Test Bank for Psychiatric & Mental Health Nursing for Canadian Practice 4E by Austin,Peternelj,Kunyk

TEST BANK

TEST BANK

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TB- Psychiatric & Mental Health Nursing[4CE,Austin,Boyd]

Chapter 01: Psychiatric and Mental Health Nursing: From Past to Present Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. During the 1800s, what did Pinel believe that the cure for mental illness was?

A) arrest and confinement B) early psychotherapy C) humane treatment D) the use of chains 2. Who was the psychiatrist who suggested the term “mental hygiene”?

A) Clarence Hincks B) Sigmund Freud C) Philippe Pinel D) Adolf Meyer

3. Before the 19th century, seriously mentally ill clients with severely disturbing behaviour were usually cared for by: A) family members at home.

B) spiritual healers in asylums.

C) laypersons in hospitals.

D) staff in prisons and poorhouses.

4. Which variable of communities had the most influence on the early forms of institutional ways of caring for the mentally ill people?

A) quality of housing and number of professionals B) social stability and availability of resources C) political climate and public policy D) legal structure and role of nurses

5. Which factor has been historically related to increased intolerance and ill treatment of people with mental disorders?

A) social change and instability B) increased family size and mobility C) emphasis on religious beliefs D) increased number of asylums treating mentally ill

6. Which effects of industrialization and urbanization contributed positively to the humane treatment of mentally afflicted treatment? Select all that apply.

A) the growing number of poor and deviant people who were not able to sustain themselves B) more general anxieties during a period of rapid social change and instability C) moral, pedagogical treatment that would help restore innate capacity for selfcontrol D) the Enlightenment, which changed medical and social ideas about mental illness

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recognition of mental illness by the medical community

7. Which was a primary reform accomplished by Dorothea Lynde Dix? A) establishment of “commitment” laws in state legislatures B) introducing compassion to the care of mentally ill clients C) use of music to treat mentally ill clients D) use of exercise therapy to treat mentally ill clients

8. Which province in Canada was first to open a mental institution in 1835?

A) Ontario B) Nova Scotia C) Quebec D) New Brunswick

9. When did involuntary confinement and institutional care of mentally ill people begin to be the foremost treatment modality?

A) the 17th and 18th centuries B) end of the 20th century C) beginning of the 19th century D) last half of the 19th century

10. Which was developed in 1909 by the National Mental Health Committee for Mental Hygiene?

A) mental health nurse training B) stress management clinics C) prison clinics D) hydrotherapy centres

11. What superintendent of various Ontario psychiatric hospitals was one of the first health care providers who reformed models of care to improve treatment approaches in Ontario?

A) Adolf Meyer B) Clifford Beers C) Charles K. Clarke D) Charles A. Barager

12. When did psychiatric nursing education in the general hospital training commence in eastern Canada?

A) 1860s B) 1900s

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C) 1930s D) 1950s

13. Which level of legislation supported confinement of mentally ill clients in Canada in the late 19th century?

A) provincial B) national C) municipal D) state

14. In the earliest institutions that cared for mentally ill members of the community, what was the most common experience of clients?

A) sporadic focus on treatment B) safer alternative to living in the community C) emphasis on rehabilitation D) deplorable living conditions

15. What psychiatrist who had a strong belief in the ability of female compassion and established a new diploma in Alberta for mental health nurses?

A) Adolf Meyer B) Charles K. Clarke C) Clarence Hincks D) Charles A. Barager

16. Which new type of therapy instituted in the 1940s made skilled nursing essential?

A) cognitive–behavioural therapy B) electroshock therapy C) pharmacologic therapy D) recreational therapy

17. Which socioeconomic classes had new opportunities to pursue careers as psychiatric nurses as the demand for skilled nursing emerged in the 1940s? Select all that apply.

A) elite class B) impoverished class C) unemployed class D) working class E) middle class

18. Psychosocial theories of mental disorders, which were proposed in the early

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A) B) C) D)

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1900s, believe that what factor contributed to disorders? biologic defects dysfunctional family systems environmental and social deprivation unconscious motivators for behaviour

19. What was the major focus of “psychiatric pluralism,” introduced by Adolf Meyer?

A) integration of the human biologic functions with the environment B) psychoanalysis integrated with daily activities of living C) biologic science integrated with bloodletting treatments D) determining the drives behind the person's behaviours

20. Which factor was believed to lead to the development of a psychosis or neurosis in an individual according to the theory proposed by Sigmund Freud?

A) a chemical imbalance in the brain B) social deprivation occurred late in adolescence C) an interference in normal development D) development of an oedipal relationship

21. Who promoted university-based scientific research to influence change and find better treatment and support for mentally ill clients?

A) Charles K. Clarke B) Clifford Beers C) Adolf Meyer D) Clarence Hincks

22. Which type of treatment focused most directly on treating the brain, ultimately facilitating discharges from institutions during the mid-20th century?

A) psychopharmacology B) insulin shock therapy C) psychosurgery D) hydrotherapy

23. Which phenomenon most supported the paradigm shift and public policy changes from the Canadian Mental Health Association in the 1960s?

A) deinstitutionalization B) increased psychiatric admissions to provincial psychiatric hospitals C) psychiatric nursing education D) psychiatric pluralism

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24. Which theorist's work influenced psychiatric mental health nursing theory by emphasizing building therapeutic nurse–client relationships and holistic nursing approaches?

A) Benner B) Peplau C) Freud D) Dix

25. Which theorist's work was the basis of the Canadian Federation of Mental Health Nurses' published Canadian Standards of Nursing Practice reflected in nursing practice today?

A) Patricia Benner B) Hildegard Peplau C) Sigmund Freud D) Dorothy Dix

26. Which is the percent of hospitalization admissions for mental illness that occurred into general hospitals in 2002, according to a report that was published by the Canadian Alliance on Mental Illness and Mental Health?

A) 36% B) 56% C) 76% D) 86%

27. Which different model and strategy to provide treatment did provinces develop as a result of the shifts in federal funding in the early 1970s?

A) criminal code changes for the not criminally responsible clients B) specialized care for children and geriatric services C) diagnosis-specific care D) day treatment programmes

28. As of the 1950s, Canada entertained two separate models of education for psychiatric mental health nursing. The existence of two separate models was largely attributable to: A) colleges and universities.

B) federal legislation.

C) regional differences.

D) scarce resources.

29. As part of a career day presentation to a group of nursing students, a psychiatric–

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mental health nurse plans to describe how this specialty developed. Which individual would the nurse describe as playing a major role in the development of psychiatric nursing as a professional specialty?

Philippe Pinel Hildegard Peplau Harriet Bailey Charles A. Barager

30. A nurse is preparing a presentation about the current status of mental health services in Canada. Which statement would the nurse include as the most reflective of this status?

A) “Mental health care in Canada is equally accessible to individuals.”

B) “Mental illness ranks second among conditions causing responsible for chronic disability.”

C) “Mental health care primarily focuses on the cure of mental illness.”

D) “Mental health care services are inadequate and fragmented.”

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Answer Key 1. C 2. D 3. D 4. B 5. A 6. C, D, E 7. B 8. D 9. D 10. C 11. C 12. C 13. A 14. D 15. D 16. B 17. D, E 18. C 19. A 20. C 21. A 22. A 23. A 24. B 25. A 26. D 27. B 28. C 29. B 30. D

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Chapter 02: Mental Health, Mental Disorder, Recovery, and Well-Being Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A nurse is teaching a new client about the relationship between mental and physical health. What should the nurse describe to the client?

A) “Mental health and physical health are the same.”

B) “There is no health without mental health.”

C) “Mental health is always considered in global health policies.”

D) “Mental health and physical health are distinct.”

2. A nurse has explained to a group of clients that mental health and physical health should not be considered distinct?

A) Mental health affects physical health and vice versa.

B) Mental health and physical health are essentially the same.

C) Mental illness and physical illness do not normally coexist in people.

D) Physical health should take priority over mental health.

3. What statement best describes the position of the International Council of Nurses' (ICN) regarding mental health?

A) All nurses must have knowledge and skills to respond to mental health needs, including their own.

B) Only psychiatric–mental health (PMH) nurses need to have knowledge and skills related to mental health.

C) It is necessary for psychiatric–mental health (PMH) nurses to have knowledge and skills to respond to mental health needs of their clients only.

D) Psychiatric–mental health (PMH) nurses should be more concerned about their own mental health needs than those of their clients.

4. The nurse is assessing a new client. What findings are suggestive that the client experiences mental health? Select all that apply.

A) The individual is more joyful than his or her peers.

B) The individual can cope with the normal stresses of life.

C) The individual is able to work productively and fruitfully.

D) The individual is able to make a contribution to the community.

E) The individual is consistently happy.

5. Which statement about mental health is most accurate?

A) Mental health is the polar opposite of mental illness.

B) It is possible to experience mental health while living with a severe mental disorder.

C) The level of mental health stays the same over a person's lifetime.

D) It is best to view mental health and mental disorders on the same continuum.

6. A nurse is describing the concept of mental health and situations where it may be

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A) B) C) D) E)

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present or lacking. Which situations are possible for a client to experience? Select all that apply.

A person without mental disorder can experience minimal mental health.

A person without mental disorder can experience optimal mental health.

Mental disorder cannot coexist with mental illness.

A person with no mental disorder can experience lack of mental health.

A person can experience both absence of mental health and maximal mental disorder.

7. A nurse is providing care for a client who has a diagnosable health condition, based on an accepted classification system with criteria related to alterations in mood and affect, behaviour, and thinking and cognition. What does this client have?

A) mental illness B) a mental disorder C) a cultural disorder D) mental health

8. Which factors should the nurse consider when determining if a person has a mental disorder to rule out a possible normal reaction? Select all that apply.

A) presence of symptoms such as speaking in tongues B) the client's current circumstances and stressors C) whether the nurse feels uncomfortable or comfortable in the presence of the client D) alterations beyond the parameters of usual psychological states encountered in life E) the client's cultural definitions of responses

9. The psychiatric–mental health nurse has assessed several individuals. Which person is most likely to be diagnosed with a mental illness?

A) a person who is a member of a religious group who begins to “speak in tongues” during worship services B) a person talking aloud as if to another person when there is no one else present C) a person who has recently experienced the sudden death of a loved one who cries intermittently D) a person who has recently experienced the expected death of a loved one from a terminal disease who cries intermittently

10. Which statement about well-being is most accurate?

A) Well-being is an outcome.

B) Well-being lies on the journey through life events.

C) Well-being is not possible for the terminally ill.

D) Well-being refers to physical health only.

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11. The nurse is comparing the quality of life for Canadians who live in different regions. What source of data should the nurse consult?

A) Gross National Happiness Index B) Gross Domestic Product Index C) Canadian Index of Wellbeing D) Social Progress Index

12. Which is a possible outcome of a large gap between the richest and poorest in a society?

A) It may negatively affect the health and well-being outcomes for all people.

B) It is a cause for concern primarily for the well-being of the wealthy.

C) It is a cause for concern for the well-being of impoverished persons.

D) There is not normally a cause for concern from a large gap between richest and poorest.

13. Which statement about recovery is accurate?

A) It occurs naturally over time.

B) It is a passive process.

C) It is the same for all persons.

D) It is a cornerstone of Canada's approach to mental health.

14. Which are key directions of Canada's national mental health strategy that are most focused on prevention? Select all that apply.

A) promoting mental health across the life span B) fostering recovery for those living with mental health problems C) reducing disparities in access to appropriate services D) providing appropriate treatment services E) promoting mental health in the workplace

15. Which concepts are the cornerstone of Canada's mental health strategy? Select all that apply.

A) mental health B) well-being C) mental illness D) recovery E) physical health

16. Which are primary purposes of the DSM-5? Select all that apply.

A) Identify the criteria required for a particular conditions to be diagnosed.

B) Describe treatment modalities for psychiatric disorders and mental illnesses.

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C) Identify various aetiologies for mental disorders based on family histories.

D) Provide optimal outcomes for treatment for individuals with mental illnesses.

E) Provide a common language for health care professionals to use.

17. Which is a potential negative consequence of diagnosing and labelling a particular person's illness?

A) The client may express specific preferences for treatment.

B) Disease-specific treatment may be delayed.

C) There can be a loss of personal identity if the labelled person becomes viewed as the diseased.

D) The client's family may misunderstand the symptoms, signs, and behaviour.

18. Which concepts are used by the DSM-5 to point to ways culture influences the illness experience? Select all that apply.

A) cultural syndrome B) cultural idiom of distress C) cultural explanation or perceived cause D) cultural centrism E) cultural diagnoses

19. The nurse is caring for a client who has schizophrenia and has consulted the DSM-5 while caring for the client. What information could the nurse access from this resource?

A) the diagnostic criteria for schizophrenia B) a sample treatment plan for a client with schizophrenia C) information about the aetiology of schizophrenia D) trends in epidemiology of schizophrenia

20. What information is contained in section II of the DSM-5?

A) an introduction and explanation of its use B) a caution regarding its forensic use C) diagnostic criteria and codes D) emerging measures and models

21. The nurse is working in a community that has a high score of the Social Progress Index (SPI). This index would consider what aspects of the community? Select all that apply.

A) nutrition and basic medical care B) population density C) water and sanitation D) shelter

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personal safety

22. In which component of the Social Progress Index (SPI) does Canada perform particularly well, compared with other nations?

A) tolerance and inclusion B) environmental quality C) access to information D) health and wellness

23. Which index complements the Gross Domestic Product (GDP) index to give a more holistic picture of a country's overall performance in delivering societal and environmental value?

A) Canadian Index of Wellbeing (CIW) B) Gross National Happiness (GNH) index C) Social Progress Index (SPI) D) Human Development Index

24. Which are examples of research-based care that has improved psychiatric and mental health nursing? Select all that apply.

A) decreasing the use of seclusion and restraint B) the need to determine an individual's trauma-related experiences when diagnosing C) the distinction between mental illness and physical illness D) research showing the efficacy of new approaches to mental health community services E) research showing that it is more important to address mental illness before addressing homelessness

25. A nursing student is assigned to care for a client diagnosed with schizophrenia.

When talking about this client in a clinical postconference, the student should use which terminology when referring to the client?

A) committed client B) schizophrenic C) schizophrenic client D) person with schizophrenia

26. After educating a group of students on mental health and mental illness, the instructor determines that the education was successful when the group identifies what characteristic as reflecting mental disorders?

A) capacity to interact with others B) ability to deal with ordinary stress C) alteration in mood or thinking

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D) lack of impaired functioning

27. A nurse is explaining recovery to the family of a client diagnosed with a mental disorder. Which statement about this process would be most appropriate for the nurse to include?

A) “It is a step-by-step process from being ill to being well.”

B) “The client focuses mainly on the emotional aspects of his or her condition.”

C) “The client is helped to live a meaningful life to his or her fullest potential.”

D) “Although peer support is important, the self-acceptance is essential.”

28. After teaching a group of nursing students about recovery, the instructor determines that more education is needed when the group identifies what as a characteristic?

A) self-direction in life B) improvement in health and wellness C) achievement of full potential D) one-time change situation

29. When describing the treatment of mental illness, what would a nurse identify as the primary goal?

A) functional status B) stigma reduction C) stress reduction D) recovery

30. Which factor is likely to be the largest barrier affecting Canadians' views of persons with mental illness?

A) lack of diagnostic criteria B) deinstitutionalization C) stigma associated with mental health problems D) limited hope for recovery

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Answer Key 1. B 2. A 3. A 4. B, C, D 5. B 6. A, B, D, E 7. B 8. D, E 9. B 10. B 11. C 12. A 13. D 14. A, C, E 15. A, B, C, D 16. A, E 17. C 18. A, B, C 19. A 20. C 21. A, C, D, E 22. A 23. C 24. A, B, D 25. D 26. C 27. C 28. D 29. D 30. C

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Chapter 03: The Context of Mental Health Care: Cultural, Socioeconomic & Geographic Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which statements are true of culture and mental illness? Select all that apply.

A) The experience of mental illness is influenced by culture.

B) Symptoms are consistent between different cultures.

C) Persons from different cultures may have different symptoms.

D) Our culture shapes our attitudes toward mental health and mental illness.

E) Understanding cultural differences will allow for more accurate diagnoses and more effective treatment.

2. Which was the relationship between spirituality, faith, and illness prior to the advent of modern Western medicine?

A) Illness and recovery were closely linked with spirituality or faith.

B) All people believed that mental illness is caused by biologic and experiential events.

C) Mental illness was seen as unrelated to metaphysical or spiritual causes.

D) Spirituality and religion had no bearing on mental illness or attitudes toward it.

3. The nurse has identified that an individual lacks insight in to the own culturally learned ideas and values regarding normal and abnormal behaviours. The individual states that these values are correct and proper for everyone. The nurse should identify what phenomenon?

A) stigma B) ethnocentrism C) stereotyping D) discrimination

4. A nurse is seeking to develop cultural competence. What action should the nurse perform first?

A) reflect on his or her own culture and its effects on thinking and behaviour B) learn about different culturally diverse groups C) identify peers who are culturally competent D) seek encounters with culturally diverse groups

5. The nurse has identified that a colleague treats members of a particular group differently than other clients. The nurse should challenge what behaviour?

A) discrimination B) prejudice C) segregation D) stigmatization

6. The nurse provides care for a diverse population of clients. This nurse's interpretation of the meaning of signs and symptoms to clients depends on the

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nurse's: age. cultural competence. level of education. cultural identity.

7. Which are the most important positive effects of the cultural competence of a psychiatric/mental health (PMH) nurse? Select all that apply.

A) better nurse–patient communication B) better patient adherence to treatment C) increased likelihood that the patient returns for care in the future D) decreased workload for the nurse E) increased efficiency and decreased costs

A) B) C) D) E)

8. Which are the components of cultural safety? Select all that apply. cultural context cultural awareness cultural diversity cultural sensitivity cultural competence

9. The nurse is describing the concept of cultural safety to a colleague. What should the nurse explain? Select all that apply.

A) Cultural safety is a process.

B) Cultural safety is an outcome.

C) Cultural safety can only exist in diverse communities.

D) It addresses the root causes of health inequities.

E) Its goal is greater equity.

10. In order to understand the mental health challenges that exist in Aboriginal communities in Canada, it is necessary to understand that: A) religious rituals are prioritized over medical interventions.

B) there is great diversity of beliefs around health and healing.

C) mental, physical, emotional, and spiritual components are consistent across Canada.

D) they are reluctant to participate in care.

11. Which Aboriginal people have mixed First Nation and European ancestry and a unique culture that draws on their diverse ancestral origins such as Scottish, French, Ojibway, and Cree?

A) Métis

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B) Inuit C) Eskimo D) Inuktitut

12. Which is true of the view of manifestations of illness in an individual?

A) Aboriginal persons often view the mind, body, and spirit as an integrated whole.

B) The Western approach generally views the mind, body, and spirit as an integrated whole.

C) Aboriginal persons typically focus on the physical disease and treatment.

D) Aboriginal persons strictly define sanity and personality disorders.

13. Which is the best definition of colonialism?

A) the rejection of culture as a significant factor in society B) a hostile attitude toward other simply because they have objectionable characteristics C) domination by a Western culture D) the institutionalized political domination of one nation over another

14. The nurse is caring for a client who expects individuals to act in a characteristic manner that conforms to a negative perception of the group. What is this client demonstrating?

A) prejudice B) stigma C) stereotyping D) discrimination

15. A nurse makes unsubstantiated assumptions and has stereotypical attitudes about those who differ from themselves. What are the serious negative consequences of this practice? Select all that apply.

A) The health care professional would not learn about culture.

B) The health care professional would place the health and well-being of the clients at risk.

C) The health care professional would seriously impair service delivery.

D) The health care professional would experience stigma.

E) The health care professional would be embarrassed when he or she finds that his or her belief was incorrect.

16. Which is true of the rates of mental health problems and suicide in Aboriginal people in Canada?

A) The rate of suicide among Aboriginals is double the national rate.

B) Suicide rates among Aboriginal youth are not tracked in Canada.

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C) For Inuit youth, suicide rates are among the lowest in the world.

D) Aboriginal people are unlikely to commit suicide, although they may have mental health problems.

17. Which are problems that have contributed to the mental health services' needs of Aboriginal persons? Select all that apply.

A) Until recently, less than 1% of health care workers in Canada were of Aboriginal ancestry.

B) Social problems of Aboriginal people are due to repeated assaults on their culture and identity.

C) Alienation has driven some Aboriginal persons to self-destruction and antisocial behaviour.

D) Public health issues of Aboriginal peoples include abuse of alcohol and drugs and family violence.

E) The social problems that have been prevalent in Aboriginal populations are rapidly resolving.

18. A psychiatric–mental health nurse is working on developing cultural competence.

Which would be most appropriate for the nurse to do?

A) Research information about the cultures of the population being served after assessing the client.

B) Recognize that one's own culture is the predominant way of addressing a client's health care needs.

C) Assume that any individual of a racial or ethnic group is the same as another individual in that group.

D) Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs.

19. A nurse is advocating for all Canadians to have adequate access to health services. An individual who lives in what location is most likely to have inadequate access?

A) an individual who lives in a village near the United States border B) a person who lives in an impoverished, urban neighbourhood C) a person who lives in a rural area of Northern Canada D) an individual who moves frequently

20. A client with severe and persistent mental illness lives in a remote community.

What action is the priority for meeting this client's health care needs?

A) encouraging the client to move to a city B) coordinating mobile service delivery C) scheduling intensive inpatient sessions in a larger centre D) teaching the client to self-manage all aspects of care

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21. A client who lives in a remote community has complex care needs and is unable to relocate to a larger community. Which strategy is most appropriate for the client?

A) enlisting volunteers B) implementing telehealth C) lowering the client's expectations for care D) providing the client with extensive literature

22. The nurse caring for a client in an Aboriginal community has become aware that the client and the client's family interpret the client's symptoms in a way that is unexpected to the nurse. When considering the family's response, the nurse should prioritize what consideration?

A) physical health B) economic status C) geographic isolation D) the family's culture

23. A nurse is planning care that reflects the reality of cultural diversity in Canada.

Which statement most accurately describes an aspect of Canada's cultural diversity?

A) A majority of Canadians were born abroad.

B) Caucasians represent less than 40% of the population.

C) Over 20% of Canadians were born outside the country.

D) One-third of Canadians were born somewhere in Asia.

24. A mental health nurse is explaining the concept of multiculturalism to a colleague who has recently immigrated to Canada. What should the nurse teach about multiculturalism?

A) Multiculturalism does not apply to Aboriginal groups.

B) Multiculturalism is a component of official government policy.

C) Multiculturalism prioritizes individuals from non-European countries.

D) Multiculturalism is a concept that was developed within psychiatric–mental health nursing.

25. The nurse is working with a family who have just recently immigrated to Canada.

What is typical health trajectory for families who move to Canada?

A) Immigrants typically arrive in poor health and their health improves over time.

B) Adult immigrants are usually healthy, but immigrant children are usually less healthy.

C) New immigrants are typically healthy, with their health declining as they spend

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more time in Canada.

D) Immigrants from Asia tend to be healthier than immigrants from other areas.

26. The nurse is providing care for an Aboriginal client who was formerly in the residential school system. The nurse should assess for which of the following?

Select all that apply.

A) posttraumatic stress disorder B) history of sexual abuse C) depression D) schizophrenia E) self-harm

27. A nurse is planning a health promotion program that will address the mental health needs of Aboriginals. The Indian Act of 1876 will have what implication for this program?

A) The provincial government funding will be matched by the federal government.

B) The program must be headed by an individual of Aboriginal ancestry.

C) Aboriginal communities will have to pay out-of-pocket for the program.

D) Funding will likely be federal rather than provincial.

28. A nurse has expressed a desire to become more culturally competent. The nurse should begin this process by doing what?

A) identifying a mentor who is a member of a different cultural group B) reflection on their own culture C) beginning to learn a new language D) learning about the effects of discrimination, stereotyping, and stigma

29. The nurse is referring to the determinants of health while planning a mental health promotion activity. What component of health is likely to have the greatest influence on participants' current mental health?

A) high intelligence B) ability to travel C) occupation D) healthy child development

30. How can a nurse best address this principle of acceptability when planning mental health care in a remote setting?

A) Educate residents about the benefits of telehealth.

B) Ensure that the care provided is culturally appropriate.

C) Encourage clients to be open and honest about their health needs to family members.

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D) Advocate for increased funding for mental health promotion.

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Answer Key 1. A, C, D, E 2. A 3. B 4. A 5. A 6. B 7. A, B, C 8. B, D, E 9. A, B, D, E 10. B 11. A 12. A 13. D 14. C 15. B, C 16. A 17. A, B, C, D 18. D 19. C 20. B 21. B 22. D 23. C 24. B 25. C 26. A, B, C, E 27. D 28. B 29. D 30. B

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Chapter 04: The Continuum of Canadian Mental Health Care Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The five types of primary health care adopted by the World Health Organization (WHO) in 1978 as the basis of health services care includes preventative, curative, rehabilitative, supportive/palliative, and: A) alternative.

B) therapeutic.

C) empowering.

D) promotive.

2. The nurse has learned of an individual who appears to have a mental disorder. In Canada, where is this individual most likely to receive care?

A) in community settings B) in inpatient care settings for short-term, intermittent care C) in emergency departments D) in inpatient care settings for long-term care

3. Which statements about a continuum of care are accurate? Select all that apply.

A) It is an integrated health system of supports and services.

B) It is designed to maximize people's health and well-being.

C) It often consists of several independent providers who each provide their services in isolation.

D) Service providers include professional health care clinicians as well as nonprofessional caregivers.

E) Service providers include professional health care clinicians only.

4. An individual with a mental health disorder has requested assistance with the coordination of care and services. What is the most likely rationale for this individual's request?

A) the need to choose between a number of hospital-based services available B) the lack of evidence underlying many interventions C) the large number of choices of available services for specific diagnostic categories D) the complexity of the continuum of care

5. The nurse has referred the family of a client to a respite program. What goals of this program should the nurse describe? Select all that apply.

A) identifying whether the client is able to continue living in the present circumstances B) preventing unnecessary long-term hospitalizations due to burnout of informal caregivers C) providing support and advocacy to informal caregivers D) reducing the burden on formal, impatient services E) validating the necessity and value of informal caregiving within the continuum of care

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6. The nurse has referred a client to a collaborative mental health care service.

Which statement best describes this service?

A) mental health treatment plans designed by a single mental health provider B) strategies to improve access to inpatient psychiatric units C) referrals from primary care settings to outpatient psychiatric services D) unified programs that offer mental and physical health care through a single entity

7. A client is receiving care through an integrated system of services provided by health professionals and those with special psychiatric and mental health expertise and community resources. This system describes: what?

A) reintegration of care B) continuum of care C) primary care D) case management

8. A client will soon be discharged from an inpatient setting. How can the nurse best promote the client's integration back into the community?

A) teaching the client about the danger of relapse B) enrolling the client in outpatient services promptly C) helping the client reflect on his or her time in treatment D) having the client return to inpatient treatment as soon as possible

9. The nurse is contributing to a comprehensive mental health system. What should the nurse and the nurse's colleagues prioritize?

A) adopting complementary and alternative therapies B) limiting inpatient treatment and increasing outpatient treatment C) promoting client adherence to treatment D) promoting mental health

10. Which are positive outcomes for people living with mental health problems or illness that can be expected from a consumer self-help organization? Select all that apply.

A) reduced hospitalizations B) increased employment C) improved social networks and support D) need for long-term treatment E) variable quality

11. The nurse is planning a client's care and is trying to ensure that care is as least restrictive as possible. Which setting is most restrictive?

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A) B) C) D)

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inpatient hospitalization intensive outpatient programs community-based residential services collaborative mental health care

12. The nurse is dealing with a client who is in crisis. The nurse is controlling precipitating symptoms through medications, behavioural interventions, and coordination with other agencies. These efforts will likely lead to what?

A) escalation B) cure C) prevention of relapse D) crisis stabilization

13. A client with a psychiatric disorder tells the nurse he or she is considering joining a self-help group with other clients with mental disorders. The priority information that the nurse should explain to the client is that consumer/survivor organizations are: A) good alternatives for clients who are suicidal.

B) run by psychiatric–mental health nurses.

C) able to provide psychotherapy for the members within the clubhouse.

D) operated exclusively by and for people with serious mental illness.

14. The case management nurse is providing a client with guidance through the wide spectrum of services. This nurse is providing the client with what?

A) quality of care B) independence C) navigation D) education

15. A nurse is interested in pursuing a role that is diverse as possible. What role should the nurse pursue?

A) crisis intervention nurse B) inpatient nurse C) case manager D) outpatient clinic nurse

16. Which principles are Canadian nurses expected to apply to their primary health care approach to practice across the continuum of care? Select all that apply.

A) accessibility B) health promotion C) private participation

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D) compartmentalized services E) appropriate technology

17. A client who has attempted suicide with a drug overdose is being released from an inpatient setting and will return to school. The client will continue to need routine psychiatric services. The nurse providing case management should explain to the client that she or he will most likely be referred to what?

A) partial hospitalization program B) in-home mental health care C) intensive outpatient program D) crisis centre in the community

18. The nurse is caring for a group of clients in a supported housing facility. Which aspect of care will most likely be prioritized?

A) drug abuse prevention B) spiritual aspects of care C) social skills training D) nutritional therapies

19. A client visits the crisis centre in acute distress because she believes someone is stalking her. The nurse should anticipate an order for what short-term medication?

A) hypnotic B) major tranquilizer C) dopamine antagonist D) anxiolytic

20. Which statement most accurately describes consumer/survivor initiative organizations?

A) They are managed by mental health professionals.

B) They are operated for people who do not have mental illness and focus on prevention.

C) They promote the values of member empowerment, participation, and community.

D) They tend to increase the stigma of mental illness.

21. Supportive housing that provides a place for people during a 24-hour period on an ongoing basis refers to what?

A) intensive residential services B) community supportive housing C) supervised living services D) community-based residential services

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22. Which are ways that clients are empowered by participating in a client-centred manner of primary care? Select all that apply.

A) Choice is promoted.

B) Responsibility is shifted to the client.

C) The client remains in control.

D) The client is forced to accept responsibility for his or her illness.

E) When possible, the client remains in his or her community.

23. An enormous gap exists between the prevalence of mental disorders and the number of people receiving treatment and care. What service has been identified as a means to closing this gap?

A) drop-in centres B) more available beds in hospitals C) primary mental health care D) more nursing outreach services

24. Which is the most important reason that mental health care services should be integrated?

A) to be eligible for more funding B) clients prefer to have related caregivers C) to address the multiple causes of mental illness D) to save money and time

25. The nurse is employed by a long-term residential treatment centre that provides care to a variety of clients with chronic mental disorders. Which role would the nurse primarily assume when working with these clients?

A) therapist B) medication administrator C) mediator D) educator

26. A client has been referred for mental health care, and the nurse is ensuring that the client's primary care takes place with an integrated approach. What action will best meet this nurse's goal?

A) adopting a slow and methodical pace for assessment and treatment B) advocating for community-based care rather than inpatient care C) prioritizing nonpharmacologic interventions over pharmacologic interventions D) keeping the client at the centre of all treatment decisions

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27. The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, “It's been so difficult taking care of our child. We need a break. But our child needs constant supervision.” Which would be appropriate for the nurse to suggest?

A) partial hospitalization B) acute inpatient care C) respite residential care D) intensive outpatient program

28. A nurse is working in a crisis intervention unit. The nurse would most likely be involved with which activities? Select all that apply.

A) administering medications B) short-term interventions C) relapse prevention D) ongoing therapy E) stabilizing the crisis

29. A client with a mental illness is receiving supportive housing during a 24-hour period on an ongoing basis. Which type of service is the client most likely receiving?

A) peer support services B) inpatient care C) supervised living services D) community-based residential services

30. A psychiatric–mental health nurse has evaluated a client and determines that the client needs additional services. The nurse sends the client to another setting to obtain these services. Which action is the nurse demonstrating?

A) transfer B) referral C) discharge planning D) assessment

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Answer Key 1. D 2. A 3. A, B, D 4. D 5. B, C, E 6. D 7. B 8. B 9. D 10. A, B, C 11. A 12. D 13. D 14. C 15. C 16. A, B, E 17. C 18. C 19. D 20. C 21. D 22. A, C, E 23. C 24. C 25. D 26. A 27. C 28. A, B, C, E 29. D 30. B

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Chapter 05: Contemporary Psychiatric and Mental Health Nursing Practice Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. How can the nurse best apply neurobiologic theories of mental disorders?

A) referring a client for cognitive–behavioural therapy B) applying the principles of therapeutic communication C) administering antipsychotic medications D) organizing family therapy sessions

2. When a nurse uses behaviour therapy for a client diagnosed with a psychiatric disorder, which domain is the nurse targeting the intervention toward?

A) psychological B) biologic C) social D) anthropologic

3. Which of the following interventions most likely holds the best potential for reducing rates of relapse and improving the recovery of the client?

A) providing evidence-based literature B) implementing family-based interventions C) enlisting the assistance of the client's coworkers D) treating the client in isolation

A) B) C) D)

4. Which domain includes cultural forces? spiritual domain social domain biologic domain psychological domain

5. Which nursing intervention would focus on a client's spiritual distress related to a newly diagnosed psychiatric disorder?

A) motivating the client to participate in learning activities B) developing a treatment plan that connects the client with the community C) ensuring medication adherence D) supporting the clients to find meaning in their circumstance

6. Which approach is most effective when determining the delivery of care, specific interventions, and the scope of professional practice that are needed by clients with mental disorders?

A) fragmented care B) intuitive approach C) single disciplinary approach D) interprofessional care

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7. Which is the most important role of the Canadian Federation of Mental Health Nurses related to the standards of practice for Canadian nurses?

A) ensuring licensure requirements for all PMHN B) collaborating with academic institutions to create the nursing curriculum for mental health courses C) influencing government policy and addressing national issues related to mental health D) defining the essential competencies necessary to practice as a PMHN

8. Provincial or territorial laws give nurses the legal authority to practice. These laws protect the public by addressing what aspects of practice? Select all that apply.

A) governance of the profession B) stating the code of ethics C) stating how the profession will be regulated D) overseeing educational programs E) discipline requirements

9. Which entity is responsible for setting, monitoring, and enforcing standards of nursing practice?

A) the World Health Organization B) the nursing regulatory body C) provincial and territorial governments D) the general public

10. Which are articulated in the standards of practice that the nursing regulatory bodies set, monitor, and enforce? Select all that apply. The profession's: A) salary scale.

B) values.

C) continuing competency requirements.

D) knowledge.

E) skills.

A) B) C) D)

11. Which type of governance is facilitated by the standards of nursing practice? professional self-governance provincial or territorial governance client governance physician governance

12. Which intervention is most likely to promote competent professional care

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A) B) C) D)

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through the development of a therapeutic relationship? using a range of therapeutic verbal and nonverbal communication skills utilizing evidence-based interventions to provide safe, effective nursing care incorporating knowledge of community needs or responses in the provision of care implementing appropriate protocols in the case of disaster

13. Which statements about critical pathways are true? Select all that apply.

A) Pathways are individually developed for each individual client.

B) Interventions for all disciplines are included on one plan.

C) They ensure that each client has the same course of treatment.

D) They are used to ensure a quality level of care in a cost-effective way.

E) They eliminate the need for providers to use critical thinking.

14. Which of the following are key components of PMH nursing practice? Select all that apply.

A) clinical decision-making B) critical pathways in care planning C) autonomy D) recovery as the framework for mental health care E) collaborative care

15. Which is an example of a choice made in a clinical setting that reflects a moment-to-moment decision?

A) using a critical pathway in care planning B) focusing on the client's recovery C) a nurse and a psychologist simultaneously working with a client to change behaviour related to medication compliance D) deciding whether a client should receive a PRN antipsychotic

16. Which is a recognized responsibility for nurses to provide safe, competent care to individuals with mental disorders?

A) accessing current evidence through journals, databases, and continuing education B) making generalizations based on qualitative research studies C) looking for single pieces of evidence supporting a specific treatment D) reviewing all studies published on a particular topic

17. How can a nurse apply the principles of e-Mental Health to directly benefits clients and their families? Select all that apply.

A) utilize telehealth services whenever available B) utilize educational resources regarding mental health and disorders C) perform detailed physical assessments

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D) use gamification when appropriate and available E) use relevant software to make daily functioning easier

18. Which are examples of challenges of PMH nursing in the 21st century? Select all that apply.

A) identifying individuals with severe mental disorders B) overcoming stigma and discrimination C) identifying the scope of nursing practice D) difficulties with health care delivery systems E) achieving knowledge development, dissemination, and application

19. Which is the national association for the specialty of psychiatric–mental health nurses that sets PMH nursing standards for registered nurses?

A) Canadian Nurses Association (CNA) B) the College of the Registered Psychiatric Nurses of Alberta (CRPNA) C) the International Society of Psychiatric–Mental Health Nurses (ISPN) D) the Canadian Federation of Mental Health Nurses (CFMHN)

20. Which organization consists of members who are consumers, families, researchers, and care providers from numerous professions?

A) Canadian Collaborative Mental Health Initiative (CCMHI) B) Mental Health Commission of Canada (MHCC) C) Registered Psychiatric Nurses of Canada (RPNC) D) Canadian Alliance on Mental Illness and Mental Health (CAMIMH)

21. Which is a priority of the Mental Health Commission of Canada (MHCC)?

A) encouraging nurses to develop skills in e-Mental Health B) organizing the standards in a domains of practice framework C) setting the PMH nursing standards for registered nurses D) promoting the process of recovery

22. The nurse addresses the psychological domain when assessing which of the following?

A) sleep patterns B) feelings C) family functioning D) cultural groups

23. A nurse has developed a plan of care for a client with depression. For problems related to the social domain, which issue would the nurse most likely identify?

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A) B) C) D)

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poor nutrition secondary to a loss of appetite powerlessness with feelings of loss of control inability to participate as family provider risk for self-harm from feeling like a failure

24. The plan of care for a client with schizophrenia identifies the following outcomes. Which outcomes would the nurse identify as addressing the biologic domain? Select all that apply.

A) improving problem-solving skills B) promoting economic stability C) minimizing adverse effects of drug therapy D) improving nutritional status E) providing family education

25. A psychiatric–mental health nurse is looking for information about the parameters of professional psychiatric–mental health nursing practice, specifically information that provides the framework for nursing practice. The nurse would most likely seek out which source?

A) standards of practice B) continuing competency requirements C) code of ethics for nurses D) provincial or territorial board of nursing

26. When applying the bio/psycho/social model to client care, the nurse integrates the psychological domain when involved with: A) behaviour therapy.

B) family support.

C) nutritional therapy.

D) sleep hygiene measures.

27. The nurse is applying the process of clinical decision-making to a challenging issue involved a client's care. When applying the process and choosing interventions, the nurse should prioritize what action?

A) evaluating cost considerations B) focusing on efficiency C) thinking reflectively D) documenting outcomes

28. The nurse is caring for a client with a mental health disorder in an inpatient setting. The client's care will be following a critical pathway. When organizing the client's care in this way, what should the nurse do?

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A) B) C) D)

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Ensure that each discipline creates their own critical path.

Minimize the number of interventions.

Seek guidance from the provincial nursing authority.

Be sure that the client's individual needs are addressed.

29. How can the psychiatric–mental health nurse best implement the principles of trauma-informed care?

A) ensuring that clients retain as much control as possible B) encouraging clients to talk about their trauma as often as possible C) avoiding all mention of the client's trauma D) implementing a critical pathway for posttraumatic stress disorder (PTSD)

30. The nurse is caring for a young adult client who has a long history of abuse and neglect. When caring for the client, what is the nurse's most appropriate action?

A) Ensure that the client is not faced with situations where he or she has to make decisions.

B) Place the client on one-to-one observation.

C) Implement universal trauma precautions.

D) Prioritize interventions in the biologic domain.

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Answer Key 1. C 2. A 3. B 4. B 5. D 6. D 7. D 8. A, C, E 9. B 10. B, D, E 11. A 12. A 13. B, D 14. A, B, D, E 15. D 16. A 17. A, B, D, E 18. B, D, E 19. D 20. D 21. D 22. B 23. C 24. C, D 25. A 26. A 27. C 28. D 29. A 30. C

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Chapter 06: Communication and the Therapeutic Relationship Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is aiming to develop self-awareness. The nurse should exemplify what characteristic?

A) introspective B) thorough C) uncritical D) nonjudgemental

2. Which is the potential outcome of a nurse conducting self-examination without the benefit of another's perspective?

A) biased view of self B) lack of communication C) negative self-awareness D) negative therapeutic relationship

3. Which would be the most appropriate action by a nurse who has realized that his or her attitudes are too ingrained to support a therapeutic relationship with a client with different beliefs?

A) Refer the client to someone who can be therapeutically helpful.

B) Attempt to change the client's beliefs.

C) Ask for input from peers and clients.

D) Acknowledge the difference in beliefs to the client.

4. The nurse has received a message from a client and has then interpreted the message. What part of the communication process has taken place?

A) analyzing B) encoding C) decoding D) deciphering

5. A client has asked the nurse a personal question. What should the nurse do when responding?

A) redirect the client B) answers the question honestly C) request a change in assignment D) attempt to elicit the underlying reason for the request

6. Which is one of the most effective techniques, but often the most difficult technique, during verbal interactions?

A) passive listening B) silence C) process recording

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D) giving advice

7. Which assessment is important for the nurse to continually perform because people with psychiatric problems often have difficulty expressing themselves and interpreting the emotions of others?

A) orientation B) their physical needs C) nonverbal communication D) use of silence

8. Which verbal communication technique is being used when the nurse has a nonjudgemental attitude and presents the client with a different reality of the situation?

A) confrontation B) acceptance C) avoidance D) reality testing 9. A nurse states to the client who is trembling and perspiring, “You are trembling and perspiring. When did this start?” Which verbal communication technique is being used?

A) interpretation B) observation C) reflection D) open-ended statement

10. Which statement about nonverbal communication and culture is true?

A) Nonverbal behaviour is culturally specific.

B) The nurse only needs to understand his or her own cultural context.

C) It is not necessary to consider culture related to nonverbal communication.

D) All cultures have the same boundaries.

11. The nurse is saying words of empathy to a client, but the nurse is standing far away, with the arms crossed. What is the most likely outcome?

A) the client will ignore the nurse B) the client will focus on the nurse's “closed” nonverbal cues C) the client will focus on the nurse's message of empathy D) the client will be confused 12. A hospitalized client tells the nurse, “I stayed awake all of last night because I

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A) B) C) D)

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was thought someone would come into my room and kill me.” Which response by the nurse would use the technique of interpretation?

“It sounds as if you thought someone would come into your room and kill you.”

“Why on earth would you think that someone here is going to kill you?”

“Let me see if I can understand your fears about being here.”

“It sounds as if you were really scared last night.”

13. A hospitalized client diagnosed with depression asks the nurse, “Should I go home this weekend?” Which response by the nurse would use the technique of reflection?

A) “Do you think you should go home for the weekend?”

B) “What does home mean to you?”

C) “It sounds as if you don't want to go home this weekend.”

D) “I doubt that you really should go home this weekend.”

14. A client hospitalized with bipolar disorder tells the nurse, “I hate this place. I don't belong locked up in here.” Which response by the nurse would use the technique of restatement?

A) “Why do you think you are locked up here?”

B) “It sounds as if you really don't like being here.”

C) “You don't want to be here.”

D) “There are reasons for you being here.”

15. The nurse is passively listening to a client. What is the most likely outcome of this interaction?

A) A professional relationship is cultivated.

B) The nurse concentrates only on what the client is saying, rather than nonverbals.

C) The nurse guides the client's thought processes.

D) The nurse allows the client to ramble about any subject.

16. The psychiatric nurse communicates to a client with an “I” statements in an attempt to attempt to clarify the nurse's understanding of the situation. Which verbal communication technique is being used?

A) restatement B) empathic linkages C) validation D) rapport

17. Which term did Peplau use to mean the communication of feelings?

A) empathic linkages B) self-disclosure

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C) rapport D) passive listening

18. A nurse needs to monitor his or her interactions when first learning therapeutic communication and during times when communication is a problem. The nurse will write a verbatim transcript of the interaction. What technique is the nurse implementing?

A) using symbolism B) process recording C) analyzing content themes D) using communication blocks

19. Which is the first step the nurse should perform when choosing the best response to a client?

A) assessing and interpreting the meaning of the client's communication B) listening passively C) taking verbal messages literally D) identifying the desired client outcome

20. A nurse is trying to develop skills in selecting effective communication techniques. What is the nurse's best means of achieving this goal?

A) practicing responding in a therapeutic way B) taking verbal messages literally C) learning about the role of silence D) asking for feedback from clients

21. Which action by the nurse related to self-disclosure is most conducive to establishing a therapeutic relationship?

A) The nurse should self-disclose when desired by the client.

B) The client must remain the primary focus of the interaction.

C) The nurse should match the client's level of disclosure.

D) Rapport cannot develop unless the nurse is willing to self-disclose.

22. The nurse is attempting to establish rapport with a client. What action would best achieve this goal?

A) demonstrating a nonjudgemental attitude B) sympathizing with the client's feelings C) commenting on the client's nonverbal behaviours D) giving advice when necessary for the client

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23. Which should the nurse demonstrate to establish rapport with a newly admitted client diagnosed with depression?

A) sympathy B) evaluative skills C) clinical competence D) interpersonal warmth

24. A client is reluctant to disclose information about his or her trauma to the care team. The client is establishing what type of boundary?

A) personal boundary B) psychological boundary C) spiritual boundary D) physical boundary

25. Which statements about defence mechanisms are accurate? Select all that apply.

A) They are always maladaptive.

B) A defence mechanism becomes pathologic when it is used so persistently that it becomes maladaptive.

C) They are different than coping mechanisms.

D) They are mechanisms that mediate the client's reaction to emotional conflicts and external stressors.

E) They can be maladaptive or adaptive, dependent on their severity, flexibility, and context.

26. When should a nurse discuss with the client that a client's behaviour is a defence mechanism?

A) if a client continually rationalizes antisocial behaviour B) if a client is using humour to alleviate an emotionally intense situation C) as frequently as possible D) at the beginning of the therapeutic relationship with the client

27. A nurse recognizes his or her emotional reactions to the client are based on personal unconscious needs and conflicts during the working phase of the nurse– client relationship. What phenomenon is taking place?

A) symbolism B) communication blocks C) transference D) countertransference

28. Which statement is true of testing in the nurse–client relationship?

A) It is a sign of an ineffective nurse–client relationship.

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B) It never involves the client introducing a relatively superficial issue first.

C) It usually occurs during the orientation phase of the nurse–client relationship.

D) It occurs during the working phase of the nurse–client relationship.

29. Which are effective techniques for motivational interviewing (MI)? Select all that apply.

A) having an open and collaborative relationship with the client B) acknowledging the client's own expertise C) maintaining flexibility to roll with resistance D) knowing that the client is in control of all risky behaviours E) being able to use a variety of other intervention styles to meet client needs

30. Which is the basis for the transitional relationship model (TRM)?

A) The belief that clients can make a clinical recovery and be discharged from the treatment setting but not a long-term recovery.

B) The most important consideration is the plan for the professional to discharge the client in a brief period of time.

C) The belief that peer therapeutic relationships can be helpful, but only professionals can help people heal.

D) The assumption that people need a combination of professional and peer therapeutic relationships to heal their relationships.

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Answer Key 1. A 2. A 3. A 4. C 5. D 6. B 7. C 8. A 9. B 10. A 11. B 12. D 13. A 14. C 15. D 16. C 17. A 18. B 19. A 20. A 21. B 22. A 23. D 24. B 25. B, D, E 26. A 27. D 28. C 29. A, B, C, E 30. D

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Chapter 07: Legal and Ethical Aspects of Practice Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition

A) B) C) D) E)

1. Which statements about ethics are true? Select all that apply.

Ethics is defined as the practical application of law.

Ethics is about values, relationships, principles, duties, rights, and responsibilities.

Ethics and law belong to the same domain.

Ethics is about learning how to reach our potential as human beings.

Ethics needs to be an everyday part of our lives and build into our society.

2. Which is true of the relationship between ethics and law?

A) Law and ethics are separate domains.

B) Ethics and law are the very same.

C) Laws are always ethical.

D) Ethics always guides the law.

3. Which statement best described a nurse's fiduciary relationship with the public?

A) Nurses are required to trust the public.

B) In polls, nurses are consistently rated the most honest and ethical professionals.

C) Nurses profess or claim they will honour to the public's trust as professionals.

D) Nurses are only expected to display moral courage in times of crisis.

4. A nurse has requested permission from his or her employer to refrain from providing care because an aspect of it conflicts with the nurse's moral beliefs. On what basis is the nurse making this request?

A) moral agent B) conscientious objection C) respect for autonomy D) beneficence

5. The nurse is approaching a moral dilemma by identifying previous cases that are similar and the precedents that were set. The nurse is applying what principle?

A) virtue ethics B) deontology C) principlism D) casuistry

6. A decision must be made whether individuals participating in research should be placed at risk by depriving them of the best known treatment in order to carry out a placebo-controlled study. Which approach to ethics would identify this act as inherently bad and a violation of a nurse's duty and obligations.

A) virtue ethics B) deontology C) relational ethics

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D) utilitarianism

7. A nurse is promoting a new program because it will bring about the best consequences for the greater number of people. The nurse is appealing to what principle?

A) principlism B) utilitarianism C) justice D) beneficence

8. The nurse is arguing that members of a community deserve assistance because they have experienced oppression and dominance in individual and societal-level relationships. What philosophy of ethics is the nurse appealing to?

A) virtue ethics B) casuistry ethics C) relational ethics D) feminist ethics

9. Which is the basis for the nurse's decision-making process to determine if the client is making a rational choice?

A) capacity B) age C) diagnosis D) history

10. Which elements must be present in order to ensure an ethical health care environment? Select all that apply.

A) nonquestioning B) compassion C) freedom from conflict D) empathy E) professionalism

11. A nurse is upset because his or her heavy workload does not allow him or her to provide the level of care that he or she believes his or her clients deserve. What is this nurse experiencing?

A) reactive distress B) moral distress C) moral residue D) moral dilemma

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12. The nurse is caring for a client who has a history of acting out violently against staff and other clients and who is once again seeking admission. The nurse is the shift supervisor and must decide whether the client is to be readmitted or if the client should be transferred to another setting. What phenomenon is this nurse experiencing?

A) reactive distress B) moral distress C) moral residue D) moral dilemma

13. Which factors are most likely to contribute to a nurse's moral distress? Select all that apply.

A) lack of resources B) social isolation C) institutional demands D) diversity among coworkers E) demands from society that deviant behaviour be controlled

14. Which should be the first key question when the relational ethics decisionmaking framework is being used?

A) What are the alternatives for ethical decision-making?

B) What is the most fitting thing to do?

C) What is happening here?

D) What happened as the result of our action?

15. A nurse is trying to determine whether a client's consent for a treatment is valid.

What variable should the nurse prioritize?

A) the client's history B) the client's competence C) the client's diagnosis D) the client's future plans

16. Which is an example of a type of information that may be disclosed without a client's consent?

A) information that is not related to the client's health and well-being B) information regarding the boundaries requested by the client C) health information and care decisions shared among the team D) indicators of child abuse or abuse of adults in care

17. The nurse should intervene if others within the health care system fail to meet

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obligations when the obligation concerns what factor? client assignments information about colleagues confidentiality and privacy conscientious objection

18. What is the term for a type of psychiatric research study design that raises a particular ethical concern when the subject's medications are discontinued?

A) placebo-controlled studies B) challenge studies C) questioning studies D) washout studies

19. Which questions should be considered when considering the ethical acceptability of a specific clinical genetic testing? Select all that apply.

A) How predictive is the test?

B) How long does the test take to administer?

C) Who administers the test?

D) Has the test been administered before?

E) How stigmatized is the condition being tested for?

20. Psychiatric–mental health (PMH) nurses are responsible for understanding the Mental Health Act of their province and territory and to: A) advocate on behalf of the health profession the importance of the act.

B) consider issues that affect individuals with medical problems.

C) explain the act's basic provisions to people with mental illness and their families.

D) support the provisions of the Mental Health Act and implement changes to the legislation.

21. Which are criteria for involuntary admission required by the Provincial and Territorial Mental Health Acts for all provinces and territories in Canada? Select all that apply.

A) is not suitable as a voluntary inpatient B) meets the definition of a mental disorder C) meets the criteria for harm D) likely to suffer substantial mental or physical deterioration E) refusal of treatment by the person after admission

22. If a person is unable to consent to treatment because they are deemed not competent, a substitute decision-maker can be appointed. Which are possible substitute decision-makers? Select all that apply.

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A) B) C) D) E)

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an intraprofessional team the most responsible health care provider a state appointed person a guardian or relative a person who is appointed by the persons when competent

23. What factor should be prioritized when a substitute decision-maker is making a decision for the client?

A) precedent B) the client's best interests C) clinical practice guidelines D) low risk

24. Legal provisions requiring people with a mental illness to comply with a treatment plan while living in the community refer to: A) mandatory conditional leave.

B) mandatory diversion treatment.

C) mandatory outpatient treatment.

D) community living right.

25. Which is the criterion for Involuntary Admission Criteria in clients determined to be in need of preventative detention in jurisdictions other than British Columbia, Saskatchewan, and Ontario?

A) The client is deemed not competent to consent for treatment.

B) The treatments are initiated by the client.

C) The family members consider the client to be incompetent.

D) The client is dangerous, but there is no treatment.

26. A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client states: A) “I think that the federal government is spying on me.”

B) “I get really 'turned on' by your appearance.”

C) “That doctor I had today really made me angry.”

D) “When I get out of here, I'm going to kill my neighbour.”

27. A psychiatric–mental health nurse is providing care to a client with depression.

The nurse determines that a client is competent when the client is able to: A) speak coherent English.

B) communicate his or her choice.

C) write a “living will.”

D) comply with the medical regimen.

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28. A client receives a court order for commitment. Which best exemplifies the concept of “least restrictive environment”?

A) involuntary commitment to an outpatient community mental health centre B) medication administration for sedation so the client cannot get out of bed C) placement of client in a secured padded room in response to threats of self-harm D) admission of client to a locked inpatient psychiatric unit

29. A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

A) nonmaleficence B) paternalism C) veracity D) justice

30. A 22-year-old client with schizophrenia is refusing antipsychotic medication. The client states, “I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it.” The nurse explains to the client, “Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better.”

This conversation reflects a conflict between which two types of ethical principles?

A) autonomy and justice B) paternalism and veracity C) justice and nonmaleficence D) autonomy and beneficence

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Answer Key 1. B, D, E 2. A 3. C 4. B 5. D 6. B 7. B 8. D 9. A 10. B, D, E 11. B 12. D 13. A, C, E 14. C 15. B 16. D 17. C 18. D 19. A, E 20. C 21. A, B, C, D 22. C, D, E 23. B 24. C 25. D 26. D 27. B 28. A 29. D 30. D

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Chapter 08: Theoretic Basis of Practice Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A PMH nurse is reviewing different nursing theories. What do these theories form?

A) the context for nursing practice B) the conceptual basis for nursing practice C) the spiritual basis for nursing practice D) the basis for understanding the client

2. Which statements about PMH nursing theories are accurate? Select all that apply.

A) PMH nursing theories are static and remain the same over time.

B) PMH nurses use knowledge from nursing, the health sciences, and related mental health disciplines.

C) PMH nursing theories are well researched.

D) There is general agreement of the difference between a model and a theory in PMH nursing.

E) The theory or theories used by a nurse reveal the way that nurse conceives his or her practice.

A) B) C) D) E)

3. What are the aspects of fully developed nursing theory? Select all that apply. imaginative consists of knowledge, ideas, and experiences represented symbolically seeks to illuminate phenomena unchanging

4. Which key psychodynamic concept is recognized as the core of PMH nursing intervention?

A) defence mechanisms B) needs C) transference and countertransference D) the therapeutic relationship

5. Which nursing theorist made a major contribution to psychiatric–mental health nursing introducing the conceptualization of the nurse–client relationship and its phases?

A) Dorothea Orem B) Hildegard Peplau C) Sigmund Freud D) Margaret Newman

6. Which was the focus of the nursing practice model contributed by Ida Jean Orlando?

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A) B) C) D)

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the curative process achieved by nature alone the nurse guided by the moral art and ethics of care a focus on the whole client the therapeutic relationship

7. Which theory was used in the original Canadian standards of PMH nursing practice?

A) the science of caring B) the Tidal Model of mental health recovery and reclamation C) the humanbecoming model D) the primacy of caring and the domains of nursing

8. Which are elements of caring factors in a trusting relationship according to Jean Watson? Select all that apply.

A) congruence B) empathy C) nonpossessive warmth D) effective communication E) sympathy

9. Which is the focus of the McGill model of nursing developed by students and faculty of McGill University School of Nursing?

A) holistic model B) health promotion C) formal support systems model D) classical conditioning

10. Which is the model of nursing practice that emphasizes the centrality of the lived experience of the person in care and is based on the assumption that people are their life stories and that they generate meaning through such stories?

A) general adaptation syndrome B) diathesis–stress model C) dynamic nurse–client relationship model D) Tidal Model

11. Which theory is described as nursing involving caring for the human being, with the target of health defined as adjusting to the stressors in both the internal and external environments?

A) systems approach B) spiritual attainment C) goal attainment

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D) interpersonal approach

12. According to Freud, What is the id?

A) the sum of certain mental mechanisms such as perception B) formed by unconscious desires and primitive instincts C) associated with ethics and standards of behaviour D) able to control movement and contact with reality

13. In Freud's personality structure, the ability to form mutually satisfying relationships is a fundamental function of what component identity?

A) alter ego B) super ego C) id D) ego

14. According to Freud, when sexual desire is controlled and not expressed, which is the tension transformed into?

A) melancholia B) obsession C) anxiety D) mania

15. Which psychiatrist founded the school of individual psychology and believed that the motivating force in human life is a sense of inferiority?

A) Alfred Adler B) Carl Jung C) Otto Rank D) Erich Fromm

16. Who was the psychoanalyst who created a model called analytical psychology?

A) Alfred Adler B) Carl Jung C) Fritz Perls D) Harry Stack Sullivan

17. Which concept was central to Carl Jung's theory?

A) ego B) alter ego C) persona D) empathy

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18. Which did Karen Horney, a German American psychiatrist, introduce?

A) the principles of feminine psychology B) the theory of neurosis C) the principles of play therapy D) the theory of interpersonal relationships

19. Which did Carl Rogers advocate that the therapist treating the client should do?

A) provide validation of the terminology used during the session B) focus on the client's instinctual drives C) recognize an understanding of the client's basic needs D) develop unconditional positive regard for the client

20. Which was Carl Gustav Jung's image for the dark side of every person, the side we do not like to recognize or show to others?

A) anima B) extrovert C) introvert D) shadow

21. Who proposed a gender differentiation developmental theory that female development does not follow a progression of stages but based on experiences within relationships?

A) Anna Freud B) Carl Rogers C) Carol Gilligan D) Abraham Maslow

22. Which commitment of the Tidal Model is described as where the person is the expert/authority on his or her life story?

A) value the voice B) become the apprentice C) be transparent D) craft the step beyond

23. Which commitment of the Tidal Model is described as where the person's story contains numerous examples of “what has worked” or “what might work” for this person?

A) use the available toolkit B) craft the step behind

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C) give the gift of time D) be transparent

24. Which theory attempted to reconstruct the personality by examining free associations and the interpretation of dreams?

A) cognitive–behaviour therapy B) psychoanalysis C) interpersonal relations D) transference

25. Who believed that the tension that results and is transformed into anxiety when sexual desire is controlled and not expressed?

A) Dorothea Orem B) Hildegard Peplau C) Sigmund Freud D) Margaret Newman

26. A group of nursing students is reviewing information about Freud's personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of what?

A) defence mechanisms B) unconscious C) id D) ego

27. A psychiatric–mental health nurse is integrating Carl Rogers's theory into the plan of care for a client with a mental illness. The nurse incorporates understanding of this theory by acknowledging that the therapist does what?

A) provides validation of the terminology used during the session B) focuses on the client's instinctual drives C) recognizes an understanding of the client's basic needs D) develops unconditional positive regard for the client

28. A nurse performs behaviours the treatment team wishes the client to develop. The client internalizes these behaviour through pervasive imitation. The treatment team is integrating which cognitive theory in the client's treatment?

A) Erikson's model of psychosocial development B) Albert Bandura's social cognitive theory C) Skinner's operant conditioning D) Freud's psychoanalytic model

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29. When integrating the Neuman systems model while caring for a client with a mood disorder, a nurse would focus on what about the client?

A) behaviours B) relationships C) self-care activities D) stressors

30. A nurse is integrating Peplau's model when providing care to a client with a mental illness. Which would the nurse identify as a key component?

A) suffering B) anxiety C) self-care D) nonverbal behaviours

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Answer Key 1. B 2. B, D, E 3. A, B, C, D 4. D 5. B 6. C 7. D 8. A, B, C, D 9. B 10. D 11. C 12. B 13. D 14. C 15. A 16. B 17. C 18. A 19. D 20. D 21. C 22. B 23. A 24. B 25. C 26. D 27. D 28. B 29. D 30. B

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Chapter 09: Biologic Basis of Practice Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is caring for a client who has experienced damage to Broca's area of the brain. Which will the nurse anticipate that the client will experience?

A) jargon aphasia B) anomic aphasia C) receptive aphasia D) expressive aphasia

2. Which is most likely to occur in an older adult client who has experienced damage to the frontal lobe subsequent to an automobile crash? The client will have difficulty with what?

A) smell B) concept formation C) receptive speech D) hearing

3. Which is the client most likely to have trouble with if he or she has experienced damage to the parietal lobes of the brain?

A) perceiving sensory input B) spatial orientation C) seeing objects in front of him or her D) speak fluently

4. A client has been diagnosed with memory dysfunction associated with Alzheimer's disease. The nurse is aware that in addition to deterioration of the temporal lobe structures, the client likely also has damage to the nerves of which structure?

A) basal ganglia B) limbic system C) frontal lobe D) hippocampus

5. The nurse is caring for a hospitalized client who is scheduled to undergo computed tomography (CT) of the brain following administration of intravenous iodinated contrast materials. Which should the nurse instruct the client that they may experience?

A) decreased pulse rate B) metallic taste in the mouth C) headache D) dizziness

6. Which is a disadvantage of magnetic resonance imaging (MRI)? What is true of

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A) B) C) D)

this type of testing? cannot be used with clients who have pacemakers requires the use of intravenous iodinated contrast materials provides only limited information about three-dimensional images involves high radiation levels

A) B) C) D)

7. Which is most likely visualized by clinicians with structural neuroimaging? distribution patterns of specific chemicals neurotransmitter levels tissue abnormalities cerebral blood flow

8. Which are the most important concepts for the nurse to teach a client who has been scheduled for an MRI? Select all that apply.

A) Shallow breathing techniques.

B) Health teaching of side effects of the radioactive agent.

C) All metal objects must be removed from the person and the clothing prior to having the MRI. D) Medication to be withheld before procedure.

E) If the client has permanently placed metal objects or is pregnant, the client cannot have an MRI.

9. When a client is undergoing functional neuroimaging techniques to provide insight into how the brain works, which will the nurse instruct the client to do?

A) Perform specific tasks during the test.

B) Lie still during the test.

C) Undergo sedation.

D) Try to sleep.

10. Which structure separates the left and right hemispheres of the brain?

A) central sulcus B) longitudinal fissure C) lateral sulcus D) corpus callosum

11. Which area of the brain is involved with verbal language function, including areas for both receptive and expressive speech?

A) right hemisphere B) parietal lobe C) occipital lobe D) left hemisphere

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12. Which area of the brain responsible for spatial orientation and memory?

A) right hemisphere B) frontal lobe C) temporal lobe D) left hemisphere

13. Where is Broca's area located?

A) parietal lobe B) occipital lobe C) frontal lobe D) temporal lobe

14. The structures within the limbic system are integrally involved with which functions? Select all that apply.

A) emotional behaviour B) memory C) speech D) hearing E) tactile sensations

15. Which is the largest part of the human brain?

A) cortex B) parietal lobe C) frontal lobe D) cerebrum

16. A client has experienced profound changes in mood and personality. Which structure might have altered functioning?

A) parietal lobe B) frontal lobe C) occipital lobe D) hypothalamus

17. If a client were to have a structural problem in the temporal lobe, which would likely occur? Select all that apply.

A) inability to integrate sensory and visual information B) inability to understand speech C) inability to recognize visual information D) inability to detect hunger or thirst

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E)

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memory dysfunction

18. A client has been taking psychiatric medications for many years and has developed twitches or tremors. What brain region may have been affected?

A) frontal lobe B) occipital lobe C) cortex D) basal ganglia

19. Which states are modulated by the amygdala?

A) aggression and sexuality B) loss of eyesight and hearing C) hunger and thirst D) sleep and emotional disturbances

20. Which brain structure may be responsible for temperature deregulation for clients with psychiatric disorders?

A) the hippocampus B) the brainstem C) the hypothalamus D) the basal ganglia

21. Which brain structure is most important in its role in the development of symptoms common to psychiatric disorders?

A) the parietal lobes B) the temporal lobes C) the occipital lobes D) the frontal lobe

22. A client who is taking a psychiatric medication is experiencing blurred vision, constipation, and urinary retention. Which neurotransmitter is likely being affected?

A) serotonin B) norepinephrine C) acetylcholine D) dopamine

23. What is the name for small molecules that directly and indirectly control the opening or closing of ion channels?

A) neurotransmitters

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B) plasticity C) neuropeptides D) biogenic amines

24. A client with schizophrenia has been prescribed an antipsychotic medication.

This medication likely affects metabolism of what neurotransmitter?

A) serotonin B) acetylcholine C) dopamine D) GABA

25. Which term describes diagnostic test findings that occur only in the presence of the psychiatric disorders and include such findings as laboratory and other diagnostic test results and neuropathologic changes noticeable in assessment?

A) brain hemispheres B) neurotransmitters C) synapses D) biologic markers

26. A client has been diagnosed with Addison's disease. The nurse should assess for what possible psychiatric symptom?

A) psychosis B) mania C) irritability D) anxiety

27. Which is a common example of an external zeitgeber?

A) nutrition B) light C) side effect D) infection

28. Which statements regarding biologic rhythms and psychiatric illness are accurate? Select all that apply.

A) Dysfunctions in biologic rhythms can result from a psychiatric illness.

B) Dysfunctions in biologic rhythms can contribute to the development of psychiatric illness.

C) Biologic rhythms are unrelated to psychiatric illness.

D) New information has come as biologic rhythms are more fully understood and defined.

E) The only association between biologic rhythms and psychiatric illness is that

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individuals under stress have compromised immune systems.

29. Which statements about genetics and psychiatric disorders are accurate? Select all that apply.

A) Diagnosis of psychiatric disorders in ancestors is a reliable method to predict psychiatric disorders.

B) One gene alteration may cause different symptoms in different people.

C) One gene is likely responsible for the majority of psychiatric disorders.

D) Environmental influences alter the body's functioning and often mediate or worsen genetic risk factors.

E) Psychiatric–mental health nurses increasingly will need greater understanding of the role of genetics in mental illness.

30. Which fact should inform the nurse's understanding of the genetic transmission of psychiatric disorders?

A) Similar psychiatric symptoms may have the same causes.

B) Genes present always cause the appearance of the trait.

C) A single gene in an individual produces a given disorder.

D) Environmental influences alter the body's functioning and often mediate or worsen genetic risk factors.

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Answer Key 1. D 2. B 3. B 4. D 5. B 6. A 7. C 8. A, C, E 9. A 10. B 11. D 12. A 13. C 14. A, B 15. D 16. B 17. A, B, C 18. D 19. A 20. C 21. D 22. C 23. A 24. C 25. D 26. A 27. B 28. A, B, D 29. B, D, E 30. D

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Chapter 10: The Assessment Process Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition

A) B) C) D)

1. Which statement about the nursing process is accurate?

The nursing process is static.

The nursing process is applied the same way in every situation.

The nursing process is the first step in providing nursing care.

The focus of the nursing process is the nurse.

2. Which are included in the essential components of the nursing process? Select all that apply.

A) assessment B) evaluation C) implementation D) planning E) documentation

3. Which activities are ways to collect information for assessment? Select all that apply.

A) observation B) examination C) interview D) consultation E) teaching

4. A nurse needs to collect specific information about a client's medication effects.

What type of assessment should the nurse perform?

A) comprehensive assessment B) collaborative assessment C) situational assessment D) focused assessment

5. Which elements would a comprehensive assessment include? Select all that apply.

A) complete health history and physical examination B) considers the psychological, emotional, spiritual, ethnic, and cultural dimensions of health C) attends to the meaning of the client's health illness experience D) evaluates how the individual's daily living is affected E) mini-mental status evaluation

6. Which type of assessment should the nurse perform to complete review of the biologic systems of a newly admitted client with panic disorder?

A) evaluative

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B) comprehensive C) ongoing D) screening

7. Which circumstance would necessitate the use of a comprehensive assessment, rather than a focused assessment?

A) to screen an individual who is at high risk for depression B) when the client is actively suicidal C) when the client is exhibiting symptoms of psychosis D) during the client's first admission to a psychiatric unit

A) B) C) D) E)

8. Which characteristics are elements of a focused assessment? Select all that apply. as broad as possible brief time to complete narrow scope identifies strengths and resources present oriented

9. The nurse is approaching a new client. What assessment technique should the nurse apply first?

A) documenting the assessment B) open-ended questions C) closed-ended questions D) observation of the client's behaviour

10. Which is an example of an open-ended question?

A) “Where do you live?”

B) “Are you feeling sad right now?”

C) “Did your parents treat you well as a child?”

D) “Why did you come to this clinic today?”

11. The nurse seeks an unbiased understanding of the client's experience when completing a mental status examination. What actions should the nurse perform?

Select all that apply.

A) focus exclusively on objective data B) collaborate with colleagues C) use self-reflection after the interview D) sympathize with the client E) describe his or her feelings about the client

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12. The nurse has completed a comprehensive assessment of a client and has gathered a large amount of data. Which is an example of subjective data?

A) results of physical examination B) vital signs C) diagnostic test results D) client's description of symptoms

13. Which approach of documentation would include a nurse, health care provider, and allied health care worker documenting on the client in the same section of the health record?

A) source-oriented documentation B) nurse and health care provider notes C) open-ended documentation D) problem-oriented documentation

14. The nurse is assessing a client with a mental health disorder and observes that the client's speech is rapid and increased in amount. The nurse has difficulty understanding the client's meaning. The nurse should document which concern?

A) pressured speech B) aphasic disturbances C) oral hallucinations D) speech impediment

15. A client with a mental health disorder describes feeling like he or she receives orders that he or she is obliged to obey. What is this client experiencing?

A) illusion B) delusion C) hypnagogic hallucination D) command hallucination

16. The nurse is exploring the way in which a client's ideas are formed and expressed. What component of assessment is the nurse addressing?

A) thought process B) thought content C) obsessions D) beliefs

17. The nurse is assessing a client who reports being lethargic, who cannot concentrate, and who states that she feels depressed. The client also reports cold intolerance. The nurse should ensure that the client is assessed for what health problem?

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Addison's disease hyperparathyroidism polycythemia hypothyroidism

18. The nurse is caring for a client who has been taking carbamazepine for 3 months.

Which should the nurse assess the client's laboratory studies for?

A) thrombocytopenia B) anaemia C) low serum potassium D) vitamin B12 deficiency

19. An adolescent is admitted to the inpatient unit with a binge-and-purge eating disorder. Which of the client's laboratory results will the nurse be watchful for?

A) decreased creatinine phosphokinase B) increased serum amylase C) decreased serum thyroxine D) increased bicarbonate levels

20. The nurse is assessing a client who appears depressed and very quiet. The nurse is most likely to document what finding?

A) euphoric B) dysfunctional C) dysphoric D) euthymic

21. The nurse is caring for a client who exhibits intense, frequently shifting emotional extremes. Which should the nurse document in the client record?

A) labile affect B) full affect C) dysphoric affect D) moody affect

22. The nurse is caring for a newly admitted client with panic disorder. Which task should the nurse ask the client to do to assess attention and concentration?

A) name various common objects B) interpret a proverb C) reach a conclusion about a problem D) subtract 3s from 20 without a pencil

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23. When the nurse has documented a full range of affect, which is the nurse describing?

A) limited emotional expression B) an individual displaying a wide range of strong emotions in a relatively short period of time C) an individual expressing several emotions that are consistent with his or her stated feelings D) an individual who speaks in a monotone voice and has little or no facial expressions

24. Which question should a nurse ask if the client with the diagnosis of depression affirms that he has tried to kill himself in the past?

A) “Can you tell me more about what happened at that time?”

B) “Do you have thoughts of harming anyone else?”

C) “What makes you believe that this would be a good solution?”

D) “Have you made any final preparations?”

25. The nurse is assessing a client who is depressed. When identifying the client's coping strategies, the nurse should do what?

A) Express sympathy for the client.

B) Identify problem areas and resources.

C) Highlight symptoms and behavioural diagnostic criteria.

D) Provide information to identify delusional content.

26. Which component of assessment is the nurse performing when the nurse asks the client, “What does health mean to you and what does illness mean to you?”

A) spiritual assessment B) psychological assessment C) physical assessment D) cultural assessment

27. Which alteration in thought content should the nurse suspect when the client states that he or she believes that the body is strange or unreal?

A) paranoid delusion B) magical thinking C) idea of reference D) depersonalization

28. The nurse is assessing a client who reports repeated and persistent thoughts about a particular subject. What should the nurse identify?

A) phobia

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B) compulsion C) obsession D) circumstantiality

29. A client whom the nurse is assessing exhibits rapid, continuous verbalization with frequent shifting from one topic to another. What phenomenon should the nurse identify?

A) circumstantiality B) flight of ideas C) tangentiality D) loosening of associations

30. The nurse is documenting the individual's emotional responsiveness during the interview and observation from facial expressions, vocalizations, and behaviour.

What domain of assessment is the nurse addressing?

A) mood B) affect C) perception D) sensory effect

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Answer Key 1. C 2. A, B, C, D 3. A, B, C, D 4. D 5. A, B, C, D 6. B 7. D 8. B, C, E 9. D 10. D 11. B, C 12. D 13. D 14. A 15. D 16. A 17. D 18. A 19. D 20. C 21. A 22. D 23. C 24. A 25. B 26. D 27. D 28. C 29. B 30. B

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Chapter 11: Diagnosis, Interventions, and Outcomes in Psychiatric and Mental Health Nursing Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is considering several nursing diagnoses that are relevant for a client.

On what should the nurse primarily base these diagnoses?

A) assessment data B) client goals C) nursing interventions D) individual outcomes

2. Which component of a nursing diagnosis influences or changes the individual's health status?

A) nursing interventions B) related factors C) expert outcomes D) defining characteristics

3. The Canadian Standards of Psychiatric-Mental Health Nursing specify that all of the nurse's interactions with the client should be considered: A) signs or symptoms.

B) potentially unsafe.

C) teachable moments.

D) pathological.

4. The nurse is creating a client's care plan and has identified interventions. The nurse should base these interventions on: A) unit-specific outcomes.

B) family goals.

C) specific algorithms.

D) mutually agreed-upon goals.

5. The nurse is selecting a client's interventions. On which factors should the nurse base these? Select all that apply.

A) clinical knowledge B) clinical judgement C) commitment to collaboration with client families D) commitment to partnership with clients E) the main nursing theory of the educational institution

6. The nurse is being careful to ensure that a client's varied needs are being met when choosing interventions. What factor will best achieve this goal?

A) being in partnership with the client B) the nurse's education level C) institutional tradition

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D) monitoring the client's safety as closely as possible

7. Which are purposes for the use of Best Practice Guidelines (BPGs)? Select all that apply.

A) to make work easier for nurses B) to deliver care that is effective and based on current evidence C) to cut costs D) to aid in seeking resolutions to clinical problems E) to meet or exceed current quality standards in providing excellent care

8. The nurse is working with a client who reports an inability to fall asleep at night.

What is the nurse's best initial recommendation?

A) Avoid naps in the late afternoon or evening.

B) Ask the health care provider for a prescription hypnotic.

C) Try using low doses of over-the-counter sleeping aids.

D) Establish a routine of vigorous exercise in the evening.

9. A client who has schizophrenia is taking medications that have caused a weight increase of 20 kg. What should the nurse recommend?

A) a realistic program of increased activity B) joining a commercial weight loss program C) fasting, as tolerated D) a low-protein, low-fat diet

10. Which relaxation techniques would be most appropriate for any nurse to teach the client to use when the client tells the nurse that he or she is under a great deal of stress on the job and has frequent headaches? Select all that apply.

A) biofeedback B) hypnosis C) imagery D) simple relaxation E) distraction

11. Which nursing intervention is most appropriate for clients who take psychotropic medications to prevent weight gain and type 2 diabetes?

A) Teach the client to consume a high-protein diet.

B) Use quick weight loss programs.

C) Encourage daily walks.

D) Have monthly blood work to monitor glucose levels.

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12. Which categories of psychoactive medications are most likely to increase a client's risk of obesity? Select all that apply.

A) antipsychotics B) hypnotics C) anticonvulsants D) antidepressants E) mood stabilizers

13. Which nursing intervention would be most appropriate to ensure that adequate nutrition intake is maintained for a client who believes food is poisonous?

A) having the client participate in preparing the food B) telling the client the food is not poisonous and to eat it C) delaying meals until the client is very hungry D) encouraging the client to eat with other people

14. For which reasons is it necessary for the psychiatric client to pay particular attention to his or her hydration? Select all that apply.

A) Psychiatric medications produce an increased metabolism.

B) Overhydration or underhydration can be a symptom of a psychiatric disorder.

C) Psychiatric medications affect fluid and electrolyte imbalance.

D) Increased perspiration will decrease the thirst.

E) Many psychiatric medications cause dry mouth.

15. The nurse is caring for a client who is experiencing chronic pain. What should be the nurse's initial action?

A) Tell the client that the pain is all psychological and due to stress.

B) Engage the client in identifying how the pain is disrupting the life.

C) Teach the client that he or she should only try one intervention at a time.

D) Encourage the client to rest in bed when he or she is experiencing the pain.

16. The nurse is taking action to ensure a client's medication adherence. What is the nurse's best initial action?

A) exploring the client's attitude to taking medication B) administering the medications on time C) recognizing and providing insight to the client's symptoms D) providing rewards for taking the medication

17. The nurse is using reminiscence therapy with an 84-year-old client. What outcome would indicate that the therapy is successful?

A) The client describes family relationships.

B) The client develops new relationships.

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C) The client adheres to the medication regimen.

D) The client identifies past coping strategies.

18. Which is the main purpose of using behaviour therapy with a newly admitted client with a diagnosis of schizophrenia that should be explained to the client?

A) focus on the client's childhood traumas B) focus on desirable behaviours C) impose limit setting on abnormal behaviours D) alter the client's responses to anger

19. The nurse is using cognitive therapy with a client who visits the mental health centre. When explaining the process to the client, the nurse should explain to the client that cognitive therapy is aimed at what?

A) solving the client's problems for him or her B) reinforcing desired behaviours on a daily basis C) changing the client's ways of viewing experiences D) using literature to provide an outlet for the client's expressions

20. Which type of intervention would help the client who suffers from anxiety and depression to examine the meaning of events and reinterpret situations differently?

A) behavioural intervention B) cognitive intervention C) psychoeducation approach D) group therapy approach

21. The nurse can promote the nurse–client relationship and decrease the formalized nature of the hospital by: A) providing regular mealtimes.

B) having clients and staff wear street clothes.

C) having clients' personal belongings sent home to ensure safety.

D) ensuring a safe and secure environment.

22. Which element of milieu therapy will best enhance the setting's therapeutic potential by affirming a client's individuality?

A) structured client activities B) client participation in maintaining the quality of the physical surroundings C) safety and security D) validation

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23. The nurse is preparing to conduct a home visit to a client. Which is a major advantage of a psychiatric nurse making home visits?

A) the opportunity to provide family members with information and education and to engage them in planning and interventions B) the ability to gain a better understanding of the barriers to taking medication as prescribed and to assist the client and family to address them C) the ability to help reluctant clients to enter therapy D) the opportunity to maintain a client in the community regardless of his or her health status

24. Which term appropriately refers to enabling the client to know that she or he is in good hands, reflecting the integrative aspect of spiritual care including the bio/psycho/social care?

A) competency B) receptivity C) humanity D) positivity

25. Client outcomes can be most simply described as which?

A) goals for the plan of care B) nonspecific C) assessment parameters for planning care D) an individual's response to care

26. Which type of individual outcome is obtained when a nursing care plan on a client admitted 3 days ago is evaluated and updated to reflect client current status?

A) initial outcome B) discharge outcome C) quality improvement outcome D) revised outcome

27. The nurse is caring for a client who is diagnosed with depression. The client's care plan identifies an outcome of enhanced mood and affect. What type of outcome is the nurse identifying?

A) general outcome B) system-specific outcome C) diagnosis-specific outcome D) non–diagnostic-specific outcome

28. A nurse is evaluating the client's individual outcomes. Which question will best

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assist the nurse to evaluate the client's individual outcome?

What was the individual's level of satisfaction?

What role did the health care provider participate in outcome?

What response or feedback was provided from the interdisciplinary team?

Was the outcome facilitated by nursing care or by medication?

29. The nurse has intervened with behaviour modification in the form of imposed limit setting on a hospitalized aggressive client. An appropriate outcome statement for this client is that the client will: A) express feelings appropriately rather than acting out for the rest of the day.

B) remain calm and silent during mealtimes for the rest of the day.

C) describe better ways of handling aggressive behaviour.

D) write down the number of times he or she felt angry during the day.

30. Based on assessment data, the nurse formulates the nursing diagnosis for a client as sleep pattern disturbance. After teaching the client how to relax before bedtime, which would be an appropriate outcome? The client will: A) discuss feelings about not being able to fall asleep.

B) report feeling rested on awakening in AM within 3 days.

C) request sleeping medication each night before bedtime.

D) be able to sleep for short intervals throughout the night.

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Answer Key 1. A 2. B 3. C 4. D 5. A, B, C, D 6. A 7. B, D, E 8. A 9. A 10. C, D, E 11. C 12. A, D, E 13. A 14. B, C, E 15. B 16. A 17. D 18. B 19. C 20. B 21. B 22. D 23. A 24. A 25. D 26. D 27. C 28. A 29. A 30. B

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Chapter 12: Psychopharmacology and Other Biologic Treatments Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A client is experiencing the biologic action of a drug. The action will depend on how the drug's structure interacts with a specific: A) organ.

B) enzyme.

C) ion.

D) receptor.

2. A client with pain has been given an opioid analgesic, which will attach to a receptor and produces the same chemicals as endogenous opioids. What type of medication has this client received?

A) agonist B) mimic C) simulator D) duplicator

3. A client is taking a psychotropic medication. Receptors for neurochemicals other than those in specific brain regions are being affected. What will the client experience?

A) antagonists B) side effects C) agonists D) intrinsic affinity

4. A medication is known to have a high ability to produce a desired response. This drug is known to have a high degree of: A) efficacy.

B) selectivity.

C) intrinsic activity.

D) receptivity.

5. A client with a history of depression has been prescribed sertraline? Levels of which neurotransmitter will be most affected?

A) acetylcholine B) norepinephrine C) serotonin D) melatonin

6. Which term describes the ability of a drug to produce a biologic response once it becomes attached to the receptor?

A) selectivity B) intrinsic activity

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C) channel blocker D) partial agonist

7. A client's medication has a powerful bond between the drug molecules and its receptor. What characteristic does this drug possess?

A) affinity B) selectivity C) efficacy D) response

8. Which is the term for a drug that only interacts with its specific receptors in the areas of the body where these receptors occur?

A) particular B) covalent C) intrinsic D) selective

9. A client used to achieve relief from anxiety with a 0.5-mg dose of lorazepam.

However, the client now requires a 1-mg dose to achieve the same effect. What is this client experiencing?

A) sensitivity B) tolerance C) functionality D) addiction

10. A client with achieving good symptoms relief for the first few months after starting a new medication but is now experiencing a gradual return of symptoms.

What is occurring in this client?

A) treatment refractoriness B) nonadherence C) decrease in metabolism D) affinity

11. Which is the advantage of the newer antidepressants that are selective to both serotonin and norepinephrine?

A) They take longer for affinity to occur.

B) Clients do not develop tolerance.

C) There is an increased degree of receptor occupancy.

D) They have fewer side effects.

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12. A client takes a large dose of medication by mouth. However, much of the drug is inactivated before reaching the rest of the body and entering the systemic circulation. What process caused this inactivation?

A) solubility B) adverse reaction C) efficacy D) first-pass effect

13. Which statement about selectivity is most accurate?

A) The more selective a drug is, the less likely it will be to produce side effects.

B) A highly selective drug will be highly likely to produce side effects.

C) Selectivity is the ability of the drug to produce a biologic response once it attaches to the receptor.

D) Selectivity refers to the degree of attraction or strength of the bond between the drug and its receptor.

14. Which term refers to the amount of the drug that actually reaches systemic circulation?

A) bioavailability B) solubility C) selectivity D) first-pass effect

15. Which term describes how a drug moves throughout the body to get to its target receptors and then is eliminated?

A) drug concentration B) tolerance C) pharmacogenomics D) pharmacokinetics

16. A client with a mental health disorder has been prescribed a typical antipsychotic.

What is the likely mechanism of action?

A) decreasing positive target symptoms as potent postsynaptic dopamine antagonists B) blocking serotonin receptors that reside on dopamine neurons as well as dopamine receptors C) decreasing the sensitization of affected cells, making them less easy to stimulate D) reuptake inhibition at serotonin and norepinephrine transporters

17. Which are mechanisms of action for tricyclic antidepressants? Select all that apply.

A) inhibiting reuptake at serotonin and norepinephrine transporters

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B) down-regulating specific serotonin and noradrenergic receptors C) blocking cholinergic, adrenergic, and histamine receptors D) inhibiting MAO, an enzyme that breaks down biogenic amines, such as serotonin, thereby increasing synaptic neurotransmission E) increasing the amount of neurotransmitter in the synaptic space available for action on the receptors

18. Which client is most likely to experience weight gain?

A) a client prescribed atypical antipsychotics such as clozapine and olanzapine B) a client who is receiving electroconvulsive therapy C) a client whose anxiety is treated with benzodiazepines D) a client whose ADHD is treated with methylphenidate, a stimulant

19. Which is the most important nursing intervention during the stabilization phase for a hospitalized client when medications are being increased rapidly?

A) continuing to assess target symptoms B) closely monitoring vital signs and adverse reactions C) providing verbal and written educational materials D) changing medications when the client develops side effects

20. The nurse is caring for a client with acute mania. Which nursing action would be most appropriate to ensure an accurate lithium value?

A) Give the morning dose 30 minutes prior to obtaining serum sample.

B) Withhold the morning dose of lithium.

C) Ensure the evening dose of lithium is withheld prior to obtaining serum sample.

D) Administer a double dose of lithium the evening before serum sample drawn.

21. In order to reduce the client's risk of side effects, a potent drug that can produce a therapeutic dose should be given in what form?

A) higher dose B) lower dose C) divided dose D) single dose

22. The client has started a new antipsychotic medication. When the nurse observes that the client has a thick tongue, tight jaw, or stiff neck muscles, which should the nurse document?

A) akathisia B) tardive dyskinesia C) kindling D) dystonia

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23. Which somatic treatment poses the most risk to a client?

A) electroconvulsive therapy (ECT) B) light therapy C) nutrition therapy D) repetitive transcranial magnetic stimulation (rTMS)

24. A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?

A) “You may experience hypertension while taking this medication.”

B) “One of the side effects of this medication is breast engorgement.”

C) “People taking this medication often experience dermatitis.”

D) “You may experience noticeable weight gain while taking this medication.”

25. After educating a client who is receiving phenelzine, an MAOI, the nurse determines that the education was successful when the client states the need to avoid: A) fresh cottage cheese.

B) cooked sliced ham.

C) tap beers.

D) milk.

26. After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states: A) “I need to be careful because the drug can make me sleepy.”

B) “I don't have to worry about getting dizzy when I get up from lying down.”

C) “I might notice some excess saliva in my mouth at different times.”

D) “I need to avoid foods with fibre because diarrhoea can occur.”

27. A client receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate?

A) “These symptoms are not real; the medication makes your brain think they are real.”

B) “You have developed an allergy to the medication, so we need to change it.”

C) “These are the results of the drug and can be treated; your illness is not getting worse.”

D) “The sunlight together with the medication has caused these symptoms; just stay indoors.”

28. A nurse observes an older adult client who has been taking antipsychotic

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medications for 8 months. The nurse sees the client's lips smacking and eyes blinking rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?

Ask whether the client has been experiencing side effects.

Contact the client's health care provider for a different medication order.

Document the client's symptoms of tardive dyskinesia.

Instruct the client to begin tapering the medication.

29. An older adult reports anxiety and is prescribed diazepam by a family health care provider. The health care provider asks the office nurse to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize?

A) “You may experience minor urine incontinence from time to time.”

B) “You may find that you have temporary memory disturbances.”

C) “You need to use this medication cautiously because it can cause dependence.”

D) “You may feel dizzy and be prone to falls after taking this medication.”

30. A nurse is caring for a psychiatric client who is prescribed an antipsychotic agent.

The client is also receiving an antacid that contains aluminium salts. Which action by the nurse would be most appropriate?

A) Give the antacid 1 hour before the antipsychotic medication.

B) Give the antacid at the same time as the antipsychotic medication.

C) Administer the antacid 1 hour after the antipsychotic medication.

D) Administer the antacid just before the client goes to sleep.

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Answer Key 1. D 2. A 3. B 4. A 5. C 6. B 7. A 8. D 9. B 10. A 11. D 12. D 13. A 14. A 15. D 16. A 17. A, B, C 18. A 19. B 20. B 21. B 22. D 23. A 24. D 25. C 26. A 27. C 28. C 29. D 30. A

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Chapter 13: Cognitive Behavioral Interventions Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The cognitive model is described as the interconnection between behaviours, emotions, and what component?

A) incentives B) thoughts C) desires D) symptoms

2. Which client is most likely to be effectively treated with cognitive–behavioural therapy (CBT)?

A) a client with bipolar affective disorder B) a client with a long-standing diagnosis of schizophrenia C) a client with schizoaffective disorder D) a client being treated for panic disorder

3. The nurse is assessing a client's main knowledge structures that hold, organize, and interpret all information about one's view of self, others, and the world. What is the nurse assessing?

A) emotional reasoning B) core beliefs C) delusional beliefs D) intermediate beliefs

4. The advanced practice nurse is helping a client change negative thought patterns as means to improve mood and behaviour. What treatment is the nurse providing?

A) psychotherapy B) cognitive–behaviour therapy C) family interventions D) milieu therapy 5. A client tells the nurse, “If I don't get a perfect evaluation, I'm a failure.” The client is demonstrating: A) overgeneralization.

B) mental filter.

C) labelling.

D) all-or-nothing thinking.

6. Which are benefits of the structured nature of cognitive–behaviour therapy?

Select all that apply.

A) It provides clarity, reassurance, and a sense of control to the client.

B) It maintains focus and maximizes the ability to use the session effectively.

C) It prepares the client to be his or her own therapist upon therapy termination.

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D) It supports the client to listen as the therapist provides structure and direction.

E) It prevents the client from collaborating with the therapist regarding the therapeutic approach.

7. Which statement about core beliefs is accurate?

A) Core beliefs are so fundamental that they are often not articulated in explicit words but rather are accepted as absolute truths.

B) Core beliefs consist of attitudes, rules or expectations, and assumptions that influence one's perceptions, affect, and behaviours.

C) Core beliefs are “knee-jerk” in-the-moment words and images generated in a particular situation.

D) Core beliefs may not be logical and are often difficult to “shut-off.”

8. Which is an example of a core belief?

A) “I am inadequate.”

B) “If I'm not liked by everyone, it means I've failed.”

C) “I am not capable of speaking up for myself.”

D) “I must be the best in everything I endeavour.”

9. Which is the most superficial and accessible level of cognition and generally the first to be targeted in treatment?

A) core beliefs B) automatic thoughts C) intermediate beliefs D) cognitive schema

10. Which element is the foundation of core beliefs, subsequent intermediate beliefs, and automatic thoughts?

A) messages from others B) assumptions from significant others C) rules in society D) behaviours at present

11. A client experienced inconsistencies and cruelty as a child. What is the client likely to possess?

A) broad, nonspecific goals B) hypercritical beliefs about him/herself C) multiple, shallow relationships D) overachieving

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12. Which of these are intermediate beliefs? Select all that apply.

A) Assuming the worst will happen because it usually does.

B) “I am unlovable.”

C) “The world is an unsafe place.”

D) “If I'm not liked by everyone, it means I've failed.”

E) Believing that relationships will make you open to rejection.

13. Which would likely be the characteristic of the core beliefs of a client who describes his or her early experiences in life as primarily positive?

A) emotional unavailability B) overgeneralized C) realistic D) inaccurate reflection of current reality

14. A client is outlining the typical thoughts and problematic behaviours that contribute to his or her current distress. What process is taking place?

A) cognitive schema B) cognitive–behavioural formulation C) intermediate beliefs D) behavioural treatment technique

15. Which must the therapist establish with the client to allow therapeutic change to occur?

A) socratic questions B) authority C) limited and brief interaction D) therapeutic alliance

16. The nurse is encouraging the client to view his or her thoughts and feelings as hypotheses rather than rigid facts. What is the nurse encouraging?

A) inductive reasoning B) education C) socratic questioning D) goal orientation

17. Which statement regarding the length of treatment for cognitive–behavioural therapy is accurate?

A) It is a short-term treatment.

B) It may continue for years.

C) It is always used for a defined duration.

D) After the initial treatment period, there is regular contact with the therapist.

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18. Which statement about cognitive–behavioural therapy is most accurate?

A) The focus is identifying the client's weaknesses.

B) CBT involves a relationship with therapist for an indefinite period of time.

C) It cannot be used for clients who are taking medications.

D) CBT empowers clients to engage in a collaborative approach to their care.

19. The nurse is using a method of cognitive–behavioural therapy that uses deliberate questioning to examine and evaluate their thinking patterns. What technique is being employed?

A) psychotherapy B) socratic questioning C) cognitive restructuring D) interrogation

20. A client who is receiving cognitive–behavioural therapy has been assigned “homework.” What technique is the therapist employing?

A) cognitive schema B) cognitive restructuring C) socratic questioning D) self-reflective exercises

21. The nurse is teaching a client to identify automatic thoughts. What should the nurse encourage the client to focus on?

A) his or her problem-solving abilities B) identifying when his or her emotions intensify C) mental stamina D) hopes for the future

22. A nurse has set the goal of being able to perform cognitive–behavioural therapy.

What should the nurse seek?

A) basic training as a regulated health professional B) practice opportunities in providing care to depressed clients C) advanced training and clinical supervision D) observation of clinicians in an outclient setting

23. Which is a cognitive technique to identify automatic thoughts?

A) The client should view his or her thoughts and feelings as facts and unshakable truths.

B) The therapist should ask the client to recount a very problematic situation.

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C) The therapist should provide a direct approach throughout the course of treatment.

D) The therapist should create a warm and positive environment.

24. A client says, “I'm a slob. I need someone else to keep everything tidy.” Which thinking error is the client using?

A) overgeneralization B) all-or-nothing thinking C) labelling D) emotional reasoning

25. How does the Suitability for Short-Term Cognitive Therapy Rating Scale assist with individual clients?

A) It confirms that cognitive–behavioural therapy is effective for depressed clients.

B) It analyzes the diagnostic category from DSM-4.

C) It has shown to have predictive value of potential to succeed in CBT. D) It provides information on the client's psychotic features.

26. Which term describes the automatic thoughts that keep people locked into patterns of negative thinking and behaviour?

A) thinking errors B) self-reflective behaviour C) labels D) fearful situations

27. A client is receiving cognitive–behavioural therapy that involves weighing evidence for and against an automatic thought in an effort to generate a new, more balanced way of thinking. What is being taught to this client?

A) positive thinking B) emotional reasoning C) modifying thoughts D) mental filter

28. The therapist has encouraged a client to create experiences to test and challenge core beliefs. What process is being encouraged?

A) thought records B) behavioural experiments C) core belief worksheets D) cognitive schemas

29. Which behavioural strategy is most often appropriate for clients who have

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generalized anxiety disorder, panic disorder, and posttraumatic stress disorder? activity monitoring in video exposure exposure techniques relaxation strategies

30. Which statements regarding mindfulness are accurate? Select all that apply.

A) Mindfulness is a form of trained self-observation based on meditation practices.

B) It is easy to become mindful.

C) It allows people to use their old patterns of coping.

D) It involves learning to be present to what is happening to one in the immediate moment.

E) It can help people to disengage their “automatic pilot” and more closely examine their convictions and thought patterns.

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Answer Key 1. B 2. D 3. B 4. B 5. D 6. A, B, C 7. A 8. A 9. B 10. A 11. B 12. A, D, E 13. C 14. B 15. D 16. A 17. A 18. D 19. B 20. D 21. B 22. C 23. B 24. C 25. C 26. A 27. C 28. B 29. D 30. A, D, E

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Chapter 14: Interventions with Groups Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is beginning a group counselling session with an open group system.

Which rationale should the nurse offer for the selection of this method of treatment? The nurse should explain to the group members that one advantage of an open group system is what?

A) It can offer the best treatment outcomes.

B) The topics for the group can be easily controlled.

C) Relationships are more easily established in this type of group.

D) New members can join the group at any time.

2. The nurse is beginning a group counselling session in a closed group system.

When explaining the rationale for this method of treatment, the nurse should explain what advantage of a closed group system?

A) The participants become more cohesive as a group.

B) The group can function on an ongoing basis.

C) The focus of the group's work can be more fluid.

D) The group can be led by only one person.

3. The nurse is preparing to form a small group in an inpatient psychiatric setting.

In addition to the group leaders, how many clients should the nurse ideally recruit?

A) three to four clients B) five to six clients C) seven to eight clients D) nine to ten clients

4. The nurse is beginning a small group session in an inpatient psychiatric setting.

Which describes the behaviour that the nurse can anticipate that the members will likely display during the beginning stage?

A) angry B) confident C) close D) polite

5. The nurse is working with a group that has a highly centralized communication style. What is the group most likely to accomplish?

A) specific themes B) issues related to biases C) conflict management D) low-complexity tasks

6. The nurse is leading a group and is currently focused on identifying group

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themes. Doing so will allow the nurse to what? determine the central communicator understand the group dynamics evaluate outcomes of the group establish future group sessions

7. Which should the nurse recognize as the most critical element in encouraging conformity of behaviour among group members?

A) norms B) cohesiveness C) themes D) leadership

8. The nurse has begun group counselling sessions for several hospitalized clients on the psychiatric setting. Which intervention would be most likely to encourage group cohesiveness?

A) using team-building exercises B) encouraging task completion by members C) spending time with each member individually D) being consistent with the group themes

9. Which are important skills that the nurse should use while leading a group or selecting the leader of a group? Select all that apply.

A) consistently engaging in active listening B) delegating leadership to reluctant members C) tracking verbal interactions throughout the group D) being clear about the purpose of the group and tailor leadership strategies accordingly E) tracking nonverbal interactions throughout the group

10. While participating in a group therapy session, one group member asks for clarification of the topic the group is discussing. Which type of group role should the nurse recognize this member performing?

A) task B) formal C) maintenance D) evaluation

11. While conducting a group therapy session, the nurse observes that one participant consistently mediates harmony among the participants. The nurse determines that this client is performing what group role?

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task individual gatekeeper maintenance

12. Which group roles likely would detract from group functioning and may require special efforts from the group leader? Select all that apply.

A) aggressor B) blocker C) coordinator D) dominator E) recognition seeker

13. A particular group member repeatedly engages in self-disclosure, and the group's purpose is inconsistent with self-disclosure of personal problems. Which intervention would be most appropriate?

A) Limit repeated episodes and redirect discussion.

B) Ask the individual to leave the group.

C) Publicly tell the individual that this behaviour is unacceptable.

D) Explore the individual's thoughts and feelings with the group.

14. A group member is facilitating verbal and nonverbal communication to meet treatment goals individually and for the entire group. What role is the client most clearly playing?

A) individual role B) maintenance role C) gate keeper D) group leader

15. The nurse is leading a group and is trying to promote cohesiveness. However, the nurse knows that excessive cohesiveness can lead to what?

A) lack of participation B) conflict C) reluctance to express opinions D) increased dropout rates

16. The nurse leader of a therapeutic group is ensuring that groupthink does not develop during the group's interaction. What action will best meet this goal?

A) Increase the membership to more than 9 or 10 individuals, if possible.

B) Reassure the members that dissenting views are welcomed.

C) Delegate decision-making to the dominant members of the group.

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D) Maintain a laissez-faire leadership style.

17. Which group outcomes may result from a closed leadership style and time pressures?

A) conflict B) groupthink C) confusion D) consensus

18. When should the group leader explain group guidelines?

A) at the first group meeting B) at every group meeting at the beginning and at the end C) during the first group meeting and as needed D) every time there is a possibility of deviance from the norm

19. Which activities would be important for the group leader to engage in during the beginning stage of a group? Select all that apply.

A) clarifying outcomes, processes, and commitments related to the group purpose B) build a working relationship with the group and among participants C) constructing a working environment D) describing in great detail the normal group process E) establishing the presence of each member

20. Which interpersonal skills would be most desirable for a nurse leading either a supportive or educative group?

A) aloof and respectful B) expressive and interactive C) cool and noncommittal D) meaningful and secretive

21. A nurse's leadership behaviour is authoritarian and controls the interaction by giving directions and information and allowing little discussion. What leadership style is the nurse exemplifying?

A) indirect leadership B) member leadership C) laissez-faire leader D) direct leadership

22. Which variables should a nurse planning to start a new group on the unit use in member selection to ensure a well-functioning and successful group? The nurse

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should consider if: A) a potential member has leadership potential.

B) the purpose of the group matches the treatment goals of the potential member.

C) the potential member could benefit by sitting outside of the actual group and observing.

D) the potential member has highly developed social skills.

23. The nurse is preparing for a group's initial meeting. How should the nurse arrange seating?

A) arranging chairs in a circle with chairs comfortably close to one another B) using a room without doors to promote the openness of the group C) arranging chairs at a rectangular table with chairs close to one another D) using three semicircles, with one or two chairs outside the circles to seat the potential monopolizers

24. The nurse who is leading a group is having difficulty managing the group's response to one particular member, who is known to be disliked by other members. What is the nurse's best action?

A) Find an alternative group for the member to join.

B) Ask a more experienced leader to consult and supervise.

C) Temporarily delegate leadership of the group to the disliked member.

D) Ask the other members to describe why they dislike the member.

25. Which are important principles for the nurse group leader to consider when intervening with challenging group behaviours? Select all that apply.

A) Remember that challenging or deviant members may serve a function for the group.

B) Quickly remove the group member exhibiting the challenging group behaviours.

C) Consider what might be escalating difficult behaviours.

D) Describe what is observed and let the member know how it is affecting others.

E) Ensure the integrity of the individual members and the group as a whole.

26. Which statements about group conflicts are most accurate? Select all that apply.

A) It is abnormal for a group to experience periods of conflict.

B) The conflict must not be acknowledged.

C) A benefit to effectively dealing with conflict is that the group cohesion often increases.

D) The only time that conflict should occur is in the beginning stage.

E) It is problematic for a group to actively avoid conflict.

27. Which type of group is short term, oriented to education, and focused on a

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specific theme? interactive groups supportive therapy groups self-help groups structured groups

28. Which statements regarding types of groups are accurate? Select all that apply.

A) Every type of group is a therapy group.

B) Structured groups are usually of long-term duration.

C) Psychoeducational groups are randomly formed.

D) In a cognitive group, the leader identifies specific distorted thought patterns as the focus of change.

E) In behavioural groups, the leader targets specific actions to be modified.

29. The nurse is leading a group that is focused on relapse prevention. What type of group is the nurse leading?

A) anger management group B) reminiscence group C) psychoeducational group D) symptom management group

30. Which type of nursing intervention group is often established for clients suffering from dementia?

A) reminiscence groups B) self-care groups C) self-help groups D) psychotherapy groups

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Answer Key 1. D 2. A 3. C 4. D 5. D 6. B 7. A 8. A 9. A, C, D, E 10. A 11. D 12. A, B, D, E 13. A 14. D 15. C 16. B 17. B 18. C 19. A, B, C, E 20. B 21. D 22. B 23. A 24. B 25. A, C, D, E 26. C, E 27. D 28. D, E 29. D 30. A

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Chapter 15: Family Assessment and Interventions Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which outcome is best supported by evidence about family-based interventions?

A) increased medication adherence B) improve recovery of clients C) increased scope of practice for nurses D) effectiveness for all disorders

2. The nurse is encouraging a family to engage in the care of a mentally ill family member. Which factors are being recognized as promoted by the unique roles of families in mental illness? Select all that apply.

A) promoting well-being B) preventing the need for professional care C) providing care D) making decisions on behalf of the client E) facilitating recovery

3. Which is the most important reason why families of persons with mental illness should be supported by nurses and other health professionals?

A) Family assistance is not as costly as paid caregivers.

B) An estimated 1.2 million Canadian children and youth are affected by mental illness.

C) One in four Canadian seniors lives with a mental health problem or illness.

D) Family involvement is vital to successful management of the mental illness.

4. The nurse is reviewing a client's genogram. What information will the nurse be able to learn from this data source?

A) occupations of the members B) relationships with the community C) educational levels of family members D) ages of the members

5. The nurse is reviewing a client's genogram and is noting the horizontal lines on the tool. What information will the nurse learn from these lines?

A) chronic health problems of family members B) the time and location of geographic movements C) the death dates of family members D) who is married to whom in the family

6. A psychiatric–mental health nurse is interviewing a family for the purpose of constructing a genogram. The nurse should begin by explaining what purpose of the genogram?

A) Identify the dysfunctionality of the family.

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B) Provide support to the family by identifying weaknesses in the family.

C) Provide a general exploration of the family communication patterns.

D) Better understand their particular area of concern.

7. The nurse is constructing a genogram. What functions will this assessment serve?

Select all that apply.

A) a tool to gather community data B) a tool for judgement C) a tool to identify the family's aspirations D) a tool for engagement E) a tool for structured assessment

A) B) C) D) E)

8. Which data would a nurse typically include in a genogram? Select all that apply. age of each family member dates of marriage/union of each family member dates of death of each deceased family member geographic location of each family member sexual preference of each family member

9. The nurse is constructing a client's genogram. Who should the nurse include in the genogram?

A) only blood relatives B) neighbours and acquaintances C) the client's health care providers D) anyone the family identifies as significant

10. Which questions may the nurse ask in constructing an ecomap with the family?

Select all that apply.

A) “What community agencies are you involved with now?”

B) “Has anyone in your family had a problem with depression, gambling, or alcohol?”

C) “Do you think your parent's divorce is the cause of the breakdown in your family?”

D) “How might you describe your work or school relationships?”

E) “Who in the family are closest to one another?”

11. The nurse is conducting an ecomap while planning a client's care. Which statement about an ecomap should the nurse recognize as accurate?

A) An ecomap is entirely different from a genogram.

B) The ecomap should be compiled just prior to discharge.

C) Only the client can inform an ecomap.

D) The ecomap can identify strengths as well as needs.

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12. The nurse is reviewing a client's ecomap. What information will the nurse be able to identify from this resource? Select all that apply.

A) aetiology of the client's mental illness B) links with the community C) stressful relationships only D) links with the client's culture E) community resources that the client uses

13. The nurse is working with a family whose young son has a mental illness. What programs should the nurse help the family explore? Select all that apply.

A) parenting and sibling support B) financial assistance C) peer support D) respite care E) pleasant diversion

14. The nurse is conducting an assessment of a client and family. When the nurse is assessing how the family members deal with stressful events, which is the nurse attempting to determine?

A) the genogram B) decisiveness C) subsystems D) coping skills

15. Which risk factor for stress is present when adolescents become parents and the adolescents' educational opportunities are compromised, limiting their employment skills and increasing a risk of the cycle of poverty?

A) early maturation cycle B) condensed life cycle C) later life cycle D) ordinary life cycle

16. The nurse is working with a family that has a member with a mental illness. The family has a change in the family structure. The nurse should assess for what consequence of this change?

A) decreased need for resources B) exacerbation of the client's mental illness C) hostility towards the nurse D) nonadherence to the treatment plan

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17. A family is reluctant to discuss the mental disorders of their family member. The nurse should assess for what potential contributor to this situation?

A) stigma associated with mental illness B) family conflict C) inadequate resources D) lack of support available

18. Which are challenges that a family may experience when becoming a caregiver for a family member with mental illness? Select all that apply.

A) the unpredictable nature of many mental illnesses B) limited resources C) the current barriers to family involvement in the mental health system D) sharing an investment in their relationships E) the stigma associated with mental illness

19. The nurse's assessment of a family reveals that the client's mother is experiencing caregiver burden. What is the nurse's best initial action?

A) Remind the mother of the difference her input is making to her child's health.

B) Teach the mother about the need to take time for her own needs.

C) Perform a genogram and ecomap assessment.

D) Discuss options for distributing the responsibilities that the mother currently bears.

20. Which are positive outcomes that occur when families with a member with mental illness are well supported? Select all that apply.

A) enhanced recovery journey of their ill relative B) high level of caregiver burden C) improved quality of life D) feeling blamed for the problems and issues associated with mental illness E) less caregiving stress

21. The nurse is attempting to develop sensitivity about what constitutes normalcy and functionality when working with families. Which should the nurse do first?

A) study an ecomap B) complete a genogram C) engage in self-reflection D) consider spirituality

22. The nurse is applying the Calgary Family Assessment Model and the Calgary Family Intervention Model to a family's care. Which categories must the nurse conceptualize the family into? Select all that apply.

A) interpersonal

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medical functional developmental structural

23. Which nursing intervention would most enhance the family's sense of worth?

A) abruptly end the face-to-face sessions with the family B) provide shorter sessions when dealing with a translator or interpreter C) assess the distribution of tasks among the family members D) verbally commend the family's strengths, courage, resources, and capabilities

24. Which would the nurse include in a comprehensive family assessment of the family that has one or more mentally ill persons? Select all that apply.

A) family health B) strengths C) psychological well-being D) impressions of other members of the interdisciplinary team E) social functioning

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

A) severity of the client's symptoms B) barriers faced by the client C) stigma associated with the diagnosis D) risk for relapse

26. A nurse is engaged in developing a relationship with a family during a family assessment. What are appropriate nursing actions? Select all that apply.

A) demonstrating culturally competent nursing skills B) completing the assessment efficiently in the first meeting C) identifying the family's immediate needs D) exhibiting a professional image E) investigating the adherence to the medication regimen

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

A) Use circles to represent the male members.

B) Use horizontal lines to connect the parents with children.

C) Use horizontal lines to show marriages.

D) Use asterisks to denote ages listed at the bottom.

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

A) families with adolescents B) launching children and moving on C) families in later life D) leaving home: single young adults

29. The nurse is working with a family who have a member that is being treated for a mental health disorder. The client and family have stated that they want to involve the clergy member from their religion in the planning and provision of care. What is the nurse's best action?

A) Assess whether the clergy member is qualified to participate in care.

B) Determine whether the family would be open to working with a nondenominational chaplain.

C) Collaborate with the clergy member and educate him or her about mental illness as needed.

D) Identify a nursing diagnosis of spiritual distress.

30. While working with families who have a member with a mental disorder, the nurse applies the Pyramid of Family Care. Which intervention does the nurse perform most often?

A) providing consultation with other professionals B) teaching specific coping skills to families C) providing family therapy as indicated D) forming trusting connections with families

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Answer Key 1. B 2. A, C, E 3. D 4. D 5. D 6. D 7. D, E 8. A, B, C, D 9. D 10. A, D 11. D 12. B, D, E 13. A, B, C, D 14. D 15. B 16. B 17. A 18. A, B, C, E 19. D 20. A, C, E 21. C 22. C, D, E 23. D 24. A, B, C, E 25. C 26. A, C, D 27. C 28. B 29. C 30. D

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Chapter 16: Psychological Health and Safety in the Workplace Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition

A) B) C) D)

1. Which is the leading cause of disability in Canadian workplaces? violence in the workplace mental health issues communicable diseases workplace injuries

2. A nurse is trying to better understand workplace health issues. What is the nurse's best rationale for setting this goal?

A) to better address his or her own well-being and that of colleagues B) to better identify the risk factors for workplace violence C) to better understand the politics of health care facilities D) to prevent further deterioration in the health status of clients

3. Which factor is having the most direct effect on the work life of Canadians due to the transformation of the nature of work?

A) reduced specialization of work roles B) increased leisure time C) the slower pace of work–life brought about by mechanization D) downsizing by a decline in the need of middle management

4. The nurse is working with an individual who is experiencing burnout. The nurse should assess the client for effects on what systems? Select all that apply.

A) hematologic system B) circulatory system C) neurologic system D) respiratory system E) musculoskeletal system

5. A nurse is employed in a workplace where workers understand their roles and believe they can contribute to decisions about how their work is carried out.

What type of workplace does the nurse have?

A) idealized workplace B) hospital employment C) government employment D) psychologically healthy workplace

6. The nurse is consulting the National Standard of Canada for Psychological Health and Safety in the Workplace. This framework will allow the nurse to do what?

A) achieve work–life balance B) identify bullies

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C) identify and remove environmental hazards D) achieve pay equity

7. Which factors are more likely to contribute to the risks to mental health in the workplace? Select all that apply.

A) job demands in excess of worker skill levels B) rewards such as praise, recognition, acknowledgement, and credit C) refusal to recognize and accommodate the legitimate needs, rights, and claims of workers D) advice, direction, planning, and provision of resources being available E) fair wages for the work

8. A nurse finds his or her current role unfulfilling because there are not a sufficient number and variety of tasks and responsibilities to complete each day. What would this nurse be categorized as?

A) unemployed B) underemployed C) role overloaded D) compassion fatigued

9. Which is included in the World Health Organization's description of adverse effects of unemployment?

A) increased visits to general medical practitioners B) increased violence C) increased incidence of diabetes D) decreased work stress

10. Which describes an individual who finds a satisfactory interaction among all the domains of his or her life?

A) joy B) work–life balance C) work context D) workplace health

11. A nurse is unable to achieve work–life balance because he or she is unable to meet all of his or her work and nonwork roles. What is this nurse experiencing?

A) role overload B) unhealthy workplace C) work overload D) work–life conflict

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12. A nurse is struggling to reconcile the demands of caring for an elderly parent, young children, and a demanding job role. What is this nurse experiencing?

A) job strain B) role overload C) underemployment D) role chaos

13. The nurse works on a unit where many of the nurses work overtime on a regular basis. The nurse should recognize a consequent risk for what problem?

A) workplace violence B) conflict C) medication errors D) underemployment

14. Which statement is true of women in the paid workforce?

A) Women make up nearly half of the paid workforce but remain underrepresented in decision-making positions.

B) Gender stereotypes are more influential in determining career choices than in the past.

C) Males and females tend to compete for the same jobs.

D) The inequities from past generations have largely been resolved.

15. Which are knowledge gaps related to work and gender? Select all that apply.

A) the gender of all nurses who is physically assaulted in the previous year B) the difference in the nature of the work for nurses of both genders C) whether female nurses are much less likely to report work-related stress than male nurses D) the risks and health issues encountered in unpaid work E) whether biologic responses to workplace hazards are known to have gender-based variation

16. A new employee has a physical disability that could be accommodated. What is the manager's best action?

A) Offer the employee a part-time, rather than full-time, position.

B) Encourage the person to seek employment in a different setting.

C) Encourage the person to seek aggressive treatment for the disability.

D) Modify the person's job assignment accordingly.

17. Which statement about supported employment (SE) is accurate?

A) SE is a way to assist individuals with severe mental disorders to enter the

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workplace.

B) SE involves a lengthy job search.

C) Research indicates that SE is not effective.

D) SE employment is chosen according to employer preference.

18. Which is an example of relational bullying in the workplace?

A) withholding job information B) threatening violence C) sending false emails under the victim's name D) attacking personal attributes

19. Which factors are suggested by research to increase the risk of compassion fatigue in caregiving professionals? Select all that apply.

A) burnout and stress B) caregiver maintaining self-care C) lack of social support D) prolonged time in the profession E) controllable work stressors

20. Which variables are positively associated with a healthy workplace? Select all that apply.

A) Workers and managers continually collaborate.

B) Health and safety concerns are addressed.

C) Workplace culture concerns are addressed.

D) Only employees with optimal health are hired.

E) Disparities between groups of workers or individual workers are minimized or eliminated.

21. Which statement regarding nursing burnout is accurate?

A) Researchers have found that when burnout was reduced, there were fewer nosocomial infections.

B) Burnout is not considered a serious threat to the quality of health care.

C) Most of the impact from burnout occurs to the individual nurse.

D) Burnout is more likely when relationships reinforce the nurse's identity.

22. Which is a system recommendation for workplace health, safety, and well-being of the nurse?

A) for researchers to actively collaborate with health care partners to study the effectiveness of interventions aimed at improving nurse health, safety, and wellbeing B) for nursing education institutions to incorporate information about the health,

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safety, and well-being of the nurse into the core curriculum C) for nursing education institutions to model the integration of health, safety, and well-being into their own workplace culture D) for governing/accrediting bodies to incorporate recommendations from the best practice guidelines in their standards

23. The nurse manager of a hospital unit is trying to create a healthy workplace.

What action should the nurse prioritize?

A) make employees accountable to the nurse manager for their health B) screen employees' health on a regular basis C) create incentives for employees who agree to a healthy lifestyle D) collaborate with employees to address risks to safety and health

24. The Canadian Standard for Psychological Health and Safety in the Workplace is being applied at a health clinic. What action will best meet this standard?

A) identifying and monitoring clients who may be prone to violence B) offering career counselling on demand for any employee C) offering healthy workplace meals to employees D) ensuring that employees have equal opportunities for advancement

25. The nurse manager of a busy hospital unit has identified that many employees have difficulty meeting their personal obligations and maintaining work–life balance. What action should the manager take to relieve this situation?

A) Create incentives for employees to achieve work–life balance.

B) Encourage the employees to reduce their hours of work.

C) Give employees flexibility in organizing their work.

D) Encourage employees to seek psychological counselling.

26. A nurse reports to his or her supervisor that he or she is experiencing burnout.

What action by the supervisor would most directly address the nurse's burnout?

A) educate the nurse about the need for work–life balance B) assess for any incidents of workplace violence C) encourage the nurse to report any incidents of bullying D) identify and address the employee's sources of stress

27. A nurse is helping to organize a supported employment (SE) program for clients with disabilities. What factor will best ensure the success of the program?

A) Employment pays enough for clients to have a comfortable living standard.

B) Placements are individualized to clients' abilities.

C) Placements are in the public sector, not private sector.

D) Clients are paired with other clients who have similar disabilities.

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28. A hospital has proposed a program that is aimed at reducing nurses' fatigue. What is the best rationale for implementing this program?

A) Fatigued nurses are less likely to collaborate with peers.

B) Fatigue contributes to increased sick calls.

C) Fatigue reduces nurses' job satisfaction.

D) Nurses' fatigue poses a safety risk to clients.

29. A violence prevention program has been introduced at a community health centre. What intervention is most likely to reduce nurses' risks of experiencing violence?

A) providing employees with self-defence training B) ensuring that security personnel are highly visible C) screening all clients for a history of recreational drug use D) creating high expectations for respectful, civil behaviour in the workplace

30. What action has the greatest potential to reduce the compassion fatigue of psychiatric–mental health nurses?

A) Provide opportunities for continuing education about client-centred care.

B) Give nurses adequate opportunities to debrief after critical incidents.

C) Prioritize nurses' security.

D) Provide nurses with 8-hour shifts rather than 12-hour shifts.

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Answer Key 1. B 2. A 3. D 4. B, D, E 5. D 6. C 7. A, C 8. B 9. A 10. B 11. D 12. B 13. C 14. A 15. B, D, E 16. D 17. A 18. A 19. A, C 20. A, B, C, E 21. A 22. D 23. D 24. A 25. C 26. D 27. B 28. D 29. D 30. B

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Chapter 17: Trauma and Stressor-Related Disorders, Crisis, and Response to Disaster Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition

A) B) C) D)

1. Which theorist first proposed the general adaptation syndrome (GAS)?

Richard Lazarus Holmes and Rahe Meyer Friedman Hans Selye

A) B) C) D)

2. How many people does a level I social support network consists of?

2 to 3 people 6 to 12 people 20 to 30 people 40 to 50 people

3. The nurse is assessing a client's social network. What concepts should the nurse use when assessing these? Select all that apply.

A) blood relationships B) aspirations C) reciprocity D) diagnoses E) intensity

4. Which statement about the intensity of social networks is accurate?

A) Ideally, an individual's social network reflects a balance between intense and less intense relationships.

B) It is defined as the extent to which there is balanced give-and-take in a relationship.

C) Sometimes members are on the giving side of the relationship; at other times, they receive.

D) Intense relationships can enhance a person's opportunity to interact with other network members.

5. A client is being faced with new stressors. Which mechanism is the body's first line of defence against these stressors?

A) coping skills B) parasympathetic nervous system C) melatonin D) the autonomic nervous system (ANS)

6. Which is the cumulative negative effects on the body of continually having to adapt to changing environmental conditions and psychosocial challenges?

A) allostatic load B) homeostasis C) chronic stress

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D) problem-focused coping

7. A client is facing high levels of stress and has an inability to cope. What consequences is the client likely to experience? Select all that apply.

A) ill health B) well-being C) diminished self-concept D) enhanced social functioning E) deterioration in social functioning

8. The nurse is assessing a client's coping. How should the nurse best understand this concept?

A) It remains static over the course of an encounter.

B) It must be assessed in relation to its outcomes.

C) It consists of what an individual thinks and does in response to the perceived demands of the situation.

D) Those who evaluate their coping responses as effective are likely to feel competent and repeat those responses in the future.

9. Which term is appropriate to describe incorporating feedback about the effects of coping and allows for continual processing of new information?

A) reappraisal B) social functioning C) allostasis D) stressors

10. Which model proposes that preexisting genetic, biologic, and psychological vulnerabilities interact with negative or stressful life events to cause illness?

A) adaptation model B) emotion-focused coping C) problem-focused coping model D) stress–diathesis model

11. Which client is most likely experiencing a traumatic stressor?

A) a client who is unable to reach a developmental milestone B) a client who is disinterested in participating in an activity that formerly provided pleasure C) a client with symptoms of depression in response to the death of a loved one D) a client who experienced a violent assault

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12. How is emotion defined according to Richard Lazarus?

A) a state of arousal B) a pervasive and sustained state C) organized psychophysiologic reactions D) alteration of feeling tone

13. Which statement most accurately describes the definition of stress that is the central premise in the Transactional Model?

A) a relationship between demands and the ability to deal with them B) a characteristic of the person C) a response of the person D) an environmental stimulus

14. Which action would show that the client is in the secondary level of cognitive appraisal in the Transactional Model?

A) The individual evaluates the situation and determines whether he or she is in danger.

B) The individual considers the options for dealing with the situation.

C) The individual makes a perception of threat or harm.

D) The individual lacks coping skills.

15. How would a person engage in problem-focused coping? Select all that apply.

A) attempt to alter another's behaviour B) attempt to alter one's own responses C) express emotions D) talk to friends E) write a journal entry

16. Which statement is true of problem-focused coping?

A) Problem-focused coping is aimed at the individual's own distress.

B) Problem-focused coping may be inner or outer directed.

C) An example of problem-focused coping is prayer/meditation.

D) Inner-directed strategies include altering another's behaviour.

17. Which is the best example of a situational crisis?

A) completing school B) divorce C) short-stay hospitalization D) birth of one's child

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18. Which statements about disasters are accurate? Select all that apply.

A) Disasters occur slowly over time.

B) Hazards that cause disasters can originate in the geophysical or biologic environment.

C) Disasters are only related to nature.

D) Disasters exceed a community's ability to cope.

E) Disasters can occur as a result of unintentional or malicious human action.

19. Which type of disaster most often has the greatest impact on mental health morbidity?

A) natural disasters B) malicious acts of terrorism C) disasters caused by human errors D) disasters caused by technical errors

20. Which circumstances would make it more likely for an individual to have a successful resolution of a crisis?

A) The person seeks help from a professional.

B) The person has experienced a prior stressor with greater magnitude.

C) The person possesses a realistic view of the situation.

D) The person increases his or her own pressures to quickly resolve the situation effectively.

21. Which are appropriate treatments for posttraumatic stress disorder (PTSD)?

Select all that apply.

A) medication B) reexposure C) psychotherapy D) electroconvulsive therapy (ECT) E) cognitive–behavioural therapy

22. Which are the overall goals of care for those individuals actively experiencing a stress response? Select all that apply.

A) to eliminate or moderate the stressor B) to reduce untoward effects of the stress response C) to facilitate the maintenance or development of positive coping skills D) to recognize the potential for stress E) to help the client remain free of stress in the long term

23. Which would be appropriate elements to include in a biologic assessment of an individual's response to stress?

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appetite and sleep mood judgement and insight concentration

24. Which are appropriate nursing interventions for the biologic domain for untoward stress responses?

A) assessing the need for better coping B) group therapy C) establishing daily routines of meals and sleeping D) fostering use of their social support system

25. Which should the nurse assess relative to the psychological effects of stress?

A) assessing for pain B) observing for affective indicators C) exploring the medical history D) inquiring about sleep patterns

26. In order to collect data regarding the person's social network, which should the nurse inquire about most closely?

A) the number of networks B) challenges faced with social networks C) the proximity of the networks to the client D) the length and quality of relationships

27. Which intervention is most important when a nurse attends to the spiritual domain of his or her practice?

A) listening B) providing his or her own answers to help C) providing time alone for personal growth D) identifying potential coping resources

28. The nurse is working with a client in crisis. Which is the most appropriate intervention for the nurse to facilitate the client's understanding of a crisis?

A) Provide direction of next steps for the client to take.

B) Listen and assist the client to articulate his or her feelings.

C) Allow the crisis to escalate to reach a quicker resolution.

D) Focus on long-term resolutions to prevent reoccurrence of the crisis.

29. The nurse is caring for a client who tells the nurse that he or she has a large social

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A) B) C) D) E)

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network but doesn't feel that he or she receives much support from them. Which should the nurse recognize as the negative effects of social dissupport? Select all that apply. depleted resources hindered growth stress buffering emotionally destructive stress reduction

30. In a community where a large-scale disaster has occurred, which survivor would most likely require psychiatric services?

A) a person who cried continuously for the first 3 days after losing his or her home and possessions B) a person who increased the use of alcohol and other substances for the first week after the loss of several friends C) a person who is actively engaged in recovery efforts for the first 2 weeks after the event D) a person who is fearful of leaving home 4 weeks after the event

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Answer Key 1. D 2. B 3. C, E 4. A 5. D 6. A 7. A, C, E 8. C 9. A 10. D 11. D 12. C 13. A 14. B 15. A, B 16. B 17. B 18. B, D, E 19. B 20. C 21. A, C, E 22. A, B, C 23. A 24. C 25. B 26. D 27. A 28. B 29. A, B, D 30. D

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Chapter 18: Anger, Aggression, and Violence Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A client visits the clinic and tells the nurse that no matter how difficult the child acts, the client simply cannot express any anger. Which should the nurse plan to assess the client for symptoms of?

A) depression B) panic disorder C) mania D) psychosis

2. Which factors influence the variations in expression of anger for both nurses and adult clients? Select all that apply.

A) previous experiences in expressing anger and others' reactions B) genetic predisposition C) chronologic age D) emotional development during infancy and childhood E) family environment

3. A fluctuation in dietary intake of which type of nutrient is linked to anger in persons already prone to aggressive behaviour?

A) fruits and vegetables B) tryptophan C) niacin D) vitamin A

4. Which foods may influence the levels of serotonin and ultimately affect expression of anger? Select all that apply.

A) whole-wheat bread B) corn on the cob C) a serving of dairy D) a serving of eggs E) butter

5. Which is the term for the interrelationship between the processes of the limbic system and the neurocognitive processes of the frontal lobe?

A) act of aggression B) emotional circuit C) interpretation beliefs D) neuroassociation model

6. A client's behaviour is characterized by impulsivity and difficulty controlling anger. What diagnosis is this client most likely to receive?

A) depression

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B) schizophrenia C) PTSD D) borderline personality disorder

7. Which factor related to the social domain may be contributing to aggression or violence in a client and should be evaluated by the nurse?

A) financial or legal troubles B) history of substance abuse C) any delusional thoughts D) any history of brain injury

8. A son brings his father to the mental health clinic following the father's head trauma from an automobile accident. The son tells the nurse that his father has recently become very impulsive and has frequent angry outbursts. Which structure should the nurse suspect that the client has sustained an injury to?

A) cerebral cortex B) spinal cord C) brainstem D) limbic system

9. The nurse is caring for a client hospitalized in an inclient psychiatric setting for a history of violent behaviours and delusions. The nurse would know that one possible explanation is that the client has low levels of which substance?

A) serotonin B) endorphin C) acetylcholine D) estrogen

10. The nurse is caring for an elderly client in a nursing home. The client has been irritable the entire day. Which would be an appropriate snack to offer the client to potentially decrease the irritability?

A) a chocolate bar B) a handful of raisins C) a granola bar D) a glass of milk

11. Which method was used by Freud to treat individuals who were aggressive?

A) behaviour modification B) confrontation of irrational beliefs C) catharsis and expressing emotions D) changing the client's personality traits

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12. According to the drive theory, which factor is most closely linked to a client's violent behaviour?

A) cognitive schema B) inadequate coping C) learned behaviours D) blocked goals

13. The nurse is caring for a group of clients in an inpatient psychiatric setting. The nurse should be on the alert for aggressive behaviours from a client who displays which other tendencies? Select all that apply.

A) accommodating B) adaptive C) withdrawn D) coercive E) argumentative

14. Which are possible determinants of violence suggested by sociocultural theories?

Select all that apply.

A) social experiences with family B) gender differences C) neurotransmitter levels D) experiences with peers E) social consequences of physical aggression

15. Which is a factor that may contribute to violence against women according to sociocultural theories?

A) hormonal factors B) conceptualizations of gender roles C) a sense of entitlement in women D) cognitive schema such as judgements

16. The nurse is orienting a new staff member in an inclient mental health unit when a client begins to act in a violent manner. Which is the most plausible reason that some clients use violence and aggression? The client may use violence and aggression to do what?

A) get what he or she wants B) relive his or her childhood experiences C) practice assertiveness skills D) be placed in his or her room by him or herself

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17. Which intervention by the nurse is most likely to prevent a crisis or defuse a critical situation?

A) Speak loudly and let the client know that this behaviour is not tolerated.

B) Try to clarify what has upset the client.

C) Inform the client that the nurse is in charge of situation.

D) Offer medication as the solution to the outburst.

18. Which aspect of the client's thought process would be most indicative of a client's potential for aggression and require the nurse to focus on these aspects?

A) judgement B) aspirations C) insight D) perceptions

19. The nurse suggests that clients explore new ideas about a particular problem and to consider other possibilities. What type of intervention has the nurse provided?

A) validating B) cognitive intervention C) affective intervention D) behavioural intervention

20. Which approach used by the nurse is most likely to de-escalate a situation where the client is becoming aggressive?

A) use of quiet calmness B) use of assertive body language C) therapeutic touch D) reprimanding the client

21. Which nursing interventions would be most appropriate for the biologic domain?

Select all that apply.

A) administering and monitoring medications B) validating by acknowledging the client's intense feelings C) listening to the client's illness experience D) managing nutrition E) exploring the client's beliefs about the expression of anger

22. Which nursing interventions would be affective interventions? Select all that apply.

A) administering medications B) validating the client's intense feelings

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C) offering information D) listening to the client's experience E) exploring the client's beliefs

23. A nurse on the unit is talking with a client with a history of violent behaviour towards others. Which actions by the nurse would minimize the risk during this one-on-one intervention?

A) closing the door to the client's room B) sitting as close to the client as possible C) having the client sit furthest from the door D) administering medication to the client

24. Which is the most important reason that nurses working in a clinical situation be provided with regular training programmes in the prevention and management of aggressive behaviour? To: A) meet legal requirements.

B) reinforce and update what they have learned.

C) share personal experiences.

D) be aware of current incidences reported in other hospitals.

25. Which type of violence is most commonly directed towards nurses?

A) verbal abuse B) assault C) battery D) sexual abuse

26. When is it appropriate for the nurse to consider using seclusion and restraint?

A) for a client who is observed to be pacing quickly on the unit B) as an initial consideration to a client with a history of violence who is shouting at a another client C) when all other interventions have failed to control the client's behaviour D) for a client who is refusing to take a PRN medication when offered for agitation

27. Which nursing interventions will create a therapeutic relationship and decrease the potential for a client to become violent? Select all that apply.

A) advocating for the client as appropriate B) being available for the client C) collaborating with the team and family to decide on the most appropriate action D) providing client education E) collaborating with the client in treatment planning

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28. Which frame of reference would a nurse be using when thinking about client aggression and violence and decides to administer medication to prevent aggressive behaviour?

A) circular causality B) hierarchical nurse–client relationship C) mindfulness D) linear causality

29. Which client characteristic would create the highest risk of the client becoming violent and necessitate the nurse to prioritize extra effort to prevent violence?

A) diagnosed with panic disorder B) history of generalized anxiety disorder C) being treated for a somatoform disorder D) previous episodes of rage

30. Which characteristic would a nurse likely observe in a client who is achieving the desired outcome of aggression control?

A) showing an increased tolerance for frustration B) using increased doses of medication to reach a desired effect C) displaying increasing motor activity D) keeping his or her thoughts and feelings to himself or herself

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Answer Key 1. A 2. A, B, D, E 3. B 4. A, B, C, D 5. B 6. D 7. A 8. A 9. A 10. D 11. C 12. D 13. D, E 14. A, B, D, E 15. B 16. A 17. B 18. D 19. B 20. A 21. A, D 22. B, D, E 23. C 24. B 25. A 26. C 27. A, B, D, E 28. D 29. D 30. A

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Chapter 19: Self-Harm Behavior and Suicide Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which best describes suicide ideation?

A) depression and the absence of hope B) thinking about and planning one's own death C) self-harm that mimics suicidal behaviour, but intent is not to kill oneself D) wishing that one had the strength to commit suicide

2. The nurse is assessing a client who may be at risk for suicide. What characteristic creates the greatest risk for suicide?

A) unemployment B) death of the client's spouse C) previous attempt D) polydrug use

3. Which term is appropriate when the client lives through an experience of suicide despite having expected or intended to die?

A) attempt of suicide B) parasuicide C) suicidal behaviour D) suicidal ideation

A) B) C) D)

4. Which is the best definition of suicide? the engagement of suicidal behaviour where death has occurred the primary motivating force of action to not to kill oneself the voluntary and intentional act of killing oneself living through a traumatic experience and unintentionally killing oneself

5. Which is the most important protective factor that may explain the differences in suicidal rates between different Aboriginal communities?

A) gender differences B) age distribution C) geography D) self-government

6. The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse's teaching plan? Select all that apply.

A) Middle-aged (45 to 59 years) persons have among the highest suicide rate.

B) Suicide rates are generally lower for married persons.

C) Firearms are the now the most common method used by Canadian adolescents.

D) Death by suicide can be difficult to identify in some cases.

E) Child abuse is a specific vulnerability for psychopathology and suicide.

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7. The nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. Which client should the nurse institute special precautions to prevent suicide for?

A) a male with bipolar I disorder B) a female with acute stress disorder C) a male with major depressive disorder D) a female with somatoform disorder

A) B) C) D)

8. Persons of which marital status are the least likely to commit suicide? divorced widowed single married

A) B) C) D)

9. Which characteristic increases the risk of suicide completion in older adults? stronger intent to die than many younger people wider availability of methods for attempting suicide better understanding of the functioning of the human body greater access to firearms than younger people

10. Which would be an appropriate situation when a client should be physically restrained or involuntarily hospitalized? Select all that apply.

A) when the client is under the threat of imminent suicide B) when the client's status is “noncompetent” according to the mental health act C) when the client is an imminent risk to self D) when the client is an imminent risk to others client E) when the client with depression rejects treatment

11. Which principles are adhered to when a nurse clearly and specifically explains the limits of confidentiality? Select all that apply.

A) It builds and preserves the therapeutic relationship.

B) It allows the nurse to protect the client's or others' safety.

C) It makes it clear that the nurse will not, under any circumstances, share information with anyone else.

D) It makes it clear that the nurse will share information with others when the nurse deems it necessary.

E) It limits the nurse's actions to the client's desires.

12. While caring for a potentially suicidal client in a psychiatric unit, the client

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confides in the nurse that he or she has “figured out a way to commit suicide while in the hospital setting.” The priority nursing action is to do what?

Maintain the client's confidentiality.

Ask the client why he or she believes suicide is a solution.

Contact the hospital's security department.

Determine what is necessary to ensure the client's ongoing safety.

13. What skill will best enable a nurse to meet the health and safety needs of client with suicidal ideation?

A) allowing the client to have time alone B) knowing how to engage with and respond to the client C) being able to provide education about the harm of a suicidal act D) encouraging the client not of think about suicide

14. Which feeling of the client is most likely to escalate self-harm behaviour?

A) being embarrassed by his or her own actions B) being ignored and minimized by his or her caretaker C) learning his or her pain is recognized by others D) being curios about what would result from self-harm

15. A 32-year-old female is admitted to the inpatient unit for depression with suicidal thoughts. When completing the nursing assessment, the nurse should be alert for which risk factors that may be related to biologic theories of self-harm? Select all that apply.

A) history of a parent having completed suicide B) history of being a victim of child abuse C) history of a spouse having completed suicide D) history of a sibling having completed suicide E) history of an offspring having completed suicide

16. When screening a client for suicide risk, which questions would the nurse ask?

Select all that apply.

A) What is troubling you most at the moment?

B) Have you ever thought of harming yourself?

C) Why would you consider suicide a solution?

D) Do you have someone you recognize as supportive?

E) Do you currently have a plan to harm yourself?

17. Assessing the spirituality of a client with suicidal thoughts helps the nurse to identify what factor?

A) coping resource

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B) family support C) learned helplessness D) decreased self-esteem

18. Which suicide risk assessment includes a global assessment of suicide risk?

A) Tidal Model B) Beck Scale for Suicide Ideation C) Nurses' Global Assessment of Suicide Risk D) Suicide Intent Scale

19. The nurse is planning to assess a depressed client to determine if she or he is at increased risk for suicide. The nurse wants to use a short screening test that is useful to determine if the client has a strong intent to die. Which assessment would be the best choice?

A) Beck's Suicide Intent Scale B) Quick Diagnostic Interview Schedule C) National Institute of Mental Health's Diagnostic Interview Schedule D) Primary Care Evaluation of Major Depression and Subscales

20. Which would be the rationale for the nurse to assess the context of each act of prior self-harm behaviour? Select all that apply.

A) It gives a message of interest and concern.

B) It helps the client to see that his or her own behaviour is to blame.

C) It creates a judgemental attitude.

D) It can be the first step in helping the client meet needs and wants in more healthy ways.

E) It helps the nurse to understand the motivation behind the behaviour.

21. Which social factors have been found to be associated with suicide in several studies? Select all that apply.

A) socioeconomic deprivation B) not believing in God C) lack of religiosity D) history of violence against others E) unemployment

22. Which two variables determine the probability that a person will complete suicide? Select all that apply.

A) the seriousness of the person's intent B) the likelihood that the planned method will result in death C) the amount of rage that a person has

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D) whether the person is receiving psychiatric assistance E) whether the person is compliant with medication

23. Which types of clients are good candidates for safety contracting? Select all that apply.

A) clients who have made a previous suicide attempt B) clients who are psychotic C) clients who are competent D) clients who are suicidal adults E) clients who are extremely isolated

24. Which statements about contracting for safety are accurate? Select all that apply.

A) A no self-harm contract can only be negotiated after a thorough assessment of the client has been completed.

B) A contract for safety can be instituted on any client.

C) Contracting for safety is an evidence-based practice.

D) The effectiveness of safety depends upon the client's ability to keep a commitment of this kind.

E) If a no self-harm contract has been instituted, the record must contain specific provisions of the contract.

25. Which nursing intervention is most likely to maintain a safe environment for a client who is suicidal?

A) creating a stimulating environment B) maintaining confidentiality at all times with the client C) observing the client regularly D) ensuring that the client has access to all of his or her personal belongings

26. Which statement describes the most important reason that newer antidepressant medications would be prescribed for a client who has suicidal thoughts?

A) They do not have side effects.

B) The onset of action is achieved within the first 48 hours.

C) They decrease serotonin levels rapidly to minimize suicidal thoughts.

D) They are not as toxic as older antidepressants if taken as intentional overdose.

27. Which of these problems is a nurse working with suicidal clients most vulnerable to?

A) helplessness B) anger C) compassion fatigue D) hypovigilance

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28. A client has just been admitted to an inpatient psychiatric setting after an unsuccessful suicide attempt. When should the discharge planning begin?

A) prior to admission B) any time prior to discharge C) after the discharge has been ordered D) immediately after the client is admitted

29. Which specific information is critical for the nurse to provide to the client who is being discharged after an unsuccessful suicide attempt and subsequent hospitalization?

A) How to obtain emergency psychiatric care?

B) The names of significant others who can provide support.

C) The names of social groups that can provide support.

D) Which supporter should bear the responsibility for his or her safety?

30. A nurse is caring for a client whose spouse has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important?

A) Refer the client for long-term psychotherapy.

B) Determine the client's risk of psychosis.

C) Determine whether anyone in the client's family has had depression.

D) Ask the client whether he or she is thinking about killing himself or herself.

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Answer Key 1. B 2. C 3. A 4. C 5. D 6. A, B, D, E 7. C 8. D 9. A 10. A, B, C, D 11. A, B 12. D 13. B 14. B 15. A, D, E 16. A, B, D, E 17. A 18. A 19. A 20. A, D, E 21. A, E 22. A, B 23. C, D 24. A, D, E 25. C 26. D 27. C 28. D 29. A 30. D

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Chapter 20: Schizophrenia Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is caring for a client in an inpatient mental health setting. While conversing, the client continually repeats the nurse's words in a repetitive fashion. Which term would the nurse use to document this verbal behaviour?

A) echopraxia B) neologisms C) tangentiality D) echolalia

2. While caring for a client in an inpatient mental health unit, the nurse observes that the client is saying words in sequence that have no connection to each another. Which term should the nurse use to describe the client's verbal behaviour?

A) word salad B) metonymic speech C) loose associations D) circumstantiality

3. While caring for a client with schizophrenia in an inpatient setting, the nurse is discussing the client's childhood when the client switches the subject to employment at a local grocery store. The client never returns to the discussion of his or her childhood. Which term should the nurse use to describe this client's verbal behaviour?

A) loose associations B) circumstantiality C) tangentiality D) referential thinking

4. A 17-year-old is experiencing the initial onset of behaviour changes that are associated with schizophrenia. What should the nurse identify?

A) first-episode psychosis B) prodromal symptoms C) echopraxia D) recovery

5. A young man diagnosed with schizophrenia has a decreased desire to engage in hobbies and relationships. Which term would the nurse use to describe this behaviour?

A) dystonia B) tardive dyskinesia C) regressed behaviour D) emotional blunting

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6. A client with schizophrenia has experiences several relapses over the past year.

Which is the effect of each subsequent relapse?

A) increased dosage of antipsychotic medication B) increased recovery period C) decreased possibility of side effects from antipsychotic medication D) decreased need of family support

7. Which type of delusion would be manifested when a client experiences a belief that he or she is being laughed at by people around him or her?

A) grandiose delusions B) nihilistic delusions C) somatic delusions D) persecutory delusions

8. What assessment finding most clearly shows that a client is experiencing the negative symptoms of schizophrenia?

A) The symptoms are not relieved by antipsychotic medication.

B) Client expresses far less emotion than other people.

C) The client describes sights and sounds that are not there.

D) The client demonstrates tangential thinking.

9. Which term would the nurse use to best describe the affect of a client who does express emotions but the expression is much diminished?

A) positive symptoms B) blunted affect C) apathy D) full range

10. Which neurocognitive functions most often remain normal in clients with schizophrenia? Select all that apply.

A) long-term memory B) short-term memory C) intellectual functioning D) information processing E) thinking patterns

11. Which is the best description about recent findings with positron emission tomography (PET) scans of persons who have schizophrenia?

A) a general reduction in brain metabolism B) an increase cerebral blood flow capacity

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C) hypometabolism on right side of the brain D) increased serotonin levels in right side of the brain

12. Which process that is regulated by the mesolimbic tract is thought to be the cause of hallucinations and delusions?

A) abnormal body movements B) memory and emotion C) attention and social behaviour D) retention of information

13. Which statement about the patterns of family interaction that seem to affect the eventual outcome and social adjustment of individuals with schizophrenia is most accurate?

A) Family patterns that have high expressed emotion tend to be associated with increases in the client's positive symptoms and relapse.

B) Family patterns that have low expressed emotion tend to be associated with increases in the client's positive symptoms and relapse.

C) Families that rate high in the areas of criticism, hostility, and battles for control tend to be associated with infrequent positive symptoms and relapse.

D) Family patterns that are high in expressed emotion are associated with a greater family history of chronic schizophrenia.

14. Which are major social barriers that prevent people with mental illness from getting the care that they need? Select all that apply.

A) the stigma that surrounds mental illness B) particular challenges posed in more remote rural regions C) widespread availability of timely, comprehensive mental health care D) every provider focusing on recovery-oriented mental health services E) characterization of symptoms of schizophrenia as being normal

15. Which is a negative consequence of categorizing families as either high in emotional expression (EE) or low in EE? A) Families that are high in EE must be blamed for the positive symptoms and relapse of the client.

B) Families that are low in EE must have limited contact with the client.

C) EE will positively affect the client's positive symptoms and relapse.

D) Professionals may alienate families who are so vital to the care and support of the client.

16. The nurse is caring for a client with schizophrenia. What factor would be most likely to increase the client's risk for aggression?

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The client believes that someone is going to do him or her harm.

The client demonstrates echopraxia.

The client has uncontrollable repetitive, purposeless movements.

The client demonstrates delayed development.

17. Which situation would most clearly suggest that a person is experiencing an illusion?

A) when the person believes something is happening when it is really not B) when a person misperceives or exaggerates stimuli that are present C) when a person becomes isolated from others D) when a person deceives others into believing what they see

18. Which nursing diagnosis is based in the biologic domain?

A) affective lability B) social isolation C) self-care deficit D) excess religiosity

19. Which nursing diagnoses are related to the biologic domain in persons who have schizophrenia? Select all that apply.

A) self-care deficit B) altered mood states C) social isolation D) excess religiosity E) disturbed sleep pattern

20. Which would be the most appropriate action for a client with schizophrenia who frequently reports thirst?

A) to encourage the client to drink as much water as needed to quench his or her thirst B) to restrict the client's fluid intake to 750 mL/day C) to restrict the client's fluid intake to 1 L/day D) to monitor the client's physical status closely

21. Which is the most important symptom that a nurse should monitor frequently for when caring for a client diagnosed with chronic schizophrenia and tardive dyskinesia?

A) hypothermia B) choking C) hypertension D) excess perspiration

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22. The nurse is caring for a client who has been prescribed an antipsychotic medication for the treatment of schizophrenia. Which symptom would be considered an antiadrenergic effect?

A) dry mouth B) weight gain C) tremors D) decreased blood pressure

23. A client has just been prescribed clozapine. Which symptom would the nurse teach the client to be sure to alert the health care provider to? Select all that apply.

A) sore throat B) weakness C) fever D) morning drowsiness E) increased appetite

24. Which statements about the discontinuation of antipsychotic medications are accurate? Select all that apply.

A) Many clients stop taking medications on their own.

B) Except in emergency situations, antipsychotic medication dosages should be gradually lowered before discontinuing.

C) The client will only need to take antipsychotic medications as long as he or she has symptoms of psychosis.

D) Two reasons that may necessitate the immediate cessation of antipsychotic medications are neuroleptic malignant syndrome and agranulocytosis.

E) It is common for psychiatrists to discontinue medications in a client who has chronic schizophrenia.

25. When the client is experiencing an acute episode of schizophrenia and has just been hospitalized, which is the priority of care?

A) treatment with antipsychotic medication B) establishing boundaries C) seclusion or physical restraints D) assigning goals to the client

26. During which time period would nursing interventions focused towards recovery goals be most important?

A) acute phase B) periods between exacerbations C) medication stabilization phase

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D) diagnosis of first-episode psychosis

27. The nurse is working with a client who has schizophrenia. The client has undergone an abrupt discontinuation of prescribed antipsychotic medication. The nurse should assess for what possible consequence?

A) dysarthria B) catatonia C) withdrawal psychosis D) neuroleptic malignant syndrome

28. Which factor is more likely to encourage recovery in a client who has schizophrenia?

A) access to meaningful activity B) independence with little support from a social environment C) isolation, or time alone D) utilizing multiple caregivers for crisis intervention

29. Because most individuals will not spontaneously share their hallucinatory experiences with an interviewer, nurses may need to rely on indirect evidence in the client's behaviour. Which might be manifested by a client who is having hallucinations? Select all that apply.

A) pauses during conversations in which the individual seems to be preoccupied or listening to someone other than the interviewer B) engaging reasonably with the interviewer's statements and questions C) validating observations of the interviewer he or she is experiencing a hallucination when asked D) looking towards the perceived source of a voice that is not the interviewer E) responding to a conversation that the interviewer is not a part of when the interviewer is the only other person in the room

30. Which are expected client outcomes for a client who is experiencing hallucinations or delusions? Select all that apply.

A) decreased frequency and intensity of hallucinations and delusions B) recognition that hallucinations and delusions are symptoms of a brain disorder C) managing the recurrence of hallucinations or delusions D) ability to cease all medication E) social isolation

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Answer Key 1. D 2. A 3. C 4. B 5. D 6. B 7. D 8. B 9. B 10. A, C 11. A 12. B 13. A 14. A, B 15. D 16. A 17. B 18. C 19. A, E 20. D 21. B 22. D 23. A, B, C 24. A, B, D 25. A 26. B 27. C 28. A 29. A, D, E 30. A, B, C

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Chapter 21: Schizoaffective, Delusional, and Other Psychotic Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A client who has a history of a major depressive episode but had been functioning much better tells the nurse that for the last 2 weeks he or she has been hearing voices and at times thinks that someone is following him or her.

Which would be the most likely diagnosis that the health care provider formulates?

A) paranoid schizophrenia B) undifferentiated schizophrenia C) brief psychotic disorder D) schizoaffective disorder

2. Which of these diagnoses generally has the worst long-term outcome?

A) schizoaffective disorder (SCA) B) bipolar disorder C) depression D) schizophrenia

3. Which is the most common age of onset of schizoaffective disorder (SCA)?

A) childhood B) late adulthood C) early adulthood D) adulthood

4. The nurse is caring for a client who was diagnosed with schizoaffective disorder 2 years ago. Which comorbidities may pose increased risk for suicide? Select all that apply.

A) depression B) use of alcohol or substances C) cigarette smoking D) previous hospitalizations E) quiescent periods 5. A client is characterized by stating he or she feels like he or she is a “chronic roller coaster ride” of symptoms. What is this client's most likely diagnosis?

A) schizoaffective disorder (SCA) B) schizophrenia C) depression D) dementia

6. The nurse is caring for a client with schizoaffective disorder. The nurse should assess the client carefully for signs of what?

A) insomnia

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B) acts of aggression C) suicide D) anxiety disorder

7. Which statement about the aetiology of schizoaffective disorder (SCA) is accurate?

A) Poor family dynamics affect the development of SCA. B) Underactivity of the dopamine pathways results in SCA. C) The individual's birth order in the family affects the development of SCA. D) A clear familial pattern has not been established for SCA.

8. Which statement about the association of schizoaffective disorder (SCA) with gender is accurate?

A) SCA is more likely to occur in women than in men.

B) SCA is more likely to occur in men than in women.

C) Men with SCA are more likely to have better outcomes for symptom control and employment.

D) Men with SCA are behaviourally less violent when ill.

9. Which nursing diagnoses are common for the biologic domain in persons who have schizoaffective disorder? Select all that apply.

A) disturbed thought process B) disturbed sensory perception C) ineffective coping D) disturbed sleep patterns E) hopelessness

10. Clients receiving antipsychotic medications need to be aware of developing metabolic syndrome. Which disease processes are typically associated with metabolic syndrome? Select all that apply.

A) diabetes mellitus B) dyslipidaemia C) hypertension D) obesity E) hyperthyroidism

11. A client diagnosed with schizoaffective disorder with severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. Which nursing intervention would be the most important for this client? The nurse should help the client to do what?

A) Gain assistance from family members.

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B) Contact the health care provider for a change in medications.

C) Establish a routine and set goals.

D) Outline the side effects of the medications.

12. The nurse is caring for a client with schizoaffective disorder (SCA) with depression. Which statements about pharmacologic intervention are true? Select all that apply.

A) Atypical antipsychotic agents are less effective than standard antipsychotic agents and antidepressants.

B) It may be necessary to use a combination of antipsychotic and antidepressant agents.

C) Long-term atypical antipsychotic agents are as effective as standard antipsychotic agents and antidepressants.

D) It is contraindicated to use valproic acid with the antipsychotic agents.

E) Pharmacologic intervention is needed to stabilize the symptoms.

13. The nurse is caring for a client with schizoaffective disorder (SCA) with depression. Which should the nurse instruct the client about treatment with medication?

A) “The medication can be discontinued as soon as you feel a little better.”

B) “The maximum dosage will be the first dose, and then it will be reduced as you develop side effects.”

C) “You will likely need to remain on medication for the disorder.”

D) “It will not be necessary for you to have psychotherapy also.”

14. A client has been diagnosed with treatment-refractory schizoaffective disorder (SCA) of the depressive subtype, and clozapine was prescribed. Which would be appropriate for the nurse to explain to the client about clozapine therapy?

A) Clozapine requires weekly blood work.

B) Clozapine may result in weight loss.

C) Clozapine can reduce hospitalizations and risk for suicide.

D) Clozapine is usually combined with lithium for this diagnosis.

15. A client with schizoaffective disorder is prescribed clozapine to treat her or his symptoms. Which symptom should the nurse caution the client to notify the health care provider immediately?

A) dry mouth B) urinary frequency C) rapid weight gain D) drowsiness

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16. The nurse has taught a stabilized client to collaborate with professionals to make a crisis plan? What can the crisis plan help to identify?

A) delusional symptoms B) need for hospitalization C) need for ECT treatment on next hospitalization D) prodromal symptoms of decompensation

17. Which client teaching will specifically help to reduce the risk of falls in clients who take antipsychotic medications? Select all that apply.

A) Advise clients to change positions slowly.

B) Advise clients that it is safe to use over-the-counter medications.

C) Advise clients to contact their health care providers immediately if they have a dramatic increase in temperature.

D) Advise clients to report symptoms of diabetes mellitus.

E) Advise clients to maintain adequate fluid intake.

18. A nurse teaching a client about prescribed antipsychotic medication should inform the client to contact the health care provider immediately if he or she notices what change?

A) increase in weight of 1 kg or more in 1 month B) feeling dizzy for a second when the client first stands C) increase in thirst D) dramatic change in temperature

19. A nurse is providing care to a client with schizoaffective disorder during hospitalization for acute psychosis. Which nursing intervention would be most likely to encourage the client to trust staff and nursing care?

A) offering reassurance in a soft, nonthreatening voice B) reminding the client that delusions are not real C) encouraging the client to participate in group therapy daily D) avoid giving the client detailed information about the treatment plan

20. Medication regimens for clients with schizoaffective disorder (SCA) are complex. This may include which categories of medications? Select all that apply.

A) antipsychotics B) stimulants C) antidepressants D) mood stabilizers E) antianxiety agents

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21. Which statement about delusional disorder is most accurate?

A) The delusions are usually bizarre and nonsensical.

B) Delusions are false, fixed beliefs that are unchanged by reasonable arguments.

C) Delusions are always something that could never occur.

D) Delusions occur when the person misperceives stimuli that are present.

22. Which statements about delusional disorder are true? Select all that apply.

A) Delusional disorder may be encountered in a medical–surgical setting.

B) Delusional disorder usually renders a client helpless.

C) Delusional disorder is commonly of a week's duration or less.

D) Delusional disorder is difficult to distinguish from mood disorders with psychotic features.

E) Nonbizarre delusions are characterized by possible situations that could occur in real life.

23. Which type of delusions would be manifested by the client's beliefs that he or she is being malevolently treated in some way?

A) grandiose type B) persecutory type C) somatic type D) unspecified type

24. Which statement about the aetiology of delusion disorder is accurate?

A) There is likely a neurophysiologic cause.

B) There is likely a neuropsychological cause.

C) The cause of delusional disorder is usually spiritual.

D) It is important to carefully rule out possible medical reasons.

25. In which type of setting is a nurse more likely to encounter a person with delusional disorder?

A) inpatient psychiatric unit B) outpatient psychiatric care C) Alzheimer's unit D) medical–surgical unit

26. A nurse is planning interventions from the psychological domain for a client with a delusional disorder in the outpatient setting. Which type of interventions would the nurse be likely to select?

A) insight-oriented therapy B) supportive therapy C) reality therapy

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D) physical therapy

27. Which nursing diagnoses from the social domain might be appropriate for a client with a delusional disorder? Select all that apply.

A) interrupted family processes B) chronic confusion C) acute confusion D) ineffective coping E) ineffective role performance

28. Which must a nurse who is providing therapy for a client with delusional disorder remember when evaluating outcomes?

A) In most cases, outcomes are easily attained.

B) Outcomes are usually maintained for a short period only.

C) Outcomes are considered achieved when delusions completely disappear within 6month time.

D) Outcomes are often not met completely.

29. Which statement about the needs of a client with diagnosis of brief psychotic episode is most accurate?

A) The best outcomes are achieved on an outpatient client basis.

B) Electroconvulsive therapy is the first-line treatment.

C) Supervision may be required to prevent suicide.

D) Cognitive therapy is indicated.

30. Which diagnosis may be an early manifestation of schizophrenia?

A) delusional disorder B) schizophreniform disorder C) bipolar affective disorder D) schizoaffective disorder

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Answer Key 1. D 2. D 3. C 4. A, B, C, D 5. A 6. C 7. D 8. A 9. A, B, D 10. A, B, C, D 11. C 12. B, C, E 13. C 14. C 15. C 16. D 17. A, E 18. D 19. A 20. A, C, D, E 21. B 22. A, D, E 23. B 24. D 25. D 26. B 27. A, D, E 28. D 29. C 30. B

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Chapter 22: Depressive, Bipolar, and Related Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which are likely the most serious complications that are associated with major depression? Select all that apply.

A) disruption in energy B) disruption in sleep C) disruption in appetite D) suicidality E) alcohol abuse

2. The nurse makes a home visit to a client who has dysthymic disorder. Which symptoms might the nurse anticipate that the client will have?

A) low energy B) intense concentration C) agitation D) excessive appetite

3. The nurse is assessing a client who visits the community mental health centre.

Which factors in the client's history would be a risk factor for depression that the nurse must be certain to assess? Select all that apply.

A) prior episodes of depression B) family history of depressive disorder C) hospitalization for minor surgery D) sad feelings from time to time E) childhood abuse

4. A nurse assesses a client with mood disorders and observes the client's mood as mildly reduced in range and intensity of emotional expression. Which would the nurse document?

A) pathologic affect B) inappropriate affect C) labile affect D) restricted affect

5. Which term would apply for a milder but more chronic form of major depressive disorder that includes a depressed mood for most days for at least 2 years, low energy, and insomnia?

A) recurrent depression B) dysthymic disorder C) cyclothymic disorder D) bipolar disorder

6. A client assessed with the diagnosis of depression reports not feeling any

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enjoyment in activities that were previously considered pleasurable. Which term would the nurse use in documenting this? labile worthlessness anhedonia dysphoria

7. Which would be expected symptoms in a client who is diagnosed as having a major depressive episode? Select all that apply.

A) hypersexuality B) disruption of concentration C) excessive guilt D) impulsivity E) psychomotor agitation

8. The nurse is teaching a depressed client about the importance of medication adherence. Which adverse effects would be expected if the client would abruptly discontinue medication?

A) serotonin syndrome B) worsened symptoms of depression C) gastrointestinal symptoms D) hypertension

9. Which are advantages of early diagnosis of a mood disorder? Select all that apply.

A) The client can keep the illness hidden from friends and family.

B) The need to keep the diagnosis hidden, even from oneself is eliminated.

C) Awareness can lead to acceptance by clients and their families.

D) Increased awareness is fundamental to combating misperceptions.

E) Increased awareness is a principle “weapon against stigma.”

10. A common false belief that many clients and their significant others may have is that the client should just “snap out of it.” Which is the most likely effect of this belief?

A) It creates unnecessary guilt in the client.

B) It serves as a motivating factor to encourage wellness.

C) It helps the significant others to know they are not at fault.

D) The client is motivated to adhere to treatment.

11. Which theory regarding the causative psychodynamic factors in the aetiology of depression is most recent?

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A) a deficiency or dysregulation in the concentrations of neurotransmitters B) a hyperactivity of the brain's amygdala contributing to negative processing of stimuli C) an early lack of love, care, warmth, and protection, with resultant anger, guilt, and helplessness D) a “cognitive vulnerability” to depression due to uncorrected negatively biased processing

12. What should the nurse teach a client with bipolar disorder about safely and effectively taking lithium?

A) Take them on an empty stomach.

B) Do not discontinue them abruptly.

C) Take them with food.

D) Monitor heart rate during treatment.

13. Which is the overriding concern for people with mood disorders?

A) safety B) self-care C) sexual function D) sleep regulation

14. When should the nurse be especially vigilant in protecting the client with depression from self-harm? Select all that apply.

A) during the depths of a depression B) as the client feels better and has more energy C) if previously depressed and appears to be energized overnight D) between episodes of chronic depression when the client feels good E) after the client has been stabilized on antidepressant therapy

15. A client has been diagnosed with major depression. Which is the most common sleep disturbance associated with depression?

A) narcolepsy B) somnambulism C) hypersomnia D) insomnia

16. A nurse is caring for a client who has been prescribed lithium. Which should the nurse focus on as a potential drug–drug interaction with lithium when the client is also taking an angiotensin-converting enzyme inhibitor such as captopril? The interaction may include: A) increase in serum lithium levels.

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B) increase in renal excretion and decrease in lithium levels.

C) lithium tremor.

D) decreased effectiveness of lithium.

17. During which phase of treating a client with bipolar disorder can the frequency of appointments usually be reduced?

A) acute phase B) continuation phase C) subacute phase D) wellness phase

18. Which should the nurse focus on when performing an ongoing assessment of a client with mania? Select all that apply.

A) delusional content B) potential for impulsivity C) sleep patterns D) intrusiveness E) diet and body weight

19. Which would be appropriate nursing interventions that will address the spiritual nature of persons with mood disorders? Select all that apply.

A) Teach the client the nurse's spiritual beliefs.

B) Engage the client in guided conversations about spiritual beliefs.

C) Engage the client in personal life storytelling.

D) Engage the client in ritual experiences consistent with his or her beliefs.

E) Insist that the client attend church services.

20. Which would be positive outcomes of interventions for the spiritual domain?

Select all that apply.

A) relief of distress B) make meaning of suffering C) nurture hope D) promote spiritual resolution and wellness E) increased adherence to treatment

21. Which factor would increase the risk for relapse and poorer treatment outcomes for a client with bipolar disorder?

A) being female B) being married C) being obese D) being employed

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22. Which would be the expected outcome of the nurse using cognitive therapy techniques with the client during the acute phase of major depression?

A) The client will have greater knowledge.

B) The client will have reduced depressive symptoms.

C) The client will make a complete recovery.

D) Anxiety will be eliminated.

23. A client admitted to the hospital for depression may refuse to participate in activities. Which might be the effect of an overlying enthusiastic approach by the nurse? It might: A) provide a positive therapeutic approach.

B) irritate the client and block communication.

C) increase the symptoms of depression.

D) facilitate a change in a brighter mood and affect.

24. The nurse is caring for a client with a mental disorder. Which will best enable the nurse to respond to the individual more effectively?

A) being present with the client at all times B) the nurse having had a psychiatric diagnosis himself or herself C) the nurse establishing goals D) understanding the individual's personal experience of receiving a psychiatric diagnosis

25. A nurse is caring for a client with major depression. The client tells the nurse that the client “just isn't sure that life is worth living.” The nurse documents which nursing diagnosis as the priority?

A) self-esteem, low, related to depressive episode B) hopelessness related to symptoms of depression C) anxiety related to lack of energy for self-care activities D) thought processes, disturbed, related to memory loss and depression

26. A nurse is preparing to assess a middle-aged client who was brought to the emergency department by the client's spouse. The spouse reports that the client has been “extremely depressed lately.” When assessing this client, which would be a priority assessment?

A) changes in sleeping patterns B) thoughts of self-harm C) appetite changes D) level of fatigue

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

A) “You will receive a short-acting anaesthetic to relax you.”

B) “You will be awake and alert during the procedure.”

C) “You can resume your normal activities right after the treatment.”

D) “We will need to shave your scalp at the area where the magnet is placed.”

E) “You might feel a moderate amount of stinging at the site.”

28. During assessment of a client with depression, the client states, “I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to.” The nurse documents this finding as indicative of what?

A) dysthymic disorder B) anhedonia C) delusion D) psychosis

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

A) avoiding people B) sleeping more than usual C) talking faster than usual D) being hungry all the time E) reading several books at once

30. A client receiving lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess?

A) slurred speech B) fine resting hand tremor C) loose stools D) muscular weakness

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Answer Key 1. D, E 2. A 3. A, B, E 4. D 5. B 6. C 7. B, C, E 8. B 9. B, C, D, E 10. A 11. D 12. B 13. A 14. A, B, C, D 15. D 16. A 17. B 18. B, C, E 19. B, C, D 20. A, B, C, D 21. C 22. B 23. B 24. D 25. B 26. B 27. B, C 28. B 29. C, D, E 30. A

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Chapter 23: Anxiety, Obsessive Compulsive, and Related Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which must be accepted or faced to avoid subverting the everyday life of a human?

A) existential anxiety B) physical manifestations of anxiety C) conditioning theories D) misconceptions of exposure therapy

2. Which statements about anxiety and panic are true? Select all that apply.

A) It can be an extreme form of anxiety when an individual is placed in a real or perceived life-threatening situation.

B) Physical symptoms of a panic attack are similar to cardiac emergencies.

C) The intensity of anxiety is usually related to both the proximity of the object and the possibility of escape.

D) Only clients in an inpatient psychiatric setting will manifest significant anxiety.

E) Anxiety disorders are only manifested with emotional symptoms.

3. The nurse is assessing a client who has panic disorder. Which symptoms should the nurse expect to identify?

A) decreased level of consciousness B) obsessions or compulsions C) palpitations or chest discomfort D) delusions

4. The nurse is planning the care of a client with panic disorder. Which would the nurse plan to include when describing the effects of a panic disorder?

A) The client often believes he or she is having a heart attack when a panic attack occurs.

B) The client typically has fewer attacks if he or she has agoraphobia.

C) The typical onset of the disorder is after the age of 30 years.

D) Clients rarely have a comorbid condition of depression.

5. Which neurotransmitter is implicated in anxiety disorders?

A) acetylcholine B) adrenaline C) epinephrine D) norepinephrine

6. Brain regions that contain widely distributed corticotropin-releasing hormone (CRH) receptors are related to which factors?

A) fear and fear conditioning B) happiness and sadness

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C) anger and anger conditioning D) hypnotic actions

7. The nurse is caring for a client with panic disorder. The client reports that the disorder greatly reduces the quantity and quality of sleep. For what complication should the nurse assess?

A) cardiac complications B) acute stress disorder C) dissociative disorder D) depression

A) B) C) D)

8. Which factor accounts for 30% to 50% of the risk for panic disorder? genetic factors poor coping skills environmental stressors cultural differences

9. The nurse is explaining the major difference between anxiety and fear. What factor should the nurse identify?

A) characteristics of the trigger or stimulus B) the diagnosis of the client C) the environment D) the outcome

10. Which statements about fear, anxiety, and worry are accurate? Select all that apply.

A) All three are pathologic.

B) Worry is an emotion.

C) Fear is an emotion.

D) Anxiety is an emotion.

E) Worry is a symptom of anxiety.

11. Which are differences between adaptive (“normal”) anxiety and an anxiety disorder? Select all that apply.

A) Anxiety disorders are greater than expected in intensity for one's age and the situation.

B) Anxiety disorders last longer than adaptive anxiety.

C) Anxiety disorders interfere with one's quality of life.

D) Anxiety disorders interfere with one's ability to function.

E) Anxiety disorders are normal in some cultures.

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12. The nurse is planning to perform an initial assessment of a client who is tentatively diagnosed with panic disorder. Which should the nurse be sure to include in the assessment related to the client's consumption?

A) dairy products B) products containing gluten C) soy-based products D) caffeinated beverages

13. A client has a diagnosis of generalized anxiety disorder (GAD). Which comorbid condition should the nurse assess for?

A) schizophrenia B) bipolar disorder C) cardiac disease D) depression

14. A client reports that most of his or her day is spent performing handwashing rituals. Which would the nurse document to describe the handwashing?

A) compulsions B) obsessions C) allostasis D) systematic desensitization

15. Which is a tendency of individuals who experience social phobias?

A) experience high achievement B) seek out opportunities to always be the leader C) experience fears that others will judge them negatively D) experience aggressive outbursts

16. Which type of phobia often begins with an intense, irrational fear of being in an open space, being alone, or being in a public place where escape might be difficult or embarrassing?

A) phonophobia B) xenophobia C) claustrophobia D) agoraphobia

17. The nurse is providing psychoeducation to the client who has an anxiety disorder.

Which would the nurse be certain to include to help the client understand and manage anxiety symptoms? Select all that apply.

A) take shallow quick breaths

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B) C) D) E)

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diaphragmatic breathing caffeinated beverages help to calm relaxation techniques stress reduction

18. The nurse counsels a client who has been diagnosed with a panic disorder. Which should the nurse encourage the client to do to prevent panic attacks?

A) exercise once per week B) take a short nap daily C) reduce and eventually eliminate caffeine intake D) contact the health care provider if she or he experiences fatigue

19. Which would be important to explain to a client regarding benzodiazepines?

Select all that apply.

A) It is important to carefully follow the prescribed dosing frequency.

B) It should be taken on an empty stomach.

C) The medication should not be abruptly stopped.

D) The use of antidepressants is contraindicated in clients using benzodiazepines.

E) A lower dose should be taken at bedtime.

20. Which intervention within the psychological domain is most effective in treating anxiety disorder?

A) cognitive–behavioural therapy B) pharmacotherapy C) nutrition planning D) diaphragmatic breathing

21. Which treatment in the psychological domain encourages the client to assess thought patterns and then to counter false beliefs to decrease anxiety?

A) assessment of thought patterns B) distraction C) positive self-talk D) cognitive–behavioural therapy

22. Which would be an appropriate nursing intervention for panic disorders that is within the social domain?

A) reevaluating precipitating factors B) reevaluating client's lifestyle C) identifying client goals D) identifying feelings of powerlessness

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23. The nurse is caring for an elderly client in the emergency room when it is determined that the client is not having a heart attack but has suffered from a panic attack. The nurse assessing this client should begin the interview by asking what?

A) “How are you feeling now that you are lying down?”

B) “What did you experience prior to and during the attack?”

C) “Do you think that you are able to drive home?”

D) “What do you think caused you to feel this way?”

24. Which psychodynamic theory may be related to anxiety in children?

A) Separation and loss may underlie many children's anxiety.

B) Cholecystokinin induces panic attacks in children with panic disorder.

C) Corticotropin-releasing hormone increases arousal and attention to environmental cues.

D) Gamma-aminobutyric acid (GABA) is clearly demonstrated to cause anxiety in children.

25. A client with a panic disorder has been prescribed a benzodiazepine medication.

Which would the nurse emphasize as a risk associated with using this medication?

A) dietary restrictions B) withdrawal symptoms C) agitation D) faecal impaction

26. A female client is diagnosed with panic disorder. The client tells the nurse that she hasn't left her house in more than a month because she was afraid of another attack. She visited the mental health clinic today only because her son brought her. Which nursing diagnosis would be a priority for this client?

A) powerlessness related to symptoms of anxiety B) decisional conflict related to fear of leaving the house C) ineffective family coping related to symptoms of anxiety D) social isolation related to fear of recurrence of anxiety symptoms 27. During an interview, a client reports an intense fear of spiders, stating, “I can't be near them. I get so upset. I start to sweat and hyperventilate if I see one.” The nurse documents this finding as which of the following?

A) algophobia B) entomophobia C) arachnophobia D) cynophobia

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28. A client diagnosed with obsessive–compulsive disorder presents to the clinic with the client's spouse. During the visit, the spouse states, “The client is always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time.

Isn't checking once enough?” An understanding of what would the nurse need to incorporate into the response?

A) The client is attempting to exert control over the situation.

B) The client performs the ritual to relieve anxiety temporarily.

C) The client's behaviour reflects a need for safety.

D) The client is attempting to use thought stopping to decrease the behaviour.

29. A psychiatric–mental health nurse is working with a client diagnosed with obsessive–compulsive disorder. The client engages in an intense handwashing ritual, usually once an hour. Which intervention would be most appropriate for the nurse to include in a teaching plan for this client?

A) Use cold water when washing hands.

B) Apply hand cream to the skin after washing.

C) Use a strong antibacterial soap for washing.

D) Set up a schedule to wash hands every 20 minutes.

30. A psychiatric–mental health nurse is conducting a program for a group of nurses working at a primary care centre about obsessive–compulsive disorder. One of the nurses asks, “So how would we know if the person's routine is a compulsion?” Which response by the nurse would be most appropriate?

A) “If the routine interferes with the person's normal activities, then it would be considered a compulsion.”

B) “If the person can control the ritual at one time, but not at another time, then the ritual is a compulsion.”

C) “If the ritual causes anxiety while the person is doing it, then it would be considered a compulsion.”

D) “Any ritual or routine is considered a compulsion if it takes up at least 30 minutes a day.”

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Answer Key 1. A 2. A, B, C 3. C 4. A 5. D 6. A 7. D 8. A 9. A 10. C, D, E 11. A, B, C, D 12. D 13. D 14. A 15. C 16. D 17. B, D, E 18. C 19. A, C, D 20. A 21. A 22. B 23. B 24. A 25. B 26. D 27. C 28. B 29. B 30. A

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Chapter 24: Somatic Symptom and Related Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which is an accurate description of a person who has somatization?

A) deliberately produces physical symptoms B) becomes physically ill because of his or her psychological state C) experiences physical symptoms without medical explanation D) has disturbed ways of reacting to a somatic symptom

2. Which are common manifestations of individuals who have somatization? Select all that apply.

A) develop a preoccupation for their somatic symptoms B) deliberately produce physical symptoms C) become physically ill because of their psychological state D) amplify their somatic symptoms E) seek medical care for their somatic symptoms

3. The nurse is caring for a client with somatic symptom. Which disorders may also occur comorbidly with somatic symptom and related disorders? Select all that apply.

A) depression B) avoidant personality disorder C) delirium D) bipolar disorder E) anxiety

4. Which is the appropriate term to describe an individual who intentionally produces illness symptoms and is motivated to avoid work?

A) pseudologia fantastica B) drug-seeking behaviour C) Munchausen's by proxy D) malingering

5. Which statement regarding the prevalence of somatic symptom disorder is accurate?

A) It is estimated to be about 50% of the adult population.

B) The disorder is more common among younger adults than older adults.

C) Somatic symptom disorder is often diagnosed in childhood.

D) Males experience somatization at a higher rate than females.

6. Which is the reason that psychiatric and mental health (PMH) nurses do not usually care for individuals diagnosed with somatic symptom disorder?

A) People with somatization disorder sometimes cause frustration among health care providers.

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B) People with somatization disorder seek opinions from many heath care providers.

C) Individuals with somatic symptom disorder will often avoid mental health specialists.

D) The onset of this disorder tends to be very early in life.

7. A client has been diagnosed with somatoform disorder. The client asks about the possible cause of this disorder. Which should the nurse explain to the client?

A) brainstem dysfunction B) genetic markers C) hypometabolism D) dopamine stimulation

8. Which statement regarding the aetiology of somatization disorder is most accurate?

A) The exact transmission mechanism of somatization is unknown.

B) Somatization disorder has not been shown to run in families.

C) Chaotic families are the cause of somatization disorder.

D) The environment is the cause of somatization disorder.

9. Which are the biologic theories of the aetiology of somatic symptom disorder?

Select all that apply.

A) Neuropathologic theory of hypometabolism.

B) Genetic variability with serotonin in the hypothalamic–pituitary–adrenal axis.

C) Proinflammatory cytokines linked to the hypothalamic–pituitary–adrenal axis.

D) A form of social or emotional communication.

E) The mind and body are distinct and symptoms are universal within cultures.

10. Which is possibly the aetiology of somatization from a psychological prospective?

A) a way to maintain relationships B) a way of dealing with pain C) due to an imbalance of emotions D) it is intentional and conscious

11. Which is the best explanation about why somatization disorders not labelled as a psychiatric disorders in non-Western societies?

A) because non-Western societies do not experience somatization disorders B) because somatic symptom disorder is seen only as a Western society disease C) because psychiatric disorders are described as somatic disorders D) because mind–body distinctions are not made and symptoms have different meanings

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12. Which is the major difference between the clients with a somatic symptom disorder as compared with factitious disorder? In somatic symptom disorder, the client: A) deliberately produces physical symptoms.

B) has symptoms that are not deliberate.

C) has both psychiatric and medical concerns.

D) reports psychotic symptoms.

13. Which statement regarding the prevalence of factitious disorders and that of somatic symptoms is accurate?

A) The prevalence of somatic symptom disorder is estimated to be 5% to 7% of the adult population.

B) The prevalence of factitious disorder is known to be 4%.

C) The prevalence of both factitious disorder and somatic symptoms is known.

D) It is easy to determine the number of hospitalizations that are due to factitious disorder.

14. A client visits the clinic for a routine examination. Which finding would cause the nurse to suspect that the client may be experiencing illness anxiety disorder?

A) expresses concern about psychological problems B) indicates that her or his parents were always in “good health” C) reports being preoccupied with having severe illness D) indicates a need for social support from her friends

15. While assessing a client who has somatic symptom disorder, which would the nurse anticipate that the client is most likely to report?

A) loss of sensation B) numbness C) pain D) diarrhoea

16. The nurse is assessing a client diagnosed with somatic symptom disorder. Which would the nurse anticipate will be the client's physical functioning?

A) irregular heart rate B) fatigue and low activity C) hypersexuality D) skin lesions

17. The nurse is assessing a client who has a somatic symptom disorder. Which

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would be most important for the nurse to remember?

It is important to take a very quick assessment of the medical problems.

Past medical treatment will likely not have been effective.

The client is unlikely to have a psychiatric disorder.

The client will likely have a psychiatric disorder such as depression.

18. A client has been diagnosed as having conversion disorder. When the client reports a sore throat that is causing difficulty swallowing, this is possibly due to which problem?

A) an imagined physical problem B) a pseudoneurologic symptom C) an expression of pain not from a strep throat infection D) an expression of a neurologic disease

19. A psychiatric–mental health nurse completing an assessment for a depressed client is alerted to the possibility of somatization disorder when the nurse discovers which finding?

A) Frequent falls and amnesia.

B) Multiple surgeries and medical problems.

C) Reports of migraine headaches in last 4 years.

D) The client states that the pain is not real.

20. Assessment of a client with somatic symptom disorder includes assessing his or her personal strengths. Which question might the nurse ask to best assess the client's spiritual health?

A) “How often do you attend religious services?”

B) “How long have you had spiritual beliefs?”

C) “How has your illness changed the way you understand the world?”

D) “How do you know that the connectedness to your beliefs is real?”

21. The nurse is caring for a client who has a somatic symptom disorder? What plan of care is most likely to meet the client's needs?

A) liberal treatment of the medical concerns B) maximal pain control with analgesics C) short-term interventions D) one health care provider at regularly scheduled visits

22. A client is diagnosed with somatoform disorder. Pharmacologic treatment is most likely to include what drug category?

A) anticonvulsants B) antidepressants

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C) typical antipsychotics D) atypical antipsychotics

23. Which is the reason that nursing interventions that focus on the biologic dimension are especially important when caring for people who have somatic symptom disorder?

A) because medical treatment must be aggressive B) because pharmacologic treatment must be aggressive C) because the goal is to help the person better understand the meaning behind the symptoms D) because the nurse should focus mostly on physical concerns

24. Which is most accurate about approaching the topic of mental health promotion with a client diagnosed with a somatization disorder?

A) It will ensure the client's disorder is cured.

B) It must be within the context of preventing further problems.

C) It can be easily addressed with the client.

D) It should be within the context multiple care provider involvement.

25. Which is true of effective nursing interventions for clients who have factitious disorder, imposed on self?

A) The nurse must be aware of his or her feelings and resolve them by understanding the psychodynamic issues.

B) It is important that the client receives services sporadically with a variety of providers.

C) The client must be made to confess that his or her symptoms are fabrications.

D) There should not be any communication between the client and the mental health care team and family members.

26. A client is admitted to a mental health unit with a diagnosis of factitious disorder.

When reviewing the client's history, which would a nurse most likely find?

A) intentional self-injurious behaviour B) pain to achieve a self-serving goal C) malingering to avoid work D) parents who were restrictive

27. While assessing a client thought to have a factitious disorder, a nurse asks the client to describe when the client felt nurtured as a child. Which response would the nurse interpret as supporting the client's diagnosis?

A) “I never felt nurtured or loved when I was growing up.”

B) “The only time I felt loved and appreciated was when I made the honor roll at

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school.”

C) “The only time I ever felt loved was when I was sick enough to miss school.”

D) “I felt loved and accepted when my father apologized for spanking me so hard.”

28. After educating a group of nurses about somatic symptom disorder (SSD), an instructor determines that the education was successful when the group identifies which as a characteristic?

A) symptoms that remain relatively static B) manifestations highly variable C) symptoms that are easily manageable D) reports of overall health as good

29. A client with somatic symptom disorder is reporting significant pain in the joints.

When providing care to this client, which would be most important for a nurse to keep in mind?

A) Opioid analgesics are the primary mode of therapy.

B) The client's experience of pain is real.

C) Complementary therapies are usually of little benefit.

D) Outcomes need to reflect the biologic aspects of the pain.

30. A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition?

A) depression B) bipolar disorder C) thought disorder D) sleep disorder

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Answer Key 1. D 2. A, D, E 3. A, E 4. D 5. B 6. C 7. C 8. A 9. A, B, C 10. A 11. D 12. B 13. A 14. C 15. C 16. B 17. B 18. B 19. B 20. C 21. D 22. B 23. C 24. B 25. A 26. A 27. C 28. B 29. B 30. A

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Chapter 25: Eating Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. A client is hospitalized with a diagnosis of anorexia nervosa. Which variable is most likely to be associated with a poorer outcome?

A) the lifetime presence of vomiting B) earlier age of onset C) low socioeconomic status D) impulsive behaviours

2. Which are differences in the diagnostic criteria for anorexia nervosa (AN) in DSM-5 as opposed to previous DSM editions? Select all that apply.

A) amenorrhea as a required element B) a specific amount of weight loss or lack of weight gain C) family history of an eating disorder D) weight that is less than minimally expected for children and adolescents E) defined body mass index (BMI) cutoffs to denote severity of AN

3. A female client has been hospitalized with a diagnosis of anorexia nervosa. The nurse anticipates that the client will exhibit what?

A) a limited need to control her environment B) feelings of superiority about her body image C) preoccupation with thoughts of food D) euphoric symptoms and an obsession with sex

4. While caring for a client with anorexia nervosa, the nurse anticipates that the client will have difficulty expressing which emotion?

A) anger B) sadness C) fear D) pain

5. The nurse is working with a client who has bulimia nervosa. Which would the nurse anticipate that the client will exhibit?

A) impulsivity B) aggression C) hyperactivity D) delusions

6. The nurse is caring for a client with bulimia nervosa. Which history finding would the nurse find that is consistent with this diagnosis?

A) dieting excessively for 1 month to control weight gain B) binge eating and purging on a regular basis C) overeating and using excessive exercise to control weight gain

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D) weight loss of at least 25 pounds in the last 2 months

7. Which eating disorder is associated with few outward signs?

A) anorexia nervosa B) bulimia nervosa C) binge-eating disorder D) obesity

8. Which are potentially life-threatening complications of bulimia nervosa (BN)?

Select all that apply.

A) suicide B) financial difficulties C) legal difficulties D) self-mutilation E) impulsivity

9. Which comorbid conditions may increase the risk of suicide in individuals with bulimia nervosa (BN)? Select all that apply.

A) diabetes B) depression C) anxiety D) substance misuse E) borderline personality disorder

10. An adult client is admitted to the hospital with anorexia nervosa. Which characteristic would the nurse expect that the client would demonstrate?

A) aggression B) a positive mood C) apathy about food D) perfectionism

11. Which would an individual with anorexia nervosa (AN) likely have difficulty expressing? Select all that apply.

A) sadness B) anger C) controlling attitude D) shame E) guilt

12. What do clients who have anorexia nervosa (AN) often lack that specific

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A) B) C) D)

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prevents them from naming the feelings they are experiencing? self-monitoring behaviour interoceptive awareness cognitive misconceptions enmeshment

13. According to social theories related to the aetiology of anorexia nervosa (AN), which is most likely to influence young females to focus on their weight?

A) the depiction of thin and emaciated females as glamorous by the media B) peer pressure focusing on academic achievements C) parents who are supportive to help young females to lose weight D) friends who are focused on opportunities to volunteer in the community

14. Which label describes the family dynamics of a person with anorexia nervosa (AN) in which members the family members are overprotective, rigid, and unable to resolve conflicts?

A) supportive B) distant C) accepting D) enmeshed

15. Which most accurately describes the spiritual development of a person with anorexia nervosa (AN)?

A) an ability to affirm his or her self-worth and identity B) defining oneself as the eating disorder C) feeling connected with family and friends D) feeling compassion for self and others

16. Which are the most common psychiatric comorbid conditions for binge-eating disorders? Select all that apply.

A) substance use B) delusional disorder C) schizophrenia D) mood and anxiety disorders E) delirium

17. Which diagnosis generally has the best outcome?

A) anorexia nervosa B) bulimia nervosa C) binge-eating disorder D) severe anorexia nervosa

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18. The nurse is caring for a newly admitted client with anorexia nervosa and paranoia. What action will best address the client's paranoia?

A) ask the client to report any visual or audio hallucinations B) reassure her that no staff will try to have sexual relations with her C) assure her that no one will kill or injure her D) reassure her that no one is trying to make her fat

19. Which statements about the aetiology of bulimia nervosa (BN) are true? Select all that apply.

A) Some of the predisposing or risk factors for BN overlap with theories of causality.

B) The interplay of separation–individuation issues helps to explain the aetiology.

C) BN stems from substance misuse.

D) Dieting may put an individual at risk for developing BN. E) The interplay body dissatisfaction helps to explain the development of BN.

20. For which possible physiologic consequences of anorexia nervosa (AN) should the nurse assess the client for? Select all that apply.

A) respiratory distress B) cardiac arrhythmias C) loss of bone density D) neuronal deficits E) hormonal changes

21. Which are significant social influences in the development of eating disorders for both females and males? Select all that apply.

A) the media B) the fashion industry C) peer pressure D) appeal to possible mates E) body satisfaction

22. The nurse is counselling a client with anorexia nervosa whose family members are with her. The nurse be aware that in the past, families of persons with anorexia nervosa (AN) have which characteristics? Select all that apply.

A) overprotective B) loosely bound C) enmeshed D) rigid E) unable to resolve conflicts

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23. Which are common nursing diagnoses for individuals with anorexia nervosa (AN)? Select all that apply.

A) chronic confusion B) anxiety C) ineffective coping D) disturbed body image E) imbalanced nutrition: less than body requirements

24. A hospitalized individual with diagnosis of anorexia nervosa is on a weightincreasing protocol to encourage weight gain. What should be characteristics of a behavioural plan?

A) implements a psychoanalytic regimen B) implements positive and negative reinforcements C) created by the members of the care team D) promotes regular monitored exercise

25. Which is appropriate term for a nurse providing treatment by means of emphasizing the resumption of normal eating and the restoration of weight, energy requirements, and relearning to eat normally as an intervention that has been found to be successful?

A) interpersonal training B) cognitive–behavioural therapy C) behaviour modification D) supportive clinical management

26. Which is the treatment of choice for bulimia nervosa (BN)?

A) behavioural therapy B) cognitive–behavioural therapy C) interpersonal therapy D) self-help therapy

27. A nurse providing psychoeducation to a client with the diagnosis of bulimia nervosa (BN) needs to include what topics?

A) Caloric intake of meals.

B) Limit setting.

C) Laxatives do not produce permanent weight loss.

D) Exercise tolerance.

28. A client brought to the emergency room is found to have anorexia nervosa (AN) and has a dangerously low body mass index. Which would the nurse anticipate

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A) B) C) D)

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will be the setting for the initial therapy? outpatient treatment residential treatment partial hospitalization full hospitalization

29. For clients with anorexia nervosa, when will intensive therapies needed to help clients with their underlying issues usually begin?

A) after refeeding B) before refeeding C) during refeeding D) after discharge

30. Which might make it difficult for a nurse to establish a therapeutic alliance with an individual with anorexia nervosa (AN)?

A) The client may be suspicious and mistrustful of health care professionals.

B) Most health care professionals have never had AN. C) Most health care professionals are obese.

D) Because nurses are usually nonreactive to power struggles.

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Answer Key 1. A 2. D, E 3. C 4. A 5. A 6. B 7. B 8. A, D, E 9. B, C, D, E 10. D 11. B, D, E 12. B 13. A 14. D 15. B 16. A, D 17. B 18. D 19. A, B, D, E 20. B, C, D, E 21. A, B, C, D 22. A, C, D, E 23. B, C, D, E 24. B 25. D 26. B 27. C 28. D 29. A 30. D

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Chapter 26: Substance-Related and Addictive Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which conditions/symptoms may qualify a client to access medical marijuana legally? Select all that apply.

A) dementia B) appetite stimulation related to HIV/AIDS treatment C) hypertension D) pain E) nausea

2. Which statements about addiction or substance dependence are true? Select all that apply.

A) Addiction is primarily a health problem of the young.

B) Addiction is described as a chronic mental disorder.

C) Discontinuation of treatment is likely to result in relapse of addiction.

D) Addiction is not an all-or-none problem, but rather a matter of degree.

E) Substance-related and addictive disorders are widely considered to be amenable to treatment.

3. Which are the categories of criteria that are used to diagnose a substance use disorder? Select all that apply.

A) impaired control B) social impairment C) substance-induced disorders D) risky use E) pharmacologic categories

A) B) C) D)

4. Which persons are most susceptible to substance use disorders? those who have never been exposed the addictive object those who have repeatedly used the any addictive object those who have recovered from their addiction those who have used the addictive object

5. Which statement best describes the neurobiologic effect of an addictive substance when taken in excess?

A) experience of extreme pleasure B) relief of boredom in a pleasurable way C) improved performance—either mental or physical D) the direct activation of the brain reward system

6. Which domains are possibly affected when an individual is potentially susceptible to addiction? Select all that apply.

A) biologic

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B) C) D) E)

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psychological social spiritual moral

7. Besides tobacco, which are the most commonly used substances in Canada?

Select all that apply.

A) opioids B) cannabis C) caffeine D) bath salts E) alcohol

8. Which statement may explain why people who abuse drugs are at risk for relapse even after long periods of abstinence?

A) Drugs of abuse alter the brain's structure and function, resulting in changes that persist long after drug use has ceased.

B) Drugs have potentially devastating consequences that the abuser is aware of but ignores.

C) The drug abuser used the illicit substance one time.

D) Some people are more susceptible to addiction than others.

9. Which statement regarding appropriate treatment of persons who have substance abuse disorders is most accurate?

A) The same treatment is appropriate for every person with a substance abuse disorder.

B) Persons with the same type of substance abuse disorder will respond the same to the same treatment.

C) Not every person who has a substance use disorder requires treatment or interventions.

D) It is critical to match the treatment setting, interventions, and services to an individual's particular problems and needs.

10. A nurse is providing addiction treatment for an individual. Which intervention should the nurse prioritize to promote success?

A) slow progress towards abstinence over several months B) use of polypharmacy to counteract addictive substance C) immediate abstinence from substance D) adherence to mutually agreed-upon goals

11. Which aspect of nursing care and addiction treatment depends on building a

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foundation of trust, being nonjudgemental, and providing hope for recovery? confrontational model therapeutic alliance reduction framework an initial contract built on goals

12. Which intervention is most appropriately described as a patient-centred style of psychotherapy that allows for the process of change to be viewed along a continuum, with concrete steps taken to help individuals increase readiness for changing behaviour and resolve their ambivalence?

A) harm reduction B) twelve-step facilitation C) motivational interviewing D) relapse prevention therapy

13. The nurse is caring for a client who has been without a drink for 24 hours after abusing alcohol for many years. The nurse should assess for what priority problem?

A) drowsiness B) dehydration C) hypertension D) seizures

14. The nurse is caring for a newly admitted adult in a detoxification unit. Which symptoms should the nurse assess for? Select all that apply.

A) perceptual disturbances B) confusion C) diaphoresis D) hypotension E) fever

15. A client has been admitted to the hospital with a diagnosis of Wernicke's syndrome. Which would be the treatment that the nurse should explain to the client and the client's family is necessary?

A) thiamine B) vitamin C C) riboflavin D) vitamin K

16. A client tells the nurse that he or she smokes cocaine occasionally. Which should the nurse teach the client about absorption of smoked cocaine?

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A) B) C) D)

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that smoked cocaine is absorbed more slowly than injected cocaine that smoked cocaine is absorbed more quickly than injected cocaine that smoked cocaine is minimally absorbed compared to injected cocaine that smoked cocaine is absorbed into the bloodstream as rapid as by injection

17. A client is admitted to the detoxification unit for cocaine abuse. The nurse should explain to the client and client's family that long-term use of cocaine followed by discontinuation of the drug can cause a “crash” related to the which neurotransmitter?

A) norepinephrine B) epinephrine C) serotonin D) acetylcholine

18. The nurse is caring for a client who has been a long-term cocaine user and who is experiencing withdrawal symptoms from cocaine abuse. Which is the priority assessment that the nurse should make when the client wakes up from his or her “crash?”

A) cocaine craving B) coping C) suicidality D) energy level 19. A client tells the nurse that she has been using “bath salts” on a regular basis.

Which substance would the nurse know the effect of “bath salts” is most like?

A) amphetamine B) cocaine C) marijuana D) alcohol

20. A client presents to the emergency room after ingesting a large amount of LSD. Which symptoms would the nurse anticipate that the client may experience and should monitor for? Select all that apply.

A) respiratory depression B) paranoia C) tachycardia D) hallucinations E) delusions

21. A client has been unable to stop using heroin through psychosocial interventions.

What medication may promote recovery?

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A) B) C) D)

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buspirone methadone triazolam disulfiram

22. The nurse is preparing a presentation on the topic of drug abuse for a group of high school students for health promotion. Which fact should the nurse include in this presentation?

A) Withdrawal symptoms from amphetamines are worse than from cocaine.

B) Cannabis is the most commonly used illicit drug in Canada.

C) Alcohol withdrawal symptoms include sedation and drowsiness.

D) Naltrexone (Trexan) is used to treat withdrawal from opiates.

23. Which drug causes a state of acute mental decompensation that is characterized by diminished ability to think and carry on daily activities and a loss of memory?

A) marijuana B) ketamine C) amphetamines D) alcohol

24. A nurse is caring for an intoxicated individual. The nurse understands the risk of central nervous system depression that warrants an even higher level of vigilance is use of alcohol and which other substance?

A) marijuana B) caffeine C) hallucinogens D) opiates

25. Which condition would be considered similar to withdrawal from opiates?

A) “asthma attacks” B) “worst headache ever” C) “bad case of the flu” D) “a real high”

26. A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/minute, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6 degree above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?

A) disturbed thought processes B) risk for injury

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C) ineffective coping D) ineffective denial

27. A nurse is working with a client who is addicted to heroin. The nurse engages in harm reduction by educating the client about which aspect?

A) needle exchange program B) problem solving C) healthy coping skills D) proper use of naltrexone

28. A 20-year-old client arrives at the emergency department by ambulance. The client is unconscious, with slow respirations and pinpoint pupils. There are “tracks” visible on the client's arms. The friend who came with the client reports that the client had just “shot up” heroin when the client became unconscious.

Which medication would the nurse most likely expect to administer?

A) naloxone B) naltrexone C) bupropion D) varenicline

29. A group of nurses is reviewing information about substances that are abused. The nurses demonstrate understanding of the information when they identify which agent as a stimulant? Select all that apply.

A) alcohol B) cocaine C) heroin D) nicotine E) phencyclidine

30. A nurse is implementing a brief intervention with a client who is abusing alcohol.

The nurse most likely would be involved with which action?

A) asking the client questions about alcohol use B) negotiating a conversation with the client about the need to change C) pointing out the inconsistencies in thoughts, feelings, and actions D) helping the client change the way the client thinks about a situation

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Answer Key 1. B, D, E 2. B, C, D, E 3. A, B, D, E 4. B 5. D 6. A, B, C, D 7. A, B, C, E 8. A 9. D 10. D 11. B 12. C 13. D 14. A, B, C, E 15. A 16. D 17. A 18. C 19. A 20. B, C, D, E 21. B 22. B 23. B 24. D 25. C 26. B 27. A 28. A 29. B, D 30. B

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Chapter 27: Personality Disorders and Disruptive, Impulse-Control, and Conduct Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition

A) B) C) D)

1. Which determines how a person interprets events and stimuli? self-esteem cognitive schema emotional arousal impulse control

2. Which are key personality traits that are included in the five-factor model? Select all that apply.

A) openness B) conscientiousness C) extraversion D) argumentation E) neuroticism

3. Which factors characterize a personality disorder and distinguish it from a personality trait? Select all that apply.

A) The individual must demonstrate the criteria behaviours persistently.

B) The behaviours impair the ability of the person to function socially and occupationally.

C) The individual has a tendency to behave, feel, perceive, and think in consistent ways across time and across situations.

D) The individual has a complex pattern of characteristics of which the individual may not be aware.

E) The individual is likely to seek treatment regarding his or her personality.

4. Which variables interact in complicated ways to form the personality? Select all that apply.

A) emotional dysregulation B) biologic dispositions C) projective identification D) environmental situations E) psychological experiences

5. Which statement about the aetiology of personality disorders is most accurate?

A) Personality disorders are known to be neurobiologically determined.

B) They are known to evolve within the development of an individual's personality.

C) The aetiology of personality disorders undetermined to a large degree.

D) Personality disorders are not felt to be related to a person's temperament.

6. Which is a risk factor associated with borderline personality disorder (BPD) that is associated with the biosocial viewpoint in which a social situation negates an

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individual's private emotional responses and communication? affective instability emotional vulnerability emotional dysregulation invalidating environment

7. Which is a risk factor associated with borderline personality disorder (BPD) that is associated with the psychoanalytical view in which a person does not develop a sense of self or a permanent sense of significant others?

A) projective identification B) separation–individuation C) maladaptive cognitive abilities D) adaptive inferiority process

8. Which term would the nurse use to describe a cognitive dysfunction common in borderline personality disorders in which thoughts and ideas can be split off from consciousness?

A) delusions B) disorganized thinking C) dissociation D) dichotomous thinking

9. The nurse is assigned to care for a client with a paranoid personality disorder (PPD). Which are hallmark features of paranoid personality disorder? Select all that apply.

A) persistent ideas of self-importance B) tendency to be rigid and controlled C) preoccupation with sex D) passivity in relationships E) hallucinations

10. Which statement regarding cognitive schema of persons with borderline personality disorder (BPD) is most accurate?

A) They misinterpret environmental stimuli continuously.

B) They are flexible when they are rejected.

C) They enjoy encountering new people or situations.

D) The dysfunctional ways begin in late adulthood.

11. A nurse is assessing a client and learns that during school-age years, the client mutilated the neighbour's cat. Which diagnosis would the nurse suspect?

A) narcissistic personality disorder

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B) antisocial personality disorder C) histrionic personality disorder D) remorseful personality disorder

12. During the initial assessment, the client admits to having a strictly organized life, difficulty making decisions, and admits to his or her stubbornness. Which diagnosis does the nurse consider is most likely?

A) obsessive–compulsive personality disorder B) antisocial personality disorder C) borderline personality disorder D) avoidant personality disorder

13. Which are core components of maladaptive personality functioning that have been identified by research? Select all that apply.

A) lack of identity integration B) self-control C) responsibility D) social concordance E) relational capacities

14. Which neurotransmitter is involved in cluster B disorders?

A) norepinephrine B) serotonin C) GABA D) dopamine

15. The nurse is caring for a client with a cluster A disorder. Which temperament and character dimensions should the nurse anticipate? Select all that apply.

A) high novelty seeking B) high harm avoidance C) self-harm D) social attachment E) low-reward dependence

16. The nurse is caring for a client with schizoid personality disorder (SPD). Which therapeutic intervention would be important for the nurse to include when creating a care plan?

A) social skills training B) anger management training C) relaxation techniques D) coping skills training

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17. The nurse is trying to facilitate self-responsibility in a person who has antisocial personality disorder (ASPD)? What interventions should the nurse include?

Select all that apply.

A) bargaining about unit rules with the client B) holding the client responsible for his or her behaviour C) arguing with the client when discussing unit rules D) monitoring the extent that self-responsibility is assumed E) discussing the consequences of not dealing with responsibilities

18. Which assessment should the nurse focus on when caring for a client who has histrionic personality disorder (HPD)?

A) the nurse's own reaction to the client B) the quality of the individual's interpersonal relationships C) whether there is currently someone on whom the person relies D) the nurse's self-awareness of the client's charm

19. A nurse is caring for a client with borderline personality disorder (BPD). Which nursing goal is most appropriate for the client?

A) Develop positive coping strategies, rather than relying on medications.

B) Avoid daily stressful encounters that will modify behaviour.

C) Achieve psychological balance with regular medication adherence.

D) Take action to increase the client's self-esteem.

20. A nurse is caring for a client with a diagnosis of borderline personality disorder (BPD) who has a tendency to do things impulsively. Which nursing intervention would assist the client to address emotional regulation?

A) Promote slowdown of automatic responses, allowing time to think before acting.

B) Encourage use of PRN medications immediately.

C) Challenge thoughts of paranoia.

D) Identify if this is a reaction to a delusion.

21. A nurse is teaching a client with a diagnosis of borderline personality disorder skills for tolerating painful feelings. The nurse should help the client develop skills that will allow him or her to do what?

A) Participate in a stressful activity to avoid the painful feeling.

B) Experience completely opposite emotions.

C) Focus on the painful experience and how to deal with it.

D) Avoid situations that may cause pain.

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22. Which type of environment is the best for helping the client to learn effective feeling management and to practice techniques?

A) the client's own family setting B) an inpatient setting C) day treatment and group settings D) a new exposure to an interdisciplinary team

23. A nurse is assessing a client with diagnosis of borderline personality disorder.

Which is most important for the nurse to include?

A) observing the client behaviour to elicit if the client is experiencing psychotic behaviour B) listening to the client's story and his or her past experiences in hospital C) asking if the person thinks about suicide or engages in self-injurious behaviour D) identifying subjective possibilities of suicidal or self-injurious behaviour from the client's affect and mood

24. The nurse is caring for a client who has borderline personality disorder. During the initial assessment of this client, the nurse should focus on a history of what?

A) anxiety disorders B) hallucinations C) unstable insecure attachments D) substance abuse

25. The nurse is caring for a client with borderline personality disorder and observes that the client exhibits a sudden shift in moods. Which would the nurse document in the client's record?

A) affective instability B) unstable moods C) dissociative behaviours D) emotional lability

26. The nurse has admitted a client with borderline personality who is admitted because of cutting her or his wrists. Which should the nurse explain to the client and the client's family is the motivation for clients who self-mutilate?

A) relieve stress B) sedate themselves C) avoid delusions D) relieve boredom

27. Which is the nurse trying to accomplish when performing a social assessment of an individual who has borderline personality disorder?

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A) B) C) D)

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to assess the quality of interpersonal relationships to assess the number of relationships to assess the proximity of individuals within their client's life to identify the number of newly established relationships with health care providers

28. The nurse is assigned to care for a client with paranoid personality disorder.

Which is the primary reason that interventions based on the establishment of a nurse–client relationship are difficult to implement?

A) Because the client likely will not communicate.

B) Persons with paranoid personality disorder usually trust nurses.

C) Nurses use a matter-of-fact approach.

D) Nurses create a nonthreatening environment.

29. When providing education to a person with a personality disorder, it is important for the nurse to know when a client is experiencing negative emotional arousal.

When this occurs, the client will have decreased ability to do what?

A) remember past experiences B) respond with appropriate emotions C) respond to follow directions D) remember new information

30. Which are characteristics of intermittent explosive disorder? Select all that apply.

A) The individual cannot resist the urge to steal.

B) Episodes of aggressiveness that result in an assault or destruction of property.

C) The individual engages in deliberate and purposeful fire setting more than once.

D) The episodes can have serious psychosocial consequences.

E) The severity of the behaviour is out of proportion to the provocation.

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Answer Key 1. B 2. A, B, C, E 3. A, B, C 4. B, D, E 5. C 6. D 7. B 8. C 9. A, B 10. A 11. B 12. A 13. B, C, D, E 14. D 15. D, E 16. A 17. B, D, E 18. B 19. A 20. A 21. B 22. C 23. C 24. C 25. A 26. A 27. A 28. A 29. D 30. B, D, E

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Chapter 28: Sleep Wake Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which are the three stages of non–rapid eye movement (NREM) phase of sleep?

Select all that apply.

A) dreaming B) intermediate stage (drowsiness and sleep onset) C) process C D) light stage E) deep stage (slow-wave sleep)

A) B) C) D)

2. Which type of waking may be common in a person who is a good sleeper? wakes completely several times a night for several minutes remembers each time that he or she wakes walks while dreaming return to wakefulness several times a night

A) B) C) D) E)

3. Which occurrences are characteristic of REM sleep? Select all that apply.

The body can move easily.

The body is almost paralyzed.

There is minimal mental activity.

The brain is activated.

There are muscle twitches.

4. Which are characteristics of sleep? Select all that apply.

A) physical stillness characterized by no or few movements B) stereotypical body postures (closed eyes, usually lying down) C) reduced responsiveness to external stimulation D) rapid reversibility between states E) subconscious engagement with the environment

A) B) C) D)

5. Which is the most frequently reported length of sleep for young adults? about 5.5 hours each night about 9 hours each night about 8.5 hours on weekday nights and 7.5 hours on a weekend night about 7.5 hours on weekday nights and 8.5 hours on a weekend night

6. Which is the strongest of external cues, also called zeitgebers, that affects circadian rhythm?

A) ambient temperature B) body's activity level C) meal consumption D) intensity of ambient light

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7. A client with a history of sleep disorders is undergoing testing to measure several variables associated with sleep. What test will best meet this client's needs?

A) polysomnography B) oxygen saturation C) electrocardiography D) respiratory effort

8. Which type of sleep study is used to diagnose narcolepsy and idiopathic insomnia?

A) polysomnography B) oxygen saturation C) melatonin level D) multiple sleep latency test

9. Which types of sleep studies rely exclusively on client self-report? Select all that apply.

A) actigraphy B) maintenance of wakefulness C) multiple sleep latency test D) sleep diary E) sleep questionnaires

10. Which sleep–wake disorders are included in the DSM-5? Select all that apply.

A) insomnia disorder B) narcolepsy C) hyposomnolence disorder D) REM sleep behaviour disorder E) restless legs syndrome

A) B) C) D)

11. Which effect might tricyclic antidepressants have on sleep?

The client would go for extended periods of time without REM sleep.

The client would go for extended periods of time without NREM sleep.

An increase in insomnia symptoms.

The same length of time in the REM and NREM phases of sleep.

12. Which categories of medications are frequently associated with insomnia? Select all that apply.

A) decongestants B) corticosteroids C) benzodiazepines

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D) calcium channel blockers E) beta-blockers

13. Which statements describe the relationship between mental illness and sleep?

Select all that apply.

A) Antidepressants and atypical antipsychotics should be used to improve sleep.

B) Sleep disturbances can be a cause of mental illness.

C) Physical and mental illness are unrelated to sleep.

D) Sleep disturbances can be an effect of mental illness.

E) Sleep disturbances can be related to medications used to treat mental illness.

14. Which would be the most important activities of a nurse regarding obstructive sleep apnea (OSA)? Select all that apply.

A) performing a sleep study on anyone at risk B) prescribing CPAP or other treatment C) identifying people at risk for OSA D) educating people about OSA assessment and treatment E) encouraging persons to adhere to their prescribed treatment

15. Which factors are most highly associated with obstructive sleep apnea (OSA) and require further investigation and follow-up? Select all that apply.

A) body mass index less than 15 B) age greater than 50 years C) neck size greater than 40 cm D) gender is male E) reports of the subject snoring

16. Which nursing interventions would be most important in a client who has obstructive sleep apnea (OSA) and has been prescribed CPAP therapy? Select all that apply.

A) Ask the client how many hours per night he or she has used the device over the past week.

B) Inquire about possible reasons for nonadherence, if not using the device.

C) Tell the client that 95% of other persons with OSA use the CPAP at least 4 hours per night.

D) Encourage the client to attend support groups and have an immediate support person to promote CPAP adherence.

E) Ensure that the client is aware of specific signs and symptoms are related to OSA.

17. Which details should the nurse teach the client to collect in a sleep diary? Select all that apply.

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A) B) C) D) E)

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waking time time that the client turned the lights out waking during sleep time naps detailed descriptions of other activities in bed

18. Which test would the nurse instruct the client about that would enable the client to collect data over time to assess the client's sleep–wake patterns?

A) Epworth Sleepiness Scale B) Pittsburgh Sleep Quality Index C) Dysfunctional Beliefs and Attitudes about Sleep Scale D) sleep diary

19. Which category of antidepressant medications would the nurse recognize is most likely to cause vivid nightmares?

A) selective serotonin reuptake inhibitors (SSRIs) B) norepinephrine–dopamine reuptake inhibitors (NDRIs) C) serotonin–norepinephrine reuptake inhibitors (SNRIs) D) tricyclic antidepressants

20. Which factors are most likely to contribute to nurse fatigue? Select all that apply.

A) excess REM sleep B) circadian rhythm disturbances C) sleepiness D) sleep habits E) chronic nightmares

21. Which sleep disorders are treated by bright light therapy? Select all that apply.

A) jet lag B) shift work C) obstructive sleep apnea D) narcolepsy E) insomnia

22. Which are untoward effects that may be expected from bright light therapy?

Select all that apply.

A) nausea B) headache C) nervousness D) retinopathy E) eye damage

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23. Which are factors that can contribute to jet lag? Select all that apply.

A) travelling to an area that is 2 hours earlier than the client's time zone B) sleep deprivation C) the discomfort of airplane travel D) in-flight caffeine or alcohol intake E) travelling to an area that is 1 hour later than the client's time zone

24. A nurse is giving a presentation to a community group about sleep and its relationship to health. In explaining the relationship between REM sleep and body temperature, which statement by the nurse would be most appropriate?

A) “There is no observable relationship between REM sleep and body temperature.”

B) “With higher levels of REM sleep, we also experience higher body temperatures.”

C) “Our REM sleep and body temperature cycles are inversely related.”

D) “The extent of our experience of REM sleep is directly proportional to a rise in body temperature.”

25. The nurse is assessing the sleep patterns of a female client aged 70 years with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep pattern?

A) “When I was younger, I didn't notice any differences in how I felt in the morning or evening.”

B) “Now it seems like I have difficulty falling asleep or staying asleep even when circumstances are adequate for sleep.”

C) “When I worked days, I'd always have trouble feeling sleepy in the morning.”

D) “When I was younger, the amount of sleep I got didn't seem to matter.”

26. A nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which of the following would be most appropriate for the nurse to suggest?

A) “Eat right before you go to bed, as long as it is something rich that will make you sleepy.”

B) “Try exercising a bit right before your bedtime so you will feel tired and sleepy.”

C) “Drinking a warm cup of tea right before bedtime will help to relax you.”

D) “Establish a regular time for going to bed and getting up in the morning.”

27. A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he or she should do when he or she goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate?

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A) “Go to bed at the same time every night and watch a television show that relaxes you.”

B) “Save your bedroom for sleeping; that means no work and no TV in the bedroom.”

C) “Why don't you ask your psychiatrist for a prescription for a sleeping pill?”

D) “Make sure to keep the bedroom warm and toasty.”

28. A nurse is obtaining information about a client's sleep patterns and asks the client about the total amount of sleep time, as compared to the amount of time spent in bed. The nurse is assessing which aspect?

A) sleep latency B) sleep architecture C) sleep efficiency D) sleep–wake cycle

29. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing with the client the effect of caffeine on sleep, which of the following would the nurse incorporate into the discussion as a caffeine effect?

A) decreased sleep latency B) increased total sleep time C) decreased REM sleep D) increased slow-wave sleep

30. A client with insomnia is prescribed zopiclone. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following?

A) gamma-aminobutyric acid (GABA) B) serotonin C) dopamine D) norepinephrine

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Answer Key 1. B, D, E 2. D 3. B, D, E 4. A, B, C, D 5. D 6. D 7. A 8. D 9. D, E 10. A, B, D, E 11. A 12. A, B, D, E 13. A, B, D, E 14. C, D, E 15. B, C, D, E 16. A, B, D, E 17. A, B, C, D 18. D 19. C 20. B, C, D 21. A, B 22. A, B, C 23. A, B, C, D 24. C 25. B 26. D 27. B 28. C 29. C 30. A

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Chapter 29: Mental Health Promotion and Assessment: Children and Adolescents Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which type of relationship is most likely to be a protective factor against the development of psychopathology?

A) sibling relationships B) relationships with peers C) emotionally distant parents D) relationships with extended family members

2. Which factors are protective against emotional and behavioural problems in children of divorce? Select all that apply.

A) low parental conflict B) parental nurturance C) parental remarriage D) joint custody E) parental mental health

3. Which are protective factors for children of parents who divorce and remarry?

Select all that apply.

A) warm, supportive relationship with stepparents B) a structured home environment C) avoiding any mention of the divorce D) reasonable and consistent limits E) a structured school environment

4. Which factors are more likely associated with a mentally healthy child? Select all that apply.

A) personal fable B) normal physical and psychosocial development C) fewer siblings D) an easy temperament E) secure attachment at an early age

5. Which are frequently identified as protective factors that decrease a child's or adolescent's risk for mental illness? Select all that apply.

A) self-confidence B) positive relationships C) competencies D) community involvement E) stern parental upbringing

6. Who plays the most critical role in preventing adverse outcomes in a child or adolescent?

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A) B) C) D)

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the nurse parents the siblings society

7. Which variables have the most influence on behavioural outcomes in children who experience a divorce in their family? Select all that apply.

A) income B) family dysfunction C) ethnicity D) parental nurturance E) siblings

A) B) C) D)

8. Which statement about grief in children and adolescents is accurate?

Children do not grieve in stages.

Children grieve in the same way as adults do.

Children's grief is shaped by developmental stages.

Children all respond to grief in the same ways.

9. Which variables are most likely to influence the health of young people and their families? Select all that apply.

A) income and distribution of wealth B) lifestyle choices C) employment and working conditions D) application of medical knowledge E) equitable access to education

10. Which statement about children/youth living in poverty is most accurate?

A) They are no more at risk for childhood psychopathology than the general population.

B) They are more likely to be from a two-parent family.

C) They are less likely to be recent immigrants.

D) They have increased risk of exposure to causes of childhood psychopathology.

11. Which youth populations are particularly at risk for becoming homeless or street involved? Select all that apply.

A) youth being treated for developmental disabilities B) runaway youth C) youth being treated for mental health issues D) lesbian, gay, bisexual, and transgender (LGBT) youth E) youth in foster care

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12. Which statement about the role of nurses with respect for mental health promotion with children and families is most accurate?

A) Nurses are in a key position to identify and intervene by virtue of their close contact with children and families in health care settings and their roles as educators.

B) Nurses are less likely to come into contact with children with psychopathology in the general population.

C) Nurses who work in mental health services are generally the only ones who will see childhood psychopathology.

D) Psychopathology is less likely in children who have serious physical disabilities.

13. When a nurse is interviewing a parent and a child in any setting, which fact should the nurse remember about the role of parents?

A) Parents are usually the cause of their child's mental health problems.

B) Parents are always most concerned with the well-being of their child.

C) Parents are the primary resource to the child and expert who knows about that child.

D) If the parent has psychopathology, the child will also have psychopathology.

14. The nurse is using play while working with a preschooler. What will this allow the nurse to do?

A) measure factors of attachment B) measure their abilities C) elicit the child's feelings D) help assess the child's cognition

15. The nurse is caring for an adolescent in the outpatient psychiatric setting. Which statement by the nurse is most likely to feel more in control of the initial therapy sessions?

A) “I won't share anything that you don't want me to with your parents.”

B) “Adolescents often feel a distrust of authority figures. Is that true with you?”

C) “Your parents care a great deal about you. That's why you are here.”

D) “You do not have to discuss anything with me that you don't want to discuss.”

16. For which age group is it most important for the nurse to allow the normal attachment process between the parents and the child to unfold?

A) infants B) preschoolers C) school-aged children D) adolescents

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17. A nurse speaking to a child about the death of his or her sister. How is the death of a child's sister best described?

A) “He or she died.”

B) “He or she passed away.”

C) “He or she is sleeping.”

D) “We lost him or her.”

18. Which is the most important outcome of a nurse understanding the difference between normal child development and psychopathology?

A) The nurse can form a positive relationship with the child and create long-lasting rapport.

B) The nurse can help the parents to view their children's behaviour realistically and respond appropriately.

C) It is helpful for the nurse when working with clients from different cultures.

D) It helps the nurse to understand the child's parents better.

19. Which conversational approach is most likely to be helpful to a nurse who is working with teenagers?

A) encourage questioning and argument B) talking to the adolescent in an authoritative manner C) to act like a teenager D) to restrict conversation to health matters

20. The nurse is preparing to interview a girl 6 years of age and her mother in an outpatient psychiatric setting. To establish a treatment alliance and rapport with the child, the nurse should do what?

A) Tell the child she watches Sesame Street all the time.

B) Talk to the child while standing up and looking down at her.

C) Tell the child that this must be a bit scary for her.

D) Ask the parent if the child can be interviewed alone.

21. A nurse is interviewing a child aged 12 years in an outpatient psychiatric setting.

Which of the following would be most appropriate for the nurse to say to establish a high degree of credibility?

A) “How would you describe your parents?”

B) “Tell me about your best friend.”

C) “I have several teddy bears; would you like one to hold?”

D) “You'd get along better with your parents if you'd follow their advice.”

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22. The nurse is providing care to a 10-year-old child who is hospitalized in a psychiatric setting. To establish rapport with the child, which statement by the nurse would be most appropriate?

A) “Let's compare your situation to that of Cinderella's in the fairy tale.”

B) “I'm going to use the DECA tool to measure your self-control and initiative.”

C) “Let's have you draw a picture of yourself.”

D) “Would you like to play a game of checkers with me?”

23. The nurse is caring for an adolescent in the outpatient psychiatric setting. To help the adolescent feel more in control of the initial therapy sessions, which statement by the nurse would be most appropriate?

A) “I won't share anything with your parents that you don't want me to share.”

B) “Adolescents often feel a distrust of authority figures. Is that true with you?”

C) “Your parents care a great deal about you. That's why you are here.”

D) “If something is uncomfortable for you, you don't have to talk about it.”

24. The nurse is assessing the self-concept of a child aged 8 years. Which of the following would be least appropriate for the nurse to ask?

A) “If you had three wishes, what would you wish for?”

B) “What would you like to be when you grow up?”

C) “What subjects do you like best in school?”

D) “What did you have for breakfast this morning?”

25. A nurse in an outpatient clinic is assessing a child, and the nurse will interview the child and the child's parents separately. Which of the following comments would the nurse anticipate the child making during the upcoming interview?

A) “I can't get along with my parents.”

B) “I yell at my parents a lot.”

C) “I'm sad a lot, and I have trouble sleeping.”

D) “I refuse to do what my parents tell me to.”

26. A nurse is performing an assessment interview of a boy aged 14 years who is being admitted to an adolescent substance abuse unit. His parents are concerned about their son's repeated problems at school that they associate with his drug use. The boy stalks into the office, abruptly sits down, crosses his arms, and says, “Okay, ask your stupid questions, but don't expect me to cooperate!” Which response by the nurse would be most appropriate?

A) “Your attitude is offensive; I can see why your parents brought you here.”

B) “Why don't we wait until you've calmed down a bit to start the interview?”

C) “Why are you so angry?”

D) “You seem pretty upset. Tell me about what is upsetting you.”

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27. The nurse is beginning an assessment interview with a girl aged 8 years who has been brought in for counselling by her parents. When beginning the interview, which question would be most appropriate for the nurse to ask first?

A) “How are you feeling?”

B) “How old are you?”

C) “Has anyone told you about why you are here today?”

D) “Why do you think I'm talking to you alone without your parents here?”

28. A nurse is interviewing a boy aged 12 years who has been diagnosed with depression. The client's depression was triggered by the death of his father 2 years ago. The nurse interprets which comment made by the boy as reflecting egocentrism?

A) “If I hadn't yelled at my dad and told him to go away, he never would have died.”

B) “I'm still sad because my dad died a couple of years ago.”

C) “I think I'm just experiencing normal grieving.”

D) “My father was the best friend I ever had; I still can't believe he's gone for good.”

29. A nurse is preparing an in-service presentation for a group of staff psychiatric nurses who will be providing care to children and adolescents in a new outpatient psychiatric clinic. When describing important issues related to interviewing children, which of the following would the nurse emphasize? Select all that apply.

A) Use simple terms such as sad or nervous instead of depressed or anxious.

B) Need to individualize the questions based on judgement and discretion.

C) Use questions that lead the child to the response desired.

D) Speak in longer sentences that include a description of what is being asked.

E) The need for the child's statements and behaviours to guide the interview.

30. A nurse is preparing to assess a child aged 9 years who has been sexually abused.

Which would be the priority for the nurse?

A) finding out when the abuse occurred B) documenting the assessment for use in court C) using anatomically correct dolls to elicit information D) ensuring that the environment is safe and supportive

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Answer Key 1. A 2. A, B, D, E 3. A, B, D, E 4. B, D, E 5. A, B, C, D 6. B 7. A, B, D 8. C 9. A, C, E 10. D 11. B, D, E 12. A 13. C 14. C 15. D 16. A 17. A 18. B 19. A 20. C 21. B 22. D 23. D 24. D 25. C 26. D 27. C 28. A 29. A, B, E 30. D

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Chapter 30: Psychiatric Disorders in Children and Adolescents Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is planning a presentation about mental health in children to a group of adults. What would be the rationale for the nurse's plan to instruct the adults that psychiatric problems are less easily diagnosed in children?

A) Symptoms are usually less severe in children.

B) Symptoms are often attributed to a medical condition.

C) Symptoms can be similar to normal growth and development turbulence.

D) Symptoms are often ignored by parents and professionals.

2. Which has been demonstrated in longitudinal studies that followed groups of children with ADHD into adulthood?

A) that the symptoms disappear during adulthood B) that symptoms persisted into adulthood C) that ADHD is associated with vaccine use D) that ADHD is more likely to be diagnosed in adulthood E) that girls are more likely to have ADHD

3. Which are most likely to occur in mothers of children with autism spectrum disorders (ASDs)? Select all that apply.

A) mental health difficulties B) greater stress C) a sense of accomplishment providing care to child with a disability D) increased social opportunities with formal support services E) depression

4. How is speech therapy best described?

A) diagnostic assessment of language disorder B) therapy directed at the motor aspects of speaking C) therapy directed at the social and interpersonal aspects of language D) characterized by therapeutic interventions directed at family communication patterns

5. Which types of treatment are more likely to achieve outcomes in a child diagnosed with ADHD that require less medication with a decreased risk of side effects?

A) environmental alterations for maladaptive behaviour B) combined behavioural–psychosocial approach C) parents providing a supportive environment without restrictions D) residential care

6. Which neurodevelopmental disorder of childhood has the diagnostic characteristics of marked impairment in social interaction and communication

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A) B) C) D)

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with a restrictive repertoire of activity and interest?

Asperger disorder oppositional defiant disorder autism spectrum disorder transient tic disorder

7. A 6-year-old child has been diagnosed as having an autism spectrum disorder (ASD). Which characteristics would the nurse tell the parents that their child may manifest? Children with ASD: A) are often aggressive.

B) are tolerant of change.

C) are mentally retarded.

D) may or may not have an intellectual disability.

8. Which are factors most likely to contribute to the dramatic rise in the incidence of autism spectrum disorder? Select all that apply.

A) the use of broader diagnostic criteria B) more systematic assessment practices C) an actual increase in the incidence D) increased awareness and attention by health professionals E) a variable that many children are exposed to—vaccines

9. The nurse is counselling a family whose child has an autism spectrum disorder.

Which would the nurse explain about the epidemiology and aetiology of autism spectrum disorders?

A) are usually accompanied by seizure disorders B) are not detected until the child reaches school age C) are diagnosed much more often than in the past D) occur in females more often than in males

10. The nurse is caring for an autistic child who continually repeats phrases spoken by the nurse. Which would the nurse document?

A) dysphagia B) echopraxia C) echolalia D) dyslexia

11. The nurse is caring for a family with a child who is severely affected by autism spectrum disorder (ASD). Which should the nurse explain is a common feature of children with ASD? A) dyslexia

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B) phonic tics C) stereotypic behaviour D) impulsiveness

12. The nurse is caring for a family with a 3-year-old daughter who has autism spectrum disorder (ASD). Which should the nurse explain to the family?

A) Children usually have seizure disorders in addition to autism.

B) Children are typically higher in IQ range than other children.

C) Children usually have a comorbid diagnosis of dyslexia.

D) Children will have multiple, varied needs throughout childhood.

13. Which types of trauma may a child with posttraumatic stress disorder have been exposed to? Select all that apply.

A) domestic or community violence B) various forms of abuse and neglect C) violent video games D) war E) natural disasters

14. How might a child who has posttraumatic stress disorder manifest this disorder?

Select all that apply.

A) repetitive play themes B) nightmares C) aggressive acts D) regression of otherwise acquired skills E) reenactment of the event in dissociative space

15. Which is the most common obsession in children?

A) family safety B) social situations C) physical illnesses D) contamination

16. Which is the most prevalent mental illness in Canadian children between 4 and 17 years of age?

A) ADHD B) depression C) anxiety D) autism spectrum disorder

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17. Which statement about school phobia is most accurate?

A) It is often a side effect of antipsychotic medication.

B) It is often a manifestation of several other psychiatric disorders.

C) It is extremely rare in Canada.

D) It is unrelated to other phobias.

18. Which is an example of an anxiety disorder in children?

A) a toddler who is afraid of the dark B) a school-aged child who fears animals C) a teenager who worries about relationships with peers D) a child who is constantly terrified of attending school

19. Which is a diagnosis describing children who are easily distracted and lack persistence of age-appropriate tasks, reflecting an inability to filter stimuli and/or sustain attention?

A) oppositional defiant disorder B) conduct disorder C) ADHD D) autism spectrum disorder

20. Which diagnosis is likely for children who often fail to consider the consequences of their actions, exercise poor judgement, and have more bumps and bruises because of their risk-taking behaviour?

A) autism B) ADHD C) compulsive disorder D) disruptive behaviour

21. Which statements about the aetiology of attention deficit hyperactivity disorder are accurate? Select all that apply.

A) The aetiology of ADHD remains unclear.

B) There is only one causal factor in ADHD. C) Children with ADHD have multiple risk factors.

D) ADHD is caused by ineffective parenting.

E) There is not a genetic component to the risk for ADHD.

22. Which are typical functional impairments that are associated with attention deficit hyperactivity disorder (ADHD)? Select all that apply.

A) school dysfunction B) occasional inattention C) slightly high energy levels

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D) peer problems E) family conflicts

23. Which statement regarding oppositional defiant disorder (ODD) is accurate?

A) Children with ODD challenge authority or have temper tantrums.

B) Children with ODD persistently, consistently, and excessively behave defiantly.

C) Children with ODD only behave defiantly with their siblings.

D) Children with ODD behave defiantly for less than 6 months.

24. Which statements about oppositional defiant disorder (ODD) are accurate? Select all that apply.

A) There is growing evidence that there are both genetic and environmental components to this disorder.

B) Often, ODD is accompanied by other coexisting conditions such as ADHD or a learning disability.

C) Children with ODD are likely to bully or be bullied.

D) Behavioural modification is consistently effective.

E) It is caused from children using computer games.

25. Which onset type of conduct disorder may have a poorer prognosis?

A) childhood before the age of 10 years B) adolescence after 10 years C) unknown age of onset D) onset in infancy

26. The nurse is caring for a school-aged child who has encopresis. Which intervention may be used in a child and family behavioural treatment programme for encopresis?

A) daily sitting on the toilet after each meal for a predetermined period of time B) using enemas every other day to strengthen the muscles C) ensuring the child eats a diet low in fibre D) identifying the fears of the child that have caused this disorder

27. A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which would the nurse identify as reflecting impulsiveness in the child?

A) inability to wait the child's turn B) restlessness C) difficulty completing a task D) risk-taking behaviour

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28. After educating the parents of a child diagnosed with ADHD on the disorder and its treatment, the nurse determines that the education has been effective when the parents state which of the following?

A) “We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention.”

B) “We need to be careful so he doesn't develop a substance abuse problem as he grows older.”

C) “We should stop the medication after 2 months to see how effective it is in really controlling his symptoms.”

D) “We should set up regular routines for him, but not worry if he violates the limits once in a while.”

29. A child with autism spectrum disorder engages in a repetitive rocking behaviour that does not pose a threat to the child's safety. When educating the child's family on managing this behaviour, which action would be appropriate for the nurse to suggest?

A) ignore it B) redirect the child C) use positive reinforcement D) pad the area around the child

30. A nurse is caring for a family with a child who has autism spectrum disorder.

When developing an education plan for the parents, which would the nurse most likely emphasize?

A) The child is at higher risk for seizure disorder.

B) The child's IQ will typically be higher than that of other children.

C) Dyslexia also may be a comorbid condition.

D) A structured physical environment is important for the child.

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Answer Key 1. C 2. B 3. A, B, E 4. B 5. B 6. C 7. D 8. A, B, D 9. C 10. C 11. C 12. D 13. A, B, D, E 14. A, B, D, E 15. D 16. C 17. B 18. D 19. C 20. B 21. A, C 22. A, D, E 23. B 24. A, B, C 25. A 26. A 27. D 28. A 29. A 30. D

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Chapter 31: Mental Health of Older Adults: Promotion and Assessment Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. While assessing an older adult, the nurse observes that the client is slow in providing answers to the nurse's questions. The client apologizes for being slow to respond. The nurse should explain that it is common for older to do what?

A) focus more on accuracy than speed in responding B) have memory impairments that affect their responses C) exercise less caution due to the aging process D) be risk takers more often than younger adults are

2. The transition of individuals from young-old to old is a gradual bio/psycho/social/spiritual process. Which is the most positive outcome of this perspective on aging?

A) reminiscing about the good times B) strengthening of religious beliefs and cultural factors C) identification of the psychopathology of their mental illness D) providing time for personal growth and development

A) B) C) D) E)

3. Which may pose threats to memory for an older adult? Select all that apply. gastrointestinal disturbances heart and lung disease depression or alcohol use poor nutrition infection or thyroid problems

4. Which are dimensions of growth in an older adult that are associated with Erikson's final stage of gerotranscendence? Select all that apply. Growth in: A) physiologic strength.

B) spirituality.

C) psychological strength.

D) insight and concentration.

E) inner strength.

5. An elderly client tells the nurse that she or he is becoming more forgetful. Which variable is the most plausible threat to memory in older adults?

A) anxiety B) normal aging C) GI disturbances D) medications

6. Which is a critical factor in older adults' mental health that protects against suicide and despair in later life?

A) having a sense of meaning or purpose

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B) having a substantial income C) having a large number of children D) having family responsibilities

7. Which are negative experiences that many older immigrants and refugees who come to Canada face in addition to loneliness? Select all that apply.

A) frequent physical assault B) having difficulties expressing their mental health needs C) not qualifying for public health care D) not speaking the same language E) becoming further isolated

8. Which nursing intervention related to drug therapy in older adults is most appropriate?

A) Exercise caution when administering medication with a long half-life.

B) Always administer medications with food or fluid.

C) Increase the dosage if the client has renal or hepatic damage.

D) Automatically give a lower dose than is prescribed.

9. Which are the nursing implications of older adults' preference to “age in place”?

Select all that apply.

A) Understand that elderly people will need to be admitted to a nursing facility.

B) Be vigilant in their assessment skills.

C) Understand that all elderly people become demented at some point.

D) Provide ongoing support.

E) Facilitate early interventions when indicated.

10. Which statement about bereavement and loss in older adults is accurate?

A) Men are more likely to experience the death of a spouse.

B) Women are more likely to experience the death of a spouse.

C) Both genders experience life events at the same ages.

D) Men tend to become widowers at a younger age.

11. Older adults are at greater risk for complications of polypharmacy because of what factor?

A) complex drug therapies and age-related changes B) noncompliance with medication regimens C) their insistence that they need more medication D) their strong tendency to self-medicate

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12. The nurse is providing support sessions for older adults who have experienced the death of a loved one. Which would be the highest priority for a guest speaker to present on?

A) medication management B) financial planning C) transportation management D) assisted living and nursing home options

13. Which is the most important risk factor for suicide in older adults?

A) having to work B) having been physically active during youth C) being newly married D) depression

14. The nurse is providing education to the older adult about medication. Which information is most likely to reduce the chance of a drug–drug interaction?

A) the cost of the drugs and the pharmacokinetics of the drug category B) the consequences of not taking the drug exactly as prescribed C) to consult with his or her health care provider before taking any over-the-counter medication D) the potency of the drug compared to other drugs in the same category

15. According to the Canadian Mental Health Association project, which examined seniors' mental health and home care using mental health promotion principles, which needs are met by using a holistic model of care for older adults?

A) increased amount of physical activity B) increased information accessible at primary care clinics C) accessible health care providers D) incorporating both medical and psychosocial supports

16. Which statement about older adults reporting symptoms is most accurate?

A) Older individuals are more likely to report somatic symptoms than psychological ones.

B) Older individuals are more likely to report psychological symptoms than somatic ones.

C) Symptoms of psychological disorders mask somatic ones.

D) Older individuals are not likely to report any symptoms that they experience.

17. During an assessment of an older adult, the nurse must identify chronic health problems in order to do what?

A) identify client management of mental health problems

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B) make psychiatric diagnoses C) link direct results of physical problems to mental health problems D) use information for cognitive testing

18. A nurse is assessing an older adult who has been treated with typical antipsychotics. Which symptom is critical for the nurse to assess the client for?

A) delirium B) aggression C) tardive dyskinesia D) diabetes

19. The nurse is assessing an older adult. Which is an instrumental activity of daily living?

A) bathing B) dressing C) transferring D) shopping

20. The nurse is assessing an older adult client's blood pressure to obtain a baseline and has been monitoring fluctuations. What risk does this pattern of assessments address?

A) risk for cerebral edema B) risk for falls C) risk for constipation D) risk for urinary retention

21. A nurse is assessing an older adult in the clinic who has present in for his or her follow-up appointment. The nurse detects the smell of alcohol on the client's breath. Which screening test would be most appropriate for the nurse to use when following up on this finding?

A) mini mental status B) functional assessment C) BEHAVE-AD rating scale D) CAGE questionnaire

22. The nurse is caring for an 83-year-old client in an outpatient setting who has been diagnosed with depression. The client tells the nurse that he or she has had trouble swallowing the food lately. Which term should the nurse use to document this complaint?

A) dyspepsia B) alopecia

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C) dysphagia D) dysphoria

23. An older adult client tells the nurse about being constipated for the last few days.

The health care provider has prescribed fibre laxative. Which side effect should the nurse advise the client that this medication may cause?

A) bloody stool B) vomiting C) flatus D) decreased appetite

24. The nurse is assessing an 80-year-old client who is visiting the mental health clinic. During the assessment, the client tells the nurse that he or she is taking a complex and large medication regimen. Which food should the nurse assess if the client consumes?

A) grapefruit juice B) orange juice C) tomato juice D) grape juice

25. A 74-year-old woman reports not feeling rested in the morning when she awakens. She states that she falls asleep very easily but awakens early in the morning. Which assessment would be important for the nurse to complete in light of this complaint?

A) use of alcohol B) history of seizures C) dietary intake in the evenings D) spiritual beliefs

26. The nurse is assessing an 86-year-old client with a hearing deficit due to presbycusis. Which would be important for the nurse to do?

A) use a higher volume of speech B) address the client's family members C) ask if the client can use sign language D) use lower-pitched tones

27. The nurse is caring for a client who has been diagnosed with dementia. Which other mental health issue is this client at increased risk for?

A) bulimia B) hallucinations C) anxiety

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D) hypertension

28. A son brings his 87-year-old father to the mental health clinic. During the assessment process, the father remains silent, and the son tells the nurse, “My father doesn't seem to have any ability to move. I had to practically drag him in here. He is usually very active.” Which disease process should the nurse screen the client for?

A) Alzheimer's disease B) schizophrenia C) Tourette's syndrome D) panic disorder

29. Which would be the best use of the Mini-Mental State Examination (MMSE)?

A) assessing the client's biologic/physical status B) diagnosing anxiety in an older adult C) identifying a person with depressive symptoms D) screening for cognitive functioning related to dementia

30. The nurse is assessing a 78-year-old client who lives alone in his or her own home. Which would the nurse inquire about to assess the client's instrumental activities of daily living? The frequency with which the client: A) takes a bath or shower.

B) gets dressed for the day.

C) cooks his or her own meals.

D) takes the bus to church.

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Answer Key 1. A 2. D 3. B, C, D, E 4. B, E 5. D 6. A 7. B, D, E 8. A 9. B, D, E 10. B 11. A 12. B 13. D 14. C 15. D 16. A 17. A 18. C 19. D 20. B 21. D 22. C 23. C 24. A 25. A 26. D 27. C 28. A 29. D 30. D

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Chapter 32: Neurocognitive Disorders: Delirium and Dementia Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Which findings are characteristic of neurocognitive disorders (NCDs)? Select all that apply.

A) NCDs only occur in older adults.

B) NCDs increase the risk for falls and fractures.

C) NCDs may have multiple aetiologies.

D) NCDs cause deficits in cognition or memory.

E) NCD deficits include deterioration from previous level of functioning.

2. Which neurocognitive deficit (NCD) is an irreversible syndrome that is characterized by ongoing decline in intellectual functioning sufficient to disrupt physical, social, and/or occupational functioning?

A) dementia B) delirium C) toxicity D) temporal–occipital dysfunctions

3. Which neurocognitive deficit (NCD) is a temporary disorder of physical origin with an abrupt onset characterized by fluctuating consciousness and attention?

A) dementia B) delirium C) toxicity D) temporal–occipital dysfunctions

4. Which statement about delirium is accurate?

A) Delirium requires immediate interventions because it can be a sign of impending death.

B) Delirium is irreversible and involves an ongoing decline in intellectual functioning.

C) It is not possible for a client to have dementia and also experience delirium.

D) Delirium is less common than dementia.

5. The nurse is caring for a delirious client who is exhibiting marked excitability.

The client is crying out frequently and is clamouring to remove his or her hospital gown. What type of delirium does the client most likely have?

A) hyperactive delirium B) hypoactive delirium C) mixed delirium D) fluctuating delirium

6. Which lifestyle factors are currently believed to decrease the risk of developing dementia? Select all that apply.

A) increased physical activity

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B) C) D) E)

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moderate alcohol intake keeping vaccinations current keeping mentally active keeping socially active

7. Which is an early symptom of Alzheimer's disease?

A) persistent tics B) withdrawal from normal activities C) lost the ability to feed self D) incontinence

A) B) C) D)

8. Which is the cause of the rare and fatal brain disorder, Creutzfeldt-Jakob disease? distinctive intraneuronal Pick's bodies a subcortical dementia repeated head injuries infectious agents known as prions

9. Which is the cause of most substance/medication-induced dementias in the older adult?

A) “Huffing” solvents B) carbamazepine C) NSAIDs D) alcohol

10. Which symptom is included in the campaign of the Alzheimer's Society of Canada to educate the public to know the 10 warning signs of Alzheimer's dementia?

A) visual hallucinations B) problems with language C) the need for a hearing aid D) a slower gait

11. The nurse is completing an assessment on older adult with symptoms of dementia. What is the nurse's best action?

A) perform the assessment outside the client's home B) exclude family members to prevent prompting the client to answer questions C) ensure the client's eyeglasses and hearing aid in place D) provide nutritional snacks to promote cooperation with assessment

12. Which are identified risk factors for delirium? Select all that apply.

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A) B) C) D) E)

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advanced age infection genetic disposition electrolyte imbalance preexisting dementia

13. An older adult client has been diagnosed with substance-induced dementia.

Which cause is most likely?

A) environmental toxins B) food additives C) opioids D) prescription medications

14. The primary treatment goal is prevention or resolution of the delirious episode with return to previous cognitive status. Which is an outcome measure on the part of the client that will meet this goal?

A) experience a slower progression of disease process B) verbalize fears experienced with delirium C) verbalize understanding of confusion D) verbalize identification of causative agent

15. Which behavioural response of a client in the late stages of Alzheimer's disease is likely most difficult for families to understand?

A) forgetfulness B) slight improvement in cognition C) lack of empathy D) inability to prepare meals

16. Which assessment should the nurse prioritize for an elderly client with delirium brought to the emergency department after a fall?

A) assessment of sleep pattern B) assessment of social support C) assessment of underlying cause of delirium D) assessment of gait

17. Which would be important nursing focuses to consider in addition to those related to confusion for a client with impaired cognitive function? Select all that apply.

A) hyperthermia B) dehydration C) impaired skin integrity

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D) cyanosis E) disturbed sleep pattern

18. Which nursing intervention in the psychological domain would be most appropriate for a client experiencing delirium who is confused, experiencing illusions, or hallucinating?

A) placing the client in a milieu with other delirious clients B) interacting frequently with the client C) isolating the client from others D) limiting family interaction

19. The nurse is caring for a client with dementia. When the client has just finished engaging in a social outing, the client then experiences an outburst of delusional accusations. Which should the nurse consider is a contributing factor to this behaviour?

A) There was too much activity.

B) The client has become desensitized.

C) The client is hungry.

D) The client wants to return to the place of the social outing.

20. The nurse is caring for a client with delirium. The client is hypervocalizing, and this is disturbing the other clients. Which nursing intervention would be most appropriate?

A) utilizing background music to soothe the clients B) setting firm behavioural limits C) ensuring that the electronically controlled exits are working D) administering medication

21. The nurse is assessing a client who has received a tentative diagnosis of delirium.

The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

A) “Basically, this diagnosis is based on the client's inability to talk normally.”

B) “Your report of gradually developing confusion over time was the basis for the diagnosis.”

C) “The client's diagnosis is primarily based on the rapid onset of the change in consciousness.”

D) “The client's exposure to an infectious agent led us to determine the diagnosis.”

22. As part of a follow-up home visit to a client aged 80 years who has had surgery, a nurse discusses the client's risk for delirium with the family members. Which would the nurse include as placing the client at increased risk? Select all that

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A) B) C) D) E)

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apply. urinary tract infection hypertension acute stress bone fractures dehydration

23. A nurse is caring for a client diagnosed with delirium who has been brought for treatment by the client's adult child. While taking the client's history, which question would be most appropriate for the nurse to ask the client's adult child?

A) “Has your parent taken any medications recently?”

B) “Are you aware of your parent falling or injuring the head in any way?”

C) “Has your parent had a recent stroke?”

D) “Has your parent experienced any major losses recently?”

24. A nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help care for the client.

Which nursing diagnosis would the nurse identify as the priority?

A) ineffective family coping related to care of a client with Alzheimer's disease B) risk for activity intolerance related to Alzheimer's disease C) caregiver role strain related to social isolation D) powerlessness related to seclusion and long-term care of client

25. While the nurse is caring for a hospitalized client in the advanced stages of Alzheimer's disease, the client begins to have a catastrophic reaction to feeding himself or herself. Which should the nurse do first?

A) remain calm and reassuring B) restrain the client temporarily C) draw the curtains to darken the room D) offer to feed the client

26. A group of nurses is reviewing information about delirium and dementia. The nurses demonstrate a need for additional review when they identify which as a characteristic of dementia?

A) fluctuating changes within a 24-hour period B) possible hallucinations C) normal psychomotor activity D) globally impaired cognition

27. A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the

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A) B) C) D)

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assessment, the nurse asks the client to identify common objects. The nurse is assessing for what? aphasia apraxia agnosia executive functioning

28. A nurse is providing care to a client with Alzheimer's disease who is exhibiting suspiciousness and delusional thinking. Which would be most important for the nurse to do with this client?

A) Tell the client that he or she is experiencing delusions.

B) Confront the client about his or her distorted thinking.

C) Correct the client's interpretation of the situation.

D) Determine the trigger for the distorted thinking.

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

A) hypersexuality B) disinhibition C) hypervocalization D) apathy

30. After educating a group of nurses on Alzheimer's disease and appropriate nursing care, the group leader determines that the education was successful when the nurses identify which as the foundation for providing care to the client and family?

A) therapeutic relationship B) medication therapy C) injury prevention D) functional independence

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Answer Key 1. B, C, D, E 2. A 3. B 4. A 5. A 6. A, B, D, E 7. B 8. D 9. D 10. B 11. C 12. A, B, D, E 13. D 14. C 15. C 16. C 17. A, B, D, E 18. B 19. A 20. A 21. C 22. A, C, D, E 23. A 24. C 25. A 26. A 27. C 28. D 29. C 30. A

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Chapter 33: Care of Persons with Concurrent Substance-Related, Addictive & Other Disorders Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. The nurse is caring for a client with a mental health disorder. Which diagnosis must the client also have for the term “concurrent disorder” to be correctly applied?

A) physical illness B) acute stress experience C) substance abuse disorder D) anxiety

2. Which is true of the terms concurrent disorders and dual disorders?

A) They are completely interchangeable.

B) They have universal meanings.

C) Dual diagnosis can mean a person with a mental disorder and an intellectual disability.

D) They are the same as bipolar disease.

3. Which statements about the epidemiology of concurrent disorders are true?

Select all that apply.

A) It is estimated that 50% of persons seeking help for addiction also have a mental disorder.

B) Fifteen to twenty percent of persons with mental illness also suffer from a substance-related addictive disorder.

C) People who have adequate financial resources are more likely to be affected.

D) People who are from minority backgrounds are more likely to be affected.

E) Rates are highest in Quebec.

4. A client with major depression visits the mental health clinic and tells the nurse that he or she has recently started smoking marijuana. Which would the nurse determine is the aetiology of this client's current mental health problem?

A) primary mental illness with subsequent substance abuse B) primary substance abuse disorder with psychopathologic sequelae C) dual primary diagnoses D) a common aetiology

5. The nurse knows that it is complicated to treat clients who have concurrent disorders of anxiety and substance-related addictive disorder. Which category of traditional medications used to treat anxiety are addicting and should therefore be avoided for these clients?

A) mood stabilizers B) benzodiazepines C) antipsychotics D) hypnotics

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6. Which models are currently believed to explain aetiology in co-occurrence of substance-related/addictive disorders and other mental disorders? Select all that apply.

A) common factor models B) secondary substance abuse disorder models C) control of supply models D) secondary psychiatric disorder models E) bidirectional models

7. A client is believed to have a genetic susceptibility to both addiction and depression. Which of the models for explaining the aetiology of concurrent disorders is represented in this client?

A) the common factor model B) secondary substance use disorder models C) secondary psychiatric disorder models D) bidirectional model

8. Which of the models for explaining the aetiology of concurrent disorders is due to a process where substance-related/addictive disorders and other mental illnesses each increase the risk for the development of the other condition?

A) the common factor model B) secondary substance use disorder models C) secondary psychiatric disorder models D) bidirectional model

9. The use of which substance had been identified as an independent risk factor for schizophrenia?

A) marijuana B) opioids C) alcohol D) inhalants

10. A client combines the use of alcohol and illicit substances in addition to the medications prescribed for mental illness. This client has an increased risk of what?

A) drug interactions and exacerbation of side effects B) withdrawal manifestations C) further addiction of medication prescribed D) improvement in the mental health status

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11. Suspiciousness and confusion are potential effects of using which substance? tobacco alcohol benzodiazepines cannabis

12. A client visits the mental health clinic and tells the nurse that he or she has bipolar I disorder and has been using marijuana to deal with some of the symptoms since adolescence. When smoking marijuana, the client fails to take prescribed medication and subsequently becomes manic. Which would the nurse determine is the aetiology of this client's problem?

A) genetic vulnerability B) a common aetiology C) primary mental illness with subsequent substance abuse D) self-medication

13. Which are among the most common examples of combinations of substancerelated/addictive disorders with other mental disorders? Select all that apply.

A) mood disorders and substance-related/addictive disorders B) intellectual disability and substance-related/addictive disorders C) psychotic disorders and substance-related/addictive disorders D) personality disorders and substance-related/addictive disorders E) attention deficit hyperactivity disorder and substance-related/addictive disorders

14. Which should an assessment of a client with a concurrent disorder include that is specifically related to the substance-related/addictive disorder? Select all that apply.

A) acute intoxication and/or withdrawal potential B) readiness to change C) relapse/continued use/continued problem potential D) recovery environment E) whether the substance is illicit in the locale where the client lives

15. A client has major depression and abuses alcohol. Which symptom should the nurse explain to the client that continued use of alcohol can cause?

A) vivid hallucinations B) mild agitation C) frequent seizures D) suicide risk

16. The nurse is caring for a client who has depression and is withdrawing from

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A) B) C) D)

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opiates. Which would be the most appropriate nursing intervention? withholding the medication used to treat depression forming an empathic, hopeful, nurse–client relationship ensuring that the client is restrained teaching the client how to appropriately deal with anxiety

17. A nurse caring for a client with anxiety disorder should recognize that what treatment options is most likely to be prioritized?

A) desensitization techniques B) enhanced psychoactive medication C) cognitive–behavioural therapy D) benzodiazepine administration

18. Which is a type of care for concurrent disorder that involves provision by the same cross-trained team members in the same program?

A) integrated B) assertive community treatment C) strength-based perspective D) clinical rehabilitation

19. Which is an approach to treatment whereby care is received in sequential treatment episodes in separate systems of care?

A) serial treatment B) assertive community treatment C) strength-based perspective D) clinical rehabilitation

20. Which is the best approach in caring for clients with concurrent disorders?

A) to address both illnesses simultaneously B) to treat the substance-related/addiction first C) to treat the mental illness first D) intervention is not likely to be effective

21. Which characteristics of clients with addiction most increase the risk for relapse?

A) financial difficulties B) untreated mental illness C) unclear legal status D) dishonesty

22. Which type of concurrent personality disorder is likely the most challenging of

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A) B) C) D)

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all concurrent disorders? borderline personality disorder and substance-related/addictive disorders psychotic disorders and substance-related/addictive disorders attention deficit hyperactivity disorder and substance-related/addictive disorders OCD and substance-related/addictive disorders

23. In a client whose family members are no longer involved in their lives or are also living with an addiction and/or mental health problem, which is the most important need for the nurse to focus on?

A) referral to vocational and employment guidance B) education about the aetiology of addictions C) developing and sustaining a healthy lifestyle D) finding alternative supports and/or social services

24. Which are needs for further research for concurrent disorders? Select all that apply.

A) research into how mental illness causes most addictions B) research into effective punishments for illegal drug use C) a unified approach to all components of concurrent disorders D) research into systems' approaches E) research into the effectiveness of different treatment approaches

25. The nurse is caring for a female adolescent client diagnosed with depression and substance abuse. Which would be most appropriate for the nurse to do?

A) Determine if the client is experiencing hyperactivity.

B) Ask her if she is having thoughts of harming herself.

C) Determine if the client is exhibiting Wernicke's syndrome.

D) Ask the client if she has had problems with excessive anxiety.

26. A client with schizophrenia and substance abuse disorder is admitted to a detoxification program. The client has been prescribed medications for schizophrenia. When caring for this client, the nurse would implement interventions to reduce the client's risk for relapse, integrating knowledge that relapse frequently is secondary to which of the following?

A) poor social skills B) lack of vocational skills C) medication nonadherence D) dysfunctional family systems

27. A nurse is working as part of an interdisciplinary treatment team for a client diagnosed with a mental illness and substance abuse disorder. As part of the

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recovery process, which would be most important for the team to do initially?

A) Provide a series of short-term hospitalizations that apply leverage to pressure the client into adhering to a prescribed treatment regimen.

B) Establish rules that will enhance the client's recognition of staff as authority figures who know what is best for the client's care and well-being.

C) Use heavy confrontation, intense emotional pressure, and discouragement of the use of medications, since all medications have the potential to be addictive.

D) Provide immediate help with a situational crisis the client is experiencing in order to promote trust in the client and have the client buy into the treatment process.

28. A nurse is readmitting a client with co-occurring diagnoses of schizophrenia and alcohol abuse who has relapsed. The client says, “I'm just a failure. I'll never be anything but just a drunk.” Which response by the nurse would be most appropriate?

A) “Relapse is a normal part of recovery; you can learn from this experience so it will be easier to avoid a similar one in the future.”

B) “Face it, you will always be an alcoholic, and relapse is inevitable because it is part of the illness.”

C) “If you didn't have disturbed thoughts from your schizophrenia, you wouldn't be tempted to drink.”

D) “Please clarify something for me. When you say, 'just a drunk,' what exactly are you trying to say?”

29. A client with co-occurring disorders of schizophrenia and substance abuse is admitted for treatment. Which should the nurse exclude from the client's care plan?

A) assessment B) group therapy C) control of psychiatric symptoms D) treatment of withdrawal symptoms

30. A nurse is working with a client with co-occurring disorders who is in the early stages of recovery. The client has abstained from alcohol for the past 3 weeks.

During a follow-up visit, the nurse is educating the client on the effects of alcohol on the body. Which would be most important for the nurse to keep in mind about the client?

A) The client will be highly suggestible to information, being unable to reason critically.

B) The alcohol abuse has destroyed the brain cells that are necessary for learning.

C) Some cognitive impairment may be present, which hinders his or her ability to learn new things.

D) The underlying effects of the substance abuse will prevent him or her from being able to learn.

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Answer Key 1. C 2. C 3. A, B, D 4. C 5. B 6. A, B, D, E 7. A 8. D 9. A 10. A 11. D 12. D 13. A, C, D, E 14. A, B, C, D 15. D 16. B 17. C 18. A 19. A 20. A 21. B 22. A 23. D 24. C, D, E 25. B 26. C 27. D 28. A 29. B 30. C

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Chapter 34: Care of Persons with a History of Abuse Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. According to feminist theory, which are three major characteristics of a patriarchal society that supports violence against women? Select all that apply.

A) ambiguous gender roles B) devaluation of women C) male desire to take care of women D) the view of women as property E) power inequities

2. Which statement best describes the relationship between alcohol or drug abuse and violence?

A) The use of alcohol and other drugs is commonly associated with violent incidents.

B) Alcohol or drug use alone sufficiently accounts for most violence.

C) People are not legally accountable for their behaviour while intoxicated.

D) Violence has been mistakenly attributed to alcohol and drugs in the past.

3. Which biologic factors demonstrate the relationship of alcohol use to intimate partner violence? Select all that apply.

A) Alcohol use impacts cognitive and physical functions.

B) People cannot be held liable for actions committed while under the influence of alcohol.

C) Users of alcohol expect that alcohol increases the tendency towards aggression.

D) People often attempt to justify their criminal behaviour by blaming alcohol after the fact.

E) Alcohol reduces self-control.

4. The psychopathology theory of violence prioritizes what characteristic of people who commit violence?

A) their personality traits B) their childhood C) their family type D) their intelligence

5. The nurse is caring for a client who is involved in a relationship with an abusive boyfriend. Which is a common reason that many women are afraid or reluctant to identify their abusers?

A) These women have limited education.

B) Women are afraid of retaliation against themselves or their children.

C) These women enjoy the dependent relationship they have with the man.

D) These women are accustomed to being used as property by the man.

6. Which statement about violence and social learning theory is most accurate?

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A) Women who witness violence in their homes often perpetuate violent behaviour in their families as adults.

B) Violence in the home does not necessarily predict with certainty that violence will occur in future relationships.

C) Women who reported violence in childhood by their fathers were more likely to be aggressive towards their male partners.

D) Violent tendencies are more related to genetics than to environment.

7. Which factor is the most significant predictor of whether or not a male will abuse his family?

A) if there was violence in his childhood home B) lack of a father figure in his childhood home C) education level of his parents D) if he had one parent who abused alcohol

8. Which is one of the strongest reasons that women may stay in violent relationships?

A) economic B) community norms C) lack of education D) apathy

9. Which is the most appropriate question that should be asked about women who stay in violent relationships?

A) “Why do women stay in violent relationships?”

B) “How does she ever manage to leave given all the strikes against her?”

C) “Why do women like to be the victim in violent relationships?”

D) “How much abuse will a woman cause?”

10. How do drugs such as flunitrazepam increase the incidence of rape?

A) They cause a woman to be sexually aroused.

B) They are often prescribed to treat victims after a rape.

C) They facilitate sexual assault because it renders the user incapable of resisting rape.

D) They cause a man to be more sexually aggressive.

11. Which factors were found to be predictive of dating violence in a longitudinal study of dating violence in adolescent boys residing in Montreal? Select all that apply.

A) harsh parenting B) antisocial behaviour C) substance use

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D) level of education E) availability of suitable partners

12. Which is the single greatest cause of serious injury to women?

A) automobile accidents B) household falls C) fire in the home D) battering

13. Which are likely outcomes of children who are emotionally abused? Select all that apply.

A) become a better parent B) become a highly productive member of society C) suffer depression D) engage in more risk-taking behaviours E) retaliate against the parent 14. Which is a form of child abuse that includes “the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care for the purpose of indirectly assuming the sick role?”

A) acute anxiety disorder B) factitious disorder by proxy C) posttraumatic stress disorder D) seizure disorder

15. Who is most often responsible for family violence against older adults?

A) the female spouse B) strangers C) an acquaintance D) adult children

16. Which may result from posttraumatic stress disorder (PTSD) that is secondary to battering of women? Select all that apply.

A) increased disability B) severe physical health problems C) schizophrenia D) poor quality of life E) increased suicide attempts

17. Which has been identified as the most current problem of Aboriginal children

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A) B) C) D)

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having been placed in a residential school within the last century?

They were deliberately deprived of all connections with their culture and identity.

They were prohibited from speaking their mother tongue.

Depression in the persons who attended a residential school.

Depression in the offspring of the persons who attended a residential school.

18. Which is the reason that criminal harassment legislation was introduced?

A) The stalker is in danger.

B) It is likely to escalate into serious physical harm primarily against women.

C) The intimidation that the victim of stalking feels.

D) Legal consequences for the stalker.

19. Which statements about posttraumatic stress disorder (PTSD) are accurate?

Select all that apply.

A) PTSD has become a rare diagnosis in Canada.

B) Symptoms remain the same in intensity throughout the period.

C) Women's risk for PTSD varied according to the type of trauma.

D) There are gender differences in incidence and prevalence.

E) PTSD symptoms dissipate over time.

20. Which are risks faced by women who have PTSD? Select all that apply.

A) schizophrenia B) anxiety C) violent tendencies D) depression E) substance abuse

21. Which term is defined as a disruption in the normally occurring linkages between subjective awareness, feelings, thoughts, behaviour, and memories?

A) extinction B) dissociation C) depression D) emotional abuse

22. Which is a condition where an individual may not be able to recognize or label painful feelings?

A) alexithymia B) extinction C) traumatic bonding D) dysthymic

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23. Which underlies the hyperarousal that can result from behaviour sensitization following exposure to severe uncontrollable stressors?

A) dissociation B) alexithymia C) extinction D) kindling

24. Which is produced when high levels of stress damage the hippocampus and decrease its volume?

A) memory deficits B) depressive symptoms C) fight or flight D) emotional dysfunction

25. A woman is seeking medical help. Which finding would most clearly suggest that the woman has been abused?

A) precise information about the cause of the problem B) appropriate reactions of significant others accompanying the client to the appointment C) seeking treatment after a delay between occurrence of injury D) consistent information between history and physical exam

26. Which term is described by the capacity to overcome adversity in spite of extreme stresses and involves the balancing of risk and protective factors?

A) self-esteem B) resilience C) behavioural sensitization D) emotional well-being

27. Which is a nursing diagnosis focusing on the human responses from the biologic domain that would be managed by a nurse?

A) posttrauma syndrome B) ineffective coping syndrome C) ineffective role performance D) powerlessness

28. The nurse is caring for a client who has experienced a sexual assault. Which intervention should the nurse include to prevent short- or long-term psychopathology?

A) delaying treatment to assess physical findings first and dealing with the treatment

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at a later time B) ensuring routine physical assessment is performed C) providing the client with a follow-up appointment as soon as possible to prevent infection for physical symptoms D) early treatment because initial levels of distress are strongly related to later levels of PTSD

29. Which intervention should the nurse provide for a client who is being abused to help her to decide to leave an abusive relationship?

A) telling the client that she is responsible for the abuse B) assisting the client to identify aspects of her life that is under her control C) assuring the client that violence will stop once she leaves her abuser D) reminding the client that abuse is upsetting for the nurse to hear about

30. Which has been found to result from a health care worker asking screening questions specifically about abuse?

A) The results of screening are not completely clear.

B) The detection of abuse has decreased.

C) The incidence factors have become skewed.

D) Females are not believed when reporting the abuse.

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Answer Key 1. B, D, E 2. A 3. A, E 4. A 5. B 6. B 7. A 8. A 9. B 10. C 11. A, B 12. D 13. C, D 14. B 15. D 16. A, B, D, E 17. D 18. B 19. C, D 20. B, D, E 21. B 22. A 23. D 24. A 25. C 26. B 27. A 28. D 29. B 30. A

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Chapter 35: Care of Persons under forensic Purview Psychiatric & Mental Health Nursing for Canadian Practice 4th Edition 1. Who has the responsibility for the care and disposition for an individual who is found unfit to stand trial or not criminally responsible for the offense committed?

A) mental health services B) penitentiaries C) prisons D) review boards

2. What is the frequency of mental health problems among federal correctional populations compared to the general Canadian population?

A) two times more common B) three times more common C) five times more common D) ten times more common

3. Which activity is made more difficult by the complex psychosocial issues that forensic clients face?

A) interdisciplinary care B) remorse recognition C) intersectoral approaches D) relapse prevention

4. Forensic mental health nurses are challenged to engage in partnerships that encourage growth in their clients, as this population is categorized as which?

A) unreliable B) vulnerable C) supreme D) manipulative

5. When it is recognized that the accused individual is not fully capable of instructing legal counsel, how is the individual categorized?

A) not criminally responsible B) community treatment order C) court diversion program D) unfit to stand trial

6. A mentally ill person has come into conflict with the law. An alternative option that may be exercised to force the person to receive treatment is what?

A) failure to comply order B) community treatment order C) early discharge order as client is suffering from a mental disorder D) sentence to the federal penitentiary

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7. The court is considering a client's state of mind at the time of committing an offence. This determination is the basis for what finding?

A) not criminally responsible B) unfit to stand trial C) court diversion D) community treatment order

8. Which forensic population has seen a marked increase during the past decade in Canada?

A) women B) cultural minorities C) adolescents D) elderly

9. Nurses caring for forensic clients must be cognizant of common relationship issues that may arise. Which are special circumstances that increase the likelihood of problems? Select all that apply.

A) the index offense the client has committed B) the cultural and philosophical differences between nurses, clients, and other forensic staff C) the complexity of health care needs of a forensic client D) the seductive pull of helping and the intensity of relationships that can develop E) the professional isolation experienced by forensic nurses

10. Which is the term used mean a way of learning about the forensic client through trying to understand the world from the client's perspective?

A) manipulation B) exclusionary othering C) inclusionary othering D) splitting

11. When did the criminalization of the mentally ill which is frequently attributed to the deinstitutionalization movement occur?

A) 1980s to 1990s B) 1940s to 1950s C) 1960s to 1970s D) 1990s to 2000s

12. Which is a component of the Forensic Nursing: A Model of Care in addition to

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A) B) C) D)

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the forensic client, treatment setting, professional role development, and the nurse–client relationship? societal good societal norms social necessities societal factors

13. Which is the single factor that differentiates forensic nursing from mental health nursing?

A) provision of punishment and nursing care B) provision of nursing care in a locked environment C) implementation of increased use of restraints and seclusion D) implementation of increased use of medication intervention

14. Which is deemed critical to the safe operations of all forensic facilities but increases the stressors of nurses caring for forensic clients?

A) lack of visiting hours B) surveillance of staff and clients C) locked medication and nursing stations D) the presence of clients from wide age ranges

15. The adaptation to the professional roles of forensic nurses has been made more difficult by the myth that nurses who work with forensic clients are: A) “second class nurses.”

B) “security guards.”

C) “babysitters.”

D) “correctional staff.”

16. Which are types of health care needed by incarcerated older forensic clients that are not usually needed by their younger counterparts? Select all that apply.

A) developmental B) physical C) behavioural D) mental health E) reproductive

17. Which term or phrase is often used to describe the moral climate of forensic settings, which is shaped by the divergent and competing demands for custody and caring?

A) “chaotic” B) violent and dangerous

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C) corrupted D) “hotbeds” for potential problems

18. The nurse is trying to maintain her professional authority and responsibility while working in a criminal justice system. What is the nurse's best action?

A) promoting an environment categorizing clients according to their crime B) promoting exclusionary othering C) avoiding the use of professional authority with staff D) avoiding the temptation to align himself or herself with correctional staff

19. The nurse is working with a client who is using deceit to reach a goal that could not be pursued openly. What is this client exhibiting?

A) othering B) vulnerability C) participatory othering D) manipulation

20. Which may be an option that is considered in Canada on an individual basis for a very few long-term and infirm forensic clients who need palliative care?

A) compassionate release B) immediate release C) parole on account of illness D) parole to custody of family

21. Which mental health disorders have been consistently shown to be more likely to occur in youth in custody than youth in the general population? Select all that apply.

A) depression B) substance use disorders C) anxiety disorders D) posttraumatic stress disorders E) attention deficit hyperactivity disorder (ADHD)

22. Which has, in the past, ultimately interfered with successful community rehabilitation for forensic clients from varied cultural backgrounds?

A) a greater sense of belonging B) unequal laws C) assumption of sameness D) unsafe nurse–client relationships

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23. Which are benefits of continuing professional development for nurses who practice in forensic settings? Select all that apply.

A) It reinforces the therapeutic identity of nurses.

B) It erases the myth of forensic nurses being “second class nurses.”

C) It impacts negatively on their adaptation to their professional roles.

D) It assists with nursing policy development.

E) It contributes to recruitment and retention in this specialized area of practice.

24. Which type of data are often difficult for a forensic nurse to obtain about the client and are particularly problematic?

A) charges and psychiatric history B) home environment and support system C) treatment received in the past D) preferences to community reintegration

25. A nursing instructor is explaining to a group of nursing students that in addition to facing the stigma associated with being mentally ill, forensic clients who are mentally ill also experience the stigma associated with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which response by the instructor would be most appropriate?

A) “Nurses may be reluctant to care for mentally ill criminals because of unrealistic fears for their own safety, and that of their other clients.”

B) “Nurses may prefer to care for forensic clients because they do not believe criminals can be mentally ill.”

C) “An example would be volunteering to work only with forensic clients because of the belief that forensic clients experience only mild mental health problems.”

D) “An example would be unfounded fear of what such clients might do after they are discharged from treatment.”

26. When preparing the plan of care for a forensic client, a nurse determines not to investigate the details of the crime. Which best supports the rationale for the nurse's decision?

A) Knowing the crime details would be extremely frightening for the nurse.

B) Denying the crime details will help to protect the nurse from undue anxiety.

C) It will keep the nurse's attitudes about the crime from influencing care.

D) It will help maintain proper professional boundaries between the nurse and the client.

27. A forensic client with whom the nurse has developed rapport asks the nurse for her address so he can send her a Christmas card. Which response by the nurse would be most appropriate?

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A) “Sure, let me write it down for you; it would be great to hear from you.”

B) “I read that you molested a 4-year-old girl. I have a 2-year-old child. I would be crazy to give you my address.”

C) “We need to get to know each other better before I would feel comfortable about giving you my address.”

D) “It is inappropriate for me to give you my address because our relationship is professional rather than social.”

28. The nurse is performing an admission assessment on a forensic client. Which would be most important for the nurse to include when explaining the purpose of the assessment to the client?

A) “This is just a routine assessment, and we will be discussing specific events that have led to you being admitted to this unit.”

B) “I will be asking you questions so we can determine how to best meet your needs.”

C) “It is important during this initial assessment that you relate the specific details of the crimes of your case so we can effectively treat you.”

D) “I will be asking you questions that will focus on mental health and behavioural issues rather than on the specific details of any crimes associated with your case.”

29. The nurse is reviewing the medical record of a forensic client who has been found not criminally responsible on account of mental disorder. The nurse interprets this to mean which of the following?

A) The client knows that he committed a wrongful act.

B) The client is unable to control actions at the time of the crime.

C) The client is unable to assist in his defence.

D) The client's mental illness is a factor in the crime.

30. The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse–client relationship?

A) health teaching B) personal conduct C) maintaining boundaries D) conducting exercise sessions

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Answer Key 1. D 2. B 3. D 4. B 5. D 6. B 7. A 8. A 9. B, C, D, E 10. C 11. C 12. B 13. A 14. B 15. A 16. B, D 17. D 18. D 19. D 20. A 21. A, B, C, E 22. C 23. A, D, E 24. B 25. A 26. C 27. D 28. D 29. B 30. A

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