Evidence-based practice dependds on a combination of which of the following sources of information and knowledge? Select all that apply.

1. Clinical expertise

2. Randomized controlled trials

3. Theories of ethical decision making

4. Patient preferences

1. Clinical expertise

2. Randomized controlled trials

4. Patient preferences

A student nurse receives her final course evaluation for her clinical practicum in psychiatry, which took place at an urban mental health clinic. Her professor reported that she demonstrated competent and knowledgeable practice but gave her a grade of "C." The student is disbelieving and confused. Which of the following is the most likely rationale by the professor?

1. The student was reported to be anxious about patients' reactions during the first week.

2. The student was reported to lack a compassionate attitude toward patients.

3. The student was unable to delineate differences between symptoms of bipolar disorder and manic depression.

4. The student did not conduct a comprehensive review of psychiatric nursing literature during her semester.

2. The student was reported to lack a compassionate attitude toward patients.

Which of the following defines "clinical practice guideline?"

1. A step-by-step flowchart representing alternative diagnostic and treatment approaches

2. A compilation of interventions that should occur within a specific timeframe

3. A systematically developed summary of the best available evidence used to make informed decisions about specific health problems

4. A list of expected outcomes using a measurable format

3. A systematically developed summary of the best available evidence used to make informed decisions about specific health problems

Which of the following provides the strongest evidence on which to base clinical nursing practice?

1. A randomized, controlled study

2. A nurse's clinical experience in a direct patient care setting

3. A descriptive clinical study

4. A report from a practice guidance committee

1. A randomized, controlled study

When an experienced psychiatric nurse listens carefully to a patient's detailed recounting of a traumatic emotional experience, the nurse is:

1. acting as a patient advocate

2. using an attending behavior

3. interpreting the "best evidence"

4. using a systematic approach to care

2. using an attending behavior

Which statement about mental illness is true?

1. Mental illness is a matter of individual nonconformity with societal norms

2. Mental illness is present when individual irrational and illogical behavior occurs

3. Mental illness is defined in relation to the culture, time in history, political system, and group in which it occurs

4 Mental illness is evaluated solely by individual control over behavior and appraisal of reality

3. Mental illness is defined in relation to the culture, time in history, political system, and group in which it occurs

A nursing student new to psychiatric nursing asks a peer what resource he or she can use to figure out which symptoms are part of the picture of a specific psychiatric disorder. The best answer would be:

1. Nursing Interventions Classifications (NIC)

2. Nursing Outcomes Classifications (NOC)

3. NANDA-I nursing diagnoses

4. DSM-IV-TR

4. DSM-IV-TR

Why is it important for a nurse to be aware of the multiple factors that can influence an individual's mental health?

1. Rates of the illness differ among various groups

2. The DSM-IV-TR cannot be used without information on multiple factors

3. The nurse diagnoses and treats human responses, which are influenced by many factors

4. The nurse must contribute these data for epidemiological research

3. The nurse diagnoses and treats human responses, which are influenced by many factors

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

1. providing information about effective nursing techniques

2. identifying risk factors that contribute to the development of a disorder

3. identifying who in the general population will develop a specific disorder

4. identifying which individuals will respond favorably to a specific treatment

2. identifying risk factors that contribute to the development of a disorder

Which statement best describes a major difference between a DSM-IV-TR diagnosis and a nursing diagnosis?

1. There is no functional difference between the two. Both serve to identify a human deviance.

2. The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.

3. The DSM-IV-TR is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.

4. The DSM-IV-TR diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing.

4. The DSM-IV-TR diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing.

Which of the following contributions to modern psychiatric nursing practice was made by Freud?

1. The theory of personality structure and levels of awareness

2. The concept of a "self-actualized personality"

3. The thesis that culture and society exert significant influence on personality

4. Provision of a developmental model that includes the entire life span

1. The theroy of personality structure and levels of awareness

The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which of the following early theorists?

1. Freud

2. Piaget

3. Sullivan

4. Maslow

3. Sullivan

The concepts at the heart of Sullivan's theory of personality are:

1. needs and anxiety

2. basic needs and meta-needs

3. schemata, assimilation, and accommodation

4. developmental tasks and psychosocial crises

1. needs and anxiety

The premise that an individual's behavior and affect are largely determined by the attitudes and assumptions the person has developed about the world underlies:

1. modeling

2. milieu therapy

3. cognitive therapy

4. psychoanalytic psychotherapy

3. cognitive therapy

Providing a safe environment for patients with impaired cognition, referring an abused spouse to a "safe house," and conducting a community meeting are nursing interventions that address aspects of:

1. milieu therapy

2. cognitive therapy

3. behavioral therapy

4. interpersonal psychotherapy

1. milieu therapy

A nurse administering a benzodiazepine should understand that the therapeutic effect results from the benzodiazepine binding to receptors adjacent to receptors for the neurotransmitter:

1. GABA

2. dopamine

3. serotonin

4. acetylcholine

1. GABA

Fluoxetine (an SSRI) exerts is antidepressant effect by blocking the reuptake of:

1. GABA

2. dopamine

3. serotonin

4. norepinephrine

3. serotonin

A psychiatric nurse routinely administers the following drugs to patients in the community mental health center. The patients who should be most carefully assessed for untoward cardiac side effects are those receiving:

1. lithium

2. clozapine

3. diazepam

4. sertraline

1. lithium

Which of the following classes of psychotropic medications could trigger the development of parkinsonian movement disorders among individuals who take therapeutic doses?

1. SSRIs

2. DRAs

3. Benzodiazepines

4. Tricyclic antidepressants

2. DRAs

Atypical antipsychotic medications have which of the following effects? Select all that apply.

1. Reduction of positive symptoms of schizophrenia

2. Reduction of negative symptoms of schizophrenia

3. Reduction of body mass

4. Possible improvement in cognitive function

1. Reduction of positive symptoms of schizophrenia

2. Reduction of negative symptoms of schizophrenia

4. Possible improvement in cognitive function

Which statement by a nurse suggests an undesirable outcome of a psychiatric assessment interview conducted by the psychiatric nurse?

1. "I think I was able to establish good rapport with the patient."

2. "I believe the patient understands that my values differ from his."

3. I was able to obtain a good understanding of the patient's current problem."

4. "I was able to perform a complete assessment of the patient's level of psychological functioning."

2. "I believe the patient understands that my values differ from his."

Assessment of an older adult patient will be facilitated if the nurse:

1. identifies and accommodates patient physical needs early

2. pledges complete confidentiality of all topics to the patient

3. adheres strictly to the order of questions on the standardized assessment tool

4. interprets data without regard to the patient's spiritual and cultural beliefs and practices

1. identifies and accommodates patient physical needs early

A nurse tells a peer, "I place greatest weight on the subjective data I obtain during patient assessment." From this the peer can infer that the nurse depends more on:

1. data obtained from secondary sources than data obtained from the primary source

2. the patient's perceptions of the presenting problem than on data obtained from the mental status exam

3. data obtained from the mental status exam than on information elicited during history taking

4. gut-level hunches about patient strengths and weaknesses than on data obtained from rating scales

2. the patient's perceptions of the presenting problem than on data obtained from the MSE

Which statement about a nursing diagnosis is correct?

1. A nursing dx has 3 structural components: a problem, the etiology of the problem, and supporting data that validate the diagnosis

2. A nursing dx is complete when the problem statement reflects an unmet need and the etiology given reflects a probable cause

3. An accurate nursing dx requires a problem statement that identifies causes the nurse can treat via nursing interventions

4. A nursing dx always must be based on objective data measured by the nurse; subjective data may be used only as supporting data to validate the diagnosis

1. A nursing dx has 3 structural components: a problem, the etiology of the problem, and supporting data that validate the diagnosis

What is the relationship between evidence-based practice and clinically relevant research?

1. Evidence-based practice reflects realistic processes for achieving patient progress, whereas clinical research suggests best nursing practices

2. EBP is a set of guidelines for meeting nursing standards and does not relate directly to clinical research

3. EBP is accomplished partly by using clinically relevant research

4. EBP is required as part of interdisciplinary treatment plans, whereas clinically relevant research is specific to the discipline of nursing

3. EBP is accomplished partly by using clinically relevant research

Paraphrasing, restating, reflecting, and exploring are techniques used for the purpose of:

1. clarifying

2. summarizing

3. encouraging comparison

4. placing events in time and sequence

1. clarifying

Which communication technique would yield positive results within the context of a therapeutic relationship?

1. Advising

2. Giving approval

3. Listening actively

4. Asking "why" questions

3. Listening actively

When the patient makes the statement, "I get all balled up when I try to talk to him," and the nurse responds, "Give me an example of getting all balled up," the nurse is using the technique called:

1. exploring

2. reflecting

3. interpreting

4. paraphrasing

1. exploring

Which statement by the nurse to a patient would be considered nontherapeutic?

1. "I know exactly how you feel."

2. "I'm not sure I understand what you mean."

3. "Tell me more about what happened when you resigned."

4. "I see that you are wringing your hands as we talk about the job interview."

1. "I know exactly how you feel."

Which of the following is an accurate statement about transference?

1. Transference occurs when the patient attributes thoughts and feelings toward the therapist that pertain to a person in the patient's past

2. Transference occurs when the therapist attributes thoughts and feelings toward the patient that pertain to a person in the therapist's past

3. Transference occurs when the therapist understands and builds a value system consistent with the patient's value system

4. Transference occurs when the therapist recalls circumstances in his or her life similar to those the patient is experiencing and shares this with the patient

1. Transference occurs when the patient attributes thoughts and feelings toward the therapist that pertain to a person in the patient's past

A basic tool the nurse uses when establishing a relationship with a patient with a psychiatric disorder is:

1. narcissism

2. role blurring

3. consistency

4. formation of value judgments

3. consistency

Which nurse behavior jeopardizes the boundaries of the nurse-patient relationship?

1. Focusing on patient needs

2. Suspending value judgments

3. Recognizing the value of supervision

4. Allowing the relationship to become social

4. Allowing the relationship to become social

Which nurse behavior would not be considered a boundary violation?

1. Narcissism

2. Controlling

3. Genuineness

4. Keeping secrets about the relationship

3. Genuineness

Which statement describes an event that would occur during the working phase of the nurse-patient relationship?

1. The nurse summarizes the objectives achieved in the relationship

2. The nurse assesses the patient's level of psychological functioning, and mutual identification of problems and goals occurs

3. Some regression and mourning occur about the nurse-patient relationship, although the patient demonstrates satisfaction and competence

4. The patient strives for congruence among actions, thoughts, and feelings and engages in problem solving and testing of alternative behaviors

4. The patient strives for congruence among actions, thoughts, and feelings and engages in problem solving and testing of alternative behaviors

Shortly after being told that he has 90% blockage of 3 major coronary arteries and needs an emergency CABG, Paul is noted by the nurse to appear dazed. His thoughts are scattered, as evidenced by the fact that his conversation jumps from topic to topic. He frequently states, "I'm overwhelmed. I don't know what to do." He is unable to give direction to his wife when she asks him whom he wants her to notify. His HR rises 15 points. The nurse can assess the type of anxiety Paul is experiencing as:

1. normal anxiety at a mild level

2. sublimated anxiety at a panic level

3. acute (state) anxiety at a severe level

4. chronic (trait) anxiety at a moderate level

3. acute (state) anxiety at a severe level

Which characteristic is true of mature ego defenses but not true of ego defenses that are immature?

1. Mature defenses arise from experiencing panic-level anxiety

2. Mature defenses do not distort reality to a significant degree

3. Mature defenses disguise reality to make it less threatening

4. Mature defenses are exclusively maladaptive

2 - Mature defenses do not distort reality to a significant degree

One possible reason for panic disorder may be:

1. faulty learning

2. dopamine deficiency

3. inhibition of GABA

4. clomipramine (Anafranil) excess

3. inhibition of GABA

Mrs. T is preoccupied with persistent thoughts and impulses that intrude on her daily functioning. She performs ritualistic acts repetitively, such as cleaning the kitchen counter over and over again. She expresses distress that her attention is so consumed that she cannot accomplish her usual activities. These symptoms are most consistent with the DSM-IV-TR diagnosis of:

1. panic disorder

2. social phobia

3. GAD

4. OCD

4. OCD

In addition to prescribing an SSRI to treat Mr. G's panic disorder, the nurse psychotherapist is likely to recommend:

1. family therapy

2. psychoanalysis

3. vocational rehabilitation

4. cognitive-behavioral therapy

4. cognitive-behavioral therapy

Nurses working with patients with somatization and dissociative disorder can expect that these patients will fit on the continuum of psychobiological disorders at the:

1. mild level

2. moderate to severe level

3. severe to psychotic level

4. They do not belong on the continuum, because anxiety has been reduced by ego defense mechanisms

2. moderate to severe level

Mr. R presents with a history of having assumed a new identity in a distant locale. He has no recollection of his former identity.  Which DSM-IV-TR diagnosis can the nurse expect the psychiatrist to make?

1. Hypochondriasis

2. Conversion disorder

3. Dissociative fugue

4. Depersonalization disorder

3. Dissociative fugue

When considering a diagnosis of a somatoform disorder, which information, among the 4 types below, is least likely to require detailed assessment by the nurse?

1. Patient's level of ability to voluntarily control symptoms

2. Results of patient's diagnostic laboratory tests

3. Patient's limitations in carrying out ADLs

4. Patient's potential for violent behavior

4. Patient's potential for violent behavior

Nurse S is developing outcome criteria with her patient, who has a nursing dx of Ineffective coping. The diagnosis is r/t the patient's dependence on pain relievers to treat chronic pain of psychological origin. Which of the following are appropriate outcome criteria? Select all that apply.

1. Patient will resume performance of work role behaviors

2. Patient will identify ineffective coping patterns

3. Patient will make realistic appraisal of strengths and weaknesses

4. Patient will make realistic appraisal of family's capacity to be involved in decision making

1. Patient will resume performance of work role behaviors

2. Patient will identify ineffective coping patterns

3. Patient will make realistic appraisal of strengths and weaknesses

4. Patient will make realistic appraisal of family's capacity to be involved in decision making

Which sign or symptom would be least likely to occur for a patient with hypochondriasis?

1. Impairment in occupational functioning

2. Repetitive, time-consuming rituals

3. Misinterpretation of physical sensations

4. Loss of interest in formerly pleasurable activities

2. Repetitive, time-consuming rituals

Which of the following best describes people with personality disorders? 

1. They readily assume the roles of compromiser and harmonizer

2. They often seek help to change maladaptive behaviors

3. They have the ability to tolerate high levels of anxiety

4. They have difficulty working and loving

4. They have difficulty working and loving

After experiencing a social rejection, which patient is most likely to need a nursing plan to monitor self-destructive behavior?

1. Mr. A, who has been diagnosed with OCPD

2. Ms. B, who has been diagnosed with borderline personality disorder

3. Mr. C, who has been diagnosed with paranoid personality disorder

4. Ms. D, who has been diagnosed with schizoid personality disorder

2. Ms. B, who has been diagnosed with borderline personality disorder

For the nurse working with patients with personality disorders, which nursing intervention must be an ongoing priority?

1. Offering professional advice

2. Probing for etiological factors

3. Encouraging diversional activity

4. Setting appropriate limits

4. Setting appropriate limits

Which statement provides a foundation for understanding patients with personality disorders?

1. The background of a patient with a PD is usually trouble free

2. The tendency to develop a PD may have genetic determinants

3. A patient with a PD functions with a highly developed sense of autonomy

4. A PD is more amenable to treatment than an anxiety disorder

2. The tendency to develop a personality disorder may have genetic determinants

When nurses are caring for a patient with a personality disorder, which of the emotional states listed below are they likely to experience themselves? Select all that apply.

1. Anger

2. Confusion

3. Frustration

4. Helplessness

1. Anger

2. Confusion

3. Frustration

4. Helplessness

Which of the following is an example of all-or-nothing thinking, which is a frequent cognitive distortion of patients with an eating disorder?

1. "If I allow myself to gain weight, I'll become immense."

2. "I'm unpopular because I'm fat."

3. "When I'm thin, I'm powerful."

4. "When people say I look better, they're really thinking I look fat."

1. "If I allow myself to gain weight, I'll become immense."

Typical goals of inpatient hospitalization for an anorexic patient do NOT include:

1. stabilization of the patient's immediate condition

2. limited weight restoration

3. determination of the causes for the eating disorder

4. restoration of normal electrolyte balance

3. determination of the causes for the eating disorder

Which patient with an eating disorder would be at greatest risk for hypokalemia?  A patient with:

1. anorexia who loses weight by restricting food intake

2. anorexia or bulimia who purges to promote weight loss

3. bulimia whose predominant pathological behavior is excessive nocturnal eating

4. an eating disorder who exercises intensely more than 4 hours per day but maintains a normal electroyte balance

2. anorexia or bulimia who purges to promote weight loss

Which medication is likely to be used in the treatment of patients with eating disorders? An:

1. SSRI such as fluoxetine

2. antipsychotic such as risperidone

3. anxiolytic such as alprazolam

4. anticonvulsant such as carbamazepine

1. SSRI such as fluoxetine

Which of the following is least likely to contribute to building an effective therapeutic alliance between the nurse and an anorexic patient?

1. Establishing disciplined eating through the nurse's authoritarian approach with the patient

2. Avoiding the stance of a parental role in order to foster a sense of empowerment

3. Offering a highly structured approach in treating severely underweight patients

4. Contracting with the outpatient person about treatment terms

1. Establishing disciplined eating through the nurse's authoritarian approach with the patient

If a nurse subscribes to the theory that learned helplessness is a major factor in the development of depression, which statement best represents her belief:

1. TCAs, MAOIs, and SSRIs are the most useful tools to combat depression

2. Depression develops when a person believes he or she is powerless to effect change in a situation

3. Depressive symptoms result from experiencing significant loss and turning aggression against the self

4. Psychosocial stressors and interpersonal events trigger neurophysical and neurochemical changes in the brain

2. Depression develops when a person believes he or she is powerless to effect change in a situation

Which response to a patient experiencing depression would be helpful from the nurse?

1. "Don't worry, we all get down once in a while."

2. "Don't consider suicide. It's an unacceptable option."

3. "Try to cheer up. Things always look darkest before the dawn."

4. "I can see you're feeling down. I'll sit here with you for a while."

4. "I can see you're feeling down.  I'll sit here with you for a while."

Which of the following is considered a vegetative symptom of depression?

1. Sleep disturbance

2. Trouble concentrating

3. Neglected grooming and hygiene

4. Negative expectations for the future

1. Sleep disturbance

For a person with severe depression, which statement about cognitive functioning is true?

1. Reality testing remains intact

2. Concentration is unimpaired

3. Repetitive negative thinking is noted

4. Ability to make decisions is improved

3. Repetitive negative thinking is noted

When the nurse is caring for a depressed patient, the problem that should receive the highest nursing priority is:

1. powerlessness

2. suicidal ideation

3. inability to cope effectively

4. anorexia and weight loss

2. suicidal ideation

In communicating with a patient who is experiencing elated mood, which of the following interventions by the nurse is most appropriate?

1. Use a calm, firm approach

2. Give expanded explanations

3. Make use of abstract concepts

4. Encourage lighthearted optimism

1. Use a calm, firm approach

For a person in the "continuation of treatment" phase of bipolar disorder, which of the following is an appropriate nursing outcome? Patient will:

1. avoid involvement in self-help groups

2. adhere to medication regimen

3. demonstrate euphoric mood

4. maintain normal weight

2. adhere to medication regimen

When a patient has been prescribed lithium, the medication teaching plan should include which information?

1. The importance of periodic monitoring of renal and thyroid function

2. Dietary teaching to restrict daily sodium intake

3. The importance of blood draws to monitor serum potassium level

4. Discontinuing the drug if weight gain and find hand tremors are noticed

1. The importance of periodic monitoring of renal and thyroid function

For a patient with mania, which symptom related to communication is likely to be present?

1. Mutism

2. Verbosity

3. Poverty of ideas

4. Confabulation

2. Verbosity

When a patient is experiencing a severe manic episode, which bodily system is most at risk for decompensation?

1. Renal

2. Cardiac

3. Endocrine

4. Pulmonary

2. Cardiac

In which of the following situations can the nurse make the assessment that the patient is experiening auditory hallucinations?

1. Mrs. D tells the nurse, "There are worms crawling on my arms and legs."

2. Ms. E states, "I have seen the Vorels who are planning to abduct me."

3. Miss F mentions, "The food on my plate is poisoned. Take it away immediately."

4. Mr. G, who is seated by himself, pleads, "I am a good person. Stop shouting those bad things about me."

4. Mr. G, who is seated by himself, pleads, "I am a good person. Stop shouting those bad things about me."

To plan appropriate interventions, the nurse must know that depersonalization and derealization are examples of:

1. delusions

2. hallucinations

3. automatic obedience

4. personal boundary difficulties

4. personal boundary difficulties

Which symptoms of schizophrenia are most amenable to treatment with both low- and high-potency antipsychotic medications?

1. Hallucinations and delusions

2. Lack of motivation and initiative

3. Inadequate hygiene and grooming

4. Social withdrawal and isolation

1. Hallucinations and delusions

A nursing strategy that usually proves helpful when caring for a person with schizophrenia is:

1. asking directly about hallucinations or asking the patient to describe a delusion he/she is experiencing

2. responding to the patient's hallucinations as if they are real

3. limiting contact to one or two short interactions daily

4. assuming knowledge of what is meant when the patient talks about "they," when "they" are the internal voices that are communicating with the patient during a hallucination

1. asking directly about hallucinations or asking the patient to describe a delusion he/she is experiencing

Which nursing diagnosis is universally applicable to patients with schizophrenia?

1. Noncompliance

2. Disturbed body image

3. Disturbed thought processes

4. Risk for other-directed violence

3. Disturbed thought processes

A nurse assessing a patient with suspected delirium will expect to find that the patient's symptoms developed:

1. over a period of hours to days

2. over a period of weeks to months

3. with no relationship to another condition

4. during middle age

1. over a period of hours to days

Of the following outcomes, which one is most appropriate for a patient with cognitive impairment related to delirium?

1. Patient will participate fully in self-care from admission on

2. Patient will have stable vital signs 6 hours after admission

3. Patient will participate in simple activities that bring enjoyment

4. Patient will return to the premorbid level of functioning

4. Patient will return to the premorbid level of functioning

In caring for a patient with late Alzheimer's disease, which nursing diagnosis demands the nurse's highest priority?

1. Risk for injury

2. Self-care deficit

3. Chronic low self-esteem

4. Impaired verbal communication

1. Risk for injury

Nursing staff that care for cognitively impaired patients can develop burnout. Strategies to avoid the development of burnout include:

1. setting realistic patient goals

2. insulating self from emotional involvement with patients

3. sedating patients to promote rest and minimize catastrophic episodes

4. encouraging the family to permit the use of restraints to promote patient safety

1. setting realistic patient goals

Psychobiological agents showing promise for the treatment of cognitive impairment associated with Alzheimer's disease include:

1. cholinesterase inhibitors

2. herbals, including Ginkgo biloba

3. SSRIs and trazodone

4. benzodiazepines and buspirone

1. cholinesterase inhibitors

When interviewing with a patient who is intoxicated from alcohol, it is useful for a nurse to first:

1. let the patient sober up

2. decide immediately on care goals

3. ask which drugs other than alcohol the patient has recently used

4. gain compliance by sharing personal drinking habits with the patient

3. ask which drugs other than alcohol the patient has recently used

A principle of counseling intervention that should be observed by a nurse caring for a chemically dependent patient is to:

1. develop a warm, accepting relationship

2. communicate that clinicians expect relapses to occur

3. recognize that recovery is considered complete and absolute

4. refrain from conveying hopeful empathy in order to promote resilience

1. develop a warm, accepting relationship

As a nurse evaluates a patient's progress, which treatment outcome would indicate a poor general prognosis for long-term recovery from substance abuse? Patient demonstrates:

1. improved self-esteem

2. enhanced coping abilities

3. improved relationships with others

4. expectations for only occasional drug use in the future

4. expectations for only occasional drug use in the future

Which statement relates most specifically to nursing assessment for a patient who is experiencing the effects of CNS stimulant abuse?

1. Symptoms of intoxication include dilated pupils, dry nasal cavity, and excessive motor activity

2. Medical management focuses on removing the drugs from the body

3. Withdrawal is simple and rarely complicated

4. Postwithdrawal symptoms include fatigue and depression

1. Symptoms of intoxication include dilated pupils, dry nasal cavity, and excessive motor activity

Severe morbidity and mortality are associated with withdrawal from which of the following combinations?

1. Alcohol and CNS depressants

2. CNS stimulants and hallucinogens

3. Narcotic antagonists and caffeine

4. Opiates and inhalants

1. Alcohol and CNS depressants

Which statement about crisis theory provides a basis for nursing intervention?

1. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable

2. A person in crisis usually has had adjustment problems and has coped inadequately in his or her usual life situations

3. Crisis is precipitated by an event that enhances the person's self-concept and self-esteem

4. Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis

1. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable

Ms. T, a single mother of 4, comes to the crisis center 24 hours after an apartment fire in which all the family's household goods and clothing were lost. Ms. T has no family in the area. Her efforts to mobilize assistance have been disorganized and she is still without shelter. She is distraught and confused. The nurse assesses the situation as:

1. a maturational crisis

2. a situational crisis

3. an adventitious crisis

4. evidence of an inadequate personality

3. an adventitious crisis

As the nurse respondss to the mother of 4 who came in 24 hours after a house fire in which she lost everything, the intervention that takes priority is to:

1. reduce anxiety

2. arrange long-term shelter

3. contact out-of-area family

4. hospitalize and place on suicide precautions

1. reduce anxiety

For a nurse working in crisis intervention, which belief would be least helpful?

1. A person in crisis is incapable of making decisions

2. The crisis counseling relationship is one between partners

3. Crisis counseling helps the patient refocus to gain new perspectives on the situation

4. Anxiety reduction techniques are used so the patient's inner resources can be accessed

1. A person in crisis is incapable of making decisions

Which of the following is not a function of critical incident stress debriefing (CISD)? To debrief:

1. staff after incidents of patient violence

2. a hotline volunteer after a patient's suicide

3. a patient after transplant surgery

4. search and rescue workers after a natural disaster

3. a patient after transplant surgery

When nurses provide health teaching about how to recognize behaviors and situations that might trigger violence in families, they are engaging in:

1. primary prevention

2. secondary prevention

3. tertiary prevention

4. nonintervention

1. primary prevention

When treating a woman who has been trapped in an abusive marriage for many years, which statement would a nurse expect not to hear?

1. "If I'm patient, he'll change."

2. "I deserve to be beaten."

3. "I'll stay for the sake of the children."

4. "No adult has the right to control or harm another."

4. "No adult has the right to control or harm another."

When making assessments the nurse should bear in mind that a common characteristic of an abusing parent is:

1. being female

2. having poor coping skills

3. having realistic expectations of child behavior

4. abstaining from the use of chemical substance abuse

2. having poor coping skills

During a nursing assessment, which of the following is a "red flag" for suspecting that a patient has been a victim of physical violence?

1. Patient's explanation does not match the injury

2. Patient has no history of stress-related physical problems

3. Patient mentions having a concerned, supportive spouse

4. Patient is anxious but open and direct in explaining the complaint or injury

1. Patient's explanation does not match the injury

Which of the following nursing diagnoses is most appropriate for the Jones family? The husband is disabled, unable to work, drinks episodically, and abuses his two preschool-age children when drinking. The wife works outside the home.

1. Powerlessness

2. Caregiver role strain

3. Low self-esteem

4. Disabled family coping

4. Disabled family coping

Rape-trauma syndrome is most similar to:

1. PTSD

2. dissociative identity disorder

3. unresolved grief reaction

4. developmental crisis

1. PTSD

In the medical record of a survivor of rape, which of the following types of data are inappropriate to document?

1. Observations of the patient's physical trauma using a body map

2. Assessment of signs and symptoms of emotional trauma

3. Verbatim statements made by the patient

4. Details of the patient's sexual history

4. Details of the patient's sexual history

When an ED nurse is providing care to a rape survivor, which two of the following are important elements of care?

1. Providing nonjudgmental care

2. Conveying disgust that this would happen

3. Aligning with her sense of blaming herself

4. Assuring confidentiality

1. Providing nonjudgmental care

4. Assuring confidentiality

Which of the following observations, if found in the medical record of a sexual assault survivor, would indicate that "reorganization" after a rape crisis was not yet complete? The patient is:

1. free from somatic reactions

2. generally positive about self

3. calm and relaxed during interactions

4. experiencing frequent nightmares

4. experiencing frequent nightmares

Charles Brown, age 52, lost his wife in an automobile accident 4 months ago. Since then, he has been severely depressed, withdrawn from contacts with family and friends, and taken to drinking to "numb the pain." On the SAD PERSONS assessment scale, how many points does Mr. Brown have?

1. Three

2. Four

3. Five

4. Six

4. Six

Which of the following is an example of primary intervention in suicide?

1. Working with the family of a recent suicide victim

2. Placing a hospitalized patient on suicide precautions

3. Keeping the caller to a crisis hotline on the phone and working out alternatives to suicide for a patient

4. Providing a seminar for older adults that focuses on coping with loneliness and physical changes

4. Providing a seminar for older adults that focuses on coping with loneliness and physical changes

Miss B has a concrete plan to commit suicide by hanging. She refuses to make a no-suicide contract because she believes there is no hope for a better life now that her fiance has left her and God has abandoned her. She believes the breakup with her fiance was because he found out "how worthless I am." Which of Miss B's nursing diagnoses is of highest priority?

1. Hopelessness

2. Spiritual distress

3. Low self-esteem

4. Risk for suicide

4. Risk for suicide

Which of the following groups is known to have the highest suicide rates?

1. Asian Americans

2. African Americans

3. Native Americans

4. Hispanic Americans

3. Native Americans

Which is the clinical example of "predictability of routine" that can be used with an angry, verbally abusive patient who has underlying anxiety about getting needs heard and met?

1. The nurse refocuses conversation to minimize patient tangentiality

2. The nurse empathizes with the patient's underlying fear and anxiety

3. The nurse agrees to meet with the patient for 10 minutes q2hours

4. The nurse teaches the patient techniques to manage auditory hallucinations

3. The nurse agrees to meet with the patient for 10 minutes every 2 hours

In planning intervention for an angry patient, the nurse must understand that withdrawal of attention to verbally abusive behaviors works only if the strategy is accompanied by:

1. attending positively to nonabusive communication

2. requiring the patient to wait before granting requests

3. giving large doses of antipsychotic medication

4. using empathic communication

1. attending positively to nonabusive communication

To help prevent displays of anger and aggression, the nurse must understand that anger and aggression are preceded by feelings of:

1. vulnerability

2. depression

3. elation

4. isolation

1. vulnerability

Which of the following is most useful to the nurse planning intervention for an angry patient?

1. Creative, individualized approaches to the patient's behavior by staff members

2. The availability of group therapy sessions focused on cathartic expression of emotion

3. An understanding of the patient's medical diagnosis

4. Consistency of approach to the patient by staff members

4. Consistency of approach to the patient by staff members

The nurse should understand that encouraging a patient to vent anger:

1. is a strategic nursing intervention

2. should always be taught as a beneficial anger management technique

3. is not always useful

4. is useful only in a well-controlled inpatient setting

3. is not always useful

Grief is best described as:

1. a normal response to a significant loss

2. a mild to moderately severe mood disorder

3. the display of feelings associated with death

4. denial of the reality of the loss of a significant person, object, or state of being

1. a normal response to a significant loss

Which statement indicates that a patient has successfully mourned a loss in his or her life?

1. "She was so strong after her husband died. She never cried the whole time. She kept a stiff upper lip."

2. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest."

3. "You know, he still talks about his mother as if she were alive today, and she's been dead for 4 years."

4. "He never talked about his wife after she died. He just picked up and went on life's way."

2. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest."

K, 34 years of age, is single and has very few close friends and relatives. He was very dependent on his mother before her death, although he often complained about their arguing over her intrusiveness. What statement best describes his risk for problems in resolving his grief?

1. He is at no particular risk because the death of parents is an expected event in one's life

2. He is at low risk because the task of young adulthood is to develop independence from the family of origin

3. He is at moderate risk

4. He is at high risk because he was dependent on his mother, demonstrated unresolved conflicts with her, and has a limited support system

4. He is at high risk because he was dependent on his mother, demonstrated unresolved conflicts with her, and has a limited support system

Which statement represents a loss that involves "disenfranchised grief?"

1. Dorothy has lost her husband of 15 years in an auto accident

2. Robert is grieving the loss of his business as a result of a fire

3. Allison is grieving the loss of her therapist after 2 years of psychotherapy work ended

4. Richard is grieving the loss of his mother, who was 90 and lived 600 miles from him

3. Allison is grieving the loss of her therapist after 2 years of psychotherapy work ended

Which responses of a child to a father's untimely death represent an early stage of normal grieving? Select all that apply.

1. The child lies in bed, banging his head against the mattress, shouting, "No, no, no!"

2. The child refuses to go to school 2 weeks after his father's funeral, claiming "aches and pains all over my body."

3. The child begins to obsessively attend to his game card collection and spends hours sorting and ordering cards for the first month after his father's death

4. The child repeatedly comes home from school and reports "seeing Dad" around a corner, but then "he just disappears"

1. The child lies in bed, banging his head against the mattress, shouting, "No, no, no!"

2. The child refuses to go to school 2 weeks after his father's funeral, claiming "aches and pains all over my body."

3. The child begins to obsessively attend to his game card collection and spends hours sorting and ordering cards for the first month after his father's death

4. The child repeatedly comes home from school and reports "seeing Dad" around a corner, but then "he just disappears"

Which of the following should not be identified by the nurse as a risk factor associated with child psychiatric disorders?

1. Separation from extended family through relocation across the country

2. Severe marital discord

3. Low socioeconomic status

4. Maternal psychiatric disorder

1. Separation from extended family through relocation across the country

The nurse working in the ED usually assesses adult patients, but tonight she is responsible for assessing the suicide potential of a 13-year-old child. Which topic must be explored in this assessment of a child that is different from such an assessment in an adult?

1. The presence of distorted perceptions about suicide and death

2. The presence of ideas about hurting self seriously or causing death

3. Circumstances at the time suicidal thoughts are experienced

4. Identification of feelings such as depression, anger, guilt, and rejection

1. The presence of distorted perceptions about suicide and death

G, age 5 years, has been diagnosed by a psychiatrist as having a PDD. Which of the following disorders could also be correct medical diagnoses for the child? Select all that apply.

1. Asperger's syndrome

2. Autistic disorder

3. ADHD

4. PTSD

1. Asperger's syndrome

2. Autistic disorder

Which topic would be least relevant as a focus during the assessment of a 12-year-old with suspected ADHD?

1. Effect of impulsive behavior on the child's life at home and school

2. The child's level of physical activity and attention span

3. The child's ability to pay attention and perform in school

4. The child's progress with toilet training and self-care habits

4. The child's progress with toilet training and self-care habits

A method of modifying the disruptive behavior of a child that will be perceived by the child as punishment is:

1. therapeutic holding

2. planned ignoring

3. restructuring

4. seclusion

4. seclusion

Federal and state categorization of mental illnesses according to levels of severity has tremendous implications for which of the following? Select all that apply.

1. Providing a standard, nationally based medical classification to facilitate diagnosis

2. Setting mental health policy

3. Facilitating access to appropriate care

4. Providing employers with the basis to understand work capacities for mentally ill employees

2. Setting mental health policy

3. Facilitating access to appropriate care

NAMI has been developed to:

1. regulate neurotransmission along critical pathways involved in schizophrenia

2. provide social and employment opportunities for patients with mental health disorders through partial hospitalization programs

3. provide a structured, phased approach for improved management of ADHD

4. offer support and education for patients and families of patients with mental health disorders

4. offer support and education for patients and families of patients with mental health disorders

Which of the following are accurate statements about impulse control disorders? Select all that apply.

1. Causes of impulse control disorders are not clearly understood

2. Genetic factors are not considered to contribute to impulse control disorders

3. Anxiety may play an important role in impulse control disorders

4. Impulse control disorders are frequently associated with depression

1. Causes of impulse control disorders are not clearly understood

3. Anxiety may play an important role in impulse control disorders

Which sexual disorder is illegal?

1. Fetishism

2. Transvestism

3. Pedophilia

4. Gender dysphoria

3. Pedophilia

Which of the following nursing interventions would not be considered essential when working with an adult with ADHD?

1. Establishing a regular exercise regimen to provide physical release and daily structure

2. Guiding the patient to identify and use enhanced organzational skills

3. Educating the patient's significant others about causes, treatments, and ways to cope with symptoms

4. Guiding the patient in understanding and practicing stimulation reduction strategies

1. Establishing a regular exercise regimen to provide physical release and daily structure

For conducting a comprehensive nursing assessment of an older adult patient, which of the following would provide the broadest perspective from which to understand his needs?

1. the normal aging process

2. drug interactions

3. chronic diseases that affect older adults

4. community supports specific to the patient

1. the normal aging process

Which of the following psychiatric disorders is found most frequently among older adults?

1. Depression

2. Dementia

3. Anxiety

4. Social phobia

1. Depression

Which statement regarding the use of restraints is true?

1. Restraint-free care appreciably diminishes the overall safety of any older adult patient compared with the use of physical or chemical restraints

2. The nurse is responsible for patient safety during the time the patient is restrained

3. Chemical restraint presents less potential for patient harm than physical restraint

4. Restraint may by used to prevent exhaustion if a nursing protocol exists

2. The nurse is responsible for patient safety during the time the patient is restrained

Which of the following health problems of older adults is increasing faster than any other?

1. Suicide

2. Cancer

3. Alzheimer's disease

4. Substance abuse and dependence

4. Substance abuse and dependence

In carrying out patients' wishes and directives as a nurse, which of the following is an unethical action for the nurse?

1. Ignoring a "Do not resuscitate" order for an older adult patient in the ICU

2. Implementing a physician's order to withhold artificial hydration from an older patient in irreversible coma

3. Adhering to the choices made for an older adult patient by the individual with durable power of attorney for health care

4. Advocating for an older adult patient in the terminal stage of cancer who wishes to discontinue chemotherapy

1. Ignoring a "Do not resuscitate" order for an older adult patient in the ICU

Which resource will provide the least authoritative help for a psychiatric mental health nurse faced with a patient care ethical dilemma?

1. Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA)

2. Federal and state laws

3. ANA Code of Ethics for Nurses

4. Peer opinion

4. Peer opinion

The single most important action nurses can take to protect the rights of a psychiatric patient is to:

1. be aware of that state's laws regarding care and treatment of the mentally ill

2. refuse to participate in imposing restraint or seclusion

3. document concerns about unit short staffing

4. practice the 5 principles of bioethics

1. be aware of that state's laws regarding care and treatment of the mentally

To provide appropriate care for a patient who has been admitted involuntarily to a psychiatric unit, the nurse must be aware of the fact that the patient has the right to:

1. refuse psychotropic medications

2. be treated by unit staff of his/her choice

3. be released within 24 hours of making a written request

4. have a consultation with other mental health professionals at the hospital's expense

1. refuse psychotropic medications

In which situation might the psychiatric mental health nurse incur liability?

1. Placing a patient with annoying behavior in seclusion

2. Reporting the substandard practice of a nurse peer

3. Reporting threats against a 3rd party to the treatment team

4. Discussing an unclear medical order with the physician

1. Placing a patient with annoying behavior in seclusion

Observing the patient's right to privacy permits the psychiatric mental health nurse to:

1. freely disclose information in the medical record to the patient's employer

2. use information about the patient when preparing a journal article

3. discuss observations about the patient with the treatment team

4. disclose confidential information after the patient's death

3. discuss observations about the patient with the treatment team

The presence of which symptoms will exert the greatest pressure to admit an individual to an inpatient psychiatric unit?

1. Suicidal ideation

2. Moderate anxiety

3. Feelings of sadness

4. Auditory hallucinations

1. Suicidal ideation

A significant influence allowing psychiatric treatment to move from the hospital to the community was:

1. television

2. the development of psychotropic medication

3. identification of external causes of mental illness

4. the use of a collaborative approach by patients and staf focusing on rehabilitation

2. the development of psychotropic medication

Which of the following is a benefit for patients being treated for mental health problems by a primary care physician rather than a psychiatrist?

1. A high level of expertise in the diagnosis of psychiatric disorders

2. Extended time in the physician's office for a thorough psychiatrict assessment

3. Feeling that there is less stigma attached to treatment

4. A high level of expertise in the management of psychopharmacological medications for psychiatric illnesses

3. Feeling that there is less stigma attached to treatment

Of the following services, which are routinely provided by community mental health centers? Select all that apply.

1. Assessment and diagnosis

2. Medication management

3. Vocational and employment services

4. Emergency community disaster relief

1. Assessment and diagnosis

2. Medication management

3. Vocational and employment services

A community mental health student nurse is asked by her supervisor to develop a stress reduction class for the residents in the surrounding community. The student nurse resists, saying that her responsibilities are to her patient caseload. The supervisor explains to the student why this assignment is appropriate for her role. Which is the most suitable rationale the supervisor can provide to the student nurse?

1. Stress reduction is important to a patient's mental health

2. Funding sources will support the class only if it is developed by a nurse

3. An important concept for community health nursing is to view the entire community as a patient

4. Research has demonstrated that stress reduction reduces hypertension in mental health patients

3. An important concept for community health nursing is to view the entire community as a patient