Varcarolis Chapter 7 – Nursing Process & Standards of Care in Psychiatric Mental Health Nursing Page 1 2026-03-20
Varcarolis Chapter 7 –
Nursing Process &
Standards of Care in
Psychiatric Mental Health
Nursing
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Page 1 of 30 Varcarolis Chapter 7 – Nursing Process & Standards of Care in Psychiatric Mental Health Nursing.pdf
,Varcarolis_ Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
Page 2 2026-03-20
A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice
nurse to perform which action for patients?
a. Perform mental health assessment interviews.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANS: B
Prescriptive privileges are granted to master's-prepared nurse practitioners who have taken special courses on
prescribing medication. The nurse prepared at the basic level performs mental health assessments, establishes
relationships, and provides individualized care planning. Note that this question was also offered for Chapter 1.
A newly admitted patient diagnosed with major depression has gained 20 pounds over a few months and has suicidal
ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the
priority nursing diagnosis.
a. Imbalanced nutrition: more than body requirements
b. Chronic low self-esteem
c. Risk for suicide
d. Hopelessness
ANS: C
Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal
intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but
these problems do not affect patient safety as urgently as would a suicide attempt.
Page 2 of 30 Varcarolis_
2 of 30 Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing.pdf
, Varcarolis_ Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
Page 3 2026-03-20
A patient diagnosed with major depression has lost 20 pounds in one month, has chronic low self-esteem, and a plan
for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention has the highest
priority?
a. Implement suicide precautions.
b. Offer high-calorie snacks and fluids frequently.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
ANS: A
Implementing suicide precautions is the only option related to patient safety. The other options, related to nutrition,
self-esteem, and medication therapy, are important but are not priorities.
The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within
7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a
2-hour afternoon nap. The nurse will document the outcome as:
a. consistently demonstrated.
b. often demonstrated.
c. sometimes demonstrated.
d. never demonstrated.
ANS: D
Although the patient is sleeping 6 hours daily, the total is not one uninterrupted session at night. Therefore, the
outcome must be evaluated as never demonstrated. See relationship to audience response question.
Page 3 of 30 Varcarolis_
3 of 30 Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing.pdf
Varcarolis Chapter 7 –
Nursing Process &
Standards of Care in
Psychiatric Mental Health
Nursing
Guidehttps://www.stuvia.com/dashboard!@_)#*)(@$)($@*($@)($@*_1 of 30
Page 1 of 30 Varcarolis Chapter 7 – Nursing Process & Standards of Care in Psychiatric Mental Health Nursing.pdf
,Varcarolis_ Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
Page 2 2026-03-20
A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice
nurse to perform which action for patients?
a. Perform mental health assessment interviews.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANS: B
Prescriptive privileges are granted to master's-prepared nurse practitioners who have taken special courses on
prescribing medication. The nurse prepared at the basic level performs mental health assessments, establishes
relationships, and provides individualized care planning. Note that this question was also offered for Chapter 1.
A newly admitted patient diagnosed with major depression has gained 20 pounds over a few months and has suicidal
ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the
priority nursing diagnosis.
a. Imbalanced nutrition: more than body requirements
b. Chronic low self-esteem
c. Risk for suicide
d. Hopelessness
ANS: C
Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal
intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but
these problems do not affect patient safety as urgently as would a suicide attempt.
Page 2 of 30 Varcarolis_
2 of 30 Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing.pdf
, Varcarolis_ Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
Page 3 2026-03-20
A patient diagnosed with major depression has lost 20 pounds in one month, has chronic low self-esteem, and a plan
for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention has the highest
priority?
a. Implement suicide precautions.
b. Offer high-calorie snacks and fluids frequently.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
ANS: A
Implementing suicide precautions is the only option related to patient safety. The other options, related to nutrition,
self-esteem, and medication therapy, are important but are not priorities.
The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within
7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a
2-hour afternoon nap. The nurse will document the outcome as:
a. consistently demonstrated.
b. often demonstrated.
c. sometimes demonstrated.
d. never demonstrated.
ANS: D
Although the patient is sleeping 6 hours daily, the total is not one uninterrupted session at night. Therefore, the
outcome must be evaluated as never demonstrated. See relationship to audience response question.
Page 3 of 30 Varcarolis_
3 of 30 Chapter 7 - The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing.pdf
