellent opportunity for therapeutic touch. Aggressive clients may interpret the close presence of a caregiver as threatening. Touch must be used cautiously as a therapeutic tool and with the client’s best interest in mind.

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DIF: Cognitive Level: Comprehension REF: p. 133 OBJ: 4 TOP: Safety and Security Needs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. A 22-year-old woman is brought to the inpatient unit for attempting suicide. Her clothes are clean and her general appearance is neat and well groomed. She appears to be well nourished. In considering Maslow’s hierarchy of needs, which is a priority for this client? a. Physiologic b. Love and belonging c. Self-actualization d. Safety and security ANS: D The safety and security of the therapeutic environment is one of the most important factors in mental health care. Safety and security needs within the therapeutic environment include the feeling of physical safety, the security of a limited setting, and the ability to feel secure with others. For clients who are depressed or suicidal, the therapeutic environment offers special protection from self-harm and with the client’s best interest in mind.

DIF: Cognitive Level: Comprehension REF: p. 133 OBJ: 4 TOP: Safety and Security Needs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Inpatient services provide care mainly for mental health clients who are experiencing which conditions? (Select all that apply.) a. Acute mental or emotional problems b. Chronic mental or emotional problems c. Depression d. Crisis e. Bipolar disorder ANS: A, B, D Inpatient services provide intensive therapy and support for clients with acute and chronic mental health disorders as well as those in crisis situations, and they usually require short stays. The goal is to transition the client from the facility to the community. Depression and bipolar disorder are specific disorders that are not necessarily seen more frequently than other disorders within an inpatient setting.

DIF: Cognitive Level: Comprehension REF: p. 129 OBJ: 2 TOP: Use of the Inpatient Setting KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 2. Which are common causes for client noncompliance in the plan of care? (Select all that apply.) a. Financial concerns b. Lack of support by family c. Staff dislike of a client

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d. Inability to understand the treatment plan e. Lack of access to treatment services ANS: A, B, D, E Financial concerns, lack of family support, and lack of access to treatment often make the client feel that he or she is unable to continue in the planned treatment. The social worker is the best person to contact in these instances because he or she is aware of programs that may meet needs in these problem areas. Education and involvement of other caregivers will assist the client in eliminating the problem of inability to understand the treatment plan.

Staff dislike of a patient should never be a reason for client noncompliance.

DIF: Cognitive Level: Comprehension REF: p. 136 TOP: Compliance KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

OBJ: 8

3. Admission to an inpatient mental health unit is often a stressful event. Which actions on the part of the health care provider will help to decrease the anxiety of the client? (Select all that apply.) a. Conduct the admission interview with a team of health care providers. b. Answer any questions the client may have. c. Support the client in being oriented to the unit. d. Provide simple, clear instructions and repeat if needed. e. Communicate concern for the client.

ANS: B, C, D, E People with high anxiety levels seldom remember what was said, especially when they are in an unfamiliar setting. Therefore, approach clients in a calm and respectful manner. Give simple but clear explanations, and repeat them as necessary. Provide simple written instructions that allow clients to read about the rules after their anxiety decreases. Answer any questions the client may have. Make sure that the client is more important than the admission form you must complete. Take the time to behaviorally communicate that you are concerned for his or her welfare. Make efforts to support the client in becoming familiar with the therapeutic environment. Having one person perform the initial admission interview prevents confusion and added stress for the client.

DIF: Cognitive Level: Comprehension REF: p. 129 TOP: Compliance KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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OBJ: 8

Chapter 13: Problems of Childhood Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Social and emotional development occurs at a more simple level in the child who is: a. 5 years old. b. 8 years old. c. 10 years old. d. 12 years old.

ANS: A A child’s reasoning is simple and uncomplicated until the nervous system completely develops; therefore, the younger child’s social and emotional development moves from simple to complex with age.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 1 TOP: Normal Childhood Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. A couple comes to the sleep disorder clinic because their 3-year-old daughter has problems falling asleep every night. The parents say that it takes their daughter 1 to 2 hours each night to fall asleep, and one of the parents ends up having to lie down with her. Which intervention should the nurse first suggest? a. The parents should alternate responsibility each night for seeing the daughter to bed. b. The daughter could start falling asleep in the parents’ bed and then could move to her own bed. c. Place the child in bed at the same time each night, and don’t allow her to get out of bed. d. Follow a bedtime ritual each night, such as reading one book.

ANS: D One of the first steps in dealing with problems with sleep is following a bedtime ritual each night so as to establish a restful sleep pattern. Additional interventions include limiting watching television. The other options do not establish a restful bedtime ritual that will encourage sleep.

DIF: Cognitive Level: Application REF: p. 141 OBJ: 1 TOP: Common Behavioral Problems of Childhood KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 3. The parents of a 2-year-old boy seek assistance at a family therapy clinic because their son throws a temper tantrum every time he is not allowed to throw his food on the floor during meals. Which therapeutic intervention does the nurse suggest? a. Leave him during the tantrum, so that he feels isolated from others as a result of his behavior. b. Try to distract him when he becomes frustrated, and reward him for positive behavior.

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c. Hold the child down until the tantrum stops. d. Put him in the corner for punishment while he is having the tantrum.

ANS: B Distracting the child may lessen his frustration and prevent the tantrum from occurring, and rewarding positive behavior encourages future positive behavior. Leaving him may frighten him and/or he could hurt himself during the tantrum. Holding the child down will increase his frustration, and putting him in the corner is not effective during a tantrum because his behavior is out of control, so he won’t understand the importance of the punishment.

DIF: Cognitive Level: Application REF: p. 142 | Box 13.2 OBJ: 1 TOP: Common Behavioral Problems of Childhood KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 4. Poverty influences the growth and development of children and is often a precursor to mental health disorders in children. Nearly of children in the United States come from families that live at the poverty level. a. 10% b. 20% c. 30% d. 40% ANS: B Children who live in poverty score lower on IQ tests and exhibit higher rates of anxiety, unhappiness, and fearfulness than do children who are not living in poverty.

DIF: Cognitive Level: Knowledge REF: p. 143 OBJ: 2 TOP: Environmental Problems KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. During the interview process with a homeless client, which is an appropriate nursing action? a. Wait until later in the interview to ask questions such as address or nearest relative. b. Ask the client early in the interview what is his or her highest education level. c. Ask the client where he or she planned to sleep that night. d. Encourage the client to bathe as soon as possible.

ANS: A Asking these questions later in the interview will allow for some development of rapport and trust, so the client will more freely discuss these topics. In addition, the client may be ashamed to admit to not having an address. Asking the client about his or her highest level of education early in the conversation would make the client feel inadequate and would prevent the establishment of good rapport with the client. Asking the client about a sleeping location would occur during discharge planning, and encouraging immediate bathing would belittle the client.

DIF: Cognitive Level: Application REF: p. 144 | Box 13.4 OBJ: 2 TOP: Homelessness KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. Adult disorders such as chronic anxiety and depression often are associated with childhood:

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a. b. c. d.

illnesses. fears. education. abuse.

ANS: D Abuse experienced as a child often is assessed in adults with physical, behavioral, and emotional disorders. Illnesses, fears, and education are not typical causes of adult depression and chronic anxiety.

DIF: Cognitive Level: Knowledge REF: p. 144 OBJ: 2 TOP: Abuse and Neglect KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 7. For children older than 4 years, separation anxiety should last for no longer than: a. a few days. b. a few weeks. c. a few months. d. 1 year.

ANS: B If separation anxiety (a child’s fear of being apart from his parents) lasts longer than a few weeks, it is likely that there is a problem, and treatment should be sought. High levels of anxiety in children sometimes result in obsessive-compulsive behaviors.

DIF: Cognitive Level: Knowledge REF: p. 145 TOP: Anxiety KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 3

8. The parents of a 9-year-old girl with intellectual disability voice concerns to the nurse regarding their child’s eating insects and leaves. The parents report that this behavior has been occurring for almost 4 months. From what is this child most likely suffering? a. Pica b. Rumination disorder c. Enuresis d. Encopresis ANS: A Pica is an eating disorder that is most commonly seen in children with intellectual disability, pervasive developmental disorders, such as autism, or severe vitamin or mineral deficiencies. Treatment is aimed at keeping the child away from the items consumed and/or replacing the consumed item with a healthy food product. Rumination disorder describes a disorder in infants in which regurgitation and rechewing of the food occur. Enuresis is bed-wetting, and encopresis is repeated defecation in inappropriate places.

DIF: Cognitive Level: Comprehension REF: p. 149 OBJ: 1 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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9. As the caregiver for a male client whose intellectual disability level is classified at a moderate level, the nurse’s most appropriate action is to: a. encourage him to work in a supervised setting at a fast food restaurant. b. persuade him to look for an apartment in which he can live on his own. c. find a group home that he would adjust well to. d. seek placement for him in a long-term setting for clients with cognitive disabilities.

ANS: A A client at a moderate level of intellectual disability has good communication skills, functions academically at a second grade level, benefits from vocational training by becoming employed in supervised settings, and is successful in living in the community with supervision. Living in an apartment alone applies to a client with intellectual disability; living in a group home applies to a client with severe intellectual disability; and placement in a long-term setting for clients with cognitive disabilities applies to a client with profound intellectual disability.

DIF: Cognitive Level: Application REF: p. 150 | Table 13.6 OBJ: 6 TOP: Intellectual Disability KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. A 12-year-old female client with a normal IQ has difficulty with math at school. She performs well in all subjects except math, for which she is unable to earn above a grade of “D,” no matter how much she studies. What is this client most likely suffering from? a. Intellectual disability b. A learning disorder c. Pervasive developmental disorder d. An anxiety disorder ANS: B Because this client performs well in all other areas and has a normal IQ, she most likely has a learning disorder. Learning disorders typically affect a child’s thinking, reading, writing, calculating, spelling, or listening abilities. The client does not have intellectual disability because her IQ is normal; pervasive developmental disorder indicates difficulties with social interactions and communication skills; and an anxiety disorder refers to a vague feeling of uneasiness that persists.

DIF: Cognitive Level: Application REF: p. 150 OBJ: 7 TOP: Learning Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The parents of a 3-year-old boy are concerned because their son seems to speak very slowly and has an odd rhythm to his speech pattern. What is this child most likely experiencing? a. Reading disorder b. Phonological disorder c. Stuttering disorder d. Expressive language disorder ANS: D

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An expressive language disorder is a disorder of communication that is of concern if the problem persists or interferes with the child’s daily activities or ability to learn and function at the expected academic level. A reading disorder most likely would be difficult to determine at this age; a phonological disorder refers to an inability to use sounds and speech as expected at a given age; and a stuttering disorder refers to frequent repetition of sounds or portions of words.

DIF: Cognitive Level: Application REF: p. 150 OBJ: 1 TOP: Communication Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. A 7-year-old male client displays behaviors such as an inability to make eye contact with others, inappropriate facial expressions, difficulty in making friends, and showing little emotion with family members. He talks with adults but is awkward in his conversation.

Given these behaviors, what is this client most likely experiencing? a. Childhood disintegrative disorder b. Asperger’s syndrome c. Dyslexia d. Rett syndrome ANS: B These classic behaviors are associated specifically with Asperger’s syndrome. Childhood disintegrative disorder describes a condition in which the child regresses in various areas after 2 years of normal development. Dyslexia is a learning disorder in which individuals have difficulty integrating visual information. Rett syndrome refers to problems with motor, language, and social development between the ages of 5 months and 4 years.

DIF: Cognitive Level: Application REF: p. 151 OBJ: 8 TOP: Pervasive Developmental Disorders KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 13. The Denver II is a tool that is used for assessment of early childhood development. What is this tool used to assess? a. Temperament b. Maturation c. Gross and fine motor skills d. Speech development ANS: C In addition to motor skill assessment, the Denver II assesses language and social skills.

Temperament is assessed with several tools, such as the Toddler Developmental Scale and the Middle Childhood Questionnaire; maturation is assessed with the Preschool Readiness Screening Scale tool; and speech development is assessed with the Early Language Milestone Scale.

DIF: Cognitive Level: Knowledge REF: p. 153 | Table 13.8 OBJ: 9 TOP: Therapeutic Actions—Provide Opportunities KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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14. The emotional developmental task of industry vs. inferiority that occurs in childhood is characteristic of which age-group? a. Infancy: birth to 1 year old b. Early childhood: 1 to 3 years old c. Preschool age: 3 to 6 years old d. School age: 6 to 12 years old ANS: D Industry vs. inferiority is the developmental task of school-age children. The developmental task of infancy is trust vs. mistrust; of early childhood is autonomy vs. shame and doubt; and of preschool-age children is initiative vs. guilt.

DIF: Cognitive Level: Knowledge REF: p. 141 | Table 13.2 OBJ: 1 TOP: Normal Childhood Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance 15. Breath-holding spells typically occur when a child becomes extremely frustrated, cries, and either intentionally or unintentionally holds his or her breath. This rarely occurs in children younger than the age of . a. 6 months b. 12 months c. 18 months d. 24 months ANS: A Breath holding usually does not occur prior to this age, but it can occur until approximately 5 years of age. Breath holding resolves itself in 30 to 60 seconds. After the first incident, the child should be examined by a physician, but if no problems are identified, the best intervention for future incidents is ignoring the behavior.

DIF: Cognitive Level: Knowledge REF: p. 141 TOP: Common Behavioral Problems of Childhood KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

OBJ: 1

16. A mother of a 9 year old is concerned because her child complains of frequent stomach aches in the morning before leaving for school. No medical reason has been found for this condition. The family has recently moved to the area after the woman and her husband divorced, and the child is attending a new school. What is the most appropriate response the nurse can give to this mother? a. Ignore the child’s complaints and send the child to school. b. Allow the child to stay home from school when this occurs. c. Provide support and reassurance to the child as the child adjusts. d. Take away computer privileges to stop this behavior.

ANS: C

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A somatoform disorder is one in which the child (or adult) has the signs or symptoms of illness without a traceable physical cause. Somatic symptoms are common in school-age children. They are thought to be expressions of stress, anxiety, or underlying conflict. It is important to remember that children with somatoform disorders need understanding and reassurance rather than punishment or concessions. The child should not be ignored.

DIF: Cognitive Level: Knowledge REF: p. 145 OBJ: 3 TOP: Common Behavioral Problems of Childhood KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 17. The school nurse meets with the parents of a 7-year-old child who frequently shows a lack of respect for his teacher and the rules of the classroom. His parents report that he fights with his siblings and has tried to run away from home when they have attempted to take away privileges. Based on this assessment, what does the nurse understand about his future? a. He is experiencing a normal developmental task and will grow out of it. b. His prognosis for recovery will be good if he is not punished. c. Due to his age, his future prognosis is poor. d. He should be allowed to set his own limits.

ANS: C The long-term outlook for children with conduct disorders is poor if the problems are present before the child is 10 years old. This behavior is not typical, and relaxing rules and discipline will not aid in his recovery.

DIF: Cognitive Level: Knowledge REF: p. 148 OBJ: 5 TOP: Disruptive Behavioral Disorder KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 18. Due to the proximal to distal physical development of the child, which of the following motor skills is able to be accomplished by the toddler? a. Tying shoes b. Buttoning a shirt c. Eating finger foods d. Cutting food with a fork and knife ANS: C Eating finger foods is a gross motor skill. Tying shoes, buttoning shirts, and cutting with a knife require fine motor development.

DIF: Cognitive Level: Knowledge REF: p. 140 OBJ: 1 TOP: Normal Childhood Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance 19. The parents of a 5 year old are concerned because he has recently starting wetting himself during the day while at school. They inform their pediatrician about this when they bring their newborn daughter in for her first immunizations. After ruling out any physical cause, the pediatrician informs the parents that this is due to: a. primary nocturnal enuresis. b. secondary enuresis. c. encopresis.

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d. disobedience.

ANS: B Secondary enuresis develops when a bladder-trained child becomes incontinent. Usually it follows a stressful event, such as the birth of a sibling or a divorce.

DIF: Cognitive Level: Knowledge REF: p. 149 OBJ: 4 TOP: Normal Childhood Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The parents of a 9-year-old boy have been told by the child’s teacher that he exhibits symptoms of attention-deficit/hyperactivity disorder (ADHD). Which specific behaviors may the child exhibit for this diagnosis to be made? (Select all that apply.) a. Frequently interrupts or intrudes on others. b. Is easily distracted by outside stimuli. c. Has feelings of restlessness or frequently fidgets with hands and/or feet. d. Exhibits an excellent short-term memory. e. Often leaves tasks incomplete.

ANS: A, B, C, E These are a few of the behaviors displayed in children with ADHD. Symptoms of ADHD include 14 possible behaviors. For a diagnosis to be made, the client must exhibit at least eight of these behaviors for at least 6 months. An excellent short-term memory is the opposite of what is seen in clients with ADHD. DIF: Cognitive Level: Comprehension REF: p. 147 OBJ: 4 TOP: Attention-Deficit/Hyperactivity Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Before the diagnosis of intellectual disability can be made, which factors must be present?

(Select all that apply.) a. IQ of 70 to 100 b. Inability to communicate effectively c. Poor adaptation to social situations d. IQ less than 70 e. Inability to care for self-appropriate to age f. Maladaptive coping skills ANS: B, C, D, E, F The criteria for the diagnosis of intellectual disability include an IQ below 70 and the child’s adaptive functioning level. How well the child copes with everyday life situations is the most accurate indicator of intellectual disability.

DIF: Cognitive Level: Comprehension REF: p. 149 OBJ: 6 TOP: Intellectual Disability KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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3. A fifth grade teacher is concerned that one of his students is at risk for violent behavior.

Which signs will the school nurse advise him to be aware of? (Select all that apply.) a. Enjoys contact sports. b. Engages in risk-taking behaviors. c. Has frequent angry outbursts. d. Threatens classmates. e. Isolates self from others. f. Damages school property.

ANS: B, C, D, F Risk-taking behaviors, frequent loss of temper, announcing threats, and vandalizing or damaging property are all warning signs of violence. Engaging in contact sports is a normal activity for school-age children. Isolation from others is more indicative of depression.

DIF: Cognitive Level: Comprehension REF: p. 146 OBJ: 5 TOP: Warning Signs of Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 14: Problems of Adolescence Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The child in early adolescence experiences developmental issues with his or her identity as evidenced by: a. feeling stable with his or her self-esteem. b. conforming to group norms. c. being very self-centered. d. being idealistic.

ANS: B Acceptance and rejection of peers are very important to this age-group, so conforming to norms is frequently seen. Feeling stable with one’s self-esteem refers to late adolescence (17–20 years old), and being self-centered and idealistic applies to middle adolescence (14–17 years old).

DIF: Cognitive Level: Comprehension REF: p. 157 | Table 14.1 OBJ: 1 TOP: Psychosocial Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Internal developmental problems are seen as a causative factor for some behavioral and family problems during adolescence. Psychological developmental issues that can lead to problems during late adolescence (17–20 years old) include: a. wide mood swings. b. tendency to withdraw when upset. c. intense daydreaming. d. concealing of anger.

ANS: D Even though adolescents in this age-group experience few mood swings, they tend to conceal their anger to a greater extent than do adolescents from other developmental periods. Wide mood swings are typical of the early adolescent period (11–14 years old), and the tendency to withdraw when upset and intense daydreaming refer to middle adolescence (14–17 years old).

DIF: Cognitive Level: Comprehension REF: p. 158 | Table 14.1 OBJ: 1 TOP: Psychosocial Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A male adolescent client tells the nurse that he is almoasbtirpbo.csoim tiv/teestht at he is homosexual. This realization most likely has occurred during the developmental period of: a. late childhood. b. early adolescence. c. middle adolescence. d. late adolescence.

ANS: C

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Usually by the age of 14 to 17 years, most adolescents have discovered their sexual preference.

DIF: Cognitive Level: Comprehension REF: p. 158 | Table 14.1 OBJ: 1 TOP: Psychosocial Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. Environmental problems often lead to mental health problems among adolescents.

Approximately million children and adolescents must cope with the issue of having a parent in jail or on parole. a. 3 b. 7 c. 11 d. 14 ANS: B These adolescents have to deal with the many issues associated with having a parent in this circumstance while maintaining the energy necessary to focus on the typical growth and development issues that adolescents experience.

DIF: Cognitive Level: Knowledge REF: p. 158 TOP: External (Environmental) Problems KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

OBJ: 1

5. The nurse is working with a 15-year-old girl and her parents on a treatment plan for her diagnosis of attention-deficit/hyperactivity disorder (ADHD). The nurse should be sure to: a. encourage the parents to seek teachers for their daughter who are going to be lenient with assignment schedules because of her diagnosis. b. remind the parents to determine ahead of time consequences/punishment that they will give their daughter when she is not listening to them and/or teachers. c. teach the parents how to structure and enforce limits on their daughter’s behavior that are appropriate to her condition. d. inform the client and her parents that medications typically used for ADHD are very safe and have few side effects.

ANS: C Consistent limit-setting is helpful to teens with ADHD because it is difficult for them to set limits for themselves. Encouraging lenient teachers violates this principle. The parents should seek teachers who are understanding of their daughter’s condition but remain consistent in setting limits in their course. Positive reinforcement for appropriate behavior is more effective than punishment, and many medications for ADHD react with other medications and sometimes have serious side effects.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 3 TOP: Behavioral Disorders KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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6. The nurse is working with a teen in whom conduct disorder was diagnosed and his family on developing a plan of care for treatment. What is the nurse’s first intervention? a. Assessing and/or stabilizing the home environment b. Teaching effective communication skills to the client and family members c. Advocating behavior modification for the client to gain self-control d. Teaching effective discipline techniques ANS: A After the home environment has been assessed and stabilized, the other interventions can be implemented in the order necessary according to priority of need.

DIF: Cognitive Level: Application REF: p. 161 OBJ: 3 TOP: Behavioral Disorders KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 7. In a research study of eating disorders, it was found that the most frequent weight loss method used by female high school students was: a. exercising. b. skipping meals. c. using diet pills. d. vomiting.

ANS: B Forty-nine percent of high school females in this study used skipping meals as a weight loss method, followed by exercising, using diet pills, and vomiting.

DIF: Cognitive Level: Knowledge REF: p. 162 OBJ: 5 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. A 15-year-old girl is being admitted to an inpatient mental health clinic with the diagnosis of anorexia nervosa. The nurse knows that the most common personality characteristic of teens affected with this disorder is: a. excessive cooperation. b. underachievement. c. normal body weight. d. positive self-esteem.

ANS: A Characteristics of the personality of female teens with anorexia nervosa include being excessively cooperative and achievement oriented and having a body image of being overweight. Underachievement and positive self-esteem are opposite traits to those seen in a teen with anorexia nervosa, and normal body weight may characterize a teen with a healthy self-concept, or it may be a characteristic of bulimia.

DIF: Cognitive Level: Knowledge REF: p. 163 OBJ: 5 TOP: Eating Disorders KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

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9. When one is developing the care plan for a female adolescent with an eating disorder, the primary issue to consider as the underlying cause is: a. control. b. body image. c. self-esteem. d. coping skills.

ANS: A Although any of the issues listed in these options can be an underlying cause, control is the primary issue with an eating disorder. The client often feels that this is the only thing in her life over which she has complete control.

DIF: Cognitive Level: Comprehension REF: p. 164 TOP: Eating Disorders KEY: Nursing Process Step: Nursing Diagnosis MSC: Client Needs: Psychosocial Integrity

OBJ: 5

10. One of the major goals of therapy for adolescents with chemical dependency is: a. replacing the use of the chemical with effective coping skills. b. placing the chemically dependent adolescent in a residential treatment program. c. finding a group home setting to which the adolescent will be able to adjust. d. isolating the adolescent from family and friends during withdrawal from the chemical.

ANS: A This is the overall goal of therapy, so the adolescent will not feel the need to depend on the chemical for coping with stressors. A residential treatment program or a group home setting may be a necessary intervention in some cases, but it is not a goal of therapy. Isolation during withdrawal is not necessary.

DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 6 TOP: Chemical Dependency KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 11. Personality disorders in the adolescent are characterized by: a. onset usually in middle childhood. b. impulsivity. c. flexibility. d. high self-esteem.

ANS: B Behavior is typically impulsive, leading to poor decision-making skills. Onset of personality disorder usually occurs in adolescence or early adulthood. These individuals tend to be inflexible when dealing with others, and their self-esteem is generally low.

DIF: Cognitive Level: Knowledge REF: p. 164 OBJ: 1 TOP: Personality Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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12. The parents of a 13-year-old girl are concerned that their daughter has a gender identity disorder. Which sign or symptom most indicates that their concern is correct? a. Their daughter is playing sports typically considered boys’ sports. b. Their daughter has more male friends than female friends. c. Their daughter does not like to change her clothes in front of anyone. d. Their daughter frequently wears clothes designed for males.

ANS: D This behavior is more indicative of gender identity disorder than the other options. This behavior fulfills the need for this girl to identify with the male gender. Playing sports typically considered boys’ sports and having more male friends are not considered behaviors of gender identity disorders unless other characteristic behaviors of the disorder occur. Not wanting to change clothes in front of anyone is a common behavior that reflects a 13 year old’s need for privacy.

DIF: Cognitive Level: Application REF: p. 165 OBJ: 1 TOP: Sexual Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. Signs and symptoms of schizophrenia often are first seen in: a. early childhood. b. adolescence. c. early adulthood. d. middle adulthood.

ANS: B The onset of schizophrenia usually occurs during adolescence. The individual usually has had a normal childhood but then begins to display behaviors associated with loss of contact with reality, such as hallucinations, delusions, and paranoid feelings.

DIF: Cognitive Level: Knowledge REF: p. 165 TOP: Psychosis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. The rate of attempted suicide in adolescents is with males. a. 3 b. 6 c. 9 d. 12

OBJ: 1

times higher with females than

ANS: A Although the rate of attempted suicide is three times higher among females, males are more successful in committing suicide because of the more lethal methods that they choose to use.

DIF: Cognitive Level: Knowledge REF: p. 166 TOP: Suicide KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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OBJ: 7

15. A teenage girl’s boyfriend of 1 year ended their relationship and began to date someone else, resulting in the girl’s attempting suicide by taking an overdose of her mother’s sleeping medication. What is the most likely cause of this girl’s suicide attempt? a. Depression b. Serious mental illness c. The need to influence others d. An anxiety disorder ANS: C This is an example of her need to influence others by getting back at the boyfriend.

Depression and serious mental illness are other reasons frequently noted as causative factors when adolescents attempt suicide. An anxiety disorder is not typically a causative factor.

DIF: Cognitive Level: Analysis REF: p. 166 TOP: Suicide KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

OBJ: 7

16. By the ages of 14 to 17, teens are able to demonstrate problem-solving skills using concepts, generalizations, and being flexible in planning actions and goals. What is this an example of? a. Concrete operations b. Pre-operational thinking c. Operational thinking d. Abstract thinking ANS: D By the middle teens (14–17), abstract thinking (adaptable, flexible thinking that uses concepts, generalizations, and problem-solving) is well entrenched, along with a feeling of power and self-centeredness. Many believe that they can change the world by just thinking about it. At about 17, teens’ abstract thinking becomes more realistic and they become able to plan reachable actions, goals, and careers.

DIF: Cognitive Level: Analysis REF: p. 156 OBJ: 1 TOP: Psychosocial Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 17. A 15-year-old female started going to parties earlier in the year where drinking and drug use occurred. Her friends now notice that she actively looks for a party every weekend and attends even when her friends are not invited. If they suggest an alternate activity, she refuses to go with them, and she is avoiding them at school. What stage of chemical dependency is she exhibiting? a. Burnout b. Actively seeking c. Experimentation d. Preoccupation ANS: B

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In the actively seeking stage, the teen looks forward to and actively seeks out the mood changes brought about by the chemicals; the teen becomes expert in the use of chemicals to regulate moods; schoolwork and relationships with family erode; and friends become limited to other teens who “use.”

DIF: Cognitive Level: Analysis REF: p. 164 | Box 14.4 OBJ: 6 TOP: Stages of Chemical Dependency KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following are common signs and symptoms of the eating disorder bulimia?

(Select all that apply.) a. Intake of less than 1000 calories per day b. Purging after meals c. Body weight greater than 20% under normal d. Consumption of 5000 to 20,000 calories per day e. Erosion of tooth enamel ANS: B, D, E Purging commonly occurs after bingeing, and this causes erosion of tooth enamel. Intake of less than 1000 calories per day and body weight at least 20% less than normal are typical of anorexia nervosa. Body weight is often kept normal or within 20% of normal with bulimia.

DIF: Cognitive Level: Knowledge REF: p. 163 OBJ: 5 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Social development and forming an identity are important tasks for the adolescent. Which of the following is true regarding the function of a peer group? (Select all that apply.) a. Provides stability during change. b. Helps loosen ties to family. c. Serves as standard for dress and behavior. d. Helps to define future roles. e. Learns to doubt self-made choices.

ANS: A, B, C, D Peer groups help to loosen family ties, provide stability during times of change, and help adolescents define present and future social roles, learn to trust their own choices, and establish behavioral and dress standards.

DIF: Cognitive Level: Knowledge REF: p. 156 OBJ: 1 TOP: Functions of Peer Groups KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 15: Problems of Adulthood Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The nurse is caring for an adult male client who lacks a strong sense of personal identity.

With which area of development will this client most likely struggle the most? a. Social b. Intellectual c. Emotional d. Vocational ANS: A If an individual has little or no sense of identity, it is difficult to establish relationships with others. Lack of personal identity will not affect the other areas of development as strongly as it does social development. Vocation is not one of the areas of development; choosing a vocation or career is a core task of young adulthood.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 2 TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 2.

is a major challenge for adults because energies are not concentrated on the self, and the demands can create feelings of anxiety, isolation, inadequacy, and helplessness. a. Adulthood b. Adolescence c. Childhood d. Parenting ANS: D Most of a parent’s energy is focused on the child or children every minute of every day. The responsibility is immense and can cause various emotions, especially if the parent works outside the home. Adulthood, adolescence, and childhood do not have a primary focus on others as parenting does.

DIF: Cognitive Level: Comprehension REF: p. 171 OBJ: 3 TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

3. An adult male client is admitted to a mental health facility with the diagnosis of depression following the breakup of a long-term engagement. He states that he couldn’t “commit to marriage.” In conducting his admission assessment, the nurse learns that during his childhood he did not feel guided, nurtured, or accepted by his parents. One of the goals for this client is to help him develop a positive personal identity. Which intervention should the nurse implement to meet this goal? a. Improve his strength in the ability to adapt to new situations. b. Develop the ability to establish and maintain an intimate relationship. c. Discern his feelings about relationship choices and level of commitment. d. Outline his life’s dream.

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ANS: C Discerning his feelings about relationship choices and commitment best meets the needs of this client at this time in his life. Improving his ability to adapt and developing his ability to establish and maintain an intimate relationship are not indicated in the scenario as an issue.

Outlining his life’s dream assists in building a positive personal identity but is too broad a task for this client at this time.

DIF: Cognitive Level: Analysis REF: p. 173 OBJ: 4 TOP: Personal Identity KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. The term “sandwich generation” best describes adults: a. caught between adulthood and late adulthood. b. caring for their children and aging parents. c. caring for their children and grandchildren. d. caught between young adulthood and adulthood.

ANS: B This generation can be a problem for many adults in that they face multiple responsibilities, resulting in increased levels of stress.

DIF: Cognitive Level: Knowledge REF: p. 173 TOP: Internal (Developmental) Problems KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. An increasing number of States. a. married couples b. single women c. single men d. relatives

OBJ: 5

are the head of the household of families in the United

ANS: B In single family households, the single parent must function as father, mother, and provider.

The joys of children can be overshadowed by the work and stress of providing for them.

Without support and intervention, adults in these families have a high potential for developing several mental health problems.

DIF: Cognitive Level: Knowledge REF: p. 174 OBJ: 5 TOP: Guiding the Next Generation KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. The nurse is caring for a client who is a single mother of two young children, has no financial or parental support from her ex-husband, is troubled by her financial circumstances and future, and works at a local fast-food restaurant. She is seeking help for depression.

What is the nurse’s best action? a. Assist the client in seeking educational and/or vocational programs for single

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parents. b. Encourage the client to explore her feelings related to the reasons for her divorce. c. Persuade the client to contact her ex-husband for financial and parental support. d. Share information with the client regarding support groups for single mothers.

ANS: A Assisting the client in finding programs for single parents helps the client by giving her support as she tries to better her financial situation in a way that will improve her self-esteem, independence, and personal identity and will help her to secure her financial future. Exploring feelings related to the divorce and having the client contact her ex-husband are not going to help her depression at this time. Sharing information about support groups will be helpful in the future but does not meet her immediate need.

DIF: Cognitive Level: Application REF: p. 174 TOP: Education KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

OBJ: 6

7. An adult female calls a crisis hotline stating that she moved a few months ago to seek a new job “in a big city.” She is crying and says that she doesn’t think she can stand being so lonely anymore but doesn’t want to move back to her small hometown and face her family and friends as a “failure.” What is the nurse’s first response? a. “Would you like me to call your family to assist you in deciding what is best for you to do?” b. “I am sure you will make friends once you find a steady job that you like.” c. “Can you tell me what you mean by your statement that you don’t think you can stand being lonely anymore?” d. “Let me give you a list of some social groups that might be of interest to you.”

ANS: C The nurse must first clarify what the client’s statement is referring to so as to eliminate the possibility that the client is thinking of harming herself. Once this is clarified, and if it is not what the client is indicating, a list of social groups might be supplied later in the conversation. Offering to call the client’s family and assuring her that she will make friends are disregarding what the client is telling the nurse she feels. Social isolation is not a healthy state for an individual.

DIF: Cognitive Level: Analysis REF: p. 175 OBJ: 7 TOP: Health Care Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 8. AIDS is a condition that most likely would be seen in: a. the homosexual population. b. sexually promiscuous heterosexuals. c. individuals in a heterosexual monogamous relationship. d. persons who have a chemical dependency on illegal intravenous drugs.

ANS: C

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This term stands for acute fear regarding acquired immunodeficiency syndrome (AIDS). It is seen in individuals whose behaviors based on their lifestyle put them at very little risk of contracting HIV/AIDS. Individuals in a heterosexual monogamous relationship most likely would demonstrate AIDS. The other populations are at higher risk for contracting the disease based on the behaviors associated with their lifestyle.

DIF: Cognitive Level: Comprehension REF: p. 175 OBJ: 8 TOP: Acquired Immunodeficiency Syndrome KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. How many people in the United States have a severe mental illness? a. 15 million b. 20 million c. 43 million d. 60 million ANS: C As of 2018, 43.8 million people meet the criteria for severe mental illness.

DIF: Cognitive Level: Knowledge REF: p. 176 OBJ: N/A TOP: Mental Health Problems of Adults KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. When the nursing care plan for a client with a mental health disorder is developed, what is the most likely reason that interventions are ineffective and goals are not met? a. The client sees his goals as less important. b. The client’s family is not supportive. c. The client’s disorder is difficult to treat. d. The client’s medications are being adjusted.

ANS: A Unrealistic goals set the client up for failure. Even the best interventions will not be successful in this circumstance. The nurse must be sure to accurately assess the client’s life situation when working with the client to set realistic goals. The other options must be considered when a care plan is being developed, but if taken into consideration, they do not hinder the outcome as much as the client not seeing importance in his goals. Therapeutic actions will have greater results if goals are as important to the client.

DIF: Cognitive Level: Application REF: p. 176 OBJ: 9 TOP: Health Care Interventions KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 11. A 42-year-old male client continues to enter into business deals that cause him to lose large amounts of money. He subsequently seeks mental health care for stress-related disorders.

Which characteristic of a successful adult is this client lacking? a. Acceptance of self b. Finding a balance between giving and taking c. Making sound decisions d. Learning from past decisions

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ANS: D Making sound decisions and learning from past decisions describe this client’s situation, but learning from past decisions applies the most in that he has made the wrong decision numerous other times in the past. Acceptance of self is not addressed in this scenario, and finding a balance between giving and taking refers to maintaining a balance between caring for others and taking care of oneself.

DIF: Cognitive Level: Synthesis REF: p. 170 OBJ: 3 TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. A 68-year-old woman tells the nurse that since she retired a few months ago, she has been “taking it easy” by sleeping later and staying around the house to rest. She has recently noticed that she is having a little trouble with remembering things. The nurse is aware that intellectual development is continuous and suggests to the client: a. “You might think about volunteering somewhere to keep your mind sharp.” b. “You are probably just tired from all those years at work.” c. “After you have gotten used to being at home, I am sure your memory will improve.” d. “Sometimes we must accept the fact that as we get older, we sometimes become more forgetful.”

ANS: A To maintain intellectual development, individuals must engage in productive activities at all ages.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 3 TOP: Adult Growth and Development KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 13. A 49-year-old woman who has been the owner of a successful large business for several years decides to sell her business and move to a remote island to open a small dress shop.

She most likely has made this decision based on her need to: a. avoid becoming stagnant in her life. b. earn more money. c. prevent another company from taking over her business. d. improve her social development.

ANS: A Making a dramatic change in one’s adult life prevents an individual from becoming dormant in his or her daily life. People who are unhappy tend to develop mental health disorders.

DIF: Cognitive Level: Application REF: p. 172 OBJ: 3 TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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14. A 37-year-old client who has been divorced for several years recently lost joint custody of a 10-year-old daughter because of drug and alcohol use, along with nonpayment of child support. The client is referred to the clinic as the result of a court order. When arriving at the clinic, the client has been on a drinking binge for 2 days. What is the most appropriate nursing diagnosis for this client? a. Health-seeking behaviors b. Family processes, readiness for enhanced c. Coping, ineffective d. Hopelessness ANS: C This client is using drugs and alcohol as coping mechanisms. It is unlikely that the client is choosing these actions as a health-seeking mechanism. The client is not ready to work on family processes, and there is not enough evidence to suggest hopelessness.

DIF: Cognitive Level: Analysis REF: p. 172 OBJ: 4 TOP: Internal (Developmental) Problems KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity 15.

% of the adult population in the United States has a mental health disorder. a. b. c. d.

10 15 18 25

ANS: C This percentage refers to diagnosable mental health disorders.

DIF: Cognitive Level: Knowledge REF: p. 176 OBJ: N/A TOP: Mental Health Problems of Adults KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. A newly married couple residing in a large city is expecting the birth of their first child in 3 months. The wife wishes to maintain her career and remain in their apartment. The husband has expressed the desire to relocate to a more suburban setting to raise their child. Their ability to successfully face this challenge depends upon their ability to: a. negotiate a mutually satisfying solution. b. employ appropriate coping mechanisms. c. avoid conflict by dealing with the issue at a later time. d. maintain a firm sense of individuality.

ANS: A Compromise involves a willingness to negotiate and enter into interactions in which neither person wins or loses. Conflicts are resolved by defining and solving the problem. The focus is kept on the issue. Couples who compromise, communicate openly, listen carefully, and try to understand their partner’s point of view find that their relationship is respected and cherished.

DIF: Cognitive Level: Knowledge TOP: Adult Growth and Development

REF: p. 172 OBJ: 3 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Psychosocial Integrity 17. An obese woman is seen in the emergency department complaining of headaches. Her blood pressure is 150/92. Also present are her 4-year-old son and 2-year-old daughter. When the nurse offers to call a family member to pick up the children, the woman states that they are living alone in a women’s shelter. What is the most appropriate action for the nurse to take? a. Instruct the client on proper nutrition and educate her regarding the dangers of hypertension. b. Make a referral for the client to a weight loss center. c. Assist the client to plan better coping strategies. d. Assess the family’s daily living needs and consult social work for community resources.

ANS: D It is crucial to learn about the client’s living conditions and work within the reality of their situation. Instruction on nutrition and health practices and development of coping strategies cannot be addressed until basic needs for food, clothing, and shelter are met.

DIF: Cognitive Level: Knowledge REF: p. 174 OBJ: 6 TOP: Health Care Interventions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. The parents of a 21 year old who attended church services on a consistent basis are concerned when their child returns home from college and announces she is converting to another religion. This individual is most likely experiencing: a. a personality disorder. b. the need to challenge a value and belief system. c. instability due to dysfunctional parenting. d. regression to an unresolved developmental task.

ANS: B Development within the spiritual dimension focuses on defining one’s value system and belief system. Young adults often challenge their current religious practices by changing churches or refusing to attend services. This is not seen as a personality disorder or a result of dysfunctional parenting. This task is expected during this phase of development.

DIF: Cognitive Level: Knowledge REF: p. 172 OBJ: 6 TOP: Adult Growth and Development KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements describe the adult who has achieved the successful emotional development of adulthood? (Select all that apply.) a. The adult is able to function effectively in a stressful environment. b. The adult possesses effective intellectual and abstract problem-solving skills. c. The adult is able to adapt to growing older. d. The adult sets realistic personal and professional goals.

ANS: A, C, D

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These are characteristics of an individual who has achieved the expected emotional development of adulthood. Possessing effective intellectual and abstract problem-solving skills refers to intellectual development of adulthood.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 3 TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 2. One of the ways in which the social development of adults can be assessed is by observing the individual’s ability to effectively communicate with whom? (Select all that apply.) a. His or her significant other b. His or her physician c. His or her children d. His or her coworkers ANS: A, C, D These are people with whom the adult interacts on a daily basis, so effective communication will confirm that one aspect of the social task of adulthood is achieved. It would be unfair to base this on how effectively the client communicates with his or her physician because this interaction does not occur on a daily basis and often occurs during stressful times.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 1 TOP: Adult Growth and Development KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 3. Therapeutic interventions are effective in the prevention of mental and emotional disorders and assisting the client to cope. Which of the following interventions assists in providing for a positive personal identity? (Select all that apply.) a. Continue to define identity in terms of role in nuclear family. b. Develop career path and goals. c. Recognize how emotions influence achievement of goals and relationships. d. Maintain personal distance in relationships.

ANS: B, C The individual is assisted to develop a positive personal identity by differentiating self from the nuclear family, developing occupational goals, assessing how emotions influence achievement and relationships, and deciding on relationship choices and level of commitment.

DIF: Cognitive Level: Application REF: p. 171 OBJ: 2 TOP: Therapeutic Interventions for a Positive Personal Identity KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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Chapter 16: Problems of Late Adulthood Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1.

% of older adults are living at poverty level. a. b. c. d.

12 18 26 23

ANS: A This is similar to the economic status of other ages.

DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: 1 TOP: Facts and Myths of Aging KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing: a. ageism. b. gerontophobia. c. an age phobia. d. elder phobia.

ANS: B This term also includes refusal to accept the elderly into the mainstream of society. Ageism is stereotyping the elderly as weak, dependent, and nonproductive. Age phobia and elder phobia are not used terms.

DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: 1 TOP: Facts and Myths of Aging KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow after one reaches the age of approximately: a. 35. b. 45. c. 65. d. 85.

ANS: D Signs of aging continue to show themselves until around 85 years. Physical aging is affected by genetics, health care, lifestyle, and attitude.

DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: N/A TOP: Physical Health Changes KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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4. An elderly man has serious vision problems and is no longer allowed to obtain a driver’s license. He has been very independent until this time. Which nursing diagnosis is most appropriate for this situation? a. Confusion, chronic b. Coping, ineffective c. Self-esteem, risk for situational low d. Grieving, dysfunctional ANS: C “Self-esteem, risk for situational low” is most appropriate because of his previous independence. The other options are also nursing diagnoses, but the situation does not lend itself to these diagnoses.

DIF: Cognitive Level: Application REF: p. 183 OBJ: 2 TOP: Physical Adaptations KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 5. The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who is on a fixed income. He was discharged from the hospital a few weeks ago with his newly prescribed medication to keep his BP under control. His BP measurements have been gradually increasing over the last few visits, with no other changes in status assessed. Which nurse statement would be most appropriate? a. “Have you been taking your medication as often as you are supposed to?” b. “I don’t understand why your BP is up.” c. “Maybe I should check your BP at another time.” d. “I hope you are taking your medication. Otherwise, I am wasting my time.”

ANS: A Clients on fixed incomes often take less of their medications so they will last longer. None of the other options meets the need of the situation, and saying that the client is wasting the nurse’s time is an inappropriate statement.

DIF: Cognitive Level: Application REF: p. 185 OBJ: 3 TOP: Psychosocial Adaptations KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 6. A 2015 survey estimates the average number of elderly who are abused is a. 2,150,000 b. 3,250,000 c. 1,850,000 d. 1,500,000

.

ANS: A Today, it is estimated that the average number of elderly who are abused is 2,150,000 (NCEA, 2015).

DIF: Cognitive Level: Knowledge REF: p. 187 TOP: Elder Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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OBJ: 5

7. Which intervention will be most effective when one is teaching a client about his or her medications and their administration? a. Pointing out the colors of the medications for easier identification b. Referring to medications by name and providing written instructions c. Quizzing the client on each medication’s purpose, side effects, and drug interactions d. Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information ANS: B Referring to the medications by name and providing written instructions will lead to less confusion. Pointing out colors can be a problem if there is visual impairment; quizzing the client is not necessary; and encouraging the client to hold questions may cause questions to be forgotten.

DIF: Cognitive Level: Application REF: p. 185 OBJ: 8 TOP: Age-Related Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 8. The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics nurse before retiring. Despite her dementia, she still remembers terms and procedures and basic nursing care interventions from her past career. This is an example of: a. working memory. b. reasoning. c. information processing. d. crystallized intelligence.

ANS: D Crystallized intelligence is specialized accumulated knowledge, and it is common for individuals to remember this specialized information, even if they experience dementia.

Working memory is the random access memory to which one refers. Reasoning is the ability to solve problems and make choices, and information processing is the ability to relate to, store, and retrieve information.

DIF: Cognitive Level: Comprehension REF: p. 181 OBJ: 2 TOP: Mental Health Changes KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. An elderly client states that she paid $10,000 to a “nice repairman” for fixing her broken window and fence. This is an example of elder abuse known as: a. violation of rights. b. exploitation. c. psychological abuse. d. neglect.

ANS: B It is estimated that approximately 10% of the elderly population are victims of this type of abuse.

DIF:

Cognitive Level: Comprehension

REF: p. 187

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OBJ: 5

TOP: Elder Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. The nurse must be aware of physical signs and symptoms of depression because these are often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of depression include: a. decreased or slowed memory. b. fatigue. c. changes in appetite. d. abdominal pain.

ANS: D Abdominal pain, muscle aches, and dry mouth are common physical symptoms of depression in the older adult. Other physical causes of these symptoms must be ruled out, and further assessment of other signs of depression must be noted. Decreased or slowed memory is cognitive; fatigue is emotional; and change in appetite is behavioral.

DIF: Cognitive Level: Comprehension REF: p. 188 | Box 16.3 OBJ: 6 TOP: Depression KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 11. The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used? a. Sympathy b. Empathy c. Helping the client write a paragraph about his life d. Contacting old acquaintances for their interpretation of the client’s life ANS: B Empathy and several other interventions constitute validation therapy. The other options are not used in validation therapy.

DIF: Cognitive Level: Knowledge REF: p. 188 | Box 16.4 OBJ: 9 TOP: Depression KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. It is important for the nurse to be aware that % of individuals over 45 years old take prescription medications, over-the-counter medications, or a combination of these medications. a. 35 b. 55 c. 75 d. 95 ANS: C Seventy-five percent of individuals over 45 years old take prescription medications, over-the-counter medications, or a combination of medications. This is important to know when one is planning interventions.

DIF:

Cognitive Level: Knowledge

REF: p. 185 | Box 16.2

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OBJ: 4 TOP: Substance Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 13. One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring of: a. DSM-IV-TR standards. b. State boards of health. c. Standards of geriatric nursing practice. d. State nurse practice acts.

ANS: C Standards of geriatric nursing practice were developed to specifically address the needs of the elderly population.

DIF: Cognitive Level: Knowledge REF: p. 188 OBJ: 7 TOP: Standards of Geriatric Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 14. It is projected that by 2050, the population of those aged 65 and over will be million. a. 83.7 b. 61.3 c. 43.8 d. 56.5 ANS: A By “2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012” (U.S. Census Bureau, 2018).

DIF: Cognitive Level: Knowledge REF: p. 179 OBJ: 1 TOP: Overview of Aging KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 15. The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that she is losing weight. While performing an assessment, the nurse discovers that the client’s dentures are ill-fitting and this makes eating painful. The client claimed she informed her daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned that this is a possible sign of: a. abuse. b. neglect. c. domestic violence. d. depression.

ANS: B Neglect is defined as failing to meet basic physical needs. Abuse and domestic violence are evidence of actual physical harm. This situation does not describe depression.

DIF: Cognitive Level: Knowledge REF: p. 187 | Box 16.2 OBJ: 5 TOP: Elder Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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16. The nurse is completing an admission interview with an older adult on a busy medical unit.

What action is most appropriate for the nurse to take? a. Complete the admission interview with the client’s son. b. Shout at the client so he or she can hear. c. Provide pen and paper and let the client write his answers. d. Allow the client time to respond to the questions regarding health history.

ANS: D Information processing speed decreases with age, and it may take longer for the client to retrieve the information and respond.

DIF: Cognitive Level: Application REF: p. 181 | Box 16.1 OBJ: 2 TOP: Mental Changes of Aging KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. A 70-year-old woman who was recently widowed expresses a desire to go back to school and finish the degree she started before her children were born. What response is most appropriate? a. “Why would you want to stress yourself at your age?” b. “That may not be possible. As you age, your ability to learn decreases.” c. “Going back to school will keep you engaged and active.” d. “Let’s do a cognitive function test to see if you are eligible.”

ANS: C It is important for older adults to stay active and engaged. Encouraging the woman in her pursuit is an appropriate response. The other options may all discourage the client from remaining engaged in society.

DIF: Cognitive Level: Comprehension REF: p. 182 | Box 16.1 OBJ: 2 TOP: Mental Changes of Aging KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 18. A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears to be confused and combative at times. Her daughter is concerned because her mother was alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is related to: a. the onset of Alzheimer’s disease. b. alteration in oxygenation. c. family neglect. d. dysfunctional coping.

ANS: B Physical problems can lead to changes in mental status. Early assessment and intervention are key for keeping an older adult’s minor problems from becoming major ones. An alteration in oxygenation can affect a client’s behavior.

DIF:

Cognitive Level: Comprehension

REF: p. 183

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OBJ: 2

TOP: Physical Adaptations KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which conditions most commonly place older adults at risk for overdose from medications and severe reactions? (Select all that apply.) a. Depression b. Higher rate of metabolism c. Interaction with other medications d. Problems with sight and memory ANS: C, D Older adults often are taking numerous medications prescribed by several specialists, and sight and memory can cause errors in taking medications. Depression is not a common cause of overdose, and metabolism is usually slower in this age-group.

DIF: Cognitive Level: Comprehension REF: p. 185 OBJ: 4 TOP: Substance Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which emotional signs and symptoms of depression in the elderly must the nurse be aware of and monitor for? (Select all that apply.) a. Increased anxiety or dependence b. Fatigue c. Feels he or she has no purpose d. Withdraws from people ANS: A, B, C Increased anxiety or dependence, fatigue, and feelings of purposelessness are emotional signs and symptoms of depression. Withdrawal from people is a behavioral sign of depression.

DIF: Cognitive Level: Application REF: p. 187 TOP: Depression KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 6

3. To respectfully and effectively provide health teaching to the older adult, which of the following actions should be employed? (Select all that apply.) a. Speak very loudly and in high-pitched tones. b. Ask clients to repeat your message. c. Break complex tasks into small, pertinent steps. d. Refer to medications by color.

ANS: B, C When teaching older adults, it is important to have them repeat your message back to you to ensure that they understand. It is also helpful to break complex tasks into smaller manageable steps to help the client remember. Speaking loudly and in high-pitched tones will not assist the client in learning. A nurse should refer to medications by name rather than color.

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DIF: Cognitive Level: Application REF: p. 189 OBJ: 8 TOP: Age-Related Interventions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 17: Cognitive Impairment, Alzheimer’s Disease, and Dementia Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. A 75-year-old male client is brought to the clinic by his son. The son states, “Ever since Mom died, Dad hasn’t been the same. At first he just seemed sad, but now he seems to get mixed up about everything.” The nurse is aware that based on the client’s history, the source of confusion is most likely: a. dementia. b. depression from the loss of his wife. c. hypoxia of the brain. d. delirium from medications.

ANS: B Depression in the elderly population is often a cause of confusion. The son’s description of the behaviors of his father since his wife’s death indicate that he became depressed, which has been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of brain injury, and delirium is sudden. Even though it appears that the confusion is caused by the depression, a thorough examination is warranted to confirm the cause.

DIF: Cognitive Level: Application REF: p. 193 OBJ: 2 TOP: The Five “Ds” of Confusion KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Vascular dementia is more common in individuals living in: a. the United States. b. Japan. c. France. d. Australia.

ANS: B The incidence of vascular dementia is more common in Japan for unknown reasons.

Japanese citizens who move to the United States have been found to have a decreased rate of vascular dementia.

DIF: Cognitive Level: Knowledge REF: p. 195 | Cultural Considerations OBJ: 5 TOP: Causes of Dementia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from: a. Alzheimer’s disease. b. acute dementia. c. sundown syndrome. d. delirium.

ANS: C

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Sundown syndrome typically occurs during the late afternoon, evening, or night when an elderly person is in unfamiliar surroundings. The other three options occur at any time of day, evening, or night. The symptoms often disappear when the client is back in familiar surroundings.

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 5 TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The elderly spouse of a 74-year-old male client states that she has noticed that her husband “doesn’t remember as well as he used to.” She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past.

The client is exhibiting signs and symptoms typical of: a. vascular dementia. b. Alzheimer’s disease. c. acute delirium. d. aging.

ANS: B The person with Alzheimer’s disease commonly shows deficits in familiar tasks. Vascular dementia and acute delirium relate more to confused states, and dementia symptoms should not be assumed to be part of normal aging.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6 TOP: Alzheimer’s Disease KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The affective losses of Alzheimer’s disease refer to losses noticed in the individual’s: a. personality. b. thought processes. c. ability to make and carry out plans. d. self-care.

ANS: A Affective losses result in personality changes in the individual with Alzheimer’s disease.

Thought processes and self-care do not relate to the individual’s personality, and the ability to make and carry out plans is referred to as conative loss.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6 TOP: Symptoms and Course of Alzheimer’s Disease KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 6. The average time that a person with Alzheimer’s disease lives after diagnosis is: a. 2 years. b. 8 years. c. 10 years. d. 20 years.

ANS: B

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Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the disease.

DIF: Cognitive Level: Knowledge REF: p. 197 OBJ: 6 TOP: After the Diagnosis KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimer’s disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease? a. Helping the loved one with memory and communication problems b. Providing a stable, routine environment c. Providing complete assistance with physical care d. Adapting to the changing personality and behavior of the loved one ANS: D The middle stage is when personality changes begin to occur. It is difficult for the family to see the loss of their loved one’s personality. Helping with memory and communication problems and providing a stable, routine environment occur in the early stage, and complete assistance with physical care is typically a responsibility of the caregiver during the severe stage.

DIF: Cognitive Level: Comprehension REF: p. 197 OBJ: 6 TOP: Stages of Alzheimer’s Disease KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 8. The nurse is answering questions from a client and his family regarding a recent diagnosis of Alzheimer’s disease. The client asks how effective medication is in treating the disease.

What is the nurse’s best response? a. “There is no cure or treatment for Alzheimer’s disease.” b. “Medications have shown little improvement in symptoms.” c. “Medications for the disease have been found to improve thinking abilities, behavior, and daily functioning in some clients.” d. “Alternative therapies, such as co-enzyme Q-10 and Ginkgo biloba, are more effective than any of the prescription medications used to treat the symptoms.”

ANS: C The most accurate statement is to say that medications have been found to improve thinking abilities, behavior, and daily functioning in some clients. Although no cure for the disease is known, it is inaccurate to say that there is no treatment. To say that medications have produced little improvement in symptoms is misleading because it sounds as though medications are not effective. Stating that alternative therapies are more effective is inaccurate because these therapies are still under investigation for determination of their effectiveness in treating symptoms of the disease.

DIF: Cognitive Level: Comprehension REF: p. 198 OBJ: 6 TOP: Interventions With Alzheimer’s Disease KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity

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9. Which of the following is an effective communication technique that should be included in the teaching plan for the family members of a woman in whom Alzheimer’s disease has been diagnosed recently? a. Use simple, familiar words, along with short and simple sentences. b. If the client tends to pace a lot, be sure to encourage her to sit during interactions. c. If she doesn’t understand the communication, change key words. d. Use hand gestures when speaking to try to explain what is being said.

ANS: A Alzheimer’s affects cognitive ability, so it is best to use words and phrases that do not require a great deal of thought to be understood. Having the client sit when she likes to pace may increase her anxiety and block communication. Repeat key words to assist in understanding; changing the key words may further confuse the client. Hand gestures may further confuse the troubled thought processes.

DIF: Cognitive Level: Application REF: p. 200 | Box 17.6 OBJ: 7 TOP: Interventions With Alzheimer’s Disease KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 10. The elderly spouse of a female Alzheimer’s client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what he can do to help her. What is the nurse’s best response? a. “Keep rooms well lit.” b. “Keep the home environment simple and user-friendly for her.” c. “Have clocks and calendars with large letters in several rooms of the house.” d. “Place large signs on doors or entryways that identify the room.”

ANS: D All of these options will assist her in keeping her orientation to the environment, but because she is wandering to the wrong rooms to look for items, signs on the doors and entryways would be most helpful to her as she finds the appropriate room.

DIF: Cognitive Level: Application REF: p. 200 | Box 17.7 OBJ: 7 TOP: Interventions With Alzheimer’s Disease KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the client’s: a. level of consciousness. b. ability to perform activities of daily living. c. degree of reasoning, judgment, and thought processes. d. level of functioning memory.

ANS: B This is an important point of assessment if the nurse is trying to determine the level of care necessary for this client. The other options also may be assessed at some point in the admission, but they do not make up the functional assessment.

DIF:

Cognitive Level: Comprehension

REF: p. 199

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OBJ: N/A

TOP: Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes to her room and cries because she misses her children. This client could benefit most from which intervention? a. Life review b. Doll therapy c. Comfort touch d. Audio presence therapy ANS: D Because missing her children brings sadness to this client, she may benefit from hearing their voices on tape and recalling pleasant family memories. The other interventions are effective therapies for clients with dementia, but they do not address this client’s immediate need.

DIF: Cognitive Level: Application REF: p. 198 OBJ: 7 TOP: Interventions With Alzheimer’s Disease KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 13. The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer’s disease. When administering this particular medication, the nurse should be especially alert to assess the client for: a. weight changes. b. tremors. c. increased sweating. d. alterations in blood pressure.

ANS: D This medication may cause high or low blood pressure. The other options typically are not seen with donepezil (Aricept) but sometimes are seen with other Alzheimer’s medications.

DIF: Cognitive Level: Application REF: p. 199 | Drug Alert OBJ: 7 TOP: Interventions With Alzheimer’s Disease KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 14. Which symptom of Alzheimer’s disease is associated with disorientation to time and place? a. Forgetting in what order to put clothes on b. Forgetting simple words c. Forgetting where one lives d. Becoming suspicious of others ANS: C Additional examples of disorientation to time and place include a person’s getting lost on the street where he or she lives and forgetting how he or she got to places. Forgetting in what order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple words relates to problems with language; and becoming suspicious of others relates to changes in personality.

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DIF: Cognitive Level: Comprehension REF: p. 197 | Table 17.1 OBJ: 6 TOP: Stages of Alzheimer’s Disease KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether: a. there is a history of mental illness in the family. b. she has been given a diagnosis of a mental health disorder in the past. c. she can recall her last visit to a physician. d. she has taken any over-the-counter medications for her cold.

ANS: D Over-the-counter cold medications can cause confusion in the elderly population. Because this client has had a cold recently, it would be important to determine whether she has been taking any of these types of medications. There is no indication that the other options have any significance in relation to the acute confusion.

DIF: Cognitive Level: Application REF: p. 193 OBJ: 3 TOP: Medications and the Elderly Population KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 16. The daughter of an elderly nursing home resident is crying outside her father’s room. When the nurse comforts her, she states, “It is so hard to come here to visit when my father doesn’t even know who I am.” The nurse knows the client is in which stage of Alzheimer’s disease? a. Early stage b. Intermediate stage c. Severe stage d. End stage ANS: B Visual agnosia, the loss of recognition of previously known or familiar people, is a manifestation of the intermediate stage of Alzheimer’s disease.

DIF: Cognitive Level: Application REF: p. 197 OBJ: 6 TOP: Stages of Alzheimer’s Disease KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 17. A 75-year-old man finds that he continually misplaces items he uses every day. In addition, his wife becomes annoyed when he asks the same question several times because he does not remember the answer. What advice is the most appropriate for his health care provider to give him? a. These symptoms are a normal part of aging and he should accept it. b. He has Alzheimer’s disease and nothing can be done to help him. c. Further assessment is needed to determine the cause of these symptoms. d. Admission to a nursing home for more intensive care is needed.

ANS: C

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Multiple factors influence how one ages mentally. Culture, education, general health, genetics, and living conditions all have an influence on one’s cognitive (intellectual) abilities. We all age individually, but one thing is certain: confusion is not normal. Although it most often occurs in older adults, individuals of any age can become confused. No matter what the age, confusion demands investigation.

DIF: Cognitive Level: Application REF: p. 192 OBJ: 1 TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 18. The most common severe cognitive impairment in the United States is Alzheimer’s dementia. What percentage of the population over the age of 85 is at risk for getting the disease? a. 30% b. 50% c. 70% d. 90% ANS: B The incidence of dementia increases with age. Alzheimer’s dementia is the most common severe cognitive impairment in the United States. “For people age 85 years or older, the risk of getting Alzheimer’s Dementia approaches 50%” (Small, 2010).

DIF: Cognitive Level: Application REF: p. 196 OBJ: 4 TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 19. Which client exhibits signs and symptoms of delirium and not dementia or depression? a. The onset is sudden and acute. b. The cognitive changes are hidden by the client. c. The client demonstrates apathetic demeanor or flat affect. d. The client’s ability to perform ADLs is intact.

ANS: A Cognitive changes that occur with delirium are sudden in nature. Clients with dementia may attempt to hide cognitive changes in the early stages, and they are able to perform ADLs in the early stage as well. Clients suffering from depression often display apathy or a flat affect.

DIF: Cognitive Level: Application REF: p. 193 OBJ: 4 TOP: Clients With Delirium KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity MULTIPLE RESPONSE 1. The nurse anticipates that the normal aging process of losing neurons and shrinkage of brain size will result in which assessment findings in older adults? (Select all that apply.) a. Confusion b. Slower response times

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c. Depression d. Deficiencies in short-term memory ANS: B, D These are normal occurrences in aging. Confusion and depression are not considered normal responses to aging and should be investigated further.

DIF: Cognitive Level: Knowledge REF: p. 192 OBJ: 1 TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 2. Which characteristics are commonly seen in clients with dementia? (Select all that apply.) a. Gradual onset b. Poor short-term memory c. Problems with judgment d. Fast onset e. Poor remote memory f. Difficulty with abstract thinking g. Personality changes ANS: A, B, C, E, F, G These are all signs and symptoms of dementia, regardless of whether it is classified as Alzheimer’s or non–Alzheimer-type dementia.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 5 TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 3. Which interventions will help to lessen the effects of sundown syndrome? (Select all that apply.) a. Provide activity which stimulates the client’s interest. b. Assist in toileting to prevent incontinence. c. Turn on lights before the room gets dark. d. Provide companionship. e. Prepare client for sleep by turning off lights. f. Reduce environmental stimulation at dinner. g. Maintain client’s familiar routine.

ANS: B, C, D, F, G Sundown syndrome is associated with physical and social stressors including the decrease of visual and social cues. Interventions include meeting the client’s basic needs and maintaining a consistent routine without abrupt changes such as decreasing lighting, withdrawing companionship, and changing or increasing stimulation.

DIF: Cognitive Level: Knowledge REF: p. 195 OBJ: 2 TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

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Chapter 18: Managing Anxiety Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. When a client has a mild level of anxiety, his or her emotional response is: a. relaxed and calm. b. energized. c. feeling overloaded. d. helplessness with loss of control.

ANS: A Mild anxiety results in relatively comfortable feelings. An energized emotional response describes feelings of moderate anxiety. Feeling overloaded is characteristic of severe anxiety, and feeling helpless with loss of control refers to the highest level of anxiety, which is panic.

DIF: Cognitive Level: Comprehension REF: p. 205 | Table 18.1 OBJ: 1 TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. A female college student is seeking help from the counseling center for test anxiety. She reports that during an exam, she “freezes,” and says, “It feels like the time I have to take the exam is racing by, and I can’t answer any of the questions when I know the answers.”

Which level of anxiety is the client experiencing? a. Mild b. Moderate c. Severe d. Panic ANS: C These are typical symptoms when someone experiences a severe level of anxiety. During mild anxiety, the perceptual field is broad; moderate anxiety is the best state for problem-solving and learning because perception is focused; panic results in totally scattered or closed perception, and problem-solving is nearly impossible.

DIF: Cognitive Level: Application REF: p. 205 | Box 18.1 OBJ: 1 TOP: Levels of Anxiety KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A learned response to an anticipated event, such as when a person who does not like to fly experiences nausea and sweaty palms before boarding an airplane, is best described as: a. a normal anxiety response. b. signal anxiety. c. an anxiety state. d. an anxiety trait.

ANS: B

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This response occurs as the individual anticipates a stress-provoking event. A normal anxiety response does not best meet the description in this situation; an anxiety state refers to when a person’s coping abilities have become overwhelmed and the person has lost emotional control; and an anxiety trait is part of an individual’s personality that occurs as an overreaction to situations.

DIF: Cognitive Level: Comprehension REF: p. 205 OBJ: 1 TOP: Types of Anxiety KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. A client tells the nurse that exercising in the gym helps him keep his stress level reduced.

Which type of coping mechanism best describes this situation? a. Spiritual b. Emotional c. Intellectual d. Physical ANS: D Stress-release activities such as exercise, jogging, and yoga are considered physical coping mechanisms. Spiritual coping mechanisms include prayer, faith, and rituals. Emotional coping mechanisms consist of crying, talking, and defense mechanisms. Intellectual coping mechanisms are observed when an individual changes his or her perceptions of a threat to make it less meaningful.

DIF: Cognitive Level: Comprehension REF: p. 206 OBJ: 2 TOP: Coping Methods KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The charge nurse is angry with another nurse who has arrived 1 hour after the shift begins.

Rather than expressing her anger, the nurse avoids confrontation by denying approval of the nurse’s requested vacation day. What does this behavior demonstrate? a. Substitution b. Restitution c. Suppression d. Rationalization ANS: A Substitution is defined as disguising motivations by replacing an inappropriate behavior with one that is more acceptable. Restitution is defined as doing something to resolve guilt feelings; suppression is removing anxiety about a conflict from consciousness; and rationalization uses a good, but unreal, reason to make an excuse for an action.

DIF: Cognitive Level: Comprehension REF: p. 207 | Table 18.2 OBJ: 2 TOP: Defense Mechanisms KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 6. The nurse is aware that several theories have been proposed to explain anxiety. Which theory explains anxiety as a result of interactions with others? a. Biological model b. Psychodynamic model

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c. Interpersonal model d. Behavioral model ANS: C The basis of this theory is that the anxiety response develops in early childhood as a result of interactions with others. The biological model relates to neurochemicals in the brain. The psychodynamic model is Freud’s theory that anxiety results from conflict between the ego and the id. The behavioral model describes anxiety as a learned response.

DIF: Cognitive Level: Knowledge REF: p. 208 OBJ: N/A TOP: Interpersonal Model KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. Adolescents who ineffectively cope with anxiety often express their anxiety through: a. inappropriate behaviors. b. calm behavior. c. psychotic behavior. d. suicide.

ANS: A Behaviors such as defiance, experimenting with drugs, aggressiveness, and manipulation are examples of these behaviors. The other options are responses that are not commonly seen among adolescents with ineffective coping skills.

DIF: Cognitive Level: Knowledge REF: p. 209 OBJ: 3 TOP: Anxiety in Adolescence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. What is the term for physical expression of anxiety by an individual in ways such as nausea or headaches? a. Compensation b. Somatization c. Denial d. Fantasy ANS: B Often when an individual denies his or her feelings of anxiety, the anxiety is expressed physically. The other options are examples of defense mechanisms.

DIF: Cognitive Level: Knowledge REF: p. 210 OBJ: 3 TOP: Anxiety in Older Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which term best describes an individual’s feelings of anxiety that are broad, long-lasting, and excessive? a. Generalized anxiety disorder b. Panic attack c. Phobic disorder d. Obsessive-compulsive disorder ANS: A

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This diagnosis is given to individuals with these symptoms. Panic attacks last a short time, phobias relate to excessive fear of a specific object or situation, and obsessive-compulsive disorder is a constant thought and behavior.

DIF: Cognitive Level: Knowledge REF: p. 211 OBJ: 4 TOP: Generalized Anxiety Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. A client has constant thoughts about locking his front door every time he leaves his house.

This client is experiencing a/an: a. compulsion. b. phobia. c. obsession. d. anxiety reaction.

ANS: C Obsession is constantly thinking about something, and compulsion is acting it out. Phobia is irrational fear, and anxiety reaction is not a used term.

DIF: Cognitive Level: Comprehension REF: p. 212 OBJ: 5 TOP: Obsessive-Compulsive Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. Which is a typical symptom of posttraumatic stress disorder? a. Constant use of defense mechanisms b. Flashbacks c. Distressing persistent thoughts d. Irrational fear ANS: B Flashbacks are vivid recollections of the trauma. Constant use of defense mechanisms is simply a maladaptive way of coping. Distressing, persistent thoughts represent obsession, and irrational fear is a phobia.

DIF: Cognitive Level: Knowledge REF: p. 214 OBJ: 6 TOP: Posttraumatic Stress Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. The treatment team and a male client in whom obsessive-compulsive disorder associated with handwashing has been diagnosed decide on a treatment plan for the disorder. The nurse begins to implement the plan by having the client gradually extend the time between hand washes. This intervention is an example of which type of therapy? a. Behavior modification b. Desensitization c. Flooding d. Pharmacological therapy ANS: B

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This method gradually desensitizes the anxiety reaction, replacing it with effective coping skills. Behavior modification replaces maladaptive behavior with positive behavior; flooding is the complete opposite of desensitization; and pharmacological therapy is the use of medications.

DIF: Cognitive Level: Comprehension REF: p. 214 | p. 215 OBJ: 9 TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 13. A female client is taking a benzodiazepine for her anxiety disorder. She complains of anorexia and nausea since she started taking the medication a few days ago. What is the nurse’s best response? a. “Be sure to take the medicine on an empty stomach to avoid these symptoms.” b. “It takes a while to get used to the medicine. Give it a couple of weeks.” c. “Try taking the medication with food or milk, and see if the symptoms improve.” d. “Stop taking the medication immediately, and I will notify your doctor.”

ANS: C Taking the medication with food or milk usually alleviates GI side effects of this class of drugs. An empty stomach will intensify the side effect. It is not true to say that it takes a while to adjust to the medication. Completely stopping the medication is not necessary.

DIF: Cognitive Level: Application REF: p. 215 | Table 18.3 OBJ: 8 TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 14. A male client has had agoraphobia for several years. In the past 2 years, he has not left his home, and he only speaks to people on the phone occasionally. Which nursing diagnosis has the highest priority in this situation? a. Social isolation b. Thought processes, disturbed c. Coping, ineffective individual d. Powerlessness ANS: A All of the nursing diagnoses apply, but given the length of time of isolation, “Social isolation” is most appropriate.

DIF: Cognitive Level: Application REF: p. 206 OBJ: 9 TOP: Therapeutic Interventions KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity 15. Of individuals who suffer from panic attacks, a. 20 b. 30 c. 50 d. 70 ANS: D

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% are women.

Other demographics include individuals who are separated or divorced and individuals between the ages of 24 and 44 years.

DIF: Cognitive Level: Knowledge REF: p. 211 OBJ: 4 TOP: Panic Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. Symptoms of obsessive-compulsive disorder can occur in children as young as: a. 3 years old. b. 5 years old. c. 7 years old. d. 9 years old.

ANS: A Symptoms can occur at this age, but in most cases, symptoms either do not occur or are not diagnosed until adolescence.

DIF: Cognitive Level: Knowledge REF: p. 212 OBJ: 5 TOP: Obsessive-Compulsive Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. An adolescent caught stealing a classmate’s laptop says that he needed it to write his paper and that the classmate “has enough money to buy another one anyway.” This adolescent is demonstrating which of the following defense mechanisms? a. Denial b. Restitution c. Rationalization d. Conversion ANS: C The adolescent is using the reason of the classmate’s financial advantage as a rationalization for stealing the laptop. Denial is refusal to acknowledge conflict, restitution deals with giving back to resolve guilt, and conversion is the channeling of unbearable anxiety into physical signs and symptoms.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: 2 TOP: Common Defense Mechanisms KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. On the morning of a final exam, a student is feeling tense and excited, with her heart rate and breathing slightly increased. She is feeling energized and alert, with her attention focused on the exam. Based on these findings what advice can the student be given? a. Practice deep breathing and do some exercise to stabilize vital signs. b. Request to take the exam at a later date when anxiety decreases. c. Take the exam more seriously and treat it with more concern. d. The level of anxiety described should allow for a positive outcome.

ANS: D

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Moderate anxiety provides focus, alertness, and a narrowed perception. It also allows the individual to engage in competitive activity and learn new skills through feelings of readiness and being energized.

DIF: Cognitive Level: Knowledge REF: p. 205 OBJ: 1 TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Safety 19. A 6 year old is preparing to have a dental procedure. His anxious mother is in the room with him. When the child asks if everything will be okay, she assures him it will but continues to pace and wring her hands. What is the most appropriate action for the dentist to take? a. Give the mother a seat near the child and continue to assure the mother. b. Request that the mother wait in the waiting room. c. Allow the mother to verbalize what her concerns are. d. Tell the child to ignore his mother.

ANS: B Children learn to cope with anxiety by imitating and learning from others. In this case, the mother is demonstrating emotional/behavioral manifestations of anxiety. By allowing the mother to remain in the room in her current emotional state, anxious behavior is reinforced to the child as a method of coping.

DIF: Cognitive Level: Knowledge REF: p. 209 OBJ: 1 TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Safety 20. The nurse is meeting with a client suffering from agoraphobia who recently moved to the United States from a country where acts of violence and civil unrest are common. The theoretical model that links anxiety to the uncontrollable events the client experienced in his previous country is the model. a. behavioral b. interpersonal c. environmental d. psychodynamic ANS: C The environmental model ties anxiety with uncontrollable events or situations such as fires, floods, and assaults and human-induced traumas. The behavioral model considers anxiety a learned response, the interpersonal model explains anxiety in terms of interactions with others, and the psychodynamic model states anxiety is a result of conflict between the ego and the id.

DIF: Cognitive Level: Knowledge REF: p. 208 OBJ: 1 TOP: Theories Relating to Anxiety KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements best describe an anxiety disorder? (Select all that apply.)

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a. b. c. d.

Anxiety is expressed in ineffective ways.

Coping mechanisms are used to deal with anxiety.

Coping mechanisms do not relieve anxiety.

Defense mechanisms are used occasionally.

ANS: A, C Maladaptive coping mechanisms do not relieve stress, which constitutes an anxiety disorder.

Using coping mechanisms to deal with anxiety and using defense mechanisms occasionally are effective ways of dealing with anxiety.

DIF: Cognitive Level: Comprehension REF: p. 210 OBJ: 4 TOP: Anxiety Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which symptoms may be seen in a person who is having a panic attack? (Select all that apply.) a. Shortness of breath b. Fear of dying c. Recurrent persistent thoughts d. Palpitations e. Chills f. Feelings of depersonalization ANS: A, B, D, E, F A person is considered to be having a panic attack if he or she is experiencing intense fear or discomfort that happens suddenly and peaks within 10 minutes. There are 13 possible symptoms, and the diagnosis is made if the client experiences 4 of the 13.

DIF: Cognitive Level: Knowledge REF: p. 211 OBJ: 4 TOP: Panic Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which of the following activities are examples of addictive behaviors? (Select all that apply.) a. Gambling b. Shopping c. Working d. Excessive sexual activity e. Flashbacks f. Coping ANS: A, B, C, D Obsessive-compulsive activities may take the form of certain addictive behaviors such as gambling, shopping, working, or engaging in excessive sexual activity. Flashbacks are vivid recollections of a traumatic event. Coping is not an addictive behavior.

DIF: Cognitive Level: Knowledge REF: p. 213 OBJ: 5 TOP: Behavioral Addictions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 19: Illness and Hospitalization Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The abnormal process in which aspects of the social, physical, emotional, or intellectual function of a person are diminished or impaired is called: a. health. b. illness. c. recovery. d. homeostasis.

ANS: B Illness is a state of imbalance that is compared with the person’s condition prior to development of the present condition. Health is when an individual experiences homeostasis, or a state of balance; recovery refers to improvement after an illness.

DIF: Cognitive Level: Knowledge REF: p. 220 OBJ: 1 TOP: The Nature of Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. The client feels unwell. She knows that she would be better off if she rested today, but important matters at work are waiting. She stops at the drugstore on her way to work and purchases several over-the-counter cold remedies. Her behaviors are related to the stage of illness experience called: a. symptom experience. b. medical care contact. c. assuming the sick role. d. dependent patient role.

ANS: A The first stage of the illness experience is discovering that something is wrong. The other three options are the other stages: medical care contact is stage three, seeking professional advice; assuming the sick role is stage two, seeking support for the sick role; and dependent patient role is the fourth stage, acceptance of treatment.

DIF: Cognitive Level: Application REF: p. 220 OBJ: 2 TOP: Stages of the Illness Experience KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. If illness or hospitalization results in a change in physical appearance, it is likely to have a strong impact on the person’s: a. attitude. b. body image. c. confidence. d. acceptance of the problem.

ANS: B

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Threats to body image occur with surgery, extensive diagnostic procedures, and acute and chronic illness. Changes in physical appearance also may affect attitude, confidence, and acceptance of the problem, but not as heavily as they affect body image.

DIF: Cognitive Level: Comprehension REF: p. 221 OBJ: 4 TOP: Impacts of Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. For most people, being hospitalized is seen as a/n: a. crisis. b. annoyance. c. chance to rest. d. expensive hotel.

ANS: A The crisis of hospitalization involves being removed from one’s familiar home environment to be cared for by strangers in an impersonal, uncomfortable setting.

DIF: Cognitive Level: Knowledge REF: p. 222 OBJ: 4 TOP: Situational Crisis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The client has been admitted to the medical unit for unexplained weight loss and fatigue. He does not speak except to answer questions, and he refuses to interact with other people except when necessary. Which coping mechanism is he using to deal with his hospitalization? a. Anger b. Shock c. Anxiety d. Withdrawal ANS: D Many hospitalized clients withdraw into themselves and interact only when necessary.

Clients do this to focus their attention inward and replace the energies that have been drained by illness, crisis, and hospitalization.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 5 TOP: Stages of Hospitalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. The most important reason for performing a crisis assessment on hospitalized clients is that it allows the care provider to: a. implement appropriate care measures. b. encourage clients to share their concerns. c. identify the requirements for additional supplies and personnel. d. identify problems before a crisis develops and plan preventive interventions.

ANS: D Problems are much easier to address and treat before they become a crisis situation. The other options are not necessarily directly related to a crisis situation.

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DIF: Cognitive Level: Application REF: p. 222 OBJ: 6 TOP: Psychosocial Care KEY: Nursing Process Step: Assessment | Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 7. The caregiver is encouraging a mother to participate in bathing her daughter, who is in traction for a fractured femur. The caregiver is recognizing the family’s: a. physical need to work. b. social need to stay with the client. c. intellectual need to control the situation. d. emotional need to be involved in caring for the client.

ANS: D A client’s family has a significant impact on the outcome of the client’s illness and provides emotional support.

DIF: Cognitive Level: Comprehension REF: p. 221 OBJ: 7 TOP: Supporting Significant Others KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 8. The process that helps clients cope with illness or surgery after leaving the institution is called: a. client education. b. preventative care. c. discharge planning. d. role change planning.

ANS: C Discharge planning should begin on the day of admission. Client education and preventative care are part of discharge planning; role change planning is not.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 9 TOP: Discharge Planning KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which is the best way for the nurse to assist clients in managing their pain? a. By setting mutual goals b. By focusing on nursing care c. By administering narcotic analgesics d. By telling the clients to think of something else ANS: A Setting mutual goals helps both nurses and clients to set realistic, attainable goals for pain management. Focusing on nursing care is not client centered; administering narcotic analgesics should not be a focus of pain management; and telling the clients to think of something else does not address the problem of pain.

DIF: Cognitive Level: Application TOP: Pain Management

REF: p. 226 OBJ: 9 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Psychosocial Integrity 10. The stage of hospitalization during which the client reestablishes personal identity and becomes self-centered is the time when the client is: a. going to be discharged. b. feeling overwhelmed. c. becoming emotionally stabilized. d. adapting to the environment.

ANS: C During the stabilization stage, the hospitalized person gradually gains the strength to reestablish some personal identity. Some clients become self-centered at this time because they are focusing on their illness. The time when the client is going to be discharged is not considered a stage of hospitalization; feeling overwhelmed is the first stage, and adapting to the environment is the third stage.

DIF: Cognitive Level: Knowledge REF: p. 223 OBJ: 5 TOP: Stages of Hospitalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The nurse begins discharge planning measures with a hospitalized client: a. near the time of discharge. b. at the time of admission. c. 3 days into the hospital stay. d. on the day before discharge.

ANS: B Discharge planning should be initiated as soon as possible after the client is admitted so ample time is allowed to make necessary plans for discharge to home or to another facility.

The other options will not allow sufficient time for this to occur.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 9 TOP: Discharge Planning KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. During a crisis assessment due to the diagnosis of a terminal illness, the nurse is trying to determine what the client’s history is with regard to losses. Which question will best assess this area? a. “How easily do you adapt to new situations?” b. “What is your understanding of the current situation?” c. “Who or what has helped you through crisis situations in the past?” d. “How is this situation affecting your family?”

ANS: C This question will help one to determine how this client has dealt with crises in the past.

Asking the client about adaptation to new situations assesses for other risk factors, and asking about the client’s understanding of the situation or how the situation is affecting the client’s family assesses what the illness means to the client.

DIF:

Cognitive Level: Application

REF: p. 222

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OBJ: 4

TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 13. A male client has been diagnosed recently with a chronic illness. His family tells the nurse that they have noticed that he has not been attending his weekly card game night with his friends and does not return their calls. What reaction is this client most likely experiencing? a. Anxiety b. Withdrawal c. Shock d. Anger ANS: B Withdrawal is a common response to illness. The individual removes himself from others and refuses to interact. The other options are also common emotional responses to illness: anxiety is described as feelings of uneasiness and apprehension; shock refers to an overwhelmed feeling with inability to process information; and anger is an emotional response that may be directed inward or outward.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 4 TOP: Impacts of Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. The nurse is admitting a male client so he can undergo testing for diagnostic purposes. The nurse explains how the equipment in the room works and how to order meals. After the nurse leaves the room, the client yells for the nurse because he can’t remember how to use the call light. What emotional response is the client experiencing? a. Denial b. Withdrawal c. Shock d. Anger ANS: C Shock is a common response to illness experienced by clients and their families. The individual experiences an overwhelmed feeling with an inability to process information. The other options are also common emotional responses to illness: denial is described as refusal to acknowledge a situation; withdrawal is characterized by an individual’s removing himself or herself from others and refusing to interact; and anger is an emotional response that may be directed inward or outward.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 4 TOP: Impacts of Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A female client admitted to a mental health facility for depression is frequently asking for help in deciding which foods to choose for her meals as well as which activities she should participate in. Which stage of illness is she experiencing? a. Dependency b. Symptoms c. Recovery and rehabilitation d. Sick role

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ANS: A Dependency is stage 4 of the stages of illness and is characterized by relying on and accepting the attention of others. The appearance of symptoms is the first stage of illness and refers to notice of an undesirable change and awareness that something is not right; recovery and rehabilitation constitute stage 5 of illness; and the sick role is the second stage of illness, in which an individual accepts the illness and focuses on treatment and/or recovery.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 2 TOP: Stages of Illness Experience KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The nurse is talking with a male client recently admitted to a mental health facility. He is very anxious to begin his treatment for alcohol and drug addiction because he states that he “really wants to get well this time.” Which stage of illness is the client experiencing? a. Dependency b. Symptoms c. Recovery and rehabilitation d. Sick role ANS: D The sick role is the stage of illness in which an individual accepts the illness and focuses on treatment and/or recovery. Dependency is stage 4 of illness and is characterized by relying on and accepting the attention of others. The appearance of symptoms is the first stage of illness and refers to notice of an undesirable change and awareness that something is not right; recovery and rehabilitation constitute stage 5 of illness.

DIF: Cognitive Level: Application REF: p. 221 OBJ: 2 TOP: Stages of Illness Experience KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. An individual notices that he is experiencing periods of feeling very depressed followed by periods of elation and increased energy. He knows that something is wrong and talks with his family about what he should do. This is an example of the stage of illness called: a. dependency. b. symptoms. c. recovery and rehabilitation. d. sick role.

ANS: B During stage 1 of illness, the individual notices an undesirable change, is aware that something is not right, and seeks the advice of others. Dependency is stage 4 of illness and is characterized by relying on and accepting the attention of others. Recovery and rehabilitation is stage 5 of illness, and assuming the sick role is the stage of illness in which an individual accepts the illness and focuses on treatment and/or recovery.

DIF: Cognitive Level: Application REF: p. 220 OBJ: 2 TOP: Stages of Illness Experience KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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18. A business owner is hospitalized after suffering a heart attack. The staff finds him very demanding and angry toward all personnel and noncompliant in his therapy and treatment plan. What is the best strategy for the nurse to employ with this patient? a. Give him an ultimatum to cooperate or face a longer recovery period. b. Allow him to continue this behavior due to his role outside the hospital. c. Provide him with necessary information to actively participate in goal setting. d. Request that a health care provider with a stronger personality take care of him.

ANS: C Loss of control and dependence on health care providers are feelings shared by hospitalized clients. Providing necessary information to make decisions in his own care allows the client some control over the hospitalization.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 4 TOP: Situational Crisis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. A 72-year-old woman from the Dominican Republic is hospitalized after fainting while visiting her daughter. The staff has voiced complaints regarding the family ignoring hospital rules regarding visiting hours and number of visitors allowed in the room. In addition, the daughter brings food to the mother from home which is not a part of the client’s prescribed diet. How can the staff deal with these issues in a professional manner? a. Meet with the patient and family to determine how to provide support for cultural practices. b. Have security remove the family and focus on the client’s care and needs. c. Accept the food from the family and throw it out without informing them. d. Allow family presence to take priority over treatments and therapies.

ANS: A An individual’s family is an important group in one’s life. Family members should be included and consulted for details about the client’s care. In this case the family is also in crisis and needs support and the satisfaction that their loved one is receiving good care. All other options seek to exclude the family from this support.

DIF: Cognitive Level: Application REF: p. 224 OBJ: 7 TOP: Supporting Significant Others KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 20. A woman arrives at the hospital to deliver her first child. She has no previous history of hospitalization or serious illness. During her stay, the client is highly anxious and demands to be informed of all information documented on her medical record. The client’s husband informs the nurse that the client’s mother died in the hospital 10 months ago after a brief battle with lung cancer. The most probable reason for the client’s current reaction is: a. obsessive fear of dying. b. reluctance in becoming a mother. c. symbolic meaning of the hospital. d. ambivalence regarding the sick role.

ANS: C

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The client’s reaction is due to the symbolic meaning this hospital has for her.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 7 TOP: Supporting Significant Others KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 21. The client being transferred to a rehabilitation center following hospitalization for surgical repair of a fractured hip is portrayed by the nurse in the hospital setting as being very involved and making good progress in his physical therapy sessions. However, the nurse in the rehabilitation facility observes that the client is withdrawn, and he often asks to defer his physical therapy sessions. Which statement best describes the change in patient behavior? a. The patient is suffering from delirium due to the unfamiliar surroundings. b. The patient has adapted to the recovery role and does not need rehabilitation. c. The patient enjoyed the dependency role in the hospital setting. d. The patient is adjusting to a new environment and is in a vulnerable position.

ANS: D In dealing with his hospitalization, the client has regained personal identity and adapts; however, for persons transferred to another institution, the crisis begins again. This does not indicate that the patient does not require rehabilitation. His behavior in the hospital was not reflective of a dependency. This client is not exhibiting behaviors indicative of delirium.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 5 TOP: Stages of Hospitalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. How does the experience of entering a psychiatric treatment facility differ from hospitalization for physical reasons? (Select all that apply.) a. The client may fear other clients’ behaviors. b. The client receives a negative diagnostic label. c. The client can enjoy the attention of caregivers. d. The client must cope with the stigma of mental illness. e. The client must cope with the stigma of physical illness. f. Insurance companies may deny payment for treatment. g. Insurance companies never deny payment for treatment.

ANS: A, B, D, F Because of stereotyping of mental illness, clients often fear mental health facilities and the stigma of being in one. In addition, some insurance companies have not added mental health treatment to their plans or have limited treatment coverage.

DIF: Cognitive Level: Application REF: p. 224 OBJ: 6 TOP: Psychiatric Hospitalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which natural remedies may the nurse use to assist clients in alleviating pain? (Select all that apply.)

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a. b. c. d. e.

Distraction Pain patches Massage Visualization PCA pumps

ANS: A, C, D Natural remedies are less invasive and should be attempted prior to administration of medication, such as pain patches and PCA pumps.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 8 TOP: Psychosocial Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 3. Which functions of a person are diminished or impaired during illness? (Select all that apply.) a. Social b. Medical c. Emotional d. Physical e. Intellectual ANS: A, C, D, E Illness is defined as an abnormal process in which aspects of the social, physical, emotional, or intellectual condition and function are diminished or impaired. Medical is not a human function.

DIF: Cognitive Level: Knowledge REF: p. 220 OBJ: 1 TOP: The Nature of Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

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Chapter 20: Loss and Grief Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The client is 21 years old and has just been given the diagnosis of terminal cancer. She is coping with a(n) loss. a. expected b. imagined c. internal d. temporary ANS: C Internal losses are personal and include losses that involve the self. Expected loss occurs gradually; imagined loss is perceived; and temporary loss is reversible.

DIF: Cognitive Level: Comprehension REF: p. 228 OBJ: 1 TOP: Characteristics of Loss KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. The group best able to accept their losses and grow from their experiences is: a. adults. b. toddlers. c. adolescents. d. school-age children.

ANS: A Adults who have experienced loss learn to accept their losses and learn from their experiences.

DIF: Cognitive Level: Knowledge REF: p. 229 OBJ: 2 TOP: Loss Behaviors Throughout the Life Cycle KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. The set of emotional reactions that accompany a loss is called: a. grief. b. anxiety. c. mourning. d. bereavement.

ANS: A Grief is the set of emotional reactions that accompany a loss. Anxiety is a vague, uneasy feeling that is not specifically related to a loss. Mourning refers to the process of resolving a loss, and bereavement refers to the thoughts, feelings, and activities following a loss.

DIF: Cognitive Level: Knowledge REF: p. 230 OBJ: 3 TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: N/A MSC: Client Needs: Psychosocial Integrity

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4. The behavioral state of thoughts, feelings, and activities that follow a loss is called: a. grief. b. anxiety. c. mourning. d. bereavement.

ANS: D This state is different with every person. Grief is the set of emotional reactions that accompany a loss. Anxiety is a vague, uneasy feeling that is not specifically related to a loss. Mourning is the process of working through or resolving one’s grief.

DIF: Cognitive Level: Knowledge REF: p. 230 OBJ: 3 TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Persons may refuse to acknowledge that a loss has occurred during the first stage of: a. crisis. b. the grieving process. c. the rage reaction. d. the denial process.

ANS: B The first step in the grieving process is denial.

DIF: Cognitive Level: Knowledge REF: p. 230 OBJ: 3 TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. The client lost her husband of 50 years 10 months ago. She now sees every day as a gray fog with no light. She has begun to experience changes in eating, sleeping, and activity levels; angry, hostile moods; and an inability to concentrate or complete work tasks. What is the client experiencing? a. Complicated grief b. A normal grief reaction c. Complicated depression d. Bereavement-related depression ANS: D With bereavement-related depression, the griever feels the loss so intensely that despair and worthlessness overwhelm everything. This is not considered a normal grief reaction.

Complicated grief refers to a constant yearning for the deceased without symptoms of depression. Complicated depression is not a grief reaction.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 4 TOP: Unresolved Grief KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The last stage of growth and development is called: a. dying. b. old age.

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c. wisdom. d. maturity.

ANS: A Dying is the last stage of growth and development.

DIF: Cognitive Level: Knowledge REF: p. 232 OBJ: 7 TOP: The Dying Process KEY: Nursing Process Step: N/A MSC: Client Needs: Health Promotion and Maintenance 8. The concerns of children in whom terminal conditions have been diagnosed focus on how the illness affects the child’s: a. loss of a future. b. family and friends. c. social activities. d. activities of daily living.

ANS: D Immediate concerns focus on how the illness affects the activities of daily living and limits the child’s abilities. As individuals mature, concerns turn to the remaining three options.

DIF: Cognitive Level: Comprehension REF: p. 232 OBJ: 5 TOP: Age Differences and Dying KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. To make the remainder of a terminally ill person’s life as meaningful and comfortable as possible is the goal of: a. hospice care. b. the stages of dying. c. the grieving process. d. institutional care.

ANS: A The goal of hospice care is to make the remainder of a terminally ill person’s life as meaningful and comfortable as is humanly possible. Hospice focuses not only on care of the client but also on the family as well.

DIF: Cognitive Level: Knowledge REF: p. 235 OBJ: 9 TOP: Hospice Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. When care is provided for a dying client in pain, addiction to analgesics is: a. not an issue. b. to be evaluated daily. c. to be carefully avoided. d. to be prevented with pain management techniques.

ANS: A Addiction is not an issue when care is provided for the terminally ill; the goal is to make the client comfortable and pain free.

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DIF: Cognitive Level: Comprehension REF: p. 235 OBJ: 9 TOP: Meeting the Needs of Dying Clients KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 11. Decisions about a terminally ill client’s remaining time belong to the: a. person. b. family members. c. medical care team. d. spiritual advisor.

ANS: A In a “good death,” a person controls his or her own destiny.

DIF: Cognitive Level: Comprehension REF: p. 219 OBJ: 8 TOP: Therapeutic Interventions KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 12. To assist them with their grief experiences, many health care facilities offer caregivers who work with dying clients: a. extra income. b. support groups. c. time off from work. d. peer evaluation groups.

ANS: B Many health care facilities offer support groups for caregivers who work with dying clients to help them work through their own grief experiences.

DIF: Cognitive Level: Knowledge REF: p. 234 OBJ: 9 TOP: Caregivers’ Grief KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 13. The father of three young children dies. The wife expresses how worried she is about how to raise the children on her own without the support of her husband. She finds herself crying and living through each day without accomplishing anything. In which grieving stage is this behavior typically experienced? a. Denial b. Depression and identification c. Acceptance and recovery d. Yearning ANS: D This is the second stage of grieving, in which the person longs for the deceased and feels overwhelmed by the loss. Denial is the first stage of grieving, when the person is in shock and rejects the loss of another; depression and identification is the third stage of grieving, characterized by depressed feelings followed by a period of sharing memories and seeking support from others; and acceptance and recovery is the phase of the grieving process during which individuals begin to focus their energies toward the living and their lives begin to stabilize.

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DIF: Cognitive Level: Application REF: p. 231 OBJ: 3 TOP: The Grieving Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. Three years after the loss of her husband of 35 years, the widow has a full-time job but finds that she cannot sleep well at night, has frequent mood changes, and attends the couple’s night out with friends that she and her husband attended. Upon seeking counseling, she discovers that she is exhibiting symptoms of: a. bereavement-related depression. b. complicated grief. c. anticipatory grief. d. caregiver grief.

ANS: B These are characteristic symptoms of complicated grief in which an individual experiences persistent yearning for the deceased person without signs of depression.

Bereavement-related depression refers to depression following a loss that consumes every aspect of a person’s life; anticipatory grief refers to grief felt in anticipation of a loss; and caregiver grief refers to grief felt by health care providers.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 4 TOP: Unresolved Grief KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. The 39-year-old daughter of a client with a terminal illness tells the nurse that she thinks something is wrong with her because she frequently cries, is often sad, and can’t imagine losing her mother. The nurse assures the daughter that these are normal feelings associated with: a. bereavement-related depression. b. complicated grief. c. anticipatory grief. d. caregiver grief.

ANS: C These symptoms are typically experienced with grief that is felt in anticipation of a loss.

Bereavement-related depression refers to depression following a loss that consumes every aspect of a person’s life; complicated grief is displayed as persistent yearning for the deceased person without signs of depression; and caregiver grief refers to grief experienced by health care providers.

DIF: Cognitive Level: Application REF: p. 231 OBJ: 4 TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. A family experiences the loss of their wife and mother to a car accident. Which family member is most likely to react by asking “When is mommy coming back?” a. The 17-year-old son b. The 11-year-old daughter c. The 4-year-old son d. The 7-year-old daughter

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ANS: C Because of their sense of time, preschoolers cannot understand a permanent loss such as death. School-age and adolescent children have an adult concept and understanding of loss and death.

DIF: Cognitive Level: Application REF: p. 229 OBJ: 4 TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. A 10-year-old patient on a children’s oncology unit has had an unsuccessful bone marrow transplant. The family is distraught but remains positive in front of the child. One night the child asks the nurse about death and dying. What counseling should the nurse give to the parents? a. Avoid talking about death in front of the child. b. Change the subject if the child asks about dying. c. Allow the child to have an honest discussion about dying. d. Allow the physician to discuss this with the child.

ANS: C Children are remarkably observant and have an intuitive ability to understand the seriousness of their illness and its outcomes. Whenever possible, parents should be encouraged to communicate with the dying child. Open discussions of the illness and its outcomes help children cope with feelings of isolation, anxiety, and guilt over causing distress in the family. The other options continue to isolate the child and encourage suppression of feelings.

DIF: Cognitive Level: Application REF: p. 229 OBJ: 7 TOP: Age Differences and Dying KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. Throughout the life cycle, which age-group has the most difficult time relating to their own death? a. Toddler b. Preschool c. Adolescent d. Adult ANS: C Death is particularly difficult to accept during adolescence because the developmental task at this age is to define who one is and to establish an identity. Threats of loss at this age may make a person stand out from his or her peer group.

DIF: Cognitive Level: Application REF: p. 229 OBJ: 4 TOP: Loss Behaviors Throughout the Life Cycle KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. A person with terminal cancer makes a call to a family member she has not spoken to in 30 years in order to make amends. According to Kübler-Ross, what stage of dying is this person in?

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a. b. c. d.

Denial Working Resistance Acceptance

ANS: B In the working or review stage, the individual begins to deal with unfinished business. In the denial or resistance phase, the individual fights the issue, and in the acceptance stage, the individual is comfortable with death.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 7 TOP: Stages of Dying KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following are therapeutic interventions for unresolved grief? (Select all that apply.) a. Listening b. Providing emotional support c. Keeping the griever medicated d. Referring to appropriate resources e. Forcing the client to eat properly f. Telling the client that he or she must learn to cope g. Encouraging return to work as soon as possible ANS: A, B, D Listening, providing emotional support, and referring to appropriate resources are interventions for unresolved grief.

DIF: Cognitive Level: Comprehension REF: p. 231 OBJ: 4 TOP: Unresolved Grief KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Loss of which of the following can result in the individual’s experiencing external losses?

(Select all that apply.) a. Spouse b. Possession c. Career d. Limb e. Favorite piece of jewelry f. Friendship ANS: A, B, E, F External losses are considered losses that occur outside of the individual and include objects, possessions, the environment, loved ones, and support. Loss of career or limb is an internal loss that is more personal and involves some part of oneself.

DIF: Cognitive Level: Comprehension TOP: The Nature of Loss

REF: p. 228 OBJ: 1 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Psychosocial Integrity 3. According to Glaser and Strauss, the closed awareness model can be applied to family, friends, care providers, and the dying individual. Which of the following statements are true of the closed awareness model? (Select all that apply.) a. Medical personnel and family keep the condition secret from the client. b. Caregivers and client know about impending death but do not talk about it. c. Caregivers and client accept death and have open conversations. d. Dying client feels isolated from the ability to share with family. e. Dying client becomes suspicious of the truth, and information is tightly controlled by family.

ANS: A, D, E The closed awareness model is one in which the goal of care providers and family is to keep the truth from the client. The belief centers around the rationale that telling the client the seriousness of the condition would be too upsetting. As the client begins to realize the seriousness of his condition, caregivers limit and control information. The mutual pretense model is one in which both client and family know about the pending death but do not discuss it. In the open awareness model, the client and family have open communication and accept death.

DIF: Cognitive Level: Application REF: p. 234 OBJ: 7 TOP: Stages of Dying KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 21: Depression and Other Mood Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. A prolonged emotional state that influences one’s whole personality and life functioning is called: a. mood. b. feeling. c. attitude. d. intellectual response.

ANS: A This is the definition of mood. Moods range from elation to despair and can be either adaptive or maladaptive.

DIF: Cognitive Level: Knowledge REF: p. 239 OBJ: 1 TOP: Theories Relating to Emotions and Their Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. The moods of adolescents: a. are stable. b. vary widely. c. develop slowly. d. are not related to growth and development.

ANS: B The moods of adolescents commonly swing from depression to elation. This is a time of hormonal changes and a time when teens are trying to develop their identity and both gain control over and express their emotions.

DIF: Cognitive Level: Comprehension REF: p. 241 OBJ: 3 TOP: Emotions in Adolescence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Depression in the elderly is: a. rare. b. common. c. nonexistent. d. seen occasionally.

ANS: B Major depression affects as many as 40% of older Americans and is seen most often in women, persons with medical illnesses, and those individuals who are living in long-term care facilities.

DIF: Cognitive Level: Knowledge REF: p. 242 OBJ: 3 TOP: Depression in Older Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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4. Theories that view depression as a group of learned responses are called a. social b. behavioral c. biological d. psychoanalytical

theories.

ANS: B Behaviorists view depression as a group of learned responses. Social theorists view depression as the result of flawed social interactions; biological theory focuses on causes of depression such as biochemical imbalances and genetics; and psychoanalytical theorists believe that mood disorders occur as a result of anger turned inward.

DIF: Cognitive Level: Knowledge REF: p. 240 OBJ: 2 TOP: Theories Relating to Emotions and Their Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Severe, prolonged depression affects a person’s risk for physical illness by a. decreasing b. increasing c. not affecting d. having little effect on

the risk.

ANS: B Severe, prolonged depression results in many physical changes and increases one’s risk for illness by lowering an individual’s immune response.

DIF: Cognitive Level: Knowledge REF: p. 243 OBJ: 4 TOP: Major Depressive Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n) disorder. a. anxiety b. bipolar c. dysthymic d. major depressive ANS: C A dysthymic disorder is daily moderate depression that lasts for longer than 2 years.

Anxiety refers to a vague uneasy feeling; bipolar disorder is manic-depressive disorder; and major depressive disorder refers to severe depression.

DIF: Cognitive Level: Knowledge REF: p. 244 OBJ: 4 TOP: Dysthymic Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The client’s diagnosis is most likely: a. bipolar disorder.

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b. major depression. c. an anxiety disorder. d. dysthymic disorder.

ANS: A The hallmark of a bipolar disorder is sudden and dramatic shifts in emotional extremes.

DIF: Cognitive Level: Comprehension REF: p. 244 OBJ: 5 TOP: Bipolar Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is most effective in improving symptoms in people who are experiencing: a. bipolar disorder. b. moderate depression. c. postpartum depression. d. seasonal affective disorder.

ANS: D Daily exposure to full-spectrum light reduces the symptoms of seasonal affective disorder, which is also known as winter depression and typically occurs from October to April.

DIF: Cognitive Level: Knowledge REF: p. 245 OBJ: 6 TOP: Other Problems With Affect KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 9. The goal of treatment during the first phase of depression is to: a. develop a plan for treatment. b. reduce uncooperative behaviors. c. help the client to adjust to antidepressants. d. reduce symptoms and inappropriate behaviors.

ANS: D The goal during the first phase (acute phase) is to reduce symptoms and inappropriate behaviors. This phase may last 6 to 12 weeks and may require hospitalization. Developing a treatment plan and helping the client to adjust to antidepressants refers to the second phase, which is known as the continuation phase; and reducing uncooperative behaviors may or may not occur with depression.

DIF: Cognitive Level: Comprehension REF: p. 245 | Table 21.2 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 10. During the continuation phase of therapy, a client with a diagnosis of depression asks, “What is the goal of therapy during this 4- to 9-month period?” What is the nurse’s best response? a. “We are going to work together to try to reduce your symptoms.” b. “Our goal is to determine the cause of your depression and cure it.” c. “We want to prevent you from ever having any depressive episodes in the future.” d. “Our goal is to prevent you from relapsing and experiencing distressing emotional

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states.”

ANS: D The continuation phase is the second phase of therapy for clients with depression. Working together to try to reduce symptoms occurs during the acute phase of treatment. Determining the cause of depression and preventing future depression most likely are not possible.

DIF: Cognitive Level: Application REF: p. 246 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).

Which point will the nurse teach the client? a. “ECT treatments take about 1 hour.” b. “You will most likely receive between 6 and 12 treatments over several weeks.” c. “ECT often is used as one of the first treatments for major depression.” d. “ECT treatments help your depression by decreasing levels of the neurotransmitter norepinephrine.”

ANS: B This is the normal duration for ECT treatments. ECT treatments usually take only about 15 minutes, so it is incorrect to tell the client that they will last 1 hour. ECT is an invasive treatment that is usually a last resort rather than one of the first selected treatments. ECT raises levels of norepinephrine rather than lowering them.

DIF: Cognitive Level: Application REF: p. 246 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 12. A client asks the nurse which types of antidepressants have the fewest side effects. What is the nurse’s most accurate response? a. “Tricyclic antidepressants” b. “Nontricyclic antidepressants” c. “Monoamine oxidase inhibitors (MAOIs)” d. “Selective serotonin reuptake inhibitors (SSRIs)” ANS: D SSRIs are the most widely prescribed antidepressants now because of their low incidence of side effects. MAOIs are the last group of choice because of their severe and potentially fatal side effects.

DIF: Cognitive Level: Application REF: p. 248 OBJ: 8 TOP: Drug Therapies—Antidepressants KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 13. A male client with bipolar disorder who takes lithium tells the nurse that he has been “nauseous a lot lately,” “feels tired,” and has had “some blurry vision.” The client most likely is suffering from what level of lithium toxicity? a. Insignificant b. Mild

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c. Moderate d. Severe ANS: C These are signs of symptoms of moderate lithium toxicity, with blood serum levels of 1.5 to 2.5 mEq/L. Additional signs and symptoms of moderate toxicity include ringing in the ears, irregular tremors, and frank muscle twitching. “Insignificant” is not a level of toxicity. Mild and severe levels of toxicity have signs and symptoms different from those of moderate toxicity.

DIF: Cognitive Level: Comprehension REF: p. 250 | Table 21.5 OBJ: 8 TOP: Drug Therapies—Antimanics KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 14. Which one of the following is a biological cause of mood disorders? a. Anger turned inward b. Impaired nurturing c. Reaction to external stressors d. Imbalance of neurotransmitters ANS: D Biological evidence points to several links to mood disorders including neurotransmitters which excite or inhibit brain circuits involved in mood regulation. When an imbalance occurs with the neurotransmitters, depression can occur. Anger turned inward is a psychoanalytic theory belief. Impaired nurturing and reactions to external stressors are supported by social theorists.

DIF: Cognitive Level: Comprehension REF: p. 240 OBJ: 2 TOP: Biological Evidence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A client seen in the community mental health clinic appears for one appointment in multiple layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in the waiting room about a date she had the previous evening. The next visit she is dressed in old, drab clothes without makeup. She has flat affect and is not making eye contact. The most probable cause of her behaviors is which of the following conditions? a. Bipolar I disorder b. Psychosis c. Bipolar II disorder d. Major depressive episode ANS: A Bipolar I disorder is characterized by episodes of depression alternating with episodes of mania. Bipolar II disorder is characterized by episodes of depression alternating with episodes of hypomania. Depression and psychosis are not characterized by the signs exhibited in the scenario.

DIF: Cognitive Level: Comprehension REF: p. 242 OBJ: 5 TOP: Bipolar Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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16. Which client would be a candidate for ECT? a. A client with mild depression b. A severely depressed client with congestive heart failure c. A client with severe, long-lasting depression d. A severely depressed client with history of a brain tumor ANS: C ECT is indicated for clients with severe long-lasting depression after attempts to stabilize with other therapies are unsuccessful. It is contraindicated in clients with recent heart disease, high or low blood pressure, stroke, or congestive heart failure.

DIF: Cognitive Level: Comprehension REF: p. 246 OBJ: 9 TOP: Treatment and Therapy: Electroconvulsive Therapy KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Which client is suffering from a major depressive episode? a. An adolescent who expresses feeling lost after the death of his mother last week. b. A 50 year old who has been depressed for a month and is contemplating suicide. c. A 30-year-old female who is being treated for episodes of depression she has suffered since the age of 21. d. An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer given to her 8 days ago.

ANS: B A major depressive episode is one in which the depression lasts more than 2 weeks and encompasses every part of the person’s functioning. Suicide is entertained. Feeling lost 1 week after the death of a parent is considered minor depression. Major depressive episodes that repeat for more than 2 years are considered a major depressive disorder.

DIF: Cognitive Level: Application REF: p. 243 TOP: Depression KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment

OBJ: 4

MULTIPLE RESPONSE 1. Which statements regarding depression are correct? (Select all that apply.) a. It occurs in all age groups. b. It rarely occurs in the elderly. c. It occurs in men more often than in women. d. It occurs in women more often than in men. e. It is rarely seen but is severe when it occurs. f. It is common in those who must cope with illness. g. It is one of the most common and treatable mental disorders.

ANS: A, D, F, G These are common characteristics of depression. Depression often is seen in the elderly, affecting as many as 40% of the elderly population, and it is not always severe. Depression occurs in a greater number of women than men.

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DIF: Cognitive Level: Comprehension REF: p. 242 OBJ: 4 TOP: Emotions Throughout the Life Cycle KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. In which groups does postpartum depression occur more frequently? (Select all that apply.) a. Older mothers b. Younger mothers c. Women who do not have a husband d. Women who have had a difficult delivery e. Women who experienced complicated pregnancies f. Those who are also coping with illness g. Women who are not emotionally prepared for motherhood ANS: D, E, G These women are at higher risk for postpartum depression. Postpartum depression is connected to a hormonal imbalance. The incorrect options are not characteristic of postpartum depression.

DIF: Cognitive Level: Analysis REF: p. 245 OBJ: 7 TOP: Other Problems With Affect KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A client is experiencing an episode at the level of mania. Which behaviors are characteristic of this level? (Select all that apply.) a. Outgoing, happy, and worry free b. Decreased ability to concentrate c. Confident d. Disoriented e. Unstable affect f. Pressured speech g. Poor hygiene ANS: E, F Unstable affect and pressured speech are seen most frequently at the mania level of manic behavior. Outgoing behavior, decreased ability to concentrate, and increased confidence are seen at the level of hypomania; disorientation and poor hygiene are seen at the level of delirium.

DIF: Cognitive Level: Comprehension REF: p. 244 | Table 21.1 OBJ: 5 TOP: Bipolar Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. Which of the following statements is true regarding depression in the elderly? (Select all that apply.) a. The highest rates are among individuals who receive long-term care. b. It is a normal consequence of aging. c. Most depressed older adults volunteer to share their feelings. d. Depression is higher in elderly women than elderly men. e. Older adults express feelings of depression in more subtle ways than younger persons.

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ANS: A, D, E Depression is highest in elderly persons who are women, medically ill, and receiving long-term care. Many older adults do not complain or volunteer to share their feelings. It is important to carefully assess and observe the older adult for signs of depression as they express in subtler ways such as changes in daily routine and sleeping and eating patterns.

DIF: Cognitive Level: Comprehension REF: p. 242 OBJ: 3 TOP: Emotions in Older Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Which group of medications for depression will the nurse tell the client to take at bedtime?

(Select all that apply.) a. Tricyclic antidepressants b. Nontricyclic antidepressants c. Monoamine oxidase inhibitors (MAOIs) d. Selective serotonin reuptake inhibitors (SSRIs) ANS: A, D Tricyclic antidepressants often have the side effect of sedation soon after the dose is given, so they should be taken at bedtime. SSRIs may also cause drowsiness and dizziness and should also be encouraged to be taken at bedtime. The other medications should be taken early.

DIF: Cognitive Level: Comprehension REF: p. 248 | Table 21.3 OBJ: 8 TOP: Drug Therapies—Antidepressants KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity

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Chapter 22: Physical Problems, Psychological Sources Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The human physiological stress response mechanism is also called the a. startle b. neuroleptic c. homeostasis d. fight-or-flight

response.

ANS: D The stress response is also called the fight-or-flight response (general adaptation response) and occurs in an attempt to maintain homeostasis.

DIF: Cognitive Level: Knowledge REF: p. 254 OBJ: 1 TOP: Role of Emotions in Health KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 2. People who are able to recognize and defuse their stressors early physical effects of stress. a. never b. often c. always d. seldom

suffer from the

ANS: D People who are able to recognize and defuse their stressors early seldom experience the physical effects of stress. It is nearly impossible to never experience or always feel the effects of stress.

DIF: Cognitive Level: Comprehension REF: p. 254 OBJ: 2 TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Most psychosomatic problems and somatoform disorders begin in: a. puberty. b. adulthood. c. childhood. d. adolescence.

ANS: C How an individual perceives and responds to stress is established in childhood.

DIF: Cognitive Level: Knowledge REF: p. 255 OBJ: 3 TOP: Childhood Sources KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The physiological stress response has an effect on:

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a. b. c. d.

many body systems. only the nervous system. the gastrointestinal system. the cardiovascular and respiratory systems.

ANS: A When an individual perceives stress, the body initiates production of a cascade of biochemicals that affect many body systems.

DIF: Cognitive Level: Knowledge REF: p. 254 OBJ: 2 TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 5. Several studies have demonstrated that significant display hostile or negative behaviors. a. attitudinal b. behavioral c. gastrointestinal d. immune-mediated

changes occur in people who

ANS: D Several studies have demonstrated that significant immune function and blood pressure changes occur in people who display hostile or negative behaviors during periods of conflict.

DIF: Cognitive Level: Comprehension REF: p. 254 OBJ: 2 TOP: Anxiety and Stress KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. Somatization disorder is a polysymptomatic disorder, which means that the disorder is associated with symptoms. a. few signs and b. polymorphic c. many signs and d. specific signs and ANS: C Somatization is a polysymptomatic disorder (i.e., one associated with many signs and symptoms).

DIF: Cognitive Level: Knowledge REF: p. 256 OBJ: 6 TOP: Somatization Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The client recently witnessed a horrific auto accident. Now she is complaining of double vision, loss of balance, and a constant “lump in her throat.” She is exhibiting the signs and symptoms of: a. anxiety reaction. b. behavioral disorder. c. conversion disorder.

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d. posttraumatic stress reaction.

ANS: C These are classic signs of a conversion disorder, which is a somatoform disorder that presents as problems related to sensory or motor functions. These disorders most commonly are seen in individuals of lower socioeconomic status who have little knowledge of health care.

DIF: Cognitive Level: Application REF: p. 259 OBJ: 6 TOP: Conversion Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. La belle indifference is a characteristic that most often is associated with: a. anxiety reaction. b. conversion disorder. c. depressive disorder. d. posttraumatic stress reaction.

ANS: B La belle indifference is a lack of concern about the nature or the implications of the signs or symptoms that are being experienced. The complete opposite reaction of dramatic and hysterical behavior can be seen in conversion disorder.

DIF: Cognitive Level: Knowledge REF: p. 260 OBJ: 6 TOP: Conversion Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. The client can acknowledge the possibility that she exaggerates her symptoms, but she continues to hold on to the belief that something is physically wrong, in the face of evidence to the contrary. What is the client’s diagnosis most likely to be? a. Malingering b. Hypochondriasis c. A conversion reaction d. Body dysmorphic disorder ANS: B This describes the diagnosis of hypochondriasis and is seen most often in early adulthood with individuals who were exposed to a serious illness or a life-threatening condition at an early age. Malingering refers to a condition in which an individual is purposefully engaging in factitious signs and symptoms of a disease. A conversion reaction refers to a somatoform disorder that presents as problems related to sensory or motor functions. Body dysmorphic disorder refers to a disorder characterized by a preoccupation with one’s own physical differences or defects.

DIF: Cognitive Level: Application REF: p. 259 OBJ: 8 TOP: Hypochondriasis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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10. A soldier arrives at the airport after completing a combat assignment. He reports a new-onset blindness but was able to identify his wife in the crowd awaiting passenger arrivals. He is likely experiencing symptoms of: a. somatization. b. hypochondriasis. c. conversion disorder. d. malingering.

ANS: C Psychological factors are often associated with deficits affecting voluntary or motor function. The problem cannot be fully explained by a neurological or general medical condition and is not a culturally sanctioned behavior or experience.

DIF: Cognitive Level: Analysis REF: p. 259 OBJ: N/A TOP: Conversion Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The main feature of a factitious disorder is that symptoms are purposefully produced to allow the individual to: a. get out of work. b. assume the sick role. c. assume control of treatment. d. get the attention of health care providers.

ANS: B The most important feature of a factitious disorder is that symptoms are purposefully produced to enable the individual to assume the sick role.

DIF: Cognitive Level: Comprehension REF: p. 260 OBJ: 8 TOP: Factitious Disorders and Malingering KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. The client complains of severe back pain and is excused from work. Later, he is seen water skiing and jogging. These behaviors describe: a. malingering. b. somatization. c. hypochondriasis. d. a factitious disorder.

ANS: A People who are malingering purposefully produce the signs or symptoms of illness for some form of gain.

DIF: Cognitive Level: Application REF: p. 260 OBJ: 8 TOP: Factitious Disorders and Malingering KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. A client is admitted every month for the past 4 months to the psychiatric hospital with complaints of suicidal thoughts and a plan when his monthly disability income has been spent. This client is exhibiting signs of:

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a. b. c. d.

factitious Disorder. conversion Disorder. hypochondriasis. malingering.

ANS: D When engaged in malingering behaviors, the individual produces symptoms to avoid responsibilities such as duty or obligations. Frequently, clients will produce symptoms with the goal of receiving compensation, food, or shelter for the night. However, once the motive becomes apparent to others, the symptoms usually disappear because they no longer serve a purpose.

DIF: Cognitive Level: Application REF: p. 261 TOP: Malingering KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 6

14. In the culture, mental and emotional disorders are expressed as somatoform complaints on the basis of the belief that the body is the property of the ancestors. a. Japanese b. Hispanic c. Southeast Asian d. Korean ANS: D Koreans believe that the body is the property of the ancestors. In the cultures of the Japanese and Southeast Asians, emotional and mental distresses are also expressed through physical signs and symptoms, but the belief that the body is the property of the ancestors is not associated with these cultures. In the Hispanic culture, physical complaints may be associated with mal ojo (the evil eye). It is important to know how somatoform complaints may surface in different cultures. Each culture has its own set of beliefs and ways of expressing those beliefs.

DIF: Cognitive Level: Knowledge REF: p. 257 | Table 22.1 OBJ: 5 TOP: Cultural Influences KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A female client frequently complains of chest pain, has had extensive physiological testing with negative results, and sees several different medical doctors. This client is exhibiting signs and symptoms characteristic of: a. hypochondriasis. b. conversion disorder. c. body dysmorphic disorder. d. factitious disorder.

ANS: A These are characteristic signs and symptoms of hypochondriasis. Factitious disorder is intentional production of symptoms. Conversion disorder is a somatoform disorder with a presentation of problems related to sensory and motor functions. Body dysmorphic disorder is characterized by a preoccupation with a physical difference or defect.

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DIF: Cognitive Level: Application REF: p. 259 OBJ: 7 TOP: Hypochondriasis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. Your client is a wife and mother who, in addition to doing most of the household tasks, has a difficult time saying no to helping out with functions at school and church. Based on Fromm’s psychodynamic theory, what illness is she more prone to develop? a. Cardiac problems b. High blood pressure c. Alcoholism d. Gastric ulcer ANS: D According to psychodynamic theory, certain personality types are more prone to certain illnesses. The more aggressive personality is more prone to cardiovascular disease. The quiet, uncomplaining, overburdened person may suffer from ulcers, joint problems, or skin rashes.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 4 TOP: Theories of Psychophysical Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Once the acute feelings of illness are resolved, what is an appropriate intervention when treating a client with a psychosocial problem? a. Avoid expression of feelings as this will provide a relapse of acute symptoms. b. Minimize secondary gains. c. Convey an attitude that such behavior is not acceptable. d. Assist the client to limit social network to avoid additional stress.

ANS: B A key intervention for clients with psychosocial problems is to minimize the secondary gains once the acute phase is resolved. It is recommended that the caregiver encourage expression of feelings rather than physical complaints. An accepting attitude is necessary to build trust. Assisting the client in limiting a social network limits a potential support system.

DIF: Cognitive Level: Application REF: p. 256 OBJ: 9 TOP: Implications for Caregivers KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. A mother brings her 9-month-old son to the emergency department because he stopped breathing at home. She demands that he receive a full diagnostic work-up. When asked for the name of her pediatrician, she states she has not found one she is satisfied with. The nurse suspects: a. projection. b. malingering. c. conversion disorder. d. Munchausen’s syndrome by proxy.

ANS: D

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Factitious disorder by proxy (Munchausen’s syndrome by proxy) most often involve a caregiver who induces signs of illness in a child and presents the child for medical care.

Diagnosis is difficult because offenders commonly remove their victims as soon as the disorder is suspected.

DIF: Cognitive Level: Application REF: p. 260 OBJ: 8 TOP: Factitious Disorders and Malingering KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. A woman arrives at the hospital complaining of chest pains and shortness of breath. She has come in several times over the past 2 weeks, and the staff is doubtful that her symptoms are real. What is the first action for the health care team to implement? a. Complete a history, physical, and diagnostics. b. Arrange for a psychiatric consult. c. Provide discharge instructions and arrange for a follow-up visit. d. Obtain a prescription for an antianxiety agent.

ANS: A The first goal of care in every case is to rule out the presence of any physical disease or dysfunction.

DIF: Cognitive Level: Application REF: p. 261 OBJ: 9 TOP: Conversion Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following are characteristics of somatoform disorders? (Select all that apply.) a. Relieve anxiety. b. Decrease depression. c. Have no organic medical source. d. Are related to a medical condition. e. Significantly impair one’s level of functioning. f. Often occur in those who must cope with illness. g. Occur in clients who are unaware of or unable to express emotional distress.

ANS: A, C, E, G These are the criteria for the diagnosis of a somatoform disorder, which is defined as feeling physical symptoms with no diagnosable organic medical condition.

DIF: Cognitive Level: Knowledge REF: p. 240 | p. 241 OBJ: 6 TOP: Criteria for Diagnosis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which are the essential features of conversion disorders? (Select all that apply.) a. Preoccupation with fears of disease b. Deficits in motor function c. Long history of vague complaints d. Deficits in sensory function

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ANS: B, D Deficits in motor and sensory function are specific to conversion disorders. Preoccupation with fears of disease is typical of hypochondriasis, and a long history of vague complaints is common with somatization disorder.

DIF: Cognitive Level: Comprehension REF: p. 242 OBJ: 6 TOP: Conversion Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which of the following are indicative of hypochondriasis? (Select all that apply.) a. Symptoms most commonly appear in early childhood. b. First diagnosed following a severe stressor. c. More frequent in person exposed to a serious illness in childhood. d. Sufferers usually have strained interpersonal relationships.

ANS: B, C, D Hypochondriasis commonly occurs in early adulthood and is more frequent in persons exposed to serious illness or a life-threatening condition in childhood. In some cases, initial diagnosis follows a severe stressor such as a death of a loved one. Interpersonal relationships are often strained due to the individual with hypochondriasis focusing exclusively on themselves and expecting special treatment.

DIF: Cognitive Level: Application REF: p. 243 | p. 244 OBJ: 7 TOP: Hypochondriasis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 23: Eating and Sleeping Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Trends that have contributed to the recent increase in eating disorders in the United States include a(n): a. more competitive workplace. b. increase in the number of divorces. c. focus on being thin as a measure of attractiveness. d. increase in the number of nonnutritional foods consumed.

ANS: C In most modern societies, a high value is placed on a slim body.

DIF: Cognitive Level: Knowledge REF: p. 264 OBJ: 1 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. What is the main issue for adolescents with anorexia? a. Anxiety b. Control c. Body image d. Appropriate behavior ANS: B The main issue for teenage anorectics is control.

DIF: Cognitive Level: Knowledge REF: p. 266 OBJ: 2 TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which disorder is associated with persons with a body weight that is normal or even slightly above average? a. Pica b. Bulimia c. Obesity d. Anorexia nervosa ANS: B Often, a bulimic has a body weight that is normal or even slightly above average. Pica is a disorder in which the individual is eating abnormal substances. Obese individuals are above normal weight, and individuals with anorexia nervosa have less than normal weight.

DIF: Cognitive Level: Knowledge REF: p. 268 TOP: Bulimia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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OBJ: 2

4. The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles that lasts for longer than 1 month is called: a. pica. b. bulimia. c. rumination. d. regurgitation.

ANS: A Pica is the persistent eating of nonfood items that lasts for longer than 1 month and often is associated with a severe vitamin or mineral deficiency. Bulimia refers to an eating disorder that is commonly characterized by bingeing and purging; rumination is a rare disorder that refers to regurgitation and rechewing of food; and regurgitation refers to partially digested food brought up into the mouth.

DIF: Cognitive Level: Knowledge REF: p. 270 OBJ: 1 TOP: Other Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The main focus of medical management for anorexia is to: a. encourage rapid weight gain. b. encourage the client to eat voluntarily. c. teach more appropriate food choices. d. keep the client from developing additional problems.

ANS: B The main focus is to encourage the client to consume food voluntarily because this will allow for continued normal food consumption. Too rapid weight gain will lead to a feeling of loss of control, which could induce inappropriate eating behaviors again. Teaching appropriate food choices and keeping the client from developing additional problems occur as a part of the psychological management of the disorder.

DIF: Cognitive Level: Comprehension REF: p. 267 OBJ: 5 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 6. Although all age groups can be affected, sleep disorders occur most frequently in: a. adolescence. b. later childhood. c. older adulthood. d. middle adulthood.

ANS: C Sleep disorders occur more frequently in older adults.

DIF: Cognitive Level: Knowledge REF: p. 271 OBJ: 7 TOP: Sleep-Wake Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The inability to fall asleep or stay asleep is called: a. insomnia.

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b. narcolepsy. c. hypersomnia. d. nocturnal myoclonus.

ANS: A Insomnia is a disorder of falling asleep or sustaining sound sleep. Narcolepsy refers to a condition in which an individual repeatedly experiences periods of sleep, regardless of activity or the situation; hypersomnia refers to prolonged sleep episodes; and nocturnal myoclonus refers to an individual who moves limbs involuntarily during sleep and has symptoms or problems related to this movement.

DIF: Cognitive Level: Knowledge REF: p. 274 TOP: Dyssomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 8

8. A disorder that interrupts normal sleep patterns and is characterized by repeated, brief jerks of the arms and legs that occur every 20 to 60 seconds during the beginning of sleep is called: a. insomnia. b. narcolepsy. c. hypersomnia. d. nocturnal myoclonus.

ANS: D Nocturnal myoclonus consists of repeated, brief jerks, most often in the legs, that occur at the beginning of sleep and disrupt the normal sleep pattern. These movements generally decrease during stage 4 NREM sleep.

DIF: Cognitive Level: Knowledge REF: p. 275 TOP: Dyssomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: N/A

9. Sleep disorders that are characterized by abnormal behavioral or physical events during sleep are called: a. insomnia. b. dyssomnias. c. hypersomnia. d. parasomnias.

ANS: D Sleep disorders characterized by abnormal behavioral or physical events during sleep are called parasomnias and are caused by inappropriate activation of certain centers of the brain that control physical and emotional functions. Insomnia is the inability to fall asleep; dyssomnias are sleep disorders characterized by abnormal amounts, quality, or timing of sleep; and hypersomnia is an abnormally increased amount of sleep.

DIF: Cognitive Level: Knowledge REF: p. 275 TOP: Parasomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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OBJ: 7

10. Sleep terrors usually occur only once a night, during stages 3 and 4 of NREM sleep. They are often accompanied by which physical sign? a. Intense stress b. Sexual arousal c. Physical strength d. Intense motor activity ANS: A Sleep terrors often are accompanied by physical signs of intense stress, such as increased heart rate, respirations, and muscle tone.

DIF: Cognitive Level: Knowledge REF: p. 275 TOP: Parasomnias KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

OBJ: 8

11. The first step in the treatment of sleep disorders is to: a. teach prevention. b. give hypnotics for sleep. c. evaluate sleeping patterns. d. teach clients to retire early.

ANS: A The first step in the treatment of sleep disorders is to teach prevention. Giving the client hypnotics is a last resort because these substances can be habit forming and/or may affect the quality of sleep; evaluating sleeping patterns is a diagnostic tool; and teaching clients to retire early may not be feasible.

DIF: Cognitive Level: Application REF: p. 276 OBJ: 9 TOP: Guidelines for Intervention KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. The collection of perceptions, thoughts, feelings, and behaviors that relate to one’s size and appearance is called: a. body image. b. self-esteem. c. self-concept. d. body parameters.

ANS: A This is the definition of body image.

DIF: Cognitive Level: Knowledge REF: p. 264 OBJ: 1 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. The average age for onset of anorexia nervosa is: a. 13 years old. b. 17 years old. c. 33 years old. d. 40 years old.

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ANS: B Anorexia nervosa usually is not seen before puberty, with an average age of onset of 17 years. This disorder is seldom seen after the age of 40 years.

DIF: Cognitive Level: Knowledge REF: p. 266 OBJ: 2 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. The nurse who is caring for a 23-year-old client with bulimia knows that the most common method of purging to monitor this client for is: a. vomiting. b. starvation. c. excessive enema use. d. use of syrup of ipecac.

ANS: A Vomiting and the use of diuretics and laxatives are the most common methods of purging.

Less often used are enemas and syrup of ipecac. Starvation is a typical behavior of anorexia nervosa.

DIF: Cognitive Level: Application REF: p. 268 TOP: Bulimia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 2

15. The nurse who works in a sleep clinic knows that approximately suffer from insomnia. a. 10 to 20 b. 30 to 40 c. 50 to 60 d. 70 to 80

% of adults

ANS: B Thirty to forty percent of the adult population suffers from insomnia, and the incidence increases with age and in women.

DIF: Cognitive Level: Knowledge REF: p. 274 TOP: Dyssomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 8

16. During an episode of binge eating, what type of food is usually consumed in large amounts? a. Fruits b. Red meat c. Fried or high fat content foods d. Cakes, donuts, or sweets ANS: D Binge eating is defined as consuming an amount of food that is definitely larger than most individuals would eat in similar circumstances. During a binge an individual consumes large quantities of certain foods, usually carbohydrates.

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DIF: Cognitive Level: Application REF: p. 268 TOP: Bulimia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 2

17. A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic intervention is used with caution prior to stabilization and weight gain? a. Establish rapport and trust b. IV or tube feeding c. Administering antidepressants d. Daily weights ANS: C Administering antidepressants to clients with anorexia before they regain weight may be hazardous if the individual has a history of cardiac problems or presently has a low serum potassium level. Be sure to check the laboratory results of clients with eating disorders.

DIF: Cognitive Level: Application REF: p. 271 | Drug Alert TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. Which of the following persons is most likely a candidate for primary hypersomnia? a. A 50 year old who has wakeful periods during the night and naps during the day following the death of her husband. b. A 6 year old who wakes up in the middle of the night after having a nightmare and is tired the next day. c. An obese 40 year old who has snoring and periods of apnea at night and is tired the next day. d. An 18-year-old college student whose mother complains he sleeps all night and still naps during the day.

ANS: D Primary hypersomnia begins between 15 and 30 years of age. Nighttime sleep may last from 8 to 12 hours and daytime naps may last for more than 1 hour, not caused by any other physical or mental health disorder.

DIF: Cognitive Level: Application REF: p. 274 TOP: Dyssomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 8

19. A policeman complains of feeling tired and not able to sleep for an extended period of time after being assigned to work the night shift. He is most likely suffering from: a. circadian rhythm sleep disorder. b. primary hypersomnia. c. narcolepsy. d. obstructive sleep apnea syndrome.

ANS: A

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Circadian rhythm sleep disorder is a sleep disruption that results from a mismatch between body rhythms and environmental demands. Primary hypersomnia occurs when a person sleeps during the night but naps during the day. Narcolepsy results in repeated attacks of sleep, and obstructive sleep apnea is a breathing-related sleep disorder and not a change in sleep time.

DIF: Cognitive Level: Application REF: p. 275 TOP: Dyssomnias KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 8

MULTIPLE RESPONSE 1. Which of the following conditions are eating disorders? (Select all that apply.) a. Pica b. Purging c. Cataplexy d. Binge eating e. Hypersomnia f. Nocturnal myoclonus ANS: A, B, D These are types of eating disorders. The other options describe sleeping disorders.

DIF: Cognitive Level: Knowledge REF: p. 265 | p. 275 OBJ: 2 TOP: Eating Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which are key features of anorexia nervosa? (Select all that apply.) a. Excessive laxative use b. Purging c. Severe weight loss d. Introverted personality e. Hunger is denied ANS: C, D, E These are some of the key features of anorexia nervosa. Excessive laxative use and purging are characteristic of bulimia.

DIF: Cognitive Level: Knowledge REF: p. 266 OBJ: 2 TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. What are the criteria for the diagnosis of bulimia? (Select all that apply.) a. Occasional episodes of binge eating b. Refusal to maintain body weight that is more than 15% below normal c. Excessive emphasis placed on body shape and weight d. Eating binges at least twice per week for at least 3 months ANS: C, D

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These are two of the four criteria for the diagnosis of bulimia. Bulimia criteria include recurring episodes of binge eating rather than only occasional episodes; refusal to maintain body weight that is more than 15% below normal is a criterion for the diagnosis of anorexia nervosa.

DIF: Cognitive Level: Knowledge REF: p. 268 TOP: Bulimia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 2

4. The death rate from anorexia is higher than any other mental illness. Death usually results from which of the following? (Select all that apply.) a. Dehydration b. Loss of critical muscle mass c. Diabetes d. Electrolyte imbalances e. Suicide ANS: A, B, D, E The mortality rate for anorexia due to complications of starvation, cardiac arrest, or suicide is approximately 5% per decade of follow-up. Death usually results from dehydration, loss of critical muscle mass, electrolyte imbalances, or suicide, due to the fact that often clients are not seen by health professionals until the disorder has resulted in some physical problems.

DIF: Cognitive Level: Application REF: p. 267 OBJ: 3 TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 24: Dissociative Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The father of a 6 month old and a 3 year old discovers that his wife, who is the mother of the children, has abandoned the family and moved to another state. During this developmental stage, this abandonment will have the strongest negative effect on the children’s: a. motor skills. b. self-concept. c. body image. d. cognitive skills.

ANS: B Trust and consistency play a major role in the development of a child’s self-concept.

Abandonment provides neither. The mother’s absence may not affect the motor or cognitive skills of the children. Body image is only one component of self-concept.

DIF: Cognitive Level: Comprehension REF: p. 279 TOP: Self-Concept in Childhood KEY: Nursing Process Step: Nursing Diagnosis MSC: Client Needs: Health Promotion and Maintenance

OBJ: 3

2. The hospice nurse notices that, following the death of his wife of 50 years, a surviving husband’s affect is anxious, and he reports a feeling of detachment from his body, stating, “I feel like I am seeing myself from outside of my body.” The caregiver knows that this client is displaying the characteristics of the dissociative disorder of: a. dissociative fugue. b. dissociative amnesia. c. dissociative identity disorder. d. depersonalization disorder.

ANS: D Depersonalization serves as a defense mechanism in response to severe anxiety. The person often is described as “working on automatic” or “functioning as a robot.” The characteristics listed describe the behavioral or social signs and symptoms of depersonalized disorder.

Fugue is characterized by traveling that occurs suddenly and unexpectedly with no recall of the traveling. Amnesia is the inability to remember personal information, and dissociative identity disorder was formerly known as multiple personality disorder.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 5 TOP: Depersonalization/Derealization Disorder KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 3. The nurse witnesses different personalities emerging in the client with dissociative identity disorder (DID). The primary personality is referred to as the: a. host. b. alter. c. ego.

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d. identity.

ANS: A Host is the term for the primary personality, which may not be aware of the alters (the other personalities). Ego is one component of the three-part theory of the ego, id, and super-ego identified by Sigmund Freud when referring to his belief of how personalities are structured.

Identity refers to how one sees oneself.

DIF: Cognitive Level: Knowledge REF: p. 283 OBJ: 6 TOP: Dissociative Identity Disorder KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. When developing the nursing care plan for a client with dissociative identity disorder (DID), the nurse knows that one of the major goals of therapy is to assist the client in: a. naming all personalities for clarification. b. integrating the personalities into one functional personality. c. realizing when different personalities are about to emerge. d. learning how to move from one personality to another.

ANS: B It is important for therapy to assist the client in combining the personalities into one, so that the individual is able to function and cope effectively with daily stressors. Naming the personalities might occur without thought but is not necessary. In addition, realizing when alters are about to emerge and learning how to move among personalities are not goals of treatment.

DIF: Cognitive Level: Application REF: p. 283 OBJ: 7 TOP: Dissociative Identity Disorder KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 5. During a home visit, the client tells the nurse that she feels that her medication is no longer helping her dissociative diagnosis of depersonalization disorder because she has noticed that she is not thinking clearly, is having difficulty with her memory and judgment, and is often disoriented to the time. The nurse knows that the doctor must be contacted and that this client most likely will be: a. admitted to a long-term care agency because she is a threat to herself. b. admitted to a state-psychiatric facility for an extended period for intense therapy. c. referred to a group home setting for better supervision. d. admitted to the hospital for evaluation and possible adjustment of her medications.

ANS: D Admission to the hospital will be necessary to safely evaluate and/or adjust her medications.

Moving the client from her home to any type of long-term care or group home setting or state-psychiatric facility is not warranted from her symptoms.

DIF: Cognitive Level: Application REF: p. 284 OBJ: 9 TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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6. The care provider is aware that in addition to assessment, one of the first goals of therapy for the client with a dissociative disorder is: a. revisiting of past traumas. b. pharmacological therapy. c. stabilization. d. family therapy.

ANS: C Although revisiting of past traumas, pharmacological therapy, and family therapy are all possible treatment components, stabilization must be implemented first for the client.

Stabilization consists of making the patient feel safe and able to trust the treatment team.

DIF: Cognitive Level: Application REF: p. 284 OBJ: 7 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 7. Those who care for individuals with dissociative disorders must be aware that they often will try to the staff members who are caring for them. a. manipulate b. harm c. date d. persecute ANS: A As with many individuals with mental health disorders, clients with a dissociative disorder frequently will try to manipulate the staff to benefit themselves. Harming, dating, or persecuting the staff is not typical behavior of a person with a dissociative disorder.

DIF: Cognitive Level: Comprehension REF: p. 285 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 8. Which of the following is considered a primary nursing diagnosis for a client with a dissociative disorder? a. Self-esteem, low b. Personal identity, disturbed c. Role performance, ineffective d. Anxiety ANS: B Although all of the nursing diagnoses listed are related to dissociative disorders, “Personal identity, disturbed” is the only one listed that is a primary nursing diagnosis for these disorders.

DIF: Cognitive Level: Application REF: p. 285 TOP: Treatments and Therapies KEY: Nursing Process Step: Nursing Diagnosis MSC: Client Needs: Psychosocial Integrity

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OBJ: 8

9. During assessment of a client with a dissociative disorder, the nurse notices that the client has been cutting herself on both arms. After talking with the client, the nurse, along with other members of the treatment team, decides that the best intervention at this time to prevent further self-destructive behavior would be: a. establishing a signed contract with the client to tell a team member when she is having self-destructive thoughts. b. isolating the client from all other clients and activities until she is no longer having self-destructive thoughts. c. administering medications that will reduce the client’s anxiety levels. d. involving the client in activities as a diversion from self-destructive thoughts.

ANS: A Contracts are effective in building trust between the client and the treatment team, as well as in making the client responsible to seek assistance at crucial times. Isolating a client, administering antianxiety medications, and providing diversional activities would not address the self-destructive thoughts.

DIF: Cognitive Level: Application REF: p. 284 | p. 285 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 10. A client with the diagnosis of depersonalization disorder notices that he experiences periods of depersonalization when confronted with certain stressors. When developing the care plan, the nurse is aware that one of the most helpful activities in self-control for this client is for the client to: a. contact a treatment team member to discuss his thoughts and feelings every time he is confronted with a stressor. b. keep a daily journal of his thoughts and feelings, paying special attention to thoughts and feelings during stressful times. c. recall periods of stressful times in his life during his clinic visit. d. join an exercise program that will help to decrease his stress level.

ANS: B Daily journals will allow the client to vent his feelings, will enable reflection on events that led to depersonalization episodes, and will assist the treatment team in collaborating with the client on self-control measures to help prevent episodes in the future. Contacting a team member with every stressor or trying to recall episodes is unrealistic. Although an exercise program may help to decrease stress levels, it does not deal directly with episodes.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 11. A female client with a diagnosis of a dissociative disorder who attends group meetings at a community mental health clinic often voices that her boss at work frequently complains that she is working at a level below her capabilities. The client also states that she feels that she “never gets anything done.” Which nursing diagnosis best addresses these issues? a. Self-esteem, low b. Social isolation c. Body-image, disturbed

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d. Memory, impaired ANS: A The client is exhibiting characteristics typical of low self-esteem. She is not isolating herself from others, does not indicate a distorted perception of her body, and shows no sign of problems with her memory.

DIF: Cognitive Level: Application REF: p. 285 TOP: Treatments and Therapies KEY: Nursing Process Step: Nursing Diagnosis MSC: Client Needs: Psychosocial Integrity

OBJ: 8

12. What is the first nursing priority in a client with the nursing diagnosis of “Personal identity, disturbed”? a. Promote wellness. b. Assist the client to manage any threatening feelings. c. Assess causative and/or contributing factors. d. Determine which medications will work most effectively.

ANS: C Causative and/or contributing factors would be the first priority in guiding the rest of the care planning process. The second priority for a client with this nursing diagnosis would be to assist the client to manage any threatening feelings, followed by promoting wellness.

Determining which medications are effective is not a nursing priority for this nursing diagnosis; rather, this is more of a physician-initiated action.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 13. A “spell” is a culturally defined mental health disorder or a dissociative “state” seen in African Americans, Europeans, and Americans from southern U.S. cultures. This “state” is characterized by: a. sudden collapsing with eyes open and inability to see, while still hearing and understanding, without being able to move. b. seizure activity and coma for up to 12 hours preceded by extreme excitement or irrational behavior. c. a state in which spirit possession interferes with daily activities. d. communication with deceased relatives or spirits that occurs during a trancelike state.

ANS: D A “spell” is seen in these cultures and is characterized by the behaviors listed. Sudden collapsing with eyes open and inability to see but ability to hear and understand describes the state of “falling out” seen in members of some cultures living in the southern United States and in certain Caribbean groups. Seizure activity and coma preceded by extreme excitement or irrational behavior describes “piblokto,” seen in some Arctic and sub-Arctic Eskimos; a state in which spirit possession interferes with daily activities describes “zar,” seen in cultures of individuals originating from Egypt, Ethiopia, Iran, and Sudan.

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DIF: Cognitive Level: Comprehension REF: p. 281 OBJ: 5 TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. The wife of a 70-year-old man is concerned that her husband refuses to participate in any activities with her since his retirement 2 years ago. He is often short tempered and sees any type of hobby as a “waste of time.” Which intervention or activity would help him enhance his feelings of self-worth? a. Begin taking antidepressant medication. b. Move with his wife to an assisted living community. c. Get involved in a retired businessmen’s group providing assistance to new companies. d. Taking up a less strenuous activity to decrease stress and information overload.

ANS: C A threat to the stability of one’s lifestyle (such as change in employment) can lead to changes in self-concept, as it affects personal identity, self-esteem, and role performance.

An activity which allows the person to adapt to change and regain a sense of self-esteem and self-worth will enhance the expression of self-concept. Taking antidepressants, moving to an assisted living community, and taking up a less strenuous mental and physical activity do not provide the same degree of expression of self-concept.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 3 TOP: Self Concept in Older Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A family adopts a 7-year-old boy from an international adoption agency with little information on the child’s history. They bring the child to a therapist because the child is withdrawn, destroys things in the house, and hits his adoptive siblings without provocation.

As the therapist develops a trusting relationship with the child, what type of intervention would be initially used to gain input from the child? a. Psychoeducation b. Art therapy c. Joint stabilization plan d. Development of coping strategies ANS: B During the stabilization phase, the diagnosis is established as the client reveals the complexities of his nature. In a child who is withdrawn, art therapy can be used as a means of communication and expression. Psychoeducation would not be the strategy to use at this stage. A joint stabilization plan and development of coping strategies occur after a trusting relationship and client input occur.

DIF: Cognitive Level: Application REF: p. 284 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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16. A woman has had several episodes where she finds new clothes in her closet that are much more colorful than the style she usually buys. Today, a coworker approached her to thank her for hosting a dinner party that she had no recollection of hosting. What is the most appropriate nursing diagnosis for this client? a. Self-esteem, low b. Personal identity, disturbed c. Body image, disturbed d. Anxiety ANS: B Nursing diagnoses for clients with dissociative disorders are related to self-concept responses and depend on identified problems of each client. In this case, the description the client gives relates to personal identity. Low self-esteem and disturbed body image may be contributing factors to this diagnosis.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 8 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Which dissociative disorder is a result of a disturbance of identity? a. Dissociative amnesia b. Dissociative identity disorder c. Dissociative fugue d. Obsessive-compulsive disorder ANS: B Dissociative identity disorder is a disturbance of identity. Dissociative amnesia and dissociative fugue are disturbances of memory. Obsessive-compulsive disorder is a mood disorder.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 5 TOP: Characteristics KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. A client with a dissociative disorder has the nursing diagnosis of disturbed body image.

Which nursing interventions would address the nursing priority of determining the coping abilities and skills of this client? (Select all that apply.) a. Assess the client’s current level of adaptation. b. Help the client differentiate between isolation and loneliness. c. Note the use of addictive substances. d. Identify previously used coping strategies and their effectiveness.

ANS: A, C, D The client’s current level of adaptation must be assessed as a baseline for the plan of care.

Noting the use of addictive substances may reflect dysfunctional coping mechanisms.

Identifying whether previously used coping strategies were effective will reveal whether any of them can be used again. Helping the client differentiate between isolation and loneliness is an intervention that is directed toward the nursing diagnosis of social isolation.

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DIF: Cognitive Level: Application REF: p. 285 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity 2. A male client with a dissociative disorder copes with his low self-esteem by displaying behaviors associated with an exaggerated sense of self-importance. Which behaviors would this client most likely exhibit? (Select all that apply.) a. Bragging about special abilities b. Setting unrealistic goals c. Having unrealistic dreams d. Having a view of life that everything is either right or wrong ANS: A, B, C The client with an exaggerated sense of self-importance often brags about his special abilities, sets unrealistic goals because he feels he is capable of anything, and sets unrealistic dreams for himself for the same reason. The belief that everything in life is either right or wrong is a polarized view that is seen in clients with a negative outlook about life.

DIF: Cognitive Level: Application REF: p. 285 OBJ: 5 TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A person’s self-concept, or how a person sees himself or herself, comprises which of the following? (Select all that apply.) a. Body image b. Self-esteem c. Identity diffusion d. Self-ideal e. Personal identity ANS: A, B, D, E Body image (one’s feelings about his or her body), self-esteem (one’s judgment of his or her own worth), self-ideal (one’s personal standards on appropriate behavior), and personal identity (one’s awareness of himself as an individual) constitute a person’s self-concept.

Identity diffusion refers to a person’s not being sure of who he really is.

DIF: Cognitive Level: Knowledge REF: p. 278 OBJ: 1 TOP: Self-Concept KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. Dissociative fugue is identified by which characteristics? (Select all that apply.) a. Presence of two or more distinct personalities. b. Sudden travel with inability to recall the past. c. Behave normally during travel but confused by own identity. d. May assume a new life.

ANS: B, C, D

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The main characteristic of dissociative fugue is sudden, unexpected travel with an inability to recall the past. This occurs in response to an overwhelmingly stressful or traumatic event.

Some individuals assume entirely new identities. The presence of two or more distinct personalities is a characteristic of dissociative identity disorder, not dissociative fugue.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 5 TOP: Dissociative Fugue KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 25: Anger and Aggression Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The use of inappropriate, harmful, or destructive behaviors to express current or past emotions is defined as: a. anger. b. assault. c. acting out. d. aggression.

ANS: C Acting out is the use of inappropriate, detrimental, or destructive behaviors to express current or past emotions. Anger is a normal emotional response in certain situations; assault is a threat for bodily injury; and aggression is a forceful attitude or action.

DIF: Cognitive Level: Knowledge REF: p. 288 OBJ: 1 TOP: Anger and Aggression KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Toddlers often express their anger through: a. crying. b. manipulation. c. temper tantrums. d. direct aggression.

ANS: C Toddlers engage in temper tantrums when they learn to focus their aggression on what they believe is responsible for their anger.

DIF: Cognitive Level: Knowledge REF: p. 290 OBJ: 2 TOP: Aggression Throughout the Life Cycle KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. In the assault cycle, people are unable to listen to reason, follow directions, or engage in mental exercises during the stage of: a. crisis. b. trigger. c. recovery. d. escalation.

ANS: A Assault is an aggressive behavior that violates another’s person or property. Crisis describes the behaviors in the question. Trigger refers to the phase when a stress-producing event occurs; recovery is described as the cooling-down period of the assault cycle; and escalation is characterized by a behavioral response that is approaching loss of control.

DIF:

Cognitive Level: Comprehension

REF: p. 292

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OBJ: 5

TOP: The Cycle of Assault KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. Crisis interventions are very successful if begun early in the assault cycle, in the a. crisis b. trigger c. depression d. escalation

stage.

ANS: B Crisis intervention works best in this stage because coping mechanisms can be implemented that are effective rather than allowing behavior to continue to the next phase of escalation.

DIF: Cognitive Level: Knowledge REF: p. 292 OBJ: 5 TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 5. Persons who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings are given the diagnosis of disorder. a. conduct b. adjustment c. impulse-control d. oppositional defiant ANS: A These are characteristics of conduct disorders. Adjustment disorders are characterized by a psychological response from an identifiable stressor or group of stressors that causes significant emotional or behavioral symptoms that do not meet criteria for more specific disorders; impulse-control disorders are characterized by a failure to resist impulses or temptations that are harmful to the person or to others; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.

DIF: Cognitive Level: Comprehension REF: p. 293 OBJ: 6 TOP: Aggressive Behavioral Disorders of Childhood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. Emotional or behavioral problems that develop in response to an identifiable source and last no longer than 6 months are called disorders. a. conduct b. adjustment c. impulse-control d. oppositional defiant ANS: B

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This is the criterion for adjustment disorders. Conduct disorders are characterized by individuals who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings; impulse-control disorders are characterized by failure to resist an impulse, drive, or temptation; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.

DIF: Cognitive Level: Knowledge REF: p. 294 OBJ: 6 TOP: Adjustment Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. Level one interventions for potentially assaultive clients should be practiced as: a. therapy. b. control methods. c. assessment measures. d. preventive measures.

ANS: D Level one interventions focus on the prevention of violence.

DIF: Cognitive Level: Knowledge REF: p. 295 OBJ: 8 TOP: Level One Interventions KEY: Nursing Process Step: Planning MSC: Client Needs: Safe and Effective Care Environment 8. Interventions for assaultive clients that focus on protecting the client and others from potential harm are level interventions. a. one b. two c. three d. four ANS: B Level two interventions focus on protecting the client and others from potential harm. Level one interventions focus on preventing violence, and level three is the last level of interventions that are implemented for clients whose behaviors reflect a loss of control.

DIF: Cognitive Level: Knowledge REF: p. 296 OBJ: 8 TOP: Level Two Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 9. Restrained clients must be monitored and their condition documented at least every minutes. a. 15 b. 30 c. 60 d. 90 ANS: A The use of restraints is governed by federal and state laws, institutional policies, and special procedures.

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DIF: Cognitive Level: Knowledge REF: p. 296 OBJ: 8 TOP: Level Three Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 10. As long as the client is limiting her behaviors to verbal assaults and harmless physical movements, a. she is placed in seclusion. b. the acting out may continue. c. the caregiver is prepared to apply restraints. d. she is reminded of the inappropriateness of her behavior.

ANS: B Allow clients to act out as long as they limit their behaviors to verbal assaults and harmless physical movements. However, it is important for the caregiver to maintain control of the situation and set limits on the client’s behavior.

DIF: Cognitive Level: Application REF: p. 296 OBJ: 8 TOP: Level Two Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 11. Interventions that help caregivers the most in coping with their own anger focus on: a. learning to effectively interact with clients. b. assessing which stressors and coping skills are being used. c. learning to effectively control feelings of anger. d. establishing a trusting therapeutic relationship via clear communications.

ANS: C Although all these interventions are necessary when one is dealing with clients, this intervention allows caregivers to be most effective in caring for individuals who express emotions of anger.

DIF: Cognitive Level: Application REF: p. 298 OBJ: 9 TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. Which situation would most negatively affect a female client with a diagnosis of adjustment disorder? a. Marrying her partner she has lived with for 5 years. b. Beginning college after graduating from high school 12 years ago. c. Being promoted in the company at which she has worked for the past 10 years. d. Meeting with a friend with whom she keeps in contact but has not seen for 8 years.

ANS: B Individuals with adjustment disorders have the greatest difficulty in adapting to new situations. Therefore, beginning college has the most stress potential because it has no familiar aspect to it, as the other options do.

DIF: Cognitive Level: Analysis TOP: Adjustment Disorders

REF: p. 294 OBJ: 6 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Psychosocial Integrity 13. A married couple is seeking counseling for domestic abuse issues. The husband states that he can’t control his anger when his wife constantly nags at him. In the assault cycle, the wife’s behavior in this situation is the stage known as: a. recovery. b. crisis. c. escalation. d. trigger.

ANS: D The nagging is the trigger to the assault in this situation. The trigger stage should not be confused as being a justified reason for an assault to occur.

DIF: Cognitive Level: Application REF: p. 292 OBJ: 5 TOP: The Cycle of Assault KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. A male client is being seen for anger management issues following an incident in which he was late for work, became angry at the driver in front of him for not driving faster, and intentionally ran into the car at a stop sign. This client is displaying actions most typical of: a. intermittent explosive disorder. b. passive aggressive behavior. c. oppositional defiant disorder. d. adjustment disorder with anxiety.

ANS: A The main characteristic of intermittent explosive disorder is the failure to resist aggressive impulses that result in assault of another individual or property. Passive aggressive behavior, oppositional defiant disorder, and adjustment disorder with anxiety do not result in injury or harm to persons or property.

DIF: Cognitive Level: Application REF: p. 294 OBJ: 6 TOP: Impulse-Control Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. An intramuscular injection of an antianxiety agent is administered to a client who has become violent toward the staff in the emergency room. This is an example of what level of therapeutic intervention? a. One b. Two c. Three d. Four ANS: C Level three interventions also include seclusion and restraints and are used only for clients who are out of control. Level one is the prevention stage of interventions, and level two is focused on protection of the client and others from potential harm. Level four does not exist.

DIF:

Cognitive Level: Application

REF: p. 296

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OBJ: 8

TOP: Level Three Interventions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 16. Which of the following persons is exhibiting passive aggression? a. The woman who willingly volunteers to help out at her child’s school play. b. The woman who says no when asked to go to a charity event. c. The woman who asks a coworker to cover her shift. d. The woman who agrees to cover a coworker’s shift and complains to customers that she is supposed to be home.

ANS: D A person demonstrating passive aggressive actions expresses anger in indirect ways. Instead of declining to cover the shift, the person complains to others. The other examples do not demonstrate this indirect anger.

DIF: Cognitive Level: Application REF: p. 288 TOP: Introduction KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment

OBJ: 1

17. Children in preadolescence have started to channel aggression through which positive activity? a. Fights in schoolyards b. Organized sports c. Joining gangs d. Verbal abuse ANS: B By preadolescence, most children stop hitting and learn to channel their aggression into physical activities, such as competitive sports or physical conditioning. Fighting, gangs, and verbal abuse are not positive activities.

DIF: Cognitive Level: Application REF: p. 289 TOP: Introduction KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment

OBJ: 1

18. A 15-year-old female is seen in the clinic for episodes of cutting herself since her parents divorced 6 months ago. Which nursing diagnosis is a priority for this client? a. Behavior, risk-prone health b. Spiritual distress c. Social interaction, impaired d. Family processes, interrupted ANS: A The client is demonstrating anger turned inward demonstrated by self-mutilation. The priority would be to prevent the client from further harming herself. Dealing with spiritual distress, impaired social interaction, and interrupted family processes is accomplished after this.

DIF: Cognitive Level: Application REF: p. 295 TOP: Introduction KEY: Nursing Process Step: Intervention

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OBJ: 1

MSC: Client Needs: Safe and Effective Care Environment 19. A man who hit his wife yesterday, causing her to fall and break her arm, has called out of work today to take care of her and buy her flowers. He repeatedly tells her how horrible he feels and promises this will never happen again. What stage of the assault is he demonstrating? a. Trigger stage b. Escalation stage c. Recovery stage d. Depression stage ANS: D The depression stage involves a period of guilt and attempts to reconcile (make up) with others. Aggressors are aware of the assault and genuinely feel bad about it. They may apologize frequently or provide loving care for the victim. The trigger stage occurs prior to the assault when the stress-producing event occurs. The escalation stage is when actions move closer to a loss of control, and the recovery stage occurs after the violence and injuries are assessed.

DIF: Cognitive Level: Application REF: p. 293 OBJ: 5 TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. Which mental health problems are categorized as anger control disorders? (Select all that apply.) a. Conversion disorder b. Conduct disorder c. Dissociative disorder d. Impulse-control disorder e. Dysthymic disorder f. Adjustment disorder g. Oppositional defiant disorder ANS: B, D, F, G Conduct disorder, impulse-control disorder, adjustment disorder, and oppositional defiant disorder are all examples of anger control disorders.

DIF: Cognitive Level: Comprehension REF: p. 293 OBJ: 6 TOP: Anger Control Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. During the psychosocial portion of the assessment of a client with anger, aggression, or violent behavior issues, the nurse will assess which of the following? (Select all that apply.) a. Coping skills b. General appearance c. Value and belief systems d. Cultural, spiritual, and occupational interests

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e. Potential for engaging in inappropriate behavior ANS: A, C, D Assessing coping skills, whether the client has a value and belief system, and cultural, spiritual, and occupational interests are components of the psychosocial portion of the assessment. Assessing potential for engaging in inappropriate behavior and general appearance occur during the initial portion of the assessment and during the mental status assessment, respectively.

DIF: Cognitive Level: Knowledge REF: p. 295 OBJ: 7 TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which of the following psychosocial nursing diagnoses is related to anger and aggression?

(Select all that apply.) a. Anxiety b. Violence, risk for other-directed c. Hopelessness d. Violence, risk for self-directed e. Coping ineffective, individual f. Fear ANS: A, C, E, F Anxiety, hopelessness, ineffective coping, and fear are all potential nursing diagnoses related to anger and aggression. Violence, risk for other-directed, and violence, risk for self-directed, are diagnoses in the physical realm.

DIF: Cognitive Level: Knowledge REF: p. 293 OBJ: 7 TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 26: Outward-Focused Emotions: Violence Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Mr. Right employs 22 children in his clothing factory. Each child is no older than 10 years of age and works 11 hours a day, 6 days a week. Mr. Right is practicing: a. abuse. b. neglect. c. violence. d. exploitation.

ANS: D This describes the exploitation of children in providing a profit for Mr. Right. Abuse refers to the intentional misuse of something or someone that results in harm; neglect is described as causing harm to another’s health or welfare through failure to provide for basic needs or by placing the person’s health or welfare at unreasonable risk; and violence is defined as physical force that harms another.

DIF: Cognitive Level: Comprehension REF: p. 300 OBJ: 1 TOP: Definition of Terms KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 2. The theory that cites poverty, unemployment, and crime as sources of violence is known as the theory. a. feminist b. sociological c. anthropological d. psychiatric/mental illness ANS: B Sociological theories consider environmental and social factors to be causes of violence in society. Feminist theories describe violence directed toward women. Anthropological theory is based on cultural patterns, social organizations, and sexual differences; and the psychiatric/mental illness theory refers to violence as a mental illness.

DIF: Cognitive Level: Knowledge REF: p. 301 OBJ: 2 TOP: Theories of Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. What concept do feminist theories use to explain violence against women? a. Machismo b. Femininity c. Masculinity d. Muscularity ANS: A

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Machismo is defined as compulsive masculinity that results in aggressive and violent behavior directed toward women, which occurs as the result of socialization of this behavior throughout childhood.

DIF: Cognitive Level: Knowledge REF: p. 301 OBJ: 2 TOP: Adjustment Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The term that describes repeated physical abuse, usually of a woman, child, or elder, is: a. neglect. b. battering. c. exploitation. d. gender abuse.

ANS: B This is the definition of battering. Neglect is defined as causing harm to another’s health or welfare through failure to provide for basic needs or by placing the person’s health or welfare at unreasonable risk. Exploitation refers to using an individual for selfish purposes or for profit. Gender abuse is described as various forms of abuse directed toward women.

DIF: Cognitive Level: Knowledge REF: p. 302 OBJ: 5 TOP: Domestic Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. A male who, as a child, observed the women in his family being dominated is, in his own life, more likely to: a. love. b. batter. c. belittle. d. order around.

ANS: B The social learning theory considers this to be a contributing factor to a male who has become a batterer.

DIF: Cognitive Level: Knowledge REF: p. 301 OBJ: 2 TOP: Theories of Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. Whenever there is a history of unexplained lethargy, fussiness, or irritability in an infant, caregivers should suspect syndrome. a. shaken baby b. drugged baby c. depressed infant d. feeding disorder ANS: A Shaken baby syndrome should be suspected when an infant has unexplained or vague injuries. This form of child abuse results when the child is vigorously shaken, leading to whiplash-induced bleeding in the brain.

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DIF: Cognitive Level: Comprehension REF: p. 305 TOP: Child Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

OBJ: 5

7. Eating disorders, substance abuse, delinquent behaviors, posttraumatic stress disorder, and suicide most commonly are seen as the result of abuse in this population: a. children. b. adolescents. c. adults. d. elderly.

ANS: B These disorders most frequently are seen as the result of abuse of adolescents, and abuse of this age-group is the most overlooked type of family violence.

DIF: Cognitive Level: Knowledge REF: p. 306 OBJ: 6 TOP: Adolescent Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. A physically or mentally impaired older woman who is living with a relative and has a history of unexplained bruises or injuries, burns in unusual places, or poor personal hygiene is likely a victim of: a. neglect. b. child abuse. c. elder abuse. d. adolescent abuse.

ANS: C These are typical signs of elder abuse, which most typically occurs among family members.

DIF: Cognitive Level: Comprehension REF: p. 307 TOP: Elder Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 5

9. A rule of thumb for recovering from a rape or other violent experience states that the greater the force or brutality, the greater the psychological harm and: a. recovery time. b. legal implications. c. social dysfunction. d. financial difficulty.

ANS: A Recovery time is directly related to the level of the attack.

DIF: Cognitive Level: Comprehension REF: p. 310 OBJ: 6 TOP: Rape: Trauma Syndrome KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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10. Many victims of violence believe that their abusers may attempt to hurt them again, even as they are seeking help. Recognizing this, the care provider: a. does not leave the client alone. b. posts security guards at the door. c. leaves the client alone no longer than 15 minutes. d. immediately gets the name and phone number of the perpetrator.

ANS: A The first priority of care for every victim of violence is to ensure safety and security.

DIF: Cognitive Level: Application REF: p. 310 OBJ: 8 TOP: Treating Victims of Violence KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 11. By law, what are health care providers required to do when they encounter incidents of suspected or actual abuse or neglect? a. Inspect b. Investigate c. Report to the authorities d. Report to the client’s family ANS: C By law, health care providers are required to report violent incidents to the police. It is not mandatory for health care providers to inspect clients if they have not given permission.

Investigation is the responsibility of law enforcement officials. Reporting to the client’s family is a breach of confidentiality unless requested by the client.

DIF: Cognitive Level: Knowledge REF: p. 307 OBJ: 7 TOP: Special Assessments KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 12. During the recoil stage of recovery from violence, the major characteristic is: a. fear. b. disorganization. c. reconstruction. d. struggle to adapt.

ANS: D The recoil stage is when the individual becomes aware of the impact of the violence on his or her life. Fear and disorganization occur during the impact stage, and reconstruction occurs during the reorganization stage.

DIF: Cognitive Level: Knowledge REF: p. 309 | Table 26.2 OBJ: 6 TOP: Mental Health Disorders Relating to Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. Child prostitution in Thailand is widespread, and it is estimated that children have AIDS. a. 10 b. 25

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% of these

c. 50 d. 75 ANS: C There are nearly 500,000 child prostitutes in Thailand alone. This does not include the number in the remainder of Asia or the rest of the world.

DIF: Cognitive Level: Knowledge REF: p. 305 TOP: Child Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 5

14. Which signs and/or symptoms should alert the caregiver to a child who is suffering from neglect? a. Bruises and welts at various stages of healing b. Consistently dirty, hungry, and inappropriately dressed c. Child has torn, stained, or bloody underclothing d. Any fracture in a child younger than 2 years of age or fractures at various stages of healing in a child of any age ANS: B These are only a few of the signs of neglect. Bruises and fractures are consistent with physical abuse, and torn, stained, or bloody underclothing is seen with sexual abuse.

DIF: Cognitive Level: Application REF: p. 311 | Table 26.3 OBJ: 5 TOP: Special Assessments KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. When a functional family is faced with a crisis or unexpected situation, which of the following behaviors do they exhibit to overcome it? a. Avoid the conflict and focus on positive aspects of their lives. b. Isolate the family and attempt to reach resolution without outside interference. c. Maintain clear and supportive communication to address the crisis. d. Look to the head of the family to resolve based on role.

ANS: C A functional family unit is described by what it does (processes) to achieve its goals. These processes include clear and supportive communications among all family members.

Isolating the family does not allow them to use resources outside the family, avoidance of conflict does not promote resolution, and assigning goal planning to one member does not describe the actions of a functional family.

DIF: Cognitive Level: Application REF: p. 302 OBJ: 3 TOP: Domestic Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. While an abused woman cannot be categorized to fit a specific profile, which of the following traits is most commonly identified? a. Trusting nature b. Assertive personality c. Accomplished in nontraditional female career

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d. Suspicious nature ANS: A There is no “typical” abused woman, but the victims of violence do have some characteristics in common. Perhaps the most common trait is a trusting nature, as opposed to a suspicious nature. Many women were raised to be nonaggressive and traditional, as opposed to assertive and accomplished in nontraditional female careers.

DIF: Cognitive Level: Application REF: p. 303 OBJ: 3 TOP: Gender Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Abuse during pregnancy endangers the health and well-being of the pregnant woman and her fetus. Which complicating factor is seen twice as much in women experiencing abuse during pregnancy? a. Postpartum hemorrhage b. Preterm delivery c. Maternal substance abuse d. Delivery by caesarean section ANS: B The number of women who are abused during pregnancy experiencing preterm delivery and low birth weight infants has doubled. Women also postpone prenatal care until the third trimester when it is too late to provide adequate care to treat problems. Hemorrhage after delivery, substance abuse, and operative delivery are not noted as issues more prevalent in abused pregnant women.

DIF: Cognitive Level: Application REF: p. 303 OBJ: 4 TOP: Abuse During Pregnancy KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. Which nursing diagnosis would be most appropriate for an adolescent client suffering from test anxiety who was continually told by her mother that she was inferior to her siblings and could never amount to anything? a. Noncompliance b. Denial, ineffective c. Self-esteem disturbance, situational low/chronic low d. Violence, risk for other-directed ANS: C Emotional abuse involves rejection, criticism, terrorizing, and isolation. The result is low self-esteem, in which the adolescent doubts her abilities. The adolescent in this case is not in denial and is not demonstrating behaviors that would alert the nurse to a violent nature.

Noncompliance is not an issue in this case.

DIF: Cognitive Level: Application REF: p. 313 | Box 26.5 OBJ: 5 TOP: Child Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

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1. Which are characteristics of a dysfunctional family? (Select all that apply.) a. Occasional arguments b. Setting goals c. Inconsistent authority d. No clearly defined roles e. Members are self-centered f. Family boundaries are rigid g. Clear and supportive communications ANS: C, D, E, F A dysfunctional family is described by its inability to fulfill its basic functions. All other options represent a well-functioning family dynamic.

DIF: Cognitive Level: Comprehension REF: p. 302 OBJ: 3 TOP: Domestic Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. During the first phase of the domestic abuse cycle, the female victim of domestic violence inflicted by a male usually displays which characteristics or behaviors? (Select all that apply.) a. Denial of the seriousness of the problem b. Feeling that she cannot control the man’s behavior c. Blaming alcohol and work for the man’s behavior d. Feeling that she deserves minor abuse ANS: A, C The first cycle is the tension phase. During this phase, the woman feels that she can control the man’s behavior, and she feels that she does not deserve minor abuse.

DIF: Cognitive Level: Application REF: p. 304 | Table 26.1 OBJ: 5 TOP: Domestic Violence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. A 25-year-old woman expresses concern regarding some of her new boyfriend’s behaviors.

Which of the following statements might indicate that he has an abusive personality? (Select all that apply.) a. Even though they have been dating for less than 2 months, he wants to get married as soon as possible. b. He does not allow her to go out with friends unless he accompanies them. c. He finds fault with her family and seeks to convince her that they are trying to sabotage her relationship with him. d. He has a poor relationship with his own parents, blaming them for not supporting him after he was fired from various jobs. e. He would like to further his education but realizes that he must first work for a while to pay off student loans.

ANS: A, B, C, D

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Early signs of an abusive personality include a push for quick involvement, as seen in the rush to get married. Demonstrating jealous and controlling behaviors in not allowing his partner to go out with friends, blaming his family for his own problems, and attempting to isolate his partner from her family are also signs of an abusive personality. Working to pay off loans before furthering education is a realistic expectation and not indicative of an abusive personality.

DIF: Cognitive Level: Application REF: p. 305 | Box 26.3 OBJ: 9 TOP: Early Signs of Abusive Personality KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 27: Inward-Focused Emotions: Suicide Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Self-protective responses are seen in behaviors that meet basic: a. goals. b. needs. c. wants. d. demands.

ANS: B People behave in many ways to secure basic safety and security needs.

DIF: Cognitive Level: Knowledge REF: p. 316 OBJ: 1 TOP: Continuum of Behavioral Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Bob drives fast everywhere he goes, especially when he is drinking. Last night, he was arrested for gambling and loud behavior. Bob is engaging in behavior. a. adaptive b. suicidal c. direct self-destructive d. indirect self-destructive ANS: D Indirect self-destructive behaviors are behaviors that may result in harm or death to the individual who has no intention of ending his or her life. Suicide and direct self-destructive behavior are behaviors that convey an active wish to die. The behavior in this situation is maladaptive, not adaptive.

DIF: Cognitive Level: Application REF: p. 316 OBJ: 1 TOP: Continuum of Behavioral Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Suicide in the United States is: a. not a problem. b. the tenth leading cause of death. c. most prevalent among the middle-aged. d. controlled by the use of antidepressants.

ANS: B Suicide is the tenth leading cause of death in the United States.

DIF: Cognitive Level: Knowledge REF: p. 317 OBJ: 2 TOP: Impact of Suicide on Society KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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4. The theory that suicide rates are affected by group support, social changes, regulations, religion, legal sanctions or limitations, and philosophical beliefs is known as the theory. a. biological b. sociological c. interpersonal d. psychoanalytical ANS: B Sociological theory considers the relationship between the number of suicides and the social conditions in an area. Biological theory refers to anxiety and depression caused by irregularities in neurotransmitters, leading to suicide; interpersonal theory views suicide as the result of an inability to resolve interpersonal conflicts; and psychoanalytical theory considers suicide as anger turned inward.

DIF: Cognitive Level: Knowledge REF: p. 321 OBJ: 6 TOP: Theories About Suicide KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Adolescents are at greater risk for committing suicide if they have a. family b. social c. mental health d. acute physical

problems.

ANS: C Adolescents with existing mental health problems are at greater risk for committing suicide than are other children because they often do not have effective coping skills.

DIF: Cognitive Level: Knowledge REF: p. 322 OBJ: 7 TOP: Suicide and Children KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. Suicide is attempted three times more frequently by completed by . a. adult men; women b. adult women; men c. adult fathers; mothers d. adolescent mothers; fathers

but is more often successfully

ANS: B Women attempt suicide three times more frequently than men, but men are more often successful at completing the act.

DIF: Cognitive Level: Knowledge REF: p. 323 OBJ: 2 | 7 TOP: Suicide and Adults KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The caregiver works with suicidal clients to establish therapeutic rapport. The focused communications and concerned actions encourage suicidal persons to:

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a. b. c. d.

feel in control. feel self-worth. talk about themselves. feel foolish for thinking about suicide.

ANS: B The focused communications and concerned actions of caregivers help suicidal individuals to feel self-worth, which directly affects the treatment goals of the individual.

DIF: Cognitive Level: Application REF: p. 325 OBJ: 9 TOP: Therapeutic Interventions for Suicidal Clients KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 8. Suicide attempts by are more successful because one out of every two attempts results in death. a. adolescents b. older adults c. young adults d. middle-aged adults ANS: B The incidence of successful suicides increases with age because of the fact that older adults are less likely than persons of all other age groups to communicate their intentions to others.

DIF: Cognitive Level: Knowledge REF: p. 323 OBJ: 7 TOP: Suicide and Older Adults KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. When the environment lacks security or presents dangers, the perception that life will be short or will end in violence is most compelling for: a. children. b. adolescents. c. young adults. d. middle-aged adults.

ANS: B This age-group tends to feel this way more than other age groups do, and if this is the feeling of an adolescent, he or she sees no promise for the future.

DIF: Cognitive Level: Comprehension REF: p. 322 OBJ: 7 TOP: Suicide and Adolescents KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. All people who commit suicide are depressed or psychotic. This statement is a(n): a. fact. b. myth. c. opinion. d. attitude.

ANS: B

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Many false ideas about suicide still exist. It is important for the nurse to become familiar with these myths if he is to be skilled in educating others about suicide.

DIF: Cognitive Level: Comprehension REF: p. 317 OBJ: 2 TOP: Myths About Suicide KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The nurse is caring for a male client with a major depressive disorder who has not responded well to various treatments in the past. The latest treatment method has resulted in slight improvement in the client’s symptoms. On this particular day, the client has a very positive affect and says he feels “amazingly better.” The nurse should: a. congratulate him on his recovery. b. document the client’s improvement. c. ask him what he feels has helped him feel better so suddenly. d. assess the client for signs and symptoms of suicidal thoughts.

ANS: D This behavior is frequently seen when a depressed individual has made the decision to commit suicide. The other options ignore this important sign.

DIF: Cognitive Level: Application REF: p. 327 | Box 27.1 OBJ: 2 TOP: Myths About Suicide KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 12. An adult female whose fiancé recently called off the wedding attempts suicide by taking an overdose of sleeping medication. Immediately after taking the medication, she calls friends and family to tell them what she has done. Her friends and family activate the emergency response system, and she is taken to the emergency department and is admitted to a mental health facility for monitoring. She is exhibiting signs and symptoms most evident of which suicidal motivational category? a. Cry for help b. Relieving distress c. Preoccupation with suicide d. Refusal to accept a diminished style of life ANS: A This behavior is characteristic of a cry for help. Calling others after her attempt shows that she was not intent on committing suicide. Relieving distress refers to individuals who face situations that threaten their own intactness as a person, such as terminal illness; preoccupation with suicide indicates the only form of control for one’s own life; and refusal to accept a diminished style of life refers to considering all options and then rationally deciding that suicide is the best option.

DIF: Cognitive Level: Application REF: p. 320 OBJ: 4 TOP: Categories of Motivation KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. A terminally ill female client chooses the time and place of her own death. This is an example of: a. suicide.

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b. self-injury. c. rational suicide. d. planned suicide.

ANS: C In this situation, the person knows that she is going to die, so the decision of where to die is made freely and with sound mind. Suicide and planned suicide simply refer to intentionally taking one’s own life. Self-injury is an active attempt to injure oneself.

DIF: Cognitive Level: Comprehension REF: p. 319 OBJ: 3 TOP: Social Factors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. An elderly male client’s wife of 50 years recently died from cancer. He suffers from a chronic debilitating illness and has been refusing to eat, drink, or take his medications. This client is displaying behavior characteristic of: a. suicidal threats. b. suicidal attempts. c. suicidal ideation. d. passive suicide.

ANS: D Passive suicide is seen most frequently in older adults as a result of depression and loneliness. Suicidal threats refer to written or verbal threats of suicide; suicidal attempts are self-directed actions to harm oneself; and suicidal ideation is a preoccupation with the idea of suicide.

DIF: Cognitive Level: Application REF: p. 323 OBJ: 7 TOP: Suicide and Older Adults KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. In the dimension, an individual who is considering suicide experiences distorted thinking and self-defeating thoughts. a. emotional b. social c. intellectual d. spiritual ANS: C This dimension is characterized by self-defeating thoughts rather than attempts to problem-solve. The emotional dimension refers to feelings such as ambivalence, anger, guilt, and hopelessness; the social dimension refers to feelings of inferiority; and the spiritual dimension encompasses an individual’s ethics, religion, and societal beliefs.

DIF: Cognitive Level: Comprehension REF: p. 319 OBJ: 4 TOP: Characteristics of Suicide KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. Methods of suicide differ by gender. What is a preferred method of female suicide victims? a. Firearm use

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b. Hanging c. Overdose d. Drowning ANS: C Women who commit suicide use a method such as overdose or inhalation of carbon monoxide. Men generally utilize more violent methods such as firearm use, hanging, or drowning.

DIF: Cognitive Level: Comprehension REF: p. 319 OBJ: 2 TOP: Characteristics of Suicide KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Biological studies of suicide victims show an imbalance of which neurotransmitter system? a. Serotonin b. Epinephrine c. Norepinephrine d. Dopamine ANS: A Researchers have demonstrated that when certain chemicals in the brain (neurotransmitters) are not in balance, people have difficulty regulating their moods. Irregularities in a certain neurotransmitter pattern, called the serotonin system, have been found in depressed and suicidal persons.

DIF: Cognitive Level: Comprehension REF: p. 321 OBJ: 6 TOP: Theories About Suicide: Biological Evidence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. In assessing a client for suicide, which finding presents the greatest risk for the client? a. “If I had AIDS or cancer and died, then my family would be sorry.” b. “I just don’t see any other way out of this situation.” c. “I tried to kill myself 6 months ago, but my friend stopped me. The next time, no one will know.” d. “I have thought about planning it, but I haven’t done it.”

ANS: C In assessing a client for risk of suicide, all of these factors (suicide ideation, present suicide plan, and level of despair) indicate a risk. However, a client with previous attempts presents the highest risk.

DIF: Cognitive Level: Comprehension REF: p. 322 | Box 27.2 OBJ: 8 TOP: Suicide Assessment KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. After establishing a no-harm contract with the client, the nurse should: a. begin to assess client risk factors. b. continue to maintain close observation. c. decrease observation activity to allow client autonomy. d. begin treatment with antidepressants.

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ANS: B After the client agrees to a no-harm contract, the health care provider must still maintain close observation while continuing to work on underlying issues of self-worth and despair.

The assessment process should have been started prior to this. Antidepressants are prescribed based on physician order. Decreasing observation may increase client risk at this time.

DIF: Cognitive Level: Comprehension REF: p. 325 OBJ: 9 TOP: Therapeutic Interventions for Suicidal Clients KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following are included in the continuum of self-protective responses? (Select all that apply.) a. Suicide b. Self-injury c. Depression d. Goal setting e. Self-enhancement f. Growth-promoting risk taking g. Supportive communications ANS: A, B, E, F Suicide, self-injury, positive risk taking, and self-enhancement are behaviors in the continuum of self-protective responses.

DIF: Cognitive Level: Knowledge REF: p. 316 OBJ: 1 TOP: Continuum of Behavioral Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which are facts about suicide? (Select all that apply.) a. Suicide occurs most often in lower socioeconomic classes. b. Depression is a high risk factor for attempting suicide. c. Giving away important possessions is a sign of suicidal thoughts. d. It is harmful to discuss the subject of suicide with clients. e. Suicidal threats are serious only if the client conveys the planned method.

ANS: B, C These are only two of the facts about suicide. The other options are myths regarding suicide.

It is important for the nurse to be familiar with both the facts and the myths regarding suicide.

DIF: Cognitive Level: Comprehension REF: p. 317 OBJ: 2 TOP: Myths About Suicide KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which social factors impact the incidence of suicide? (Select all that apply.) a. Social isolation

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b. c. d. e.

Legal status of gun ownership Poverty and homelessness Veterans of combat Availability of internet resources

ANS: A, B, C, D Social isolation increases as people are more mobile and separated from family and support systems. The legal availability of firearms increases the suicide rate. Circumstances where people cannot care for their basic needs through homelessness and poverty increase the incidence of suicide. Persons who have suffered some type of PTSD, such as survivors of natural disasters or veterans of combat, have higher suicide rates. Access to internet resources does not impact the incidence of suicide.

DIF: Cognitive Level: Comprehension REF: p. 318 OBJ: 3 TOP: Social Factors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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Chapter 28: Substance-Related Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Abused substances are those chemicals that alter the person’s perception by affecting the: a. central nervous system. b. autonomic nervous system. c. cardiorespiratory system. d. peripheral nervous system.

ANS: A Abused substances are chemicals that affect the central nervous system (CNS). They often enhance or depress moods or emotions.

DIF: Cognitive Level: Knowledge REF: p. 329 OBJ: 1 TOP: Definition of Terms KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 2. Children who are smaller at birth, have small heads (microcephaly), and fail to develop normally have characteristics of: a. parents who smoke. b. fetal alcohol syndrome. c. fetal alcohol intoxication. d. fetal accumulation syndrome.

ANS: B These are some of the effects of fetal alcohol syndrome, which occurs with excessive alcohol use during pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 329 OBJ: 2 TOP: Drugs in Pregnancy KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 3. With children younger than 12 years of age, drug abuse: a. does not exist. b. is never a problem. c. occurs infrequently. d. occurs more often than is suspected.

ANS: D The number of admissions of children younger than 12 to substance treatment units is increasing.

DIF: Cognitive Level: Comprehension REF: p. 330 OBJ: 2 TOP: Substance Use and Age KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The drug most often abused by adolescents is:

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a. b. c. d.

alcohol. cocaine. tobacco. marijuana.

ANS: A Alcohol is the most frequently abused drug among adolescents.

DIF: Cognitive Level: Knowledge REF: p. 330 OBJ: 2 TOP: Substance Use and Age KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The client has frequent drug reactions to, and side effects from, his medications. He is 72 years old and lives alone. What should he be assessed for? a. Clarity of mind b. Suicidal wishes c. Concurrent substance use d. Using someone else’s medications ANS: C More than 40% of all drug reactions occur in persons older than 65, which suggests the possibility of substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 330 OBJ: 2 TOP: Substance Use and Age KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. The main active ingredient in coffee, black teas, most cola drinks, and many other bottled beverages that stimulates the nervous system, relieves fatigue, increases alertness, and increases the body’s metabolic rate is: a. alcohol. b. cocaine. c. caffeine. d. amphetamines.

ANS: C Caffeine is the main active ingredient in coffee, black teas, most cola drinks, and many other bottled beverages.

DIF: Cognitive Level: Knowledge REF: p. 332 OBJ: 4 TOP: Chemicals of Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 7. One begins to prefer being high to other activities during which stage of addiction? a. The early stage b. The middle stage c. The late stage d. The chronic stage ANS: A

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These behaviors are typically seen in the early stage of addiction. Tolerance to the substance develops in the middle stage. The late stage is also known as the chronic stage, in which the need for the substance causes loss of control over one’s behavior.

DIF: Cognitive Level: Knowledge REF: p. 337 OBJ: 6 TOP: Stages of Addiction KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 8. Significant complications such as sudden death due to cardiac dysrhythmia or respiratory depression are associated with the use of: a. alcohol. b. cocaine. c. inhalants. d. hallucinogens.

ANS: C Significant complications of inhalant use include sudden death caused by cardiac dysrhythmia and respiratory depression. Inhalant use is most prevalent in adolescents and young adults.

DIF: Cognitive Level: Knowledge REF: p. 333 TOP: Inhalants KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

OBJ: 5

9. For a substance-related disorder to be diagnosed, the pattern of substance use must lead to: a. significant costs involved with the habit. b. significant disturbances in social functioning. c. significantly impaired functioning and distress. d. significant physical changes related to the abused substance.

ANS: C The pattern of substance use must be disabling and must lead to significantly impaired functioning and distress. The person must demonstrate signs of tolerance, withdrawal, and dependence.

DIF: Cognitive Level: Comprehension REF: p. 338 OBJ: 7 TOP: Criteria for Diagnosis KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. Before treatment of an addiction can actually begin, many persons first must go through the process of removing the substance from their bodies under medical supervision. This is known as: a. abstinence. b. withdrawal. c. detoxification. d. intoxication.

ANS: C

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Before treatment actually can begin, many persons first must go through detoxification, the process of withdrawing from a substance under medical supervision. Abstinence refers to not engaging in an activity; withdrawal refers to the signs and symptoms experienced when an individual stops taking a substance that he or she is dependent on; and intoxication is a state of behavioral or psychological change that results from exposure to a chemical.

DIF: Cognitive Level: Knowledge REF: p. 340 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 11. A drug that is taken daily to help reduce the desire for alcohol is: a. hydroxyzine (Atarax). b. disulfiram (Antabuse). c. methadone (Dolophine). d. meclizine (Antivert).

ANS: B Disulfiram (Antabuse) is a medication that is taken daily by recovering alcoholics because it causes a very unpleasant physical reaction when combined with alcohol.

DIF: Cognitive Level: Knowledge REF: p. 340 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 12. Typical central nervous system responses when an individual has drunk five or more alcoholic beverages or has a blood alcohol content of 0.20% within a 4-hour period include: a. thought, restraint, reaction time, and judgment are slowed, and the individual usually is more at ease socially. b. the entire motor area of the brain is depressed; the individual is staggering, easily angered, and emotional and feels fatigued. c. comatose; the medullary area of the brain is severely depressed, and respiratory failure can result in death. d. confused, unresponsive to most external stimuli; loss of ability to control involuntary responses and decreased vital signs.

ANS: B These responses can vary somewhat among individuals. Slowed reaction time usually is seen with one or two drinks or with a blood alcohol content of 0.05%; a comatose state occurs with seven or more drinks or 0.40% to 0.50% alcohol blood content; and confusion and unresponsiveness to most external stimuli occur with six to seven drinks or a blood alcohol content of 0.30%.

DIF: Cognitive Level: Application REF: p. 332 | Table 28.1 OBJ: 4 TOP: Chemicals of Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 13.

is a processed stimulant that reaches the brain immediately and produces an intense but short-lived high. a. Heroin b. Opioids

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c. Cocaine d. Crack ANS: D Crack is a processed cocaine that is extremely addicting because of the immediate high it produces. Cocaine is a natural stimulant. Heroin is an opioid, which is a central nervous system depressant.

DIF: Cognitive Level: Knowledge REF: p. 335 OBJ: 4 TOP: Chemicals of Abuse KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 14. A male client takes ibuprofen twice a day, every day, for his arthritis. He becomes very anxious when he does not take his normal doses. This client is experiencing: a. physical tolerance. b. substance dependency. c. psychological tolerance. d. early-stage addiction.

ANS: C Because ibuprofen is not a chemical that causes physical dependency, this client is experiencing psychological tolerance. Physical tolerance occurs when an individual’s body has adjusted to living and functioning with the substance in the system; substance dependency refers to the need to take a substance to prevent withdrawal symptoms; and early-stage addiction is characterized by an individual who is enjoying the effects of the substance.

DIF: Cognitive Level: Application REF: p. 338 OBJ: 6 TOP: Stages of Addiction KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. The nurse assessing a newborn shortly after delivery notes that the infant is very jittery, irritable, and has a high-pitched cry. The nurse suspects that the mother took which substance during pregnancy? a. Alcohol b. Heroin c. Cocaine d. Analgesics ANS: C Infants who were exposed to cocaine in utero have sleeping and eating problems, unusual levels of irritability, and high-pitched cries.

DIF: Cognitive Level: Application REF: p. 329 OBJ: 2 TOP: Substance Use and Age KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The school nurse reports that a student who was brought to her appears to be tense and angry, and her speech is rapid. She denies use of illegal substances. What does the nurse suspect the student has ingested?

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a. b. c. d.

Ibuprofen Penicillin Ritalin Valium

ANS: C A recent study has shown that 1 in 5 adolescents have abused prescription drugs. Tension, anger, and rapid speech are common to use of stimulants such as diet pills, amphetamines, and Ritalin.

DIF: Cognitive Level: Application REF: p. 337 OBJ: 2 TOP: Substance Use and Age KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. Which of the following persons is said to have a dual diagnosis? a. The anorexic adolescent suffering from depression b. The school-age child suffering from a learning disorder and asthma c. The older adult suffering from hypertension and diabetes d. The young adult suffering from psychosis who smokes marijuana regularly ANS: D People with serious mental illness who also are addicted to or use chemicals are said to have a dual diagnosis. It is estimated that as many as 75% of the mentally ill population have a dual diagnosis.

DIF: Cognitive Level: Application REF: p. 331 OBJ: 1 TOP: Scope of the Problem Today KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. The family of a 35-year-old alcoholic who refuses to seek treatment reaches out to the community health center for assistance. Which organization should the nurse refer them to for counseling? a. Al-Anon b. Alcoholics Anonymous c. Families Anonymous d. Narcotics Anonymous ANS: A It is important to provide support for the family and refer them to group counseling.

Al-Anon is a self-help group for families of alcoholics. Alcoholics Anonymous is a self-help group for alcoholics. Families Anonymous is a self-help group for parents, relatives, and friends of drug addicts, and Narcotics Anonymous is a self-help group for individuals recovering from drug abuse.

DIF: Cognitive Level: Application REF: p. 340 | Box 28.2 OBJ: 9 TOP: Self-Help Groups for Recovering Abusers KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

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1. The breathing in of volatile substances has become popular with adolescents and young adults because such inhalants are: (Select all that apply.) a. legal. b. illegal. c. harmless. d. expensive. e. inexpensive. f. easily obtained. g. undetectable in the body.

ANS: A, E, F Reasons that adolescents and young adults abuse inhalants include the legality of the substances, their inexpensiveness, and how easily they can be obtained.

DIF: Cognitive Level: Comprehension REF: p. 333 TOP: Inhalants KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 5

2. Which are signs and symptoms most commonly associated with heroin use? (Select all that apply.) a. Watery eyes b. Constricted pupils c. Clammy skin d. Drowsiness e. Euphoria f. Sweating ANS: B, D, E These are common signs and symptoms of heroin use. Watery eyes and sweating are characteristic of heroin withdrawal, and clammy skin is seen most commonly with heroin overdose.

DIF: Cognitive Level: Knowledge REF: p. 335 | Table 28.3 OBJ: 4 TOP: Categories of Abused Substances KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 3. It is important for the nurse to ensure that the client understands the physical reactions associated with drinking alcohol while taking disulfiram (Antabuse). Which of the following are reactions that may result from ingesting alcohol while taking Antabuse? (Select all that apply.) a. High blood pressure b. Headache c. Blurred vision d. Nausea e. Double vision f. Vomiting g. Chills ANS: B, C, D, F

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Headache, blurred vision, nausea, and vomiting occur with concomitant use of alcohol and Antabuse. Additional reactions include flushing and low blood pressure.

DIF: Cognitive Level: Knowledge REF: p. 340 OBJ: 9 TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity

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Chapter 29: Sexual Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The end of the continuum that is marked by sexual actions harmful to self or others in some manner is known as: a. adaptive. b. homosexual. c. maladaptive. d. functional.

ANS: C As the continuum moves toward maladaptive, sexual behaviors become impaired or dysfunctional. The adaptive end of the continuum consists of satisfying sexual behaviors that respect the rights and wishes of others. The other options do not relate to the continuum.

DIF: Cognitive Level: Knowledge REF: p. 345 OBJ: 1 TOP: Continuum of Sexual Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. A strong influence on discussion of sexual issues with clients is the nurse’s or caregiver’s: a. self-awareness. b. self-confidence. c. sexual knowledge. d. assessment abilities.

ANS: A The caregiver must be aware of his or her values regarding sexuality. Values are easily conveyed, often through nonverbal messages, if the caregiver is not fully aware of his or her beliefs.

DIF: Cognitive Level: Comprehension REF: p. 345 OBJ: 2 TOP: Self-awareness and Sexuality KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 3. The caregiver has been assigned to care for Mr. X, a pedophile who is being treated for AIDS. The thought of caring for him disgusts her. The caregiver’s therapeutic interactions and interventions are most likely to be: a. effective. b. ineffective. c. well received. d. effective if she can conceal her true feelings.

ANS: B Caregivers’ values often are communicated to clients. Disapproval dampens the effectiveness of the therapeutic relationship.

DIF:

Cognitive Level: Comprehension

REF: p. 345

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OBJ: 2

TOP: Self-awareness and Sexuality KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. Children learn to label themselves according to their sex around the age of a. 1 b. 6 c. 2 d. 4

year(s).

ANS: C Around the age of 2 years, children learn to label themselves according to their sex. Most respond to being called “good girls” or “brave boys” by adults.

DIF: Cognitive Level: Knowledge REF: p. 346 OBJ: 3 TOP: Sexuality in Childhood KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. By the time they enter school, it is thought that most children identify with: a. same-sex peers. b. opposite-sex peers. c. the same-sex parent. d. the opposite-sex parent.

ANS: C By school age, most children identify with the same-sex parent.

DIF: Cognitive Level: Knowledge REF: p. 346 OBJ: 3 TOP: Sexuality in Childhood KEY: Nursing Process Step: N/A MSC: Client Needs: Health Promotion and Maintenance 6. An image of the older adult as an asexual, unintelligent person who is not interested in sex represents: a. a myth. b. an ideal. c. the truth. d. an attitude.

ANS: A The picture of the older adult as asexual and not interested in sex is a myth. The emphasis of the older adult’s sexual expression is on companionship and intimate communication, rather than procreation as it was in adulthood.

DIF: Cognitive Level: Knowledge REF: p. 347 OBJ: 3 TOP: Sexuality in Older Adulthood KEY: Nursing Process Step: N/A MSC: Client Needs: Health Promotion and Maintenance 7. The client was injured in a work accident. He now has a fused spine and moves with difficulty. He wonders if he will ever be able to be intimate with his wife. What is the nurse’s most accurate response? a. “You will not be able to engage in sexual activity.”

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b. “You can enjoy a satisfying sex life with some adaptation.” c. “You eventually will return to the preinjury level of functioning.” d. “You will become more sexually active after you recover from the injuries.”

ANS: B Many permanently disabled persons are able to enjoy rich and satisfying sex lives with some adaptation. The other options provide inaccurate information.

DIF: Cognitive Level: Application REF: p. 347 OBJ: 3 TOP: Sexuality and Disability KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. People who express their sexuality with members of the opposite sex are: a. asexual. b. bisexual. c. homosexual. d. heterosexual.

ANS: D Persons who express their sexuality with members of the opposite sex are heterosexual.

Asexual refers to a group of individuals who fall into the category of homosexual, who engage in little to no sexual activity; bisexual refers to individuals who are sexually attracted to members of both genders; and homosexual refers to individuals who prefer expression of their sexual identity with members of the same gender.

DIF: Cognitive Level: Knowledge REF: p. 347 OBJ: 4 TOP: Heterosexuality KEY: Nursing Process Step: N/A MSC: Client Needs: Health Promotion and Maintenance 9. Experiencing sexual excitement from wearing the clothing of the opposite sex is defined as: a. cross-acting. b. transvestism. c. transsexuality. d. sexual dysfunction.

ANS: B Transvestism is defined as sexual excitement derived from wearing the clothing of the opposite sex.

DIF: Cognitive Level: Knowledge REF: p. 349 OBJ: 4 TOP: Transvestism KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. The client confides in the nurse that intercourse has been painful since she became menopausal. What is the nurse’s most therapeutic response? a. “Don’t worry; it will pass.” b. “Are you still sexually active?” c. “Perhaps we can discuss this with your doctor.” d. “I understand how difficult it is to discuss sex.”

ANS: C

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Many sexual dysfunctions are treatable, so clients should be referred to their physicians.

Saying that the pain will pass is a nontherapeutic response that disregards the feelings of the client; asking the client if she is still sexually active makes the client feel that she is not normal; and empathizing with the client is helpful but does not address the problem.

DIF: Cognitive Level: Application REF: p. 350 OBJ: 6 TOP: Sexual Dysfunction KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. Between the ages of years, the greatest amount of sexual activity with multiple partners and serial relationships occurs. a. 13 and 17 b. 18 and 24 c. 25 and 34 d. 35 and 44 ANS: B Because of the decreased age of first intercourse and the increased age of marriage, more unmarried adults are engaging in this type of sexual activity in today’s society.

DIF: Cognitive Level: Knowledge REF: p. 346 OBJ: 3 TOP: Sexuality in Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. An individual is bisexual. The belief that this individual’s sexual variation is related to genetic influences is the belief held by: a. biological theorists. b. behavioral theorists. c. psychosocial theorists. d. psychoanalytical theorists.

ANS: A Biological theorists believe that an individual’s sexual variation is related to genetic influences. Behavioral theorists believe that modes of sexual expression are learned responses, and psychoanalytical theorists view modes of sexual expression other than heterosexual expression to be neurotic or psychopathic in nature and due to the Oedipus/Electra complex of childhood. Psychosocial theory is not cited as a theory on sexual orientation.

DIF: Cognitive Level: Knowledge REF: p. 349 TOP: Theories Relating to Psychosexual Variations KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

OBJ: 4

13. The step in process that describes individuals who assume a homosexual lifestyle, are open about their sexuality, and give themselves permission to be who they are is identified as: a. awareness. b. commitment. c. identity assumption. d. identity recognition.

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ANS: B In the mid-20s and beyond, commitment is identified as the step in process and describes individuals who assume a homosexual lifestyle; state to the world that they are homosexual; and give themselves permission to be who they are.

DIF: Cognitive Level: Comprehension REF: p. 348 | Table 29.2 OBJ: 4 TOP: Identity Formation Process of Gay Adolescents KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. The rate of pregnancy and transmission of HIV is higher in the adolescent population than the general population of sexually active adults due to the fact that adolescents: a. have more sexual partners. b. utilize ineffective contraception. c. have not been educated regarding sexuality. d. seek behaviors which reflect their need to be independent.

ANS: B Most adolescent girls use ineffective or no contraception at all, and most adolescent boys do not use condoms. Because of this practice, the sexually transmitted disease (including human immune deficiency virus/acquired immunodeficiency syndrome [HIV/AIDS]) and pregnancy rates are higher for adolescents than the general population of sexually active adults.

DIF: Cognitive Level: Comprehension REF: p. 346 OBJ: 3 TOP: Sexuality in Adolescence KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 15. An individual’s orientation, whether heterosexual, homosexual, or bisexual, is established by: a. adolescence. b. early adulthood. c. late childhood. d. early childhood.

ANS: C One’s sexual orientation is established by late childhood. It continues to develop through adulthood. Gender is understood in early childhood.

DIF: Cognitive Level: Comprehension REF: p. 348 OBJ: 3 TOP: Homosexuality KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 16. While performing a search of an adult male’s home based on suspicion of criminal activity, the police find pictures of him with young children between the ages of 5 and 10. The pictures are sexual in nature. The man is suspected of: a. voyeurism. b. sexual sadism. c. pedophilia.

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d. necrophilia.

ANS: C Pedophilia is fondling and/or other types of sexual activities with a prepubescent child (usually under age 13 years and having not yet developed secondary sex characteristics).

Sexual sadism is sexual arousal achieved by inflicting pain or humiliation on someone else, and voyeurism is sexual arousal achieved by observing unsuspecting persons in the act of disrobing or engaging in sexual activity. Necrophilia deals with sexual activity with a corpse.

DIF: Cognitive Level: Comprehension REF: p. 351 OBJ: 7 TOP: Description of Paraphilias KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. A 68-year-old man is being treated for an enlarged prostate. While discussing health history with the nurse, he states that he seems to be having erectile difficulties and is not sure if it is from his medical condition or the medication he is taking. Which nursing diagnosis is most appropriate? a. Sexual dysfunction b. Injury, risk for c. Coping, ineffective d. Family processes, dysfunction ANS: A Sexual dysfunction is a disturbance anywhere during these four stages of the sexual response cycle. The causes are often related to psychological distresses, medication or illicit drug use, and many physical conditions. Arthritis, diabetes, and chronic illness can result in various sexual dysfunctions or alterations in sexual desire. The other nursing diagnoses do not apply in this situation.

DIF: Cognitive Level: Comprehension REF: p. 353 OBJ: 6 TOP: Sexual Dysfunction KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which are signs of sexual addiction? (Select all that apply.) a. Inability to stop b. Bragging to others about exploits c. Refusing to stop enjoying the act d. Out-of-control sexual behaviors e. Enjoying cross-dressing f. Persisting in behaviors despite severe consequences g. Spending excessive time pursuing sexual experiences ANS: A, D, F, G Inability to stop, out-of-control sexual behaviors, persisting in behaviors despite severe consequences, and spending excessive time pursuing sexual experiences are characteristics of sexual addiction.

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DIF: Cognitive Level: Knowledge REF: p. 351 OBJ: 9 TOP: Sexual Addiction KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. The criteria for healthy or adaptive sexual response include: (Select all that apply.) a. sexual acts between two consenting adults. b. sexual acts that fulfill the desire of only oneself. c. sexual acts that are not forced or coerced. d. sexual acts that are conducted in privacy. e. sexual acts that fulfill the desire between two people.

ANS: A, C, D, E These are conditions of sexuality that are considered adaptive. Sexual acts that fulfill only the desire of oneself are maladaptive as they do not consider others.

DIF: Cognitive Level: Comprehension REF: p. 345 OBJ: 1 TOP: Continuum of Sexual Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Choose the types of relationships that put individuals at greatest risk for sexually transmitted diseases, including HIV/AIDS: (Select all that apply.) a. bisexual. b. asexual. c. functional homosexual. d. dysfunctional homosexual. e. open-coupled homosexual. f. close-coupled homosexual.

ANS: A, C, D, E These relationships pose the greatest risk because of lack of monogamy. Asexual homosexual individuals have little desire or a low level of sexual activity, and close-coupled relationships are similar to traditional monogamous heterosexual marriages.

DIF: Cognitive Level: Comprehension REF: p. 348 OBJ: 4 TOP: Homosexuality KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. Which of the following are indicative of sexual dysfunction? (Select all that apply.) a. Sexual aversion disorder b. Sadism c. Erectile disorder d. Dyspareunia e. Exhibitionism ANS: A, C, D Sexual aversion disorder, erectile disorder, and dyspareunia are examples of sexual dysfunction which are disturbances in any phase of the sexual response cycle. They are usually related to psychological distress, medication, and physical illness. Sadism and exhibitionism are examples of paraphilias, sexual variations that depart from society’s traditional and acceptable modes of seeking sexual gratification.

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DIF: Cognitive Level: Comprehension REF: p. 350 | Table 29.3 OBJ: 6 TOP: Sexual Dysfunction KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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Chapter 30: Personality Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Infants who experience nurturing environments develop the ability to: a. test others. b. trust others. c. manipulate others. d. model others’ behaviors.

ANS: B When the infant’s needs are consistently met, a sense of trust and self-worth develops.

DIF: Cognitive Level: Comprehension REF: p. 357 OBJ: 2 TOP: Personality in Childhood KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. Behavioral theorists see personality disorders as the result of: a. social stressors. b. conditioned responses. c. neurophysical problems. d. an imbalance among the three forces of the personality.

ANS: B Behaviorists see personality disorders as the result of conditioned responses caused by previous events. Social stressors refer to sociocultural theories; neurophysical refers to biological theories; and imbalance among the three forces of the personality describes psychoanalytical theories.

DIF: Cognitive Level: Knowledge REF: p. 359 OBJ: 3 TOP: Behavioral Theories KEY: Nursing Process Step: N/A MSC: Client Needs: Psychosocial Integrity 3. Paranoid personality disorders are diagnosed more often in: a. men. b. women. c. children. d. adolescents.

ANS: A Paranoid personality disorders are diagnosed in up to 2.5% of the population, more often in men than in women.

DIF: Cognitive Level: Knowledge REF: p. 360 OBJ: 5 TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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4. Studies of families, twins, and relatives with personality disorders have demonstrated that the developing personality is influenced by: a. genetics. b. order of birth. c. financial factors. d. number of siblings.

ANS: A Studies of families, twins, and relatives of individuals with personality disorders have demonstrated that behavior and personality have a strong genetic influence.

DIF: Cognitive Level: Knowledge REF: p. 358 OBJ: 3 TOP: Biological Theories KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The group of personality disorders characterized by odd or strange behaviors is known as the cluster. a. erratic b. fearful c. eccentric d. obsessive-compulsive ANS: C The eccentric cluster is characterized by odd or strange behaviors. Individuals in this cluster find it difficult to be comfortable in social settings and do not relate well to others.

DIF: Cognitive Level: Knowledge REF: p. 360 OBJ: 5 TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. The central feature of one of our most pressing mental health problems today is a pervasive pattern of disregard for, and violation of, the rights of others. This personality disorder is called: a. avoidant. b. paranoid. c. dependent. d. antisocial.

ANS: D One of our most pressing mental health problems today is antisocial personality disorder, manifested as a pervasive pattern of disregard for and violation of the rights of others.

Avoidant personality disorder refers to individuals who avoid situations for fear of rejection and humiliation; paranoid personality refers to individuals who assume that everyone is out to harm, deceive, or exploit them; and dependent personality refers to individuals who express the need to be cared for so they can avoid turning people away.

DIF: Cognitive Level: Comprehension REF: p. 361 OBJ: 4 TOP: Erratic Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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7. The client relies on deceit and manipulation to get his own way. He seems to have a complete lack of conscience. His goal is always self-gratification at the other person’s expense. He is referred to as: a. a nerd. b. a psychotic. c. a psychopath. d. narcissistic.

ANS: C The hallmark of psychopaths (sociopaths) is a lack of conscience. Psychopaths use charm, manipulation, intimidation, and violence to control others and satisfy their own selfish needs.

DIF: Cognitive Level: Application REF: p. 361 OBJ: 4 TOP: Erratic Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. The childhood trait that increases the risk for developing an antisocial personality disorder is: a. poor impulse control. b. frequent reading in solitude. c. poor preschool learning practices. d. difficulty controlling others in the environment.

ANS: A Some children have trouble controlling their impulses, so they become disruptive and develop antisocial ways of coping.

DIF: Cognitive Level: Knowledge REF: p. 361 OBJ: 2 | 6 TOP: Erratic Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. The client is a 38-year-old woman with a diagnosis of narcissistic personality disorder.

Behaviors associated with this diagnosis are: a. avoidant. b. odd or eccentric. c. attention seeking. d. reflective of lack of trust in others.

ANS: C A narcissistic personality disorder is characterized by grandiosity and the need to be admired.

DIF: Cognitive Level: Knowledge REF: p. 362 OBJ: 6 TOP: Erratic Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. The client is unable to make a decision by herself. She clings to her husband and quickly moves to fill his requests. Although she sometimes appears angry, her emotions are not expressed. The client’s diagnosis is:

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a. b. c. d.

neuroticism. paranoid personality disorder. dependent personality disorder. narcissistic personality disorder.

ANS: C The anxiety of dependent personality disorder is associated with separation and abandonment. Neuroticism refers to an individual who experiences a mental imbalance that causes distress and anxiety without affecting rational thought; paranoid personality disorder is displayed by assumptions that everyone is out to harm, deceive, or exploit; and narcissistic personality disorder involves grandiose feelings of self-importance.

DIF: Cognitive Level: Application REF: p. 363 OBJ: 6 TOP: Fearful Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The nurse is planning goals for a male client with the diagnosis of personality disorder.

What is the main goal of the client’s therapy? a. To adjust to his medications b. To learn to get along with others c. To learn to control his environment d. To become aware of how his behavior affects his life ANS: D Although all are goals of care for clients with personality disorder, the most important goal is to help clients identify and then become responsible for their own behavior. This is necessary for all other treatment to be effective.

DIF: Cognitive Level: Application REF: p. 364 OBJ: 7 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 12. In treating clients with personality disorders, compliance with prescribed medications must be monitored frequently and safeguards must be put in place to prevent or reduce the risk for: a. deceit. b. suicide. c. homicide. d. manipulation.

ANS: B Clients may hoard their medications until they have enough to make up a lethal dose.

DIF: Cognitive Level: Comprehension REF: p. 364 OBJ: 8 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment | Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity

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13. A male client has a schizotypal personality disorder. A female client compliments him on his style of dressing, and he interprets this as her caring deeply for him and desiring to date him. What is the client experiencing? a. Paranoia b. Ideas of reference c. Inappropriate affect d. Delusions of grandeur ANS: B Ideas of reference are incorrect perceptions of casual events as having great or significant meaning and are frequently seen in clients with schizotypal personality disorder. Paranoia refers to individuals who assume that everyone is out to harm, deceive, or exploit them; inappropriate affect refers to inappropriate emotional expressions; and delusions of grandeur are irrational grandiose thoughts, but they differ from ideas of reference in that an interaction is not necessary to cause the delusions of grandeur.

DIF: Cognitive Level: Application REF: p. 361 OBJ: 6 TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. A wife is discussing her coworker with her husband. The wife states, “I am so tired of her.

She is always dressing in flamboyant clothing and pretends to have an accent. She doesn’t relate well to any of our coworkers because she is so superficial.” Which personality disorder is being described? a. Paranoid b. Impulsive c. Histrionic d. Narcissistic ANS: C An individual with this type of personality disorder displays a pattern of excessive emotional expression and attention-seeking behaviors. Paranoid personality refers to individuals who assume that everyone is out to harm, deceive, or exploit them; impulsive personality refers to disorders that include behaviors such as gambling, use of drugs, and spending money irresponsibly; and narcissistic personality refers to grandiose feelings of self-importance.

DIF: Cognitive Level: Application REF: p. 362 OBJ: 6 TOP: Erratic Cluster Personality Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. Medications are used with extreme caution in clients with personality disorders because of their questionable effectiveness. If a client is receiving an antipsychotic medication, it is especially important for the nurse to monitor the client for side effects of: a. increased thirst and urination, nausea, and anorexia. b. dry mouth, altered taste, sexual dysfunction, and dizziness. c. bone marrow depression, gastrointestinal symptoms, and confusion. d. extrapyramidal movements, dry mouth, blurred vision, and photophobia.

ANS: D

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These side effects are characteristic of antipsychotic medications and should be assessed because they sometimes become irreversible. Increased thirst, urination, nausea, and anorexia are side effects most commonly seen with lithium; dry mouth, altered taste, sexual dysfunction, and dizziness are commonly seen with antidepressants; and bone marrow depression, gastrointestinal symptoms, and confusion are seen most frequently with anticonvulsants.

DIF: Cognitive Level: Application REF: p. 365 | Table 30.2 OBJ: 8 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 16. The daughter of an elderly man notices that her father has stopped seeing his friends for their daily walk and acts in an aggressive manner when anyone comes to his house. She states that he normally looks forward to interacting with his friends on a daily basis and his general demeanor is friendly and caring. What does the nurse advise? a. This is a normal part of aging and there should be no reason for concern. b. The change in personality and behavior should be ignored as it is manipulative. c. The change in personality and behavior should be evaluated. d. The change in personality and behavior indicates it is time for nursing home placement.

ANS: C A sudden change in personality is not a normal sign of aging. By older adulthood, the personality is deeply entrenched. Patterns of thinking and behaving remain intact until death. Do not assume that a personality change in an older adult is normal. Changes in emotional control, responses, and levels of interest must be investigated. Many physical and biochemical problems first appear as subtle changes in personality.

DIF: Cognitive Level: Application REF: p. 358 OBJ: 2 TOP: Personality in Older Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 17. A 40-year-old who works at the same entry level job for many years without seeking advancement and politely declines when friends ask her to try new vacation spots or hobbies may be suffering from which personality disorder? a. Histrionic b. Paranoid c. Schizoid d. Avoidant ANS: D In avoidant personality disorder, anxiety is related to a fear of rejection and humiliation. To prevent possible rejection, individuals narrow their interests to a small range of activities. It is part of the fearful cluster of disorders. Histrionic is part of the erratic cluster and is characterized by excessive emotional expression. Paranoid and schizoid are included in the eccentric cluster, and the main characteristics are suspicion and the inability to maintain relationships.

DIF: Cognitive Level: Application TOP: Fearful Cluster

REF: p. 363 OBJ: 6 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Physiological Integrity 18. Two nurses are discussing a new patient during report. They discover that she has the staff divided on their opinion of her. One group has had very positive interactions with her and find her to be very cooperative. The other group has had a difficult time in gaining her compliance in treatment interventions. What action would be most appropriate in dealing with this situation? a. Provide consistent limit-setting with the client. b. Assign the staff with the positive interactions to the client’s care. c. Work with the group experiencing the negative interactions to maintain an accepting attitude. d. Take away privileges from the client until she changes her behavior.

ANS: A Clients use a technique called splitting, emotionally dividing the staff by complimenting one group and degrading another. Consistent limit-setting and reinforcement help clients to define their limits, but care providers must keep in mind their own therapeutic boundaries and communicate with each other frequently.

DIF: Cognitive Level: Application REF: p. 365 OBJ: 9 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 19. Clients suffering from a personality disorder usually do not seek treatment because they: a. do not have identifiable impairments. b. cannot be treated. c. are unable to recognize their problems. d. often do not have health insurance.

ANS: C People with personality disorders often have serious impairments but do not seek treatment because they are unable to recognize their own problems. Their distorted self-perception and view of reality often place them in the position of seeing themselves as the victim. Most individuals with personality disorders are considered treatable to varying degrees. Health insurance is not the reason the individual does not seek treatment.

DIF: Cognitive Level: Application REF: p. 363 OBJ: 7 TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity MULTIPLE RESPONSE 1. Which are characteristics of a personality disorder? (Select all that apply.) a. Delusions b. Depression c. Hallucinations d. Inappropriate sexual behaviors e. Inflexible and maladaptive behaviors f. Difficulties with interpersonal relations

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g. Behaviors that cause significant functional impairment ANS: A, B, D, E, F, G Delusions, depression, inappropriate sexual behaviors, inflexible and maladaptive behaviors, difficulties with interpersonal relations, and behaviors that cause significant functional impairment are all characteristics of personality disorders. Hallucinations refer to other types of mental health disorders.

DIF: Cognitive Level: Comprehension REF: p. 359 OBJ: 4 TOP: Personality Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Personality disorders that are considered to be in the erratic cluster include: (Select all that apply.) a. antisocial. b. borderline. c. paranoid. d. histrionic. e. avoidant. f. obsessive-compulsive. g. narcissistic.

ANS: A, B, D, G The main characteristic of the erratic cluster of personality disorders is dramatic behavior.

Paranoid personality disorder belongs to the eccentric cluster of personality disorders, and avoidant personality disorder and obsessive-compulsive personality disorder belong to the fearful cluster.

DIF: Cognitive Level: Knowledge REF: p. 361 OBJ: 4 TOP: Personality Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Characteristics of borderline personality disorder include which of the following? (Select all that apply.) a. Fear of being abandoned b. Splitting c. Gambling d. Engaging in unsafe sex e. Isolation of self from others ANS: A, B, C, D Borderline personality disorder is characterized by fear of abandonment. Therefore, clients with this disorder avoid being alone. Because of instability, behaviors demonstrated to staff may be called splitting, which includes complimenting one group while degrading another.

Because of the impulsivity, borderline personality disorder clients often engage in risk-taking activities including gambling and engaging in unsafe sex.

DIF: Cognitive Level: Application REF: p. 362 OBJ: 6 TOP: Erratic Cluster KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

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Chapter 31: Schizophrenia and Other Psychoses Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The client lives so completely in a world of his or her own that he or she is unable to recognize reality, relate to others, or cope with life’s demands. This client is considered: a. exotic. b. anorectic. c. neurotic. d. psychotic.

ANS: D Psychosis often prevents individuals from being able to perform activities of daily living.

The other options do not cause loss of touch with reality.

DIF: Cognitive Level: Comprehension REF: p. 368 OBJ: 3 TOP: Psychosis in Adolescence KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Schizophrenia in children as young as 5 years: a. is a myth. b. can occur. c. never occurs. d. cannot occur.

ANS: B Psychotic disorders can occur in children as young as 5 years of age, with causes including genetics, complications during the pregnancy or birth, and biochemical imbalances.

DIF: Cognitive Level: Knowledge REF: p. 369 OBJ: 3 TOP: Psychoses in Childhood KEY: Nursing Process Step: N/A MSC: Client Needs: Psychosocial Integrity 3. When people successfully adapt to their environment by using logical thought and socially appropriate ways, they are said to be functioning at the adaptive end of the continuum. a. emotional b. self-protective c. neurobiological d. psychobiological ANS: C The neurobiological continuum, which is a term used in psychiatry to describe interactions based on the ability to function, change, and adapt in society, is influenced by certain physical brain functions.

DIF: Cognitive Level: Knowledge REF: p. 368 OBJ: 1 TOP: Continuum of Neurobiological Responses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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4. Schizophrenia affects approximately a. 1 b. 5 c. 9 d. 13

% of the world’s population.

ANS: A This estimate means that 2.5 million people in the United States are affected, with 10% to 15% of the homeless population in the United States being schizophrenic.

DIF: Cognitive Level: Knowledge REF: p. 372 OBJ: 4 TOP: Schizophrenia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Theories based on study of the brain and its activities are called: a. social. b. biological. c. psychological. d. psychobiological.

ANS: B Biological theories view schizophrenia as a brain disorder. Social theories view schizophrenia to be caused by the effects of the environment; psychological theories view the cause of the disease to be a character flaw combined with poor family relationships; and psychobiological theories do not exist.

DIF: Cognitive Level: Knowledge REF: p. 371 OBJ: 4 TOP: Biological Theories KEY: Nursing Process Step: N/A MSC: Client Needs: Psychosocial Integrity 6. The client has become unable to recognize formerly familiar objects and people in his environment. The client is experiencing: a. affect. b. agnosia. c. apraxia. d. anhedonia.

ANS: B Agnosia is an inability to recognize familiar objects or people; affect is an individual’s expression of emotion; apraxia refers to the loss of an individual’s ability to carry out purposeful movements, even when having the desire and physical ability to do so; and anhedonia is the inability or decreased ability to experience pleasure in life.

DIF: Cognitive Level: Comprehension REF: p. 374 OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. The client is describing her trip to town. She tells the nurse, “I cold town yellow water girl outside below ground.” This speech disturbance is called:

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a. b. c. d.

neologism. word salad. flight of ideas. verbigeration.

ANS: B Word salad is verbal communication in which a series of unrelated words with no connection is used. Neologism is words or expressions invented by the individual. Flight of ideas refers to rapid flow of speech along with a rapid change of topics; and verbigeration is purposeless repeating of phrases.

DIF: Cognitive Level: Application REF: p. 374 OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. The signs and symptoms of schizophrenia must be present for at least diagnostic label is assigned. a. 3 b. 6 c. 12 d. 18

months before a

ANS: C The signs and symptoms of schizophrenia must be present for at least 1 year before a diagnostic label is assigned.

DIF: Cognitive Level: Knowledge REF: p. 375 OBJ: 6 TOP: Phases of Becoming Disorganized KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. The client in whom schizophrenia has been diagnosed usually is medicated with what class of drugs? a. Antianxiety b. Antipsychotic c. Antidepressant d. Antihypertensive ANS: B Medications used to treat psychoses are called antipsychotic or neuroleptic drugs.

DIF: Cognitive Level: Knowledge REF: p. 376 OBJ: 7 TOP: Pharmacological Therapy KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. The client interprets the proverb “A rolling stone gathers no moss” as “As long as the rock keeps moving, it won’t turn green.” This is an example of: a. mutism. b. flight of ideas. c. concrete thinking. d. loose association.

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ANS: C Concrete thinking is the inability to identify or describe feelings, experiences, and behaviors abstractly. Mutism is a refusal to speak; flight of ideas is a rapid flow of speech along with a rapid change of topics; and loose association refers to thinking that is characterized by speech that moves from one unrelated idea to another.

DIF: Cognitive Level: Application REF: p. 374 OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: N/A MSC: Client Needs: Psychosocial Integrity 11. The nurse notes that a male client, who is taking an antipsychotic medication, is constantly moving from chair to chair during a group activity, and he complains that he feels “nervous and jittery inside.” The nurse is aware that this client most likely is experiencing: a. akinesia. b. dystonia. c. dyskinesia. d. akathisia.

ANS: D Akathisia is one of the extrapyramidal side effects of antipsychotic medications that the nurse must monitor for and report to the physician. Akinesia refers to the absence of mental or physical movement; dystonia refers to rigidity of muscles; and dyskinesia is involuntary abnormal skeletal muscle movement.

DIF: Cognitive Level: Application REF: p. 378 OBJ: 9 TOP: Special Considerations KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity 12. To cope with the devastating effects of schizophrenia and other serious mental illnesses, family members or significant others and clients will benefit most from: a. regular psychoanalysis. b. intensive short-term therapy. c. ongoing treatment and support. d. continued medication adjustments.

ANS: C Continued treatment and support are needed for family members or significant others and clients alike if they are to cope with the devastating effects of psychotic mental illnesses because all aspects of life are affected.

DIF: Cognitive Level: Application REF: p. 382 OBJ: 8 TOP: Special Considerations KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 13. The onset of schizophrenia most commonly occurs during the decade of age in the: a. teens. b. 20s. c. 30s. d. 40s.

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ANS: B This is the usual age of onset, although oftentimes it is not noticed by others, or the condition may not be diagnosed until signs and symptoms become much more prominent.

DIF: Cognitive Level: Knowledge REF: p. 370 OBJ: 3 TOP: Psychoses in Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. A female client with a psychotic disorder is experiencing olfactory hallucinations. Most likely, she would be complaining of: a. a vision that is disturbing to her. b. a sound that is disturbing to her. c. a smell that is disturbing to her. d. a sense of touch that is disturbing to her.

ANS: C Hallucinations are false sensory inputs with no external stimuli that can occur with any of the senses. Olfactory refers to the sense of smell.

DIF: Cognitive Level: Comprehension REF: p. 373 OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. The police bring a man to the emergency department because he is wandering the streets yelling to people. He attempted to attack the police officer because he accused him of “being a part of that plot to kill the president and me.” Which category of schizophrenia is he exhibiting? a. Paranoid b. Catatonic c. Disorganized d. Residual ANS: A People with paranoid schizophrenia believe someone or thing is out to get them. They have complex delusions of grandeur (belief that they are special or better than others). Because they feel they are being persecuted, they are withdrawn, suspicious, guarded, and hostile and may exhibit violent behavior. Catatonic schizophrenia is manifested by motor immobility.

Disorganized schizophrenia is manifested by being unable to think, speak, or act in an organized manner. Residual schizophrenics are free of psychosis.

DIF: Cognitive Level: Comprehension REF: p. 372 OBJ: 5 TOP: Subtypes of Schizophrenia KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The family of a client diagnosed with schizophrenia describes her behavior over the last few days as being very docile and nonconfrontational. When asked to go and change her shoes to go shopping, she goes to change them, but a when a family member checks on her several minutes later, she appears to be lost in thought. This phase of schizophrenia is the phase. a. residual

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b. prodromal c. prepsychotic d. acute ANS: C In the prepsychotic phase, individuals are usually quiet, passive, and obedient, and they prefer to be alone. Family members may report that they can sense the individual “slipping away” in front of their eyes. The prodromal phase and residual phases begin with withdrawal, a lack of energy, and little motivation. Individuals may appear confused and in a world of their own. They may complain about multiple physical problems or show a new, excessive interest in religion or philosophy. Ideas and beliefs become odd or unusual. Some individuals become agitated or angry. Speech becomes difficult to follow. In the acute phase, individuals lose contact with reality and become unable to function even in the most basic ways.

DIF: Cognitive Level: Comprehension REF: p. 375 OBJ: 6 TOP: Phases of Becoming Disorganized KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. The mother of a 20-year-old diagnosed with paranoid schizophrenia is upset by the fact that her child tried to attack her during her daily visit. What is the most appropriate support the nurse can give her after this incident? a. “Your child is working through relationship issues with you and does not know how to express them.” b. “You should stop coming for a while, as your visits upset your child.” c. “Your child’s illness is due to a loss of contact with reality, and not directed to you as his mother.” d. “You must make him realize that his behavior toward you is inappropriate.”

ANS: C People with paranoid schizophrenia believe someone or thing is out to get them. Violent behaviors are common. In addition a primary characteristic of any psychotic disorder is an inability to recognize reality. Due to this disconnect with reality, working through relationship issues, correcting behavior are not appropriate at this early point in treatment.

Parents suffer the grief of losing a normal child and then must cope with the stigma of having a child who is “mentally ill.”

DIF: Cognitive Level: Comprehension REF: p. 372 OBJ: 9 TOP: Psychosis in Adulthood KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. A woman who delivered a healthy infant 3 weeks ago is experiencing auditory hallucinations and has not changed her clothes or taken a shower in a week and expresses no interest in her infant. After a short inpatient stay, her symptoms improve and she is back to caring her herself and her infant. What disorder is this indicative of? a. Paranoid schizophrenia b. Dual diagnosis c. Schizotypal d. Brief psychotic disorder

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ANS: D A brief psychotic disorder is a psychotic disturbance that lasts for more than 1 day but less than 1 month. The individual has delusions, hallucinations, impaired functioning and speech, and disorganized behavior. They eventually return to their normal state. The episode may have been triggered by stressors or having given birth recently (1 to 4 weeks).

DIF: Cognitive Level: Comprehension REF: p. 376 OBJ: 8 TOP: Other Psychoses KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The client who is taking a low-potency antipsychotic medication should be informed by the nurse that the most common side effects are: (Select all that apply.) a. dystonia. b. akathisia. c. dry mouth. d. bradykinesia. e. blurred vision. f. urinary retention.

ANS: C, E, F Anticholinergic side effects are most common with low-potency antipsychotic medications.

The other options are extrapyramidal side effects that are seen most typically with higher-potency and long-term use of antipsychotic medications. However, all clients on antipsychotic medications should be monitored for both categories of side effects.

DIF: Cognitive Level: Knowledge REF: p. 378 OBJ: 9 TOP: Special Considerations KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity 2. Positive symptoms of schizophrenia include: (Select all that apply.) a. flat affect. b. hallucinations. c. poor grooming. d. speech problems. e. bizarre behaviors. f. withdrawal from others.

ANS: B, D, E Symptoms of schizophrenia fall into two categories: positive symptoms, which relate to maladaptive thoughts and behaviors; and negative symptoms, which relate to lack of adaptive ability. The incorrect answers are examples of the negative symptoms.

DIF: Cognitive Level: Knowledge REF: p. 375 OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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3. Neuroleptic malignant syndrome is a potentially fatal side effect of antipsychotic medications. Which of the following symptoms is indicative of NMS? (Select all that apply.) a. Hypothermia b. Hyperthermia c. Rigid posturing d. Agitation e. Tachycardia f. Diaphoresis g. Slow, shallow respirations ANS: B, C, D, E, F Symptoms of NMS begin with a sudden change in the client’s level of consciousness and a rapid onset of rigid muscles. Often there is an associated respiratory difficulty, tremors, and an inability to speak; however, the cardinal sign of NMS is a high body temperature.

Temperatures can reach as high as 108° F but usually range between 101° and 103° F. Hypothermia and slow, shallow respirations are not indicative of NMS. DIF: Cognitive Level: Knowledge REF: p. 379 OBJ: 7 TOP: Neuroleptic Malignant Syndrome KEY: Nursing Process Step: AssessmentMSC: Client Needs: Psychosocial Integrity

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Chapter 32: Chronic Mental Health Disorders Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. Persons with chronic mental health problems have much higher rates of: a. apathy. b. suicide. c. homicide. d. physical illness.

ANS: B Individuals with chronic mental health problems have much higher rates of suicide because they often cannot see a bright future for themselves and find it difficult to meet basic needs.

DIF: Cognitive Level: Knowledge REF: p. 385 OBJ: 1 TOP: Scope of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. The process of emptying state mental hospitals and placing mentally ill persons in the community is known as: a. recidivism. b. exacerbation. c. deinstitutionalism. d. deinstitutionalization.

ANS: D State psychiatric hospitals discharge long-term patients into the community through a practice called deinstitutionalization. Recidivism refers to a pattern of short hospital admissions and discharges; and exacerbation is a period of dysfunction accompanied by an increase in the signs, symptoms, and seriousness of a problem.

DIF: Cognitive Level: Knowledge REF: p. 385 OBJ: 2 TOP: Effects of Deinstitutionalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. The experience and suffering of living with mental illness: a. decreases as one grows older. b. is unique to each person. c. follows a predictable course. d. is common to all mentally ill persons.

ANS: B Each client is a unique individual; therefore, even if clients share the same diagnosis, the experiences are unique.

DIF: Cognitive Level: Comprehension REF: p. 387 OBJ: 2 TOP: Characteristics of Chronic Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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4. The client finds fault in every success she has. She is afraid to try anything new because she “just knows” that she will fail because she is mentally ill. Her behaviors demonstrate: a. low self-concept. b. suicidal ideation. c. low abstraction abilities. d. altered thought processes.

ANS: A Mentally troubled people often see themselves as helpless, ineffective, and incapable of change, which leads to chronic low self-esteem. Suicidal ideation refers to persistent thoughts of suicide; low abstraction abilities refer to the inability to think conceptually; and altered thought processes refer to a disruption in the ability to think clearly.

DIF: Cognitive Level: Application REF: p. 368 OBJ: 3 TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. The child has not developed the ability to respond to others. He cannot communicate his needs. He may remain dependent upon others throughout his life. He is most accurately described as having: a. autism. b. anxiety. c. intellectual disability. d. attention-deficit disorder.

ANS: A Children with autism do not develop the ability to respond to and communicate their needs, and they remain dependent on others, sometimes throughout their lives. These children do not respond well to reality. The other options do not accurately match the description in the situation.

DIF: Cognitive Level: Comprehension REF: p. 368 OBJ: 4 TOP: Children and Adolescents With Chronic Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 6. Approximately a. 25 b. 50 c. 75 d. 100

% of individuals with chronic mental illness use or abuse drugs.

ANS: C This statistic poses a significant problem in the treatment of mental illness.

DIF: Cognitive Level: Knowledge REF: p. 389 OBJ: N/A TOP: Persons With Multiple Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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7. The client has been diagnosed with depression for a long time. He recently started using cocaine to help relieve his depression. The most accurate description of these behaviors is a(n): a. addiction. b. dual diagnosis. c. fear of failure. d. poor prognosis.

ANS: B Although all of the options might apply, this answer most accurately describes the behavior.

Individuals with a dual diagnosis are suffering from two mental health disorders, one of which usually is substance related.

DIF: Cognitive Level: Application REF: p. 389 OBJ: 6 TOP: Persons With Multiple Disorders KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. The criterion that necessitates the need to hospitalize an individual with chronic mental health problems occurs when his or her: a. behaviors pose a threat. b. caregivers need a respite. c. subsistence benefits expire. d. medications need readjustment.

ANS: A Persons with chronic mental health problems are hospitalized only when their behaviors pose a threat to themselves or others. Other options that are less disruptive than hospitalization can be found for the other situations.

DIF: Cognitive Level: Knowledge REF: p. 389 OBJ: 7 TOP: Inpatient Environment KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 9. The client has schizophrenia. He has moved frequently between the community and mental health facilities for the past 7 years. The client’s behavior is an example of: a. relapse. b. recidivism. c. remission. d. exacerbation.

ANS: B Recidivism remains a problem for both health care professionals and their clients.

Coordinating care between the community and the institution helps to reduce the number of admissions to facilities. Relapse refers to the return to maladaptive behavior; remission is a period of partial or complete disappearance of symptoms; and exacerbation refers to the reoccurrence of symptoms.

DIF: Cognitive Level: Knowledge TOP: Access to Health Care Planning

REF: p. 386 KEY:

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OBJ: 8 Nursing Process Step:

MSC: Client Needs: Psychosocial Integrity 10. A male client is experiencing hallucinations. The intervention that would be most helpful in controlling the hallucinations is: a. actively listening to his concerns. b. establishing a trusting relationship. c. encouraging appropriate behaviors. d. teaching him to use distraction techniques when experiencing hallucinations.

ANS: D Distraction techniques, such as whistling or telling the hallucination to go away, will be helpful in controlling the hallucinations. Actively listening to his concerns and establishing a trusting relationship are interventions that will help in improving communication skills, and encouraging appropriate behaviors will help the client build social skills.

DIF: Cognitive Level: Application REF: p. 391 | Table 32.2 OBJ: 9 TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 11. Neuroleptic drugs are prescribed to treat: a. anxiety disorders. b. personality disorders. c. psychotic disorders. d. somatoform disorders.

ANS: C Neuroleptic drugs are also known as antipsychotic drugs and are used to treat psychosis.

DIF: Cognitive Level: Synthesis REF: p. 391 OBJ: 9 TOP: Pharmacological Therapy KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. Individuals with mental illness live an average of population. a. 2 to 4 b. 5 to 8 c. 10 to 15 d. 18 to 25

years less than the general

ANS: C Fifty percent of clients with mental health disorders also suffer from physical disorders, and, frequently, they are not capable of managing either disorder.

DIF: Cognitive Level: Application REF: p. 387 TOP: Access to Health Care KEY: Assessment MSC: Client Needs: Psychosocial Integrity 13. Individuals with schizophrenia tend to use the chemical a. alcohol

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OBJ: 2 Nursing Process Step:

most often.

b. cocaine c. heroin d. hypnotics ANS: A Alcohol is used most commonly by individuals with schizophrenia, whereas cocaine is used most often by individuals with mood disorders, and heroin is used most frequently by those with conduct disorders. Hypnotics are not referenced as being used predominantly by any specific group.

DIF: Cognitive Level: Application REF: p. 386 TOP: Access to Health Care KEY: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 2 Nursing Process Step:

14. A female client with a chronic mental health disorder tells the nurse that she has great difficulty every morning getting ready for work because she cannot decide what to wear to work or what to eat for breakfast. This client is experiencing: a. auditory hallucinations. b. altered thought processes. c. delusions of grandeur. d. chronic low self-esteem.

ANS: B Commonly experienced with chronic mental illness is an altered thought process, which disrupts the individual’s ability to think clearly, problem-solve, or make plans. Auditory hallucinations refer to hearing false sounds; delusions of grandeur refer to a false fixed belief of elevated self-worth; and chronic low self-esteem often is experienced by these individuals because they feel helpless and hopeless but this option does not lend itself to the situation.

DIF: Cognitive Level: Application REF: p. 388 OBJ: 3 TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A client in an inpatient mental health setting is scheduled to be discharged with follow-up at a community mental health center. His family is concerned that his inpatient stay was not long enough, and he will be re-admitted in the near future. The nurse knows that the average length of inpatient stay is: a. 5 days. b. 10 days. c. 25 days. d. 1 month.

ANS: B The average length of stay for a mental illness is 10 days. The short inpatient stay, combined with a short community care involvement often leads to recidivism, as the immediate goal in the inpatient setting is to help the client control his or her behavior.

DIF:

Cognitive Level: Application

REF: p. 389

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OBJ: 1

TOP: Inpatient Settings KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. A woman with a history of chronic mental illness was dating someone for about a month before they ended the relationship. What is the probable action the woman will take? a. Endure a brief period of grieving and seek to begin dating again. b. Speak to friends and other support persons and consider the positive aspects of the relationship. c. Withdraw and refuse to seek out or enter into another relationship. d. Take up an activity with friends to avoid staying home and thinking about the failed relationship.

ANS: C When individuals with chronic mental health problems basic needs for love and belonging go unmet, and they respond by becoming more emotionally paralyzed. The experience of a small success in a short-term relationship will often prevent them from making any further attempts because they “just know” that they will eventually fail. When self-concept is low, it is difficult to convince someone that a brighter future can exist. The other responses demonstrate positive coping strategies.

DIF: Cognitive Level: Application REF: p. 388 OBJ: 3 TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. In the United States today, the effects of deinstitutionalization include: (Select all that apply.) a. a comprehensive mental health care system. b. a decrease in the need for medical treatment. c. an increase in the jail and prison populations. d. an increase in the homeless population. e. people who cannot obtain adequate food or shelter. f. well-adjusted people with CMI. g. unlimited access to mental health care.

ANS: C, D, E Deinstitutionalization refers to the widespread discharge of clients from psychiatric hospitals into the community, largely caused by the introduction of psychotherapeutic drugs in the 1950s.

DIF: Cognitive Level: Comprehension REF: p. 385 OBJ: 1 TOP: Deinstitutionalization KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Psychiatric rehabilitation focuses on: (Select all that apply.) a. helping clients control their behaviors. b. assisting clients to cope effectively with their life situations. c. helping clients identify their feelings.

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d. preventing the client from harming himself or herself. e. assisting the client with problem-solving techniques. f. assisting with occupational and vocational training.

ANS: B, C, E, F Goals of psychiatric rehabilitation include identification and processing of feelings, learning and applying problem-solving and coping skills, and preparing for re-entry into the community with rehabilitative training to improve socialization, confidence, organizational abilities, income, and quality of life.

DIF: Cognitive Level: Comprehension REF: p. 390 OBJ: 7 TOP: Psychiatric Rehabilitation KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 3. Persons with which of the following diagnoses respond well to therapeutic interventions and may have no further problems? (Select all that apply.) a. Psychosis b. Depression c. Anxiety disorders d. Schizophrenia e. Phobias f. Erratic behavioral disorder ANS: B, C, E Persons with phobias, anxiety disorders, or depression often respond well to therapeutic interventions and have no further problems. However, for a certain group of individuals, mental illness becomes a way of life.

DIF: Cognitive Level: Comprehension REF: p. 384 TOP: Introduction KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

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OBJ: 1

Chapter 33: Challenges for the Future Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. The need for mental health applies to: a. all persons. b. people with illnesses. c. all married persons. d. people with mental problems.

ANS: A The need for mental health applies to all people. Every person experiences periods of emotional turmoil and crises, and, at some time, most individuals need some assistance with coping strategies.

DIF: Cognitive Level: Knowledge REF: p. 395 TOP: Introduction KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 1

2. An aging population, an overburdened welfare system, and a cost conscious U.S. Congress exerting its influence on the health care system are all examples of changes. a. social b. cultural c. environmental d. technological ANS: A These are all examples of social changes that affect today’s health care system. Cultural changes are exhibited in the population served in the health care setting; the environment refers to the health care setting; and technological advances guide the level of care and the way care is delivered.

DIF: Cognitive Level: Knowledge REF: p. 396 OBJ: 6 TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Families without a home now make up United States. a. 14 b. 28 c. 38 d. 44

% of the homeless population in the

ANS: C Nearly half of this population work, but they do not earn enough to pay for housing.

DIF: Cognitive Level: Comprehension TOP: Homelessness

REF: p. 396 OBJ: 2 KEY: Nursing Process Step: Assessment

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MSC: Client Needs: Psychosocial Integrity 4. To implement the concept of the least restrictive treatment environment, health care team members: a. monitor the medications schedule. b. assess the client’s ability to live alone. c. assess available financial resources. d. assess available community resources.

ANS: D The main function of the mental health care team is to coordinate care as the client moves from inpatient to community settings because this is the least restrictive treatment environment. The other options involve actions of care team members, but they are not directly related to the surroundings.

DIF: Cognitive Level: Synthesis REF: p. 399 OBJ: 4 TOP: The Mental Health Care Team KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 5. A treatment team member works with a client who is living in a residential treatment facility with a diagnosis of severe paranoid schizophrenia. The team member who collaborates with the physician to coordinate the client’s therapy and medications and necessary referrals is the: a. nurse case manager. b. psychiatric technician. c. certified nursing assistant. d. home health care provider.

ANS: A While the psychiatric technician, certified nursing assistance, and home health care provider are important care team members in the collaboration effort, they do function as independently as the nurse case manager in coordination of the client’s care.

DIF: Cognitive Level: Knowledge REF: p. 401 OBJ: 7 TOP: Expanded Role for Nurses KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 6. Routine health screenings, regular educational discussions, and support groups are nursing responsibilities that are: a. curative. b. educational. c. restorative. d. preventive.

ANS: D All of the options are responsibilities of the nurse, but preventive best represents the criteria listed in the question. Preventive health care is an important responsibility of the nurse.

Prevention reduces the incidence of illness and the difficulty associated with treatment.

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DIF: Cognitive Level: Comprehension REF: p. 401 OBJ: 7 TOP: Expanded Roles for Nurses KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 7. A way of helping people with mental health problems to readjust and adapt to life in the community that is based on a nonmedical model of treatment is: a. client advocacy. b. psychosocial treatment. c. compliance with medications. d. psychosocial rehabilitation.

ANS: D The psychosocial (psychiatric) rehabilitation model of treatment focuses on wellness, wholeness, and the abilities of the client, and it encourages freedom of choice and self-direction.

DIF: Cognitive Level: Knowledge REF: p. 402 OBJ: 7 TOP: Expanded Roles for Nurses KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 8. The deliberate effort to make things different within a system is called: a. planned change. b. unplanned change. c. unexpected change. d. workplace dynamics.

ANS: A Planned change is the deliberate effort to make things different within a system. Unplanned or unexpected change often is not desired change. With both types of change, workplace dynamics is affected and change often is met with strong reactions.

DIF: Cognitive Level: Knowledge REF: p. 402 OBJ: 8 TOP: The Change Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Each complaint of people with HIV/AIDS must be investigated carefully because CNS problems can be mistaken for: a. anxiety. b. delusions. c. compulsions. d. psychiatric problems.

ANS: D Individuals with HIV can have signs of CNS damage that may present as a psychiatric illness before HIV or AIDS is detected.

DIF: Cognitive Level: Comprehension REF: p. 403 OBJ: 9 TOP: Persons With AIDS KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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10. In the United States, 1 in a. 4 b. 8 c. 12 d. 16

individuals has a diagnosable mental health disorder.

ANS: A This figure equates to 46.6 million individuals in the United States.

DIF: Cognitive Level: Knowledge REF: p. 395 OBJ: 1 TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. Historically, the homeless population has primarily consisted of: a. families. b. African American men over 40 years of age. c. white male adults with an average age of 50 years. d. individuals in their 30s with mental and physical disabilities.

ANS: C This group constituted the majority of the homeless population in the past, but the face of the homeless population has changed over time.

DIF: Cognitive Level: Comprehension REF: p. 396 OBJ: 2 TOP: Homelessness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. Adults with chronic mental illness account for approximately population. a. 40% b. One-third c. One-half d. 50%

of the homeless

ANS: A Decreased community mental health services and lack of ability for the individual to function in daily life have led to the growing number of homeless persons with chronic mental illness.

DIF: Cognitive Level: Knowledge REF: p. 396 OBJ: 1 TOP: Homelessness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. A male client was discharged to home from an inpatient setting with the diagnosis of obsessive-compulsive disorder. Upon discharge, he was able to reason, understand, and make informed choices regarding his care. Now, he is unable to leave his house, is engaging in compulsive behaviors, and is not taking his medication. The best description of this situation is that the client is lacking in: a. competency. b. client rights.

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c. self-direction. d. self-determination.

ANS: A Competency incorporates the four criteria of being able to make a choice, understand important information, apply reasoning, and understand one’s own situation. This client is demonstrating inability in all of these areas.

DIF: Cognitive Level: Application REF: p. 399 TOP: Competency KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 5

14. A nurse is overheard by a family member of a client discussing the condition of the client.

This nurse is in violation of the: a. client’s informed consent. b. right to competent care. c. Americans with Disabilities Act. d. Health Insurance Portability and Accountability Act. ANS: D The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first national standard instituted for the protection of the privacy of an individual’s health information. Informed consent refers to appropriate information given to the client in order for the client to make informed decisions regarding his care. The right to competent care refers to the right of the client to receive care from an individual who is knowledgeable and skilled in providing care; and the Americans with Disabilities Act refers to the rights of individuals with disabilities.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 6 TOP: Obligations of Care Providers KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A woman whose culture believes her depression is the result of being possessed by the spirit of a deceased relative is considered to have a(an): a. impaired coping mechanism b. culture-bound disorder c. medically diagnosed disorder d. projection-based disorder ANS: B Some mental health problems may be specifically limited to the members of a certain group.

These types of problems are called culture-bound disorders because they appear to be related to specific cultures. For example, the Hispanic disorder susto is an emotional anxiety that results from “soul loss.”

DIF: Cognitive Level: Comprehension REF: p. 398 OBJ: 1 TOP: Cultural Influences KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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16. The nurse who advocates for a health-oriented approach to clients is likely to encourage the development of which outcome? a. The client will maintain compliance in medication administration. b. The client will adjust to the limitations of chronic illness. c. The client will keep in mind his limitations as a barrier to achievement of goals. d. The client will focus on continued progress and improvements in planning goals.

ANS: D A health-oriented approach focuses on the possibilities and positive achievements that are within the client’s grasp. The other options focus on the limitations and negative view of the client’s illness.

DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 8 TOP: A Look to the Future KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. A nurse at the mental health clinic is leaving his job and relocating to another part of the country in 6 months. What is the best way for him to deal with his clients? a. Begin to prepare clients for his departure by assisting to transition them to another nurse. b. Increase dosage of medications for each client in anticipation of the effect his leaving will have on their progress. c. Do not inform clients until after the nurse leaves to avoid additional anxiety. d. Wait until the nurse’s last day to inform clients to allow them to say goodbye, but avoid additional anxiety.

ANS: A Planning changes for clients slowly and incrementally allow for minimal resistance.

Although there may be a sense of anxiety and loss, it is diminished if done in steps.

Increasing medication dosages, and not informing clients until the nurse is gone or on his last day do not provide for the open communication and preparation.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 8 TOP: The Change Process KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. A person suffering from paranoid schizophrenia is discharged from an inpatient facility before community mental health services can be established for him. Which statement most appropriately describes this action? a. The client has a right to be discharged to the least restrictive environment. b. The client is not competent to be discharged without community mental health resources for his transition to a less restrictive environment. c. The client has a responsibility to ask to remain in the inpatient setting. d. The client will demonstrate improved compliance with treatment once in a less restrictive environment.

ANS: B

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The concept of least restrictive environment begins to break down when the client is unable to care for himself. Competence must be demonstrated. It is not the responsibility of a client who is not competent to request a longer length of stay. Without proper support and resources compliance with treatment will most likely not improve.

DIF: Cognitive Level: Comprehension REF: p. 399 TOP: Competency KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

OBJ: 5

MULTIPLE RESPONSE 1. What should the client do to cope with information overload? (Select all that apply.) a. Learn to think critically. b. Ignore any information. c. Be open to new information. d. Promise yourself that you will look at it later. e. Learn to find relationships in new information. f. Learn at least one new piece of information a day. g. Ignore new information unless it relates directly to the job.

ANS: A, C, E, F Information overload is a state of mind in which many facts have been absorbed and all become an unrelated clutter of stored information. This is a common phenomenon in today’s society with the ease of obtaining new information from so many sources, such as the internet.

DIF: Cognitive Level: Application REF: p. 404 OBJ: 10 TOP: Information Overload KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 2. In order to be actively involved in a plan of care, the client must demonstrate which of the following responsibilities? (Select all that apply.) a. Truthfulness b. Education c. Acceptance d. Responsibility e. Cooperation ANS: A, D, E In order to be involved in a plan of care that is effective for them, clients must demonstrate truthfulness in sharing information with the health care provider, responsibility in actions and behaviors, and cooperation with the treatment plan. Provision of education and acceptance are obligations of the health care provider.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 6 TOP: Obligations of Clients KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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