Fortinash: Psychiatric Mental Health Nursing, 4th Edition

Test Bank

Chapter 1: Principles of Psychiatric Nursing: Theory and Practice 

MULTIPLE CHOICE

	1.	Which of the following characteristics would the nurse evaluate as indicative of healthy boundaries?
1.	Giving as much as you can for the sake of giving	
2.	Believing others can anticipate your needs	
3.	Letting others define you	
4.	Taking responsibility to meet one’s own needs	

ANS:	4
Healthy boundaries are characterized by behaviors that are adaptive. Only option 4 is an example of an adaptive behavior.

DIF:	Cognitive Level: Analysis	REF:	Page 14	OBJ:	12
TOP:	Boundaries	KEY:	Nursing Process: Evaluation	
MSC:	NCLEX: Psychosocial Integrity

	2.	The student nurse is planning to initiate a therapeutic relationship with a client. Which intervention should she plan to incorporate in their interactions?
1.	Becoming subjectively involved	
2.	Mutually sharing ideas and experiences	
3.	Giving and receiving friendship equally	
4.	Encouraging the client to choose a topic for discussion	

ANS:	4
Encouraging the client to choose the topic for discussion maintains a client-centered focus. This is desirable and in keeping with accepted principles for therapeutic nurse-client relationships. The other responses are components of a social, rather than a therapeutic, relationship.

DIF:	Cognitive Level: Application	REF:	Page 13	OBJ:	12
TOP:	Therapeutic Relationship	KEY:	Nursing Process: Planning
MSC:	NCLEX: Psychosocial Integrity

	3.	A client frequently diverts the focus from himself by changing the topic or commenting on the nurse’s appearance. The nurse should recognize this as an example of:
1.	Transference	
2.	Resistance	
3.	Countertransference	
4.	Therapeutic alliance	

ANS:	2
Resistance is seen as client behavior that permits change of focus from the client and his or her problems to a less emotionally charged topic. 1. Transference refers to positive or negative feelings the client has for a significant figure that are attributed to the nurse. 3. Countertransference refers to feelings the nurse has for a significant figure that are attributed to the client. 4. A therapeutic alliance is another name for the therapeutic nurse-client relationship.

DIF:	Cognitive Level: Comprehension	REF:	Page 13	OBJ:	12
TOP:	Resistance	KEY:	Nursing Process: Assessment	
MSC:	NCLEX: Psychosocial Integrity

	4.	An expected outcome of the nurse’s attempts to maintain objectivity in a therapeutic relationship with a client is:
1.	Personally identifying with the client	
2.	Processing information based on facts	
3.	Subjectively determining the client’s needs	
4.	Using intellectualization to remain separate from the client	

ANS:	2
Expected outcomes of maintaining objectivity would be positive. Only option 2 is a positive outcome. Options 1, 3, and 4 are negative outcomes.

DIF:	Cognitive Level: Comprehension	REF:	Page 14	OBJ:	12
TOP:	Therapeutic Relationship	KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Psychosocial Integrity

	5.	The result of a nurse becoming subjectively involved in a therapeutic relationship is likely to be that the client will:
1.	Explore issues	
2.	Expand on topics	
3.	Feel accepted and understood	
4.	Stop sharing information	

ANS:	4
The outcome of subjective involvement with a client will be negative. Only option 4 is a negative outcome. Options 1, 2, and 3 are desirable outcomes.

DIF:	Cognitive Level: Comprehension	REF:	Page 14	OBJ:	12
TOP:	Therapeutic Relationship	KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Psychosocial Integrity

	6.	An expected outcome of the preorientation phase of the therapeutic relationship is that the nurse will:
1.	Initiate a trusting relationship with the client	
2.	Complete the required assessment process	
3.	Examine his or her own feelings and perceptions about the client	
4.	Recognize his or her own need for therapy	

ANS:	3
During the preorientation phase the nurse engages in autodiagnosis regarding the client and attempts to uncover biases or stereotypes that could influence the contact in a nontherapeutic way. Options 1 and 2 take place in other phases of the nurse-client relationship. Option 4 is not an expected outcome.

DIF:	Cognitive Level: Comprehension	REF:	Page 15	OBJ:	12
TOP:	Preorientation Phase of Relationship			
KEY:	Nursing Process: Evaluation	MSC:	NCLEX: Psychosocial Integrity

	7.	A client displays isolation, bizarre behaviors, self-mutilation, and poor hygiene. Which of the following will be the highest priority in the nursing care plan?
1.	Safety	
2.	Hygiene	
3.	Isolation	
4.	Bizarre behaviors	

ANS:	1
The safety needs associated with self-mutilation are of highest priority. Poor hygiene, isolation, and bizarre behaviors are not as likely to be life threatening.

DIF:	Cognitive Level: Analysis	REF:	Page 15	OBJ:	12
TOP:	Priority Setting		KEY:	Nursing Process: Planning
MSC:	NCLEX: Physiological Integrity: Reduction of Risk Potential	

	8.	The nurse and client have met for six predetermined sessions. The agreed-on goal has been attained. Which nursing intervention would be appropriate for the termination phase?
1.	Exploring the client’s past in depth	
2.	Confronting changes not completed	
3.	Helping client summarize accomplishments	
4.	Identifying new problem areas	

ANS:	3
Termination is a time for bringing closure. A helpful technique is having the client identify changes he or she has made toward growth and sharing nurse perceptions of the client’s progress. Options 1, 2, and 4 do not foster the goal of bringing closure. Instead, they open new topics.

DIF:	Cognitive Level: Application	REF:	Page 16	OBJ:	12
TOP:	Termination	KEY:	Nursing Process: Implementation	
MSC:	NCLEX: Psychosocial Integrity

	9.	When assessing a client, the nurse incorporates an understanding of the definitions of mental health and would describe an individual as healthy:
1.	If the client’s beliefs are consistent with the nurse’s beliefs	
2.	When behavior conforms to DSM-IV-TR criteria	
3.	If precise physiologic signs are absent	
4.	As measured by psychiatric and psychologic standards	

ANS:	4
An individual would be considered healthy based on established standards. 1. The nurse’s beliefs are not the benchmark. 2. DSM-IV-TR criteria define mental disorders. 3. Few mental disorders have easily measured physiologic signs.

DIF:	Cognitive Level: Comprehension	REF:	Page 3	OBJ:	5
TOP:	Mental Health			KEY:	Nursing Process: Assessment
MSC:	NCLEX: Psychosocial Integrity

	10.	The student nurse is learning how to reduce the stigma associated with mental illness. Which of the following statements by the student nurse would reflect that learning has taken place?
1.	“A 34-year-old is being admitted for suicidal threats as a result of cocaine use.”	
2.	“We’re admitting a cocaine addict who threatened to kill herself.”	
3.	“We’re admitting an out-of-control, manic client.”	
4.	“They’ve added another psychotic to my caseload.”	

ANS:	1
This statement reflects the nurse’s view that the client is not the disorder but is a person with and illness. Option 2 labels the client as an addict. Options 3 and 4 label the client as the disorder.

DIF:	Cognitive Level: Analysis	REF:	Page 10	OBJ:	5 | 10
TOP:	Stigma	KEY:	Nursing Process: Evaluation	
MSC:	NCLEX: Psychosocial Integrity

	11.	The psychiatric nurse plans to conduct workshops to teach job skills to clients with mental illness. This would be considered which type of prevention?
1.	Primary	
2.	Secondary	
3.	Tertiary	
4.	Quaternary	

ANS:	3
Tertiary prevention reduces the residual effects of the disorder. There is no quaternary level of prevention. Primary prevention reduces occurrences of mental disorders, and secondary prevention reduces the prevalence of disorders.

DIF:	Cognitive Level: Application	REF:	Page 2	OBJ:	3
TOP:	Levels of Prevention		KEY:	Nursing Process: Planning
MSC:	NCLEX: Health Promotion and Maintenance

	12.	A mother has just been diagnosed with a mental disorder that has a genetic predisposition. Which statement by the husband indicates that further teaching is needed about protective factors for the children?
1.	“I guess our children will all get this disorder eventually.”	
2.	“It is especially important that we try to have positive attitudes in our family.”	
3.	“I will teach the children that it is important to maintain their overall health.”	
4.	“We cannot change the genetics, but there are other factors to consider for the kids.”	

ANS:	1
Genetics is a risk factor for mental illness—not an absolute cause. The father correctly states in options 2, 3, and 4 that other factors can be protective.

DIF:	Cognitive Level: Evaluation	REF:	Page 3	OBJ:	4
TOP:	Risk and Protective Factors	KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Health Promotion and Maintenance

	13.	A client is on a cardiac unit after a heart attack. The client does not have a history of a mental disorder. In planning her care, the nurse:
1.	Focuses solely on physical symptoms, since there is a medical diagnosis	
2.	Calls in a psychiatrist to evaluate for signs of depression	
3.	Provides the patient with several pamphlets on stress and cardiac function	
4.	Assesses the client’s mental status, knowing that mind and body are inseparable	

ANS:	4
Nurses assess the mental status of all clients, since there is a mind-body interaction. Focusing only on physical symptoms is not holistic, so option 1 is incorrect. Referral to a psychiatrist is not indicated yet, and option 3 is incorrect since there is not a demonstrated need for stress information.

DIF:	Cognitive Level: Application	REF:	Page 6	OBJ:	6
TOP:	Mind-Body Interaction	KEY:	Nursing Process: Planning
MSC:	NCLEX: Psychosocial Integrity

	14.	The families of several clients have been talking and ask the nurse, “What can be done to improve community services for the long-term needs of the seriously mentally ill?” The nurse appropriately responds:
1.	“The governing bodies need to understand that adequate funding is a necessity.”	
2.	“More nurses on our staff is the key factor.”	
3.	“Doctors and other health professions just do not get along.”	
4.	“There will never be enough services because of the stigma related to these disorders.”	

ANS:	1
Response 1 is correct since resource allocation is a key to services. Response 2 is too local (specific) in focus. Responses 3 and 4 are too negative and not proactive.

DIF:	Cognitive Level: Analysis	REF:	Page 8	OBJ:	8
TOP:	Underserved Population	KEY:	Nursing Process: Planning
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care	

	15.	A layperson asks, “What is new in the area of diagnosis and treatment for the mentally ill?” The nurse should mention which two new advances in neuroscience?
1.	Insulin therapy and wet packs	
2.	Neurogenomics and neuroimaging techniques	
3.	Community settings for care of depressed persons	
4.	Electroconvulsive shock treatments and antipsychotics medications	

ANS:	2
The newest advances in neuroscience are in the areas of genetics and neuroimaging. The other options were available in the past.

DIF:	Cognitive Level: Analysis	REF:	Page 10	OBJ:	9
TOP:	Advances in Neuroscience	KEY:	Nursing Process: Implementation
MSC:	NCLEX: Health Promotion and Maintenance

	16.	The community health nurse plans to implement primary prevention in her role. Which of the following activities should be incorporated in the plan?
1.	Teaching parenting skills	
2.	Treating acutely ill clients	
3.	Referring clients to mental health providers	
4.	Providing family support to deal with a child’s addiction	

ANS:	1
Teaching basic skills that will prevent problems is an example of primary prevention. Options 2 and 3 are secondary prevention. Option 4 is tertiary prevention.

DIF:	Cognitive Level: Application	REF:	Page 2	OBJ:	3
TOP:	Primary Prevention		KEY:	Nursing Process: Planning
MSC:	NCLEX: Health Promotion and Maintenance

	17.	A new psychiatric technician asks the nurse, “Aren’t you bored? All psychiatric nursing requires is the skill of being vigilant. The only thing nurses do is watch the client.” The reply that is most educative is:
1.	“Nurses must implement knowledge of the science of nursing to provide safe, effective care.”	
2.	“Clients are people and need both protection and kindness, as well as close monitoring.”	
3.	“Psychiatric nurses must also have the ability to follow professional guidelines.”	
4.	“Your statement seems to be an attempt to define me.”	

ANS:	1
Psychiatric nurses are prepared to use the nursing process to care for clients with psychiatric disorders. Skilled clinical practice is based on knowledge, research, and interventions that use evidence-based techniques to provide safe, effective care.

DIF:	Cognitive Level: Application	REF:	Page 12	OBJ:	13
TOP:	Psychiatric Nursing		KEY:	Nursing Process: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care	

	18.	A nurse is in the orientation stage of a relationship with a client. She will be establishing a contract with the client and knows that such a contract:
1.	Is always formal and in writing	
2.	Is not really necessary	
3.	Is binding and linked to payment for services	
4.	Can be formal or informal, written or verbal	

ANS:	4
A contract can be either written or verbal. The contract is not always formal, so option 1 is incorrect, although this is a good practice. Option 3 is incorrect because the contract is not linked to any payment mechanism.

DIF:	Cognitive Level: Application	REF:	Page 15	OBJ:	12
TOP:	The Contract			KEY:	Nursing Process: Implementation
MSC:	NCLEX: Psychosocial Integrity

	19.	At a neighborhood meeting where a half-way house is being proposed for the neighborhood, a member of the community states, “We don’t want the facility. We don’t want violent people living near us.” The response by the nurse that best addresses the need to reduce stigma would be:
1.	“In truth, most individuals with psychiatric disorder are passive and withdrawn.”	
2.	“We can give you training in how to defend yourselves so you will be more comfortable.”	
3.	“Clients with psychiatric disorder are so well medicated that they do not display violent behaviors.”	
4.	“After a few weeks, the folks in the neighborhood will develop tolerance to ambiguity.”	

ANS:	1
A major reason for the existence of the stigma placed on persons with mental illness is lack of knowledge. The main fear is of violence, although only a small percentage of clients with mental illness display this behavior. Providing the public with accurate information can help reduce stigma.

DIF:	Cognitive Level: Application	REF:	Page 10	OBJ:	10
TOP:	Stigma	KEY:	Nursing Process: Implementation	
MSC:	NCLEX: Psychosocial Integrity

	20.	A client who displayed withdrawn, suspicious behavior at admission believed the CIA wished to kill him. After 5 days of hospitalization with psychotropic medication, the client is interacting appropriately with other clients and staff and states that he formerly felt afraid and thought the CIA had targeted him. Now he states, “I know that thinking was pretty sick.” Based on the client’s statement, what evaluation can the nurse make?
1.	The client is telling staff members what they wish to hear to gain discharge.	
2.	The client is experiencing continuing negative responses to stress.	
3.	Recent behavior and statements are signs of returning mental health.	
4.	Signs of mental disorder are increasing in frequency and intensity.	

ANS:	3
The ability to think logically and reach insightful conclusions is a component of mental health. There are no data to support the other responses.

DIF:	Cognitive Level: Evaluation	REF:	Page 5	OBJ:	5
TOP:	Mental Health Components	KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Psychosocial Integrity

	21.	A client makes an appointment to see the psychiatric mental health nurse about “family problems.” The nurse should assume that the principal focus of the nurse-client relationship will be determined by:
1.	Client needs	
2.	Nurse expertise	
3.	Social interaction	
4.	Epidemiology and research	

ANS:	1
An operative principle for developing and maintaining a therapeutic nurse-client relationship states that client needs and problems are the focus of the therapeutic nurse-client relationship. 2. Nurse expertise never dictates the focus; it is always client-centered. 3. Social interaction does not determine focus; needs are assessed during therapeutic interactions. 4. Epidemiology and research are not the primary focus of the relationship.

DIF:	Cognitive Level: Application	REF:	Page 13	OBJ:	12
TOP:	Nurse-Client Relationship	KEY:	Nursing Process: Implementation
MSC:	NCLEX: Psychosocial Integrity

	22.	Near the end of her orientation to a unit, a new nurse tells her mentor, “I’ve become aware of my need to influence vulnerable clients so I can feel more in control.” It can be determined that the new nurse has engaged in the process of:
1.	Labeling	
2.	Stereotyping	
3.	Subjectivity	
4.	Autodiagnosis	

ANS:	4
Autodiagnosis is the examination of one’s own thoughts, feelings, perceptions, attitudes, and motives about a situation. The need for control or power motivates some nurses to enter the profession. It is important to become aware of this motivation so that it can be replaced with a healthier motivation.

DIF:	Cognitive Level: Application	REF:	Page 15	OBJ:	12
TOP:	Psychiatric Nursing		KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care	

	23.	When a client tells the nurse, “It’s so wonderful how you’ve helped me; I think I’ve fallen in love with you,” it suggests that:
1.	The client is goal-directed	
2.	Confrontation is occurring	
3.	The client is demonstrating unhealthy boundaries	
4.	The nurse is motivated by the desire to contribute to society	

ANS:	3
Falling in love with someone who reaches out suggests the presence of unhealthy boundaries. 1. The situation does not reveal any data about the client being focused on goals. 2. This is not an example of confrontation, a process of pointing out a discrepancy. 4. The situation does not reveal information about nurse motivation.

DIF:	Cognitive Level: Application	REF:	Page 14	OBJ:	12
TOP:	Boundaries	KEY:	Nursing Process: Assessment	
MSC:	NCLEX: Psychosocial Integrity

	24.	A client states, “I am thinking about going to an advanced practice nurse. What can an advanced practice psychiatric nurse do?” The nurse knows that an advanced practice nursing intervention would be:
1.	Identifying nursing diagnoses	
2.	Evaluating client responses to nursing care	
3.	Writing prescriptions for psychotropic medications	
4.	Giving psychotropic medications to patients on a unit	

ANS:	3
Options 1, 2, and 4 are all skills for a registered nurse at the basic level of practice. Option 3 is the only advanced skill.

DIF:	Cognitive Level: Comprehension	REF:	Page 16	OBJ:	13
TOP:	Advanced Level of Practice	KEY:	Nursing Process: Planning
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care	

	25.	The nurse has begun to treat a client as a mutual friend, focusing on topics of social interest and seeking support from the client. The result that can be anticipated is most likely to be:
1.	Blurred boundaries and role confusion	
2.	Establishment and maintenance of trust	
3.	Client experiencing freedom to grow	
4.	Collaboration to determine client needs	

ANS:	1
Becoming the client’s friend is a negative event, shifting the focus from client needs, changing the purpose of the relationship, and resulting in boundary blurring and role confusion. The other choices are positive in nature.

DIF:	Cognitive Level: Application	REF:	Page 14	OBJ:	12
TOP:	Social Relationship		KEY:	Nursing Process: Evaluation
MSC:	NCLEX: Psychosocial Integrity

	26.	A client states “I can’t stand my mother. She’s always interfering.” “The nurse responds, “I know what you mean. My mother is very controlling, too.” What assessment can be made by the nurse mentor who overhears the interchange?
1.	The client has unhealthy boundaries.	
2.	The nurse’s response was subjective.	
3.	The nurse-client relationship is in the working phase.	
4.	The nurse is establishing the client-centered goals.	

ANS:	2
Option 2 is correct; subjective responses emphasize the nurse’s feelings, attitudes, and opinions. Options 1 and 3 are incorrect because there are insufficient data to make either of these assessments. Option 4 is incorrect because the nurse’s response is not objective or client-centered.

DIF:	Cognitive Level: Application	REF:	Page 14	OBJ:	12
TOP:	Subjective Response		KEY:	Nursing Process: Assessment
MSC:	NCLEX: Psychosocial Integrity

	27.	Which of the following client behaviors should suggest to the nurse that a client needs intervention and treatment? The individual who:
1.	Shoplifts and is arrested and jailed	
2.	Loses a clerical position, then volunteers in a social agency to maintain skills	
3.	Loses his wife in an accident and resumes his usual activities within a week	
4.	Is depressed and unable to work or assume family responsibilities	

ANS:	4
Mental health implies absence of signs and symptoms of mental disorder and freedom from excessive mental and emotional disability and pain. Depression and inability to work or assume family responsibilities suggests emotional pain and disability. Option 1 is criminal behavior rather than mental illness. Option 2 is adaptive behavior. Option 3 is within the range of normal behavior associated with grief work.

DIF:	Cognitive Level: Analysis	REF:	Page 5	OBJ:	4
TOP:	Mental Illness			KEY:	Nursing Process: Assessment
MSC:	NCLEX: Psychosocial Integrity

	28.	A layperson states, “With all the new information about psychiatric disorders, the need for psychiatric nurses will be drastically reduced.” The response by the nurse that shows the best understanding of current patterns of psychiatric disease burden is:
1.	“You make an excellent point about needing fewer psychiatric nurses.”	
2.	“My understanding indicates that the need for psychiatric nurses will remain stable.”	
3.	“Disability from mental illness has been seriously overestimated in the past few years.”	
4.	“The current number of psychiatric nurses is projected to be insufficient to meet future needs.”	

ANS:	4
The Global Burden of Disease and Injury Study reports the burden of psychiatric diseases has been seriously underestimated in the past. Present numbers of psychiatric nurses are insufficient, and the projections of need for the year 2020 suggest an even greater shortage.

DIF:	Cognitive Level: Application	REF:	Page 2	OBJ:	7
TOP:	Psychiatric Nursing		KEY:	Nursing Process: Implementation
MSC:	NCLEX: N/A