PSY MISC/ NUR 2356 mostly tested exam questions with all correct and verified answers

PSY MISC/ NUR 2356 mostly tested exam questions with all correct and verified answers PSYCH Chapter 2 review Self-Examination/Learning Exercise Select the answer that is most appropriate for each of the following questions. 1. Anna’s dog, Lucky, her pet for 16 years, was killed by a car 3 years ago. Since that time, Anna has lost weight, rarely leaves her home, and talks excessively about Lucky. Why would Anna’s behavior be considered maladaptive? a. It has been more than 3 years since Lucky died. b. Her grief is too intense over the loss of a dog. c. Her grief is interfering with her functioning. d. Cultural norms typically do not comprehend grief over the loss of a pet. 2. Anna states that Lucky was her closest friend, and since his death, there is no one who could ever replace the relationship they had. According to Maslow’s hierarchy of needs, which level of need is not being met? a. Physiological needs b. Self-esteem needs c. Safety and security needs d. Love and belonging needs 3. Anna’s daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a. Neurosis b. Psychosis c. Depression d. Bereavement 4. Anna, who is 72 years old, is of the age when she may have experienced several losses in a short time. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity 5. Anna has been grieving the death of Lucky for 3 years. She is unable to take care of her normal activities because she insists on visiting Lucky’s grave daily. What is the most likely reason that Anna’s daughter has put off seeking help for Anna? a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to normalize behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors will think her mother is “crazy.” 6. Lucky’s accident occurred when he got away from Anna while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember the circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression 7. Lucky sometimes refused to obey Anna’s commands to come back to her, including when he ran into the street on the day of the accident. But Anna continues to insist, “He was the very best dog. He always minded me. He always did everything I told him to do.” Which defense mechanism is Anna exhibiting? a. Sublimation b. Compensation c. Reaction formation d. Undoing 8. Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? (Select all that apply.) a. Unresolved grief over loss of her husband b. Loss of several relatives and friends over the last few years c. Repressed feelings of guilt over the way Lucky died d. Inability to prepare in advance for the loss 9. For what reason would Anna’s illness be considered a neurosis rather than a psychosis? a. She is unaware that her behavior is maladaptive. b. She exhibits inappropriate affect (emotional tone). c. She experiences no loss of contact with reality. d. She tells the nurse, “There is nothing wrong with me!” p. 20 neurosis- neuroses are psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms. It appears as a symptom such as an obsession, a compulsion, a phobia, or a sexual dysfunction. The following are common characteristics of people with neuroses: They are aware that they are experiencing distress. They are aware that their behaviors are maladaptive. They are unaware of any possible psychological causes of the distress. They feel helpless to change their situation. They experience no loss of contact with reality. Psychosis- is defined as a significant thought disturbance in which reality testing is impaired, resulting in delusions, hallucinations, disorganized speech, or catatonic behavior. The following are common characteristics of people with psychoses: They exhibit minimal distress (emotional tone is flat, bland, or inappropriate). They are unaware that their behavior is maladaptive. They are unaware of any psychological problems (anosognosia). They are exhibiting a flight from reality into a less stressful world or one in which they are attempting to adapt. 10. Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky’s death? a. “I don’t cry anymore when I think about Lucky.” b. “It’s true. Lucky didn’t always mind me. Sometimes he ignored my commands.” c. “I remember how it happened now. I should have held tighter to his leash!” d. “I won’t ever have another dog. It’s just too painful to lose them.” PSYCH Chapter 5 1. The nurse decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision? a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism 2. The nurse decides to respect family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism 3. The nurse decides to tell the client of his terminal status because she believes it is her duty to do so. Which of the following ethical theories is considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism 4. The nurse assists the physician with electroconvulsive therapy on a client who has refused to give consent. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality 5. A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality 6. Joe is very restless and is pacing the room. The nurse says to Joe, “If you don’t sit down in the chair and be still, I’m going to put you in restraints!” With which of the following legal actions might the nurse be charged because of this nursing action? a. Defamation of character b. Battery c. Breach of confidentiality d. Assault 7. An individual may be considered gravely disabled for which of the following reasons? (Select all that apply.) a. A person, because of mental illness, cannot fulfill basic needs. b. A mentally ill person is in danger of physical harm based on inability to care for himself or herself. c. A mentally ill person lacks the resources to provide the necessities of life. d. A mentally ill person is unable to make use of available resources to meet daily living requirements. 8. Which of the following statements is correct regarding the use of restraints? (Select all that apply.) a. Restraints may never be initiated without a physician’s order. b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. c. Clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. An in-person evaluation must be conducted within 1 hour of initiating restraints. 9. Guidelines relating to “duty to warn” state that a therapist should consider taking action to warn a third party when his or her client does which of the following? (Select all that apply.) a. Threatens violence toward another individual b. Identifies a specific intended victim c. Is having command hallucinations d. Reveals paranoid delusions about another individual 10. Attempting to calm an angry client by using “talk therapy” is an example of which of the following clients’ rights? a. The right to privacy b. The right to refuse medication c. The right to the least-restrictive treatment alternative d. The right to confidentiality 11. The Quality and Safety Education for Nurses guidelines identify that student nurses need to be well schooled on informatics. This most directly refers to which of the following? a. Learning how to effectively communicate information using electronic health records b. Learning the SBAR method of reporting information c. Learning guidelines for preventing lawsuits d. Learning information about new treatments to keep nursing skills current PSYCH Chapter 6 1. Miss Lee is an Asian American on the psychiatric unit. She tells the nurse, “I must have the hot ginger root for my headache. It is the only thing that will help.” What cultural belief is likely associated with Miss Lee’s request? a. She is being obstinate and wants control over her care. b. She believes that ginger root has magical qualities. c. She subscribes to the restoration of health through the balance of yin and yang. d. Asian Americans refuse to take traditional medicine for pain. 2. Miss Lee, an Asian American on the psychiatric unit, says she is afraid that no one from her family will visit her. On what belief does Miss Lee base her statement? a. Many Asian Americans do not believe in hospitals. b. Many Asian Americans do not have close family support systems. c. Many Asian Americans believe the body will heal itself if left alone. d. Many Asian Americans view psychiatric problems as bringing shame to the family. 3. Joe, an American Indian, appears at the community health clinic with an oozing stasis ulcer on his lower right leg. It is obviously infected, and he tells the nurse that the shaman has been treating it with herbs. The nurse determines that Joe needs emergency care, but Joe states he will not go to the emergency department (ED) unless the shaman is allowed to help treat him. How should the nurse handle this situation? a. Contact the shaman and have him meet them at the ED to consult with the attending physician. b. Tell Joe that the shaman is not allowed in the ED. c. Explain to Joe that the shaman is at fault for his leg being in the condition it is in now. d. Have the shaman try to talk Joe into going to the ED without him. 4. Joe, an American Indian, goes to the emergency department (ED) because he has an oozing stasis ulcer on his leg. He is accompanied by the tribal shaman, who has been treating Joe on the reservation. As a greeting, the physician extends his hand to the shaman, who lightly touches the physician’s hand, then quickly moves away. What cultural norm among American Indians most likely explains the shaman’s behavior? a. The shaman is snubbing the physician. b. The shaman is angry at Joe for wanting to go to the ED. c. The shaman does not believe in traditional medicine. d. The shaman does not feel comfortable with touch. 5. Sarah is an African American woman who receives a visit from the psychiatric home health nurse. A referral for a mental health assessment was made by the public health nurse, who noticed that Sarah was becoming exceedingly withdrawn. When the psychiatric nurse arrives, Sarah says to her, “No one can help me. I was an evil person in my youth, and now I must pay.” How might the nurse assess this statement? A. Sarah is having delusions of persecution. B. Some African Americans believe illness is God’s punishment for their sins. C. Sarah is depressed and just wants to be left alone. D. African Americans do not believe in psychiatric help. 6. Frank is a Latino American who has an appointment at the community health center for 1 p.m. The nurse is angry when Frank shows up at 3:30 p.m. stating, “I was visiting with my brother.” How must the nurse interpret this behavior? a. Frank is being passive-aggressive by showing up late. b. This is Frank’s way of defying authority. c. Frank is a member of a cultural group that is present-time oriented. d. Frank is a member of a cultural group that rejects traditional medicine. 7. The nurse must give Frank, a Latino American, a physical examination. She asks him to remove his clothing and put on an examination gown. Frank refuses. What cultural norm among Latino Americans most likely explains Frank’s response? a. Frank does not believe in taking orders from a woman. b. Frank is modest and embarrassed to remove his clothes. c. Frank does not understand why he must remove his clothes. d. Frank does not think he needs a physical examination. 8. Maria is an Italian American who is in the hospital after having suffered a miscarriage at 5 months’ gestation. Her room is filled with relatives who have brought a variety of foods and gifts for Maria. They are all talking, seemingly at the same time, and some, including Maria, are crying. They repeatedly touch and hug Maria and each other. How should the nurse handle this situation? a. Explain to the family that Maria needs her rest and they must all leave. b. Allow the family to remain and continue their activity as described, as long as they do not disturb other clients. c. Explain that Maria will not get over her loss if they keep bringing it up and causing her to cry so much. d. Call the family priest to come and take charge of this family situation. 9. Mark, who has come to the mental health clinic with symptoms of depression, says to the nurse, “My father is dying. I have always hated my father. He physically abused me when I was a child. We haven’t spoken for many years. He wants to see me now, but I don’t know if I want to see him.” With which spiritual need is Joe struggling? a. Forgiveness b. Faith c. Hope d. Meaning and purpose in life 10. As a child, Joe was physically abused by his father. The father is now dying and has expressed a desire to see his son before he dies. Joe is depressed and says to the mental health nurse, “I’m so angry! Why did God have to give me a father like this? I feel cheated of a father! I’ve always been a good person. I deserved better. I hate God!” From this subjective data, which nursing diagnosis might the nurse apply to Joe? A. Readiness for enhanced religiosity B. Risk for impaired religiosity C. Readiness for enhanced spiritual well-being D. Spiritual distress PSYCH Chapter 8 1. A client states, “I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move.” Which of the following is the most therapeutic response? a. “That’s not true.” “ b. I have a hard time believing that is true.” Voicing Doubt c. “Surely you don’t really believe that.” d. “I will help you search this room so that you can see there is no camera.” 2. Simone, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing makeup and a clean dress with hair washed and combed. Which of the following responses by the nurse is most appropriate? a. “Simone, I see you have put on a clean dress and combed your hair.” Giving recognition b. “Simone, you look wonderful today!” c. “Simone, I’m sure everyone will appreciate that you have cleaned up for the group today.” d. “Now that you see how important it is, I hope you will do this every day.” 3. Dorothy was involved in an automobile accident while under the influence of alcohol. She swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? a. “Now that you know what can happen when you drink and drive, I’m sure you won’t let it happen again.” b. “You know that was a terrible thing you did. That child could have been killed.” c. “I’m sure everything is going to be okay now that you understand the possible consequences of such behavior.” d. “How are you feeling about what happened?” reflecting 4. Judy has been in the hospital for 3 weeks. She has used Valium “to settle her nerves” for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time but states to the nurse, “I don’t know if I will be able to make it without Valium after I go home. I’m already starting to feel nervous. I have so many personal problems.” Which is the most appropriate response by the nurse? a. “Why do you think you need drugs to deal with your problems?” b. “Everybody has problems, but not everybody uses drugs to deal with them. You’ll just have to do the best that you can.” c. “Let’s explore some things you can do to decrease your anxiety without resorting to drugs.” Formulating a plan of action d. “Just hang in there. I’m sure everything is going to be okay.” 5. Mrs. S. asks the nurse, “Do you think I should tell my husband about my affair with my boss?” Which is the most appropriate response by the nurse? a. “What do you think would be best for you to do?” b. “Of course you should. Marriage has to be based on truth.” c. “Of course not. That would only make things worse.” d. “I can’t tell you what to do. You have to decide for yourself.” 6. Abby, an adolescent, just returned from group therapy and is crying. She says to the nurse, “All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I’ve never had a close friend. I guess I never will.” Which is the most appropriate response by the nurse? a. “What makes you think you will never have any friends?” b. “You’re feeling pretty down on yourself right now.” Making observations c. “I’m sure they didn’t mean to hurt your feelings.” d. “Why do you feel this way about yourself?” 7. Walter is angry with his psychiatrist and says to the nurse, “He doesn’t know what he is doing. That medication isn’t helping a thing!” The nurse responds, “He has been a doctor for many years and has helped many people.” This is an example of what nontherapeutic technique? a. Rejecting b. Disapproving c. Probing d. Defending 8. The client says to the nurse, “I’ve been offered a promotion, but I don’t know if I can handle it.” The nurse replies, “You’re afraid you may fail in the new position.” This is an example of which therapeutic technique? a. Restating b. Making observations c. Focusing d. Verbalizing the implied 9. The environment in which the communication takes place influences the outcome of the interaction. Which of the following are aspects of the environment that influence communication? (Select all that apply.) a. Territoriality b. Density c. Dimension d. Distance e. Intensity 10. The nurse says to a client, “You are being readmitted to the hospital. Why did you stop taking your medication?” What communication technique does this represent? a. Disapproving b. Requesting an explanation c. Disagreeing d. Probing 11. Joe has been in rehabilitation for alcohol dependence. When he returns from a visit to his home, he tells the nurse, “We were having a celebration and I did have one drink, but it really wasn’t a problem.” The nurse notices that his breath smells of alcohol. Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. “You are obviously not motivated to change, so perhaps we should discuss your discharge from the treatment program.” b. “You need to abstain from alcohol in order to recover, so let me talk to the doctor about the consequences of your behavior.” c. “Why would you destroy everything you’ve worked so hard to achieve?” d. “What do you mean when you say, ‘It really wasn’t a problem’?” 12. Bill, who has been diagnosed with schizophrenia and has been on medication for several months, states, “I’m not taking that stupid medication anymore.” Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. “Don’t you know that if you don’t take your medication you will never recover?” b. “Why won’t you cooperate with the treatment your doctor prescribed?” c. “Bill, the medication is not stupid.” d. “Tell me more about why you don’t want to take the medication.” PSYCH Chapter 12 1. Which of the following are basic assumptions of milieu therapy? (Select all that apply.) a. The client owns his or her own environment. P. 224-225 b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool. d. Inappropriate behaviors are punished immediately. 2. John tells the nurse, “I think lights out at 10 o’clock on a weekend is stupid. We should be able to watch TV until midnight!” Which of the following is the most appropriate response from the nurse on the milieu unit? a. “John, you were told the rules when you were admitted.” b. “You may bring it up before the others at the community meeting, John.” c. “Some people want to go to bed early, John.” d. “You are not the only person on this unit, John. You must think of others besides yourself.” 3. In prioritizing care within the therapeutic environment, which of the following nursing interventions would receive the highest priority? a. Ensuring that the physical facilities are conducive to achievement of the goals of therapy b. Scheduling a community meeting for 8:30 each morning c. Attending to the nutritional and comfort needs of all clients d. Establishing contacts with community resources 4. In the community meeting, which of the following actions is most important for reinforcing the democratic posture of the therapy setting? a. Allowing each person a specific and equal amount of time to talk b. Reviewing group rules and behavioral limits that apply to all clients p. 225 c. Reading the minutes from yesterday’s meeting d. Waiting until all clients are present before initiating the meeting 5. One of the goals of therapeutic community is for clients to become more independent and accept self-responsibility. Which of the following approaches by staff best encourages fulfillment of this goal? a. Including client input and decisions into the treatment plan b. Insisting that each client take a turn as “president” of the community meeting c. Making decisions for the client regarding plans for treatment d. Requiring that the client be bathed, dressed, and attend breakfast on time each morning 6. Client teaching is an important nursing function in milieu therapy. Which of the following statements by the client indicates the need for knowledge and a readiness to learn? a. “Get away from me with that medicine! I’m not sick!” b. “I don’t need psychiatric treatment. It’s my migraine headaches that I need help with.” c. “I’ve taken Valium every day of my life for the last 20 years. I’ll stop when I’m good and ready!” d. “The doctor says I have bipolar disorder. What does that really mean?” 7. Which of the following activities would be a responsibility of the clinical psychologist member of the IDT (interdisciplinary team)? a. Locates halfway house and arranges living conditions for client being discharged from the hospital b. Manages the therapeutic milieu on a 24-hour basis c. Administers and evaluates psychological tests that assist in diagnosis p.227 d. Conducts psychotherapy and administers electroconvulsive therapy treatments 8. Which of the following activities would be a responsibility of the psychiatric clinical nurse specialist on the IDT team? a. Manages the therapeutic milieu on a 24-hour basis b. Conducts group therapies and provides consultation and education to staff nurses c. Directs a group of clients in acting out a situation that is otherwise too painful for a client to discuss openly d. Locates halfway house and arranges living conditions for client being discharged from the hospital 9. On the milieu unit, duties of the staff psychiatric nurse include which of the following? (Select all that apply.) a. Medication administration b. Client teaching c. Medical diagnosis d. Reality orientation e. Relationship development f. Group therapy 10. Lashona was sexually abused as a child. She is a client on the milieu unit with a diagnosis of Borderline Personality Disorder. She has refused to talk to anyone. Which of the following therapies might the IDT team choose for Lashona? (Select all that apply.) a. Music therapy b. Art therapy c. Psychodrama d. Electroconvulsive therapy PSYCH Chapter 19 1. Janet failed her first test in nursing school. She thinks, “Well, that’s it! I’ll never be a nurse.” What automatic thought does this statement represent? a. Overgeneralization b. Magnification c. Catastrophic thinking p. 330 d. Personalization 2. When Jack is not accepted at the law school of his choice, he thinks, “I’m so stupid. No law school will ever accept me.” What automatic thought does this statement represent? a. Overgeneralization b. Magnification c. Selective abstraction d. Minimization 3. Nancy’s new in-laws came to dinner for the first time. When Nancy’s mother-in-law left some food on her plate, Nancy thought, “I must be a lousy cook.” What automatic thought does this statement represent? a. Dichotomous thinking b. Overgeneralization c. Minimization d. Personalization 4. Barbara burned the toast. She thinks, “I’m a totally incompetent person.” What automatic thought does this statement represent? a. Selective abstraction b. Magnification c. Minimization d. Personalization 5. Opal is a 43-year-old woman who is suffering from depression and suicidal ideation. Opal says, “I’m such a worthless person. I don’t deserve to live.” The therapist responds, “I would like for you to think about what problems committing suicide would solve.” The therapist is using which of the following cognitive therapy techniques? a. Imagery b. Role play c. Problem-solving d. Thought recording 6. The thought recording (two-column and three-column) cognitive therapy techniques help clients: a. Identify automatic thoughts. b. Modify automatic thoughts. c. Identify rational alternatives. d. All of the above. 7. The daily record of dysfunctional thoughts (DRDT) is used in cognitive therapy to help clients: a. Identify automatic thoughts. b. Modify automatic thoughts. c. Identify rational alternatives. d. All of the above. 8. A client tells the therapist, “I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn’t have fallen in love with another woman. It’s all my fault.” The therapist asks the client to explore what responsibilities the husband may have in the breakup. What cognitive therapy technique is the therapist using? a. Reattribution b. Role-play c. Decatastrophizing d. Thought recording 9. A client tells the therapist, “I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn’t have fallen in love with another woman. It’s all my fault.” The therapist wants to use the technique of “examining the evidence.” Which of the following statements reflects this technique? a. “How do you think you could have been a better wife?” b. “Okay, you say it’s all your fault. Let’s discuss why it might be your fault, and then we will look at why it may not be.” c. “Let’s talk about what would make you a happier person.” d. “Would you have wanted him to stay if he didn’t really want to?” 10. The therapist teaches a client that when the idea of herself as a worthless person starts to form in her mind, she should immediately start to whistle the tune of “Dixie.” What cognitive therapy technique is the therapist using? a. Behavioral rehearsal b. Social skills training c. Distraction d. Generating alternatives PSYCH Chapter 20 1. Electroconvulsive therapy is most commonly prescribed for which of the following? a. Bipolar disorder, manic b. Paranoid schizophrenia c. Major depression d. Obsessive-compulsive disorder 2. Which of the following best describes the average number of ECT treatments given and the timing of administration? a. One treatment per month for 6 to 12 months b. One treatment every other day, three times a week for a total of 6 to 12 treatments c. One treatment three times per week for 6 to 12 months d. One treatment every day for a total of 10 to 20 treatments 3. Which of the following conditions increases the risk of adverse events associated with ECT? (Select all that apply.) a. Increased intracranial pressure b. Recent myocardial infarction c. Severe underlying hypertension d. Congestive heart failure e. Breast cancer 4. A patient has been ordered ECT and asks the nurse, “Exactly how does ECT work?” Which of the following is the most accurate response by the nurse? a. “I’m not allowed to tell you that because that would be informed consent.” b. “The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects.” c. “The administration of a shock to the brain induces memory loss, which will make you forget you are depressed.” d. “The neuroplasticity affected by seizure activity prevents further brain damage.” 5. The most common side effects of ECT are: a. Permanent memory loss and brain damage. b. Fractured and dislocated bones. c. Myocardial infarction and cardiac arrest. d. Temporary memory loss and confusion. 6. Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Sam’s physician has hospitalized him for a course of ECT treatments. Sam says to the nurse on admission, “I don’t want to end up like McMurphy in One Flew Over the Cuckoo’s Nest! I’m scared!” What is Sam’s priority nursing diagnosis at this time? a. Anxiety related to deficient knowledge about ECT b. Risk for injury related to risks associated with ECT c. Deficient knowledge related to negative media presentation of ECT d. Acute confusion related to side effects of ECT 7. Sam, who has been hospitalized for ECT treatments, says to the nurse on admission, “I don’t want to end up like McMurphy in One Flew Over the Cuckoo’s Nest! I’m scared!” Which of the following statements would be most appropriate by the nurse in response to Sam’s expression of concern? a. “I guarantee you won’t end up like McMurphy, Sam.” b. “The doctor knows what he is doing. There’s nothing to worry about.” c. “I know you are scared, Sam, and we’re going to talk about what you can expect from the therapy.” d. “I’m going to stay with you as long as you are scared.” 8. What is the priority nursing intervention before starting ECT therapy? P. 345 a. Take vital signs and record. 2 b. Have the patient void. 3 c. Administer succinylcholine. 4 d. Ensure that the consent form has been signed 1 9. Atropine sulfate is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic 10. Succinylcholine is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic PSYCH Chapter 27 1. Ms. T. has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T. experiences panic anxiety when she encounters snakes. b. Ms. T. refuses to fly in an airplane. c. Ms. T. will not eat in a public place. d. Ms. T. stays in her home for fear of being in a place from which she cannot escape. 2. Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid b. Group therapy with other agoraphobics c. Facing the fear in gradual step progression d. Hypnosis 3. With implosion therapy, a client with phobic anxiety would be: a. Taught relaxation exercises. b. Subjected to graded intensities of the fear. c. Instructed to stop the therapeutic session as soon as anxiety is experienced. d. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation. 4. A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: a. Relieves her anxiety. b. Reduces the probability of infection. c. Gives her a feeling of control over her life. d. Increases her self-concept. 5. The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? a. Keep the client’s bathroom locked so she cannot wash her hands all the time. b. Structure the client’s schedule so that she has plenty of time for washing her hands. c. Place the client in isolation until she promises to stop washing her hands so much. d. Explain the client’s behavior to her, since she is probably unaware that it is maladaptive. 6. A client with OCD says to the nurse, “I’ve been here 4 days now, and I’m feeling better. I feel comfortable on this unit, and I’m not ill-at-ease with the staff or other patients anymore.” In light of this change, which nursing intervention is most appropriate? a. Give attention to the ritualistic behaviors each time they occur, and point out their inappropriateness. b. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. Set limits on the amount of time the client may engage in the ritualistic behavior. d. Continue to allow the client all the time she wants to carry out the ritualistic behavior. 7. Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply.) p. 578 a. Awareness training b. Competing response training c. Social support d. Hypnotherapy e. Aversive therapy 8. Joselyn is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joselyn? a. Alprazolam (Xanax) b. Diazepam (Valium) c. Fluoxetine (Prozac) p. 584 d. Olanzapine (Zyprexa) 9. A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client? a. Stay with the client and reassure of safety. b. Administer a dose of diazepam. c. Leave the client alone in a quiet room so that she can calm down. d. Encourage the client to talk about what triggered the attack. 10. Jareth has a diagnosis of generalized anxiety disorder. His physician has prescribed buspirone 15 mg daily. Jareth says to the nurse, “Why do I have to take this every day? My friend’s doctor ordered Xanax for him, and he only takes it when he is feeling anxious.” Which of the following would be an appropriate response by the nurse? a. “Xanax is not effective for generalized anxiety disorder.” b. “Buspirone must be taken daily in order to be effective.” c. “I will ask the doctor if he will change your dose of buspirone to prn so that you don’t have to take it every day.” d. “Your friend really should be taking the Xanax every day.” PSYCH Chapter 28 1. John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, “I can’t figure out why God took my buddy instead of me.” From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor’s guilt c. Intrusive thoughts d. Spiritual distress 2. John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse’s most appropriate initial intervention is to: a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident. c. Stay with John and reassure him of his safety. d. Have John listen to a tape of relaxation exercises. 3. John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy p. 607-608 and 606 b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy 4. Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent-child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems 5. Nina recently left her husband of 10 years. She was very dependent on him and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of adjustment disorder with depressed mood. What is the priority nursing diagnosis for Nina? a. Risk-prone health behavior related to loss of dependency b. Complicated grieving related to breakup of marriage p. 603 c. Ineffective communication related to problems with dependency d. Social isolation related to depressed mood 6. Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, “I feel so bad. I thought I would feel better once I left, but I feel worse!” Which is the best response by the nurse? a. “Cheer up, Nina. You have a lot to be happy about.” b. “You are grieving the loss of your marriage. It’s natural for you to feel badly.” c. “Try not to dwell on how you feel. If you don’t think about it, you’ll feel better.” d. “You did the right thing, Nina. Knowing that should make you feel better.” 7. Nina has been hospitalized with adjustment disorder with depressed mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina’s symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence. 8. The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to: a. Increase energy and elevate mood. b. Stimulate the central nervous system. c. Prevent psychotic symptoms. d. Produce a calming effect. 9. An individual who is diagnosed with adjustment disorder with disturbance of conduct most likely: a. Violates the rights of others to feel better. P. 602 b. Expresses symptoms that reveal a high level of anxiety. c. Exhibits severe social isolation and withdrawal. d. Is experiencing a complicated grieving process. 10. Emma, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that Emma refuses to change her diet and often skips her medication. Emma has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Emma at this time? a. Anxiety related to hospitalization evidenced by noncompliance b. Low self-esteem related to feeling different from her peers evidenced by social isolation c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication 11. Trauma-informed care is a philosophical approach that includes which of the following principles? (Select all that apply.) p. 596 A. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. B. Medications need to be given before any other interventions are considered. C. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. D. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide. PSYCH Chapter 41 1. b 2. c 3. d 4. b 5. b 6. b 7. a 8. c 9. a 10. b 1. Mr. J. is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J.? a. Intimacy vs. isolation b. Generativity vs. self-absorption c. Trust vs. mistrust d. Autonomy vs. shame and doubt 2. Mr. J. has been diagnosed with schizophrenia. He refuses to eat and told the nurse he knew he was “being poisoned.” According to Erikson’s theory, in what developmental stage would you place Mr. J.? a. Intimacy vs. isolation b. Generativity vs. self-absorption c. Trust vs. mistrust d. Autonomy vs. shame and doubt 3. Janet, a psychiatric client diagnosed with borderline personality disorder, has just been hospitalized for threatening suicide. According to Mahler’s theory, Janet did not receive the critical “emotional refueling” required during the rapprochement phase of development. What are the consequences of this deficiency? a. She has not yet learned to delay gratification. b. She does not feel guilt about wrongdoings to others. c. She is unable to trust others. d. She has internalized rage and fears of abandonment. 4. John is on the Alcohol Treatment Unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel and says, “That’s a stupid program! I want to watch something else!” In what stage of development is John fixed according to Sullivan’s interpersonal theory? a. Juvenile. He is learning to form satisfactory peer relationships. b. Childhood. He has not learned to delay gratification. c. Early adolescence. He is struggling to form an identity. d. Late adolescence. He is working to develop a lasting relationship. 5. Adam has antisocial personality disorder. He says to the nurse, “I’m not crazy. I’m just fun-loving. I believe in looking out for myself. Who cares what anyone thinks? If it feels good, do it!” Which of the following describes the psychoanalytical structure of Adam’s personality? a. Weak id, strong ego, weak superego b. Strong id, weak ego, weak superego c. Weak id, weak ego, punitive superego d. Strong id, weak ego, punitive superego 6. Larry, who has antisocial personality disorder, feels no guilt about violating the rights of others. He does as he pleases without thought to possible consequences. In which of Peplau’s stages of development would you place Larry? a. Learning to count on others b. Learning to delay gratification c. Identifying oneself d. Developing skills in participation 7. Danny has been diagnosed with schizophrenia. On the unit he appears very anxious, paces back and forth, and darts his head from side to side in a continuous scanning of the area. He has refused to eat, making some barely audible comment related to “being poisoned.” In planning care for Danny, which of the following would be the primary focus for nursing? a. To decrease anxiety and develop trust b. To set limits on his behavior c. To ensure that he gets to group therapy d. To attend to his hygiene needs 8. The nurse has just admitted Madison to the psychiatric unit. The psychiatrist has diagnosed Madison with major depressive disorder. The nurse says to Madison, “Please tell me what it was like when you were growing up.” Which nursing role described by Peplau is the nurse fulfilling in this instance? a. Surrogate b. Resource person c. Counselor d. Technical expert 9. The nurse has just admitted Madison to the psychiatric unit. The psychiatrist has diagnosed Madison with major depressive disorder. The nurse says to Madison, “What questions do you have about being here on the unit?” Which nursing role described by Peplau is the nurse fulfilling in this instance? a. Resource person b. Counselor c. Surrogate d. Technical expert 10. The nurse has just admitted Madison to the psychiatric unit. The psychiatrist has diagnosed Madison with major depressive disorder. The nurse says to Madison, “Some changes will have to be made in your behavior. I care about what happens to you.” Which nursing role described by Peplau is the nurse fulfilling in this instance? A. Counselor B. Surrogate C. Technical expert D. Resource person Overview of Psychological Theorists #1 – Erikson, Erik: Psychosocial Development  Eight stages of the life-cycle involving developmental crises (trust vs. mistrust; autonomy vs. shame and doubt; initiative vs. guilt; industry vs. inferiority; identity vs. role confusion; intimacy vs. isolation; generativity vs. stagnation; ego integrity vs. despair).  Relevance to mental illness: Erikson theorized that sociocultural concepts and specific tasks should be completed during each stage. Persons with mental health issues did not complete the necessary tasks from each stage. #2 – Freud, Sigmund: Psychoanalytic Theory  Five stages of personality development (oral; anal; phallic; latency; genital).  Three components of personality that influence behavior: id (pleasure principle), ego (reality principle), superego (perfection principle).  Relevance to mental illness: Freud theorized that the maladaptive behaviors seen in mental illness may be related to ego defense mechanisms. #3 – Kohlberg, Lawrence: Moral Development  Three levels and six stages of moral development, not tied to specific age groups (Pre-Conventional – Stages 1&2; Conventional – Stages 3&4; Post-Conventional – Stages 5&6).  Relevance to mental illness: Kohlberg theorized that moral development affects how people behave and how they treat others. #4 – Mahler, Margaret: Object Relations  Separation-individualization process from the primary caregiver (mother), progressing through three stages (autistic phase; symbiotic phase; separation-individualization phase).  Relevance to mental illness: Mahler theorized that emotional problems of individuals can be traced back to ineffective separation and individuation. #5 – Peplau, Hildegard: Interpersonal Theory  People must complete psychological tasks during childhood on their way to maturity.  Four stages of personality development (learning to count on others; learning to delay satisfaction; identifying oneself; developing skills in participation).  Four phases of nurse-client relationship (orientation; identification; exploitation; resolution).  Relevance to mental illness: Peplau theorized that persons with psychological illness may be stuck in, or regress to, an earlier stage of development. #6 – Piaget, Jean: Cognitive Development  Human intelligence passes through four stages that are age-related (Sensorimotor; Preoperational; Concrete Operations; Formal Operations).  Relevance to mental illness: Piaget theorized that thought distortions may help develop and maintain mood disorders. #7 – Sullivan, Harry Stack: Personality Development  Major concepts: anxiety; satisfaction of needs; interpersonal security; self-system.  Six stages of personality development (infancy; childhood; juvenile; preadolescence; early adolescence; late adolescence).  Relevance to mental illness: Sullivan theorized that personality development and behavior are the result of interpersonal relationships; poor relationships may contribute to psychological distress and dysfunction. Pharmacology-Chapter 34-Sedative Hypnotic Drugs 1. Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? a. Norepinephrine b. Acetylcholine c. Serotonin (5-HT) d. Gamma-aminobutyric acid (GABA) Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA. 2. When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? Select all that apply. a. Benzodiazepines have a high safety profile. b. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. c. Benzodiazepines are associated with a high suicide potential. d. Benzodiazepines have a low ability to cause tolerance. e. Benzodiazepines have a low abuse potential. Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression. 3. The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? a. Diazepam [Valium] b. Triazolam [Halcion] c. Zolpidem [Ambien] d. Phenobarbital [Luminal Sodium] Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine­like drugs. 4. The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? a. "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." b. "No, all of the sleep medications are controlled substances." c. "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." d. "Yes, but it is not for chronic insomnia." Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long­term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance. 5. The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? a. Naloxone [Narcan] b. Flumazenil [Romazicon] c. Acetylcysteine [Mucomyst] d. Vitamin K Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol]overdose. Vitamin K is used to reverse warfarin toxicity. 6. The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? a. Morning sedation b. A respiratory rate of 30 breaths per minute c. Constipation d. A blood pressure of 160/88 mm Hg The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills). 7. Which statements about zaleplon [Sonata] does the nurse identify as true? Select all that apply. a. Zaleplon [Sonata] is a benzodiazepine. b. Zaleplon [Sonata] is indicated for long-term management of insomnia. c. Zaleplon [Sonata] is used to maintain sleep throughout the night. d. Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. e. Zaleplon [Sonata] interacts with the neurotransmitter GABA.  Zaleplon [Sonata] belongs to a new class of drugs called the pyrazolopyrimidines. It is indicated for short­term management of insomnia. Zaleplon has a rapid onset and short duration of action and therefore is beneficial for initiating sleep but not for maintaining it throughout the night. Zaleplon and cimetidine should not be administered together. Zaleplon interacts with the neurotransmitter GABA. 8. The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? a. "When it is time to discontinue this drug, you will need to taper it off slowly." b. "Protect your skin from the sun to prevent rash and exaggerated sunburn." c. "Increase your intake of fluid and high-fiber foods to prevent constipation." d. "Take this medication on an empty stomach at least 2 hours after meals."  Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax]. 9. The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer? a. 0.25 b. 0.5 c. 1 d. 4 10. Which agent is most likely to be prescribed today for short-term management of insomnia? a. Secobarbital [Seconal Sodium] b. Meprobamate [Miltown] c. Zolpidem [Ambien] d. Flumazenil [Romazicon] Zolpidem is a benzodiazepine­like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative­hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines. Pharmacology-Chapter 35-Management of Anxiety Disorders 1. The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? a. Venlafaxine [Effexor] b. Buspirone [BuSpar] c. Paroxetine [Paxil] d. Alprazolam [Xanax] *Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.* 2. A patient asks the nurse about treatments for posttraumatic stress disorder (PTSD). Which statement by the nurse is the most helpful? a. "The primary treatment is therapy, but there are some medications that have been somewhat effective." b. "The primary treatment is monotherapy with an SSRI." c. "The primary treatment is a combination of multiple medications." d. "The primary treatment is benzodiazepine for anxiety." *Post-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved for PTSD. If none of the first-line drugs are effective, the guidelines suggest several alternatives: mirtazapine, a TCA (amitriptyline or imipramine), or an MAOI (phenelzine). Current evidence does not support the use of monotherapy with either bupropion, buspirone, trazodone, or a benzodiazepine.* 3. A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely? a. Panic disorder b. Bipolar disorder c. Generalized anxiety disorder d. Clinical depression e.  *Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.* 1. The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? a. "This medication should not make me feel drowsy." b. "This medication should help me feel less anxious." c. "I will drink grapefruit juice instead of coffee with breakfast." d. "I will take my medication three times per day."  *Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.* 1. The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? Select all that apply. a. Fluoxetine [Prozac] b. Venlafaxine [Effexor XR] c. Paroxetine [Paxil] d. Escitalopram [Lexapro] e. Duloxetine [Cymbalta]  *Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.* 6. A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? a. Clonazepam [Klonopin] b. Alprazolam [Xanax] c. Propranolol [Inderal] d. Sertraline [Zoloft] *Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, palpitations). Doses are relatively small (eg, only 10 to 80 mg for propranolol).* 7. The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? a. Diarrhea b. Risk for abuse c. Dizziness d. Weight gain *Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.* 8. The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? Select all that apply. a. Depression b. Panic disorder c. Social anxiety disorder d. Post-traumatic stress disorder e. Obsessive-compulsive disorder