Test Bank For Foundations of Mental Health Care 6th Edition by Morrison-Valfre

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Chapter 01: The History of Mental Health Care

Morrison-Valfre: Foundations of Mental Health Care, 6th Edition
MULTIPLE CHOICE
1. The belief of the ancient Greek philosopher Plato that the rational soul controlled the
irrational soul could be compared with the belief of the more recent psychological theorist:
a. Freud
b. Pinel
c. Fisher
d. Rush
ANS: A
Sigmund Freud believed that mental illness was, in part, caused by forces both within and
outside the personality. Philippe Pinel advocated acceptance of mentally ill individuals as
human beings in need of medical assistance. Alice Fisher was a Florence Nightingale nurse
who cared for the mentally ill, and Dr. Benjamin Rush was the author of the book Diseases of
the Mind.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 4
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OBJ: 2 TOP: Early Years of Mental Health
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KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
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2. During the mid-1500s, behaviors associated with mental illness were more accurately
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recorded by professionals. This practice led to ______________ for different abnormal
behaviors.
a. Classifications NURSINGTB.COM
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b. Diagnosing
c. Treatment
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d. Education
ANS: A
Classification of abnormal behaviors did not begin until this time, after the practice of more
accurate recording of behaviors was begun. Diagnoses, treatment guidelines, and any
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education regarding mental health disorders were not available during this period.
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PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 5

OBJ: 3 TOP: Mental Illness During the Renaissance
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3. During the latter part of the eighteenth century, psychiatry became a separate branch of
medicine, and inhumane treatment was greatly diminished by the French hospital director:
a. Dix
b. Beers
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c. Pinel
d. Carter
ANS: C
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Philippe Pinel advocated acceptance of the mentally ill, as well as proper treatment. Dorothea
Dix crusaded for construction of mental health hospitals. Clifford Beers wrote the book A
Mind That Found Itself. President Jimmy Carter established the President’s Commission on
Mental Health in 1978.

OBJ: 4 TOP: Mental Illness in the Eighteenth Century
4. In 1841, _______________ surveyed asylums, jails, and almshouses throughout the United
States, Canada, and Scotland and is credited with bringing about public awareness and reform
for the care of the mentally ill.
a. Sigmund Freud
b. John Cade
c. Florence Nightingale
d. Dorothea Dix
ANS: D
Dorothea Dix spent 20 years surveying facilities that housed mentally ill individuals and is
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credited with major changes in the care of the mentally ill. Sigmund Freud introduced the
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concept of psychoanalysis, John Cade discovered lithium carbonate for the treatment of
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bipolar disorder, and Florence Nightingale trained nurses in England in the 1800s.
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OBJ: 4
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TOP: Mental Illness in the Nineteenth Century
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5. As a direct result of Clifford N

Beers’
URSI work
NGT and
B.Cbook,
OMA Mind That Found Itself, the Committee
for Mental Hygiene was formed in 1909 with a focus on prevention of mental illness and:
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a. Early detection of symptoms of mental illness

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b. Education of caregivers
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c. Current treatment options

d. Removing the stigma attached to mental illness
ANS: D
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Clifford Beers’ book reflected on his attempt at suicide followed by the deplorable care he
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received for the next 3 years in mental hospitals. Beers’ work and book raised the
consciousness of people throughout the country regarding prevention and removal of the
stigma of having a mental illness. Early detection of symptoms, education of caregivers, and
current treatment options regarding mental illness were not the focus of his book, nor were
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they a priority for the Committee for Mental Hygiene.

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OBJ: 4 TOP: Mental Illness in the Twentieth Century
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6. During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma
that could last as long as 50 hours?
a. Electroconvulsive therapy
b. Insulin therapy
c. Humoral therapy

d. Amphetamine therapy
ANS: B
Insulin therapy was believed to successfully treat schizophrenia in the early 1900s.
Amphetamines were used to treat depression, and electroconvulsive therapy was used for
severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a
belief that mental illness resulted from an imbalance of the humors of air, fire, water, and
earth.

OBJ: 5 TOP: Influences of War on Mental Health Therapies
7. In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often
used to treat?
a. Schizophrenia
b. Bipolar disorder
c. Severe depression
d. Violent behavior
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ANS: C
ECT was found to be an effective treatment for severe depression in the 1930s. During this
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period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a
lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder.
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PTS: 1 rs e
DIF: Cognitive Level: Knowledge REF: p. 6
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KEY: Nursing Process Step: Assessment
N R I GMSC: B.C Client
M Needs: Psychosocial Integrity
U S N T O
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8. In the early twentieth century, a frontal lobotomy was a common treatment for violent
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behaviors. Which description of this procedure is accurate?

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a. A procedure that delivers an electrical stimulus to the frontal lobes of the brain
b. A surgical procedure that drills holes in the front of the skull to drain fluid
c. A surgical procedure that severs the frontal lobes of the brain from the thalamus
d. A surgical procedure that inserts implants into the frontal lobes of the brain
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ANS: C
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A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed
from the thalamus.
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9. Which class of drugs was introduced in the 1930s for the treatment of depression?
a. SSRIs
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b. Tricyclic antidepressants
c. MAOIs
d. Amphetamines
ANS: D

In the 1930s, amphetamines were found to boost the spirits of depressed people. SSRIs,
tricyclic antidepressants, and MAOIs are antidepressant agents, but they were not discovered
until much later.

10. In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of
mental health because it funded:
a. Research on drugs for the treatment of mental health disorders
b. Training of mental health professionals
c. Construction of psychiatric units in facilities throughout North America
d. Development of community mental health clinics
ANS: C
The Hill-Burton Act provided money for the construction of psychiatric units in the United
States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health
professionals was funded by the National Mental Health Act of 1946, and community mental
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health centers were not instituted until the 1960s.
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OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies
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11. The National Mental Health Act of 1946 provided a means for funding of programs that
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promote research on mental health and:
NURSclinics
a. Development of mental health INGT inB.C OM
the community
b. Training of mental health professionals
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c. Treatment for veterans suffering from mental health disorders

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d. Educating the public about mental illness

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ANS: B
The National Mental Health Act of 1946 provided much needed training for individuals who
cared for patients with mental health disorders. Community mental health clinics were
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initiated in the 1960s, treatment for veterans was not funded by this act, and education of the
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public occurred later.

OBJ: 5 | 9 TOP: Influences of War on Mental Health Therapies
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12. Which of the following best describes the disorder that was first recognized in veterans
following the Korean and Vietnam Wars?
a. Depression
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b. Bipolar disorder
c. Post-traumatic stress disorder
d. Paranoid schizophrenic disorder
ANS: C

Posttraumatic stress disorder was initially discovered in veterans who had been involved in
armed conflicts. The other disorders also occur in veterans but were not first recognized in
soldiers who were fighting wars.

13. The introduction of ___________ in the 1950s led to the deinstitutionalization of many
mentally ill individuals.
a. Psychotherapeutic drugs
b. Community mental health clinics
c. Residential treatment centers
d. State mental health facilities
ANS: A
Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone
during the 1950s. Patients were being released from state mental health facilities as a result of
psychotherapeutic drug therapy. Community mental health clinics and residential treatment
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centers resulted from the deinstitutionalization of patients.
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OBJ: 6 TOP: Introduction of Psychotherapeutic Drugs
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14. In 1949, an Australian physician discovered which therapy to be an effective treatment for
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bipolar (manic-depressive) illness?
a. Insulin therapy NURSINGTB.COM
b. Water/ice therapy
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c. Lithium carbonate therapy

aC s
d. Electroconvulsive therapy
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ANS: C
To this day, lithium is a treatment that is used to effectively balance the manic states and
depressive states of bipolar disorder. None of the other therapies listed are effective for
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bipolar disorder.
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15. In the early 1960s, a committee appointed by President John F. Kennedy recommended the
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development of a new approach to the way mental health care was administered, with an
emphasis on the introduction of:
a. Psychotherapeutic drugs
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b. State mental health care systems

c. Community mental health centers
d. Deinstitutionalization of patients
ANS: C

The emergence of community mental health centers was necessary, in part because of the
massive deinstitutionalization of patients from state mental health care facilities after the
introduction of psychotherapeutic drugs in the 1950s.

16. The Mental Health Systems Act of 1980 was one of the most progressive mental health bills
in the history of the United States, but its enactment was interrupted by the:
a. Election of a new president
b. Appointment of a new Surgeon General
c. Rapid expansion of community centers
d. National Alliance on Mental Illness (NAMI) surveys
ANS: A
The election of a new president and his administration led to drastic cuts in federal funding for
mental health programs. None of the other three choices were a part of the Mental Health
Systems Act of 1980.
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OBJ: 9 TOP: Congressional Actions
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17. The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with
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chronic mental illness in:
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a. Nursing homes
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b. State mental health facilities
c. Residential treatment centers
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d. Homeless shelters
aC s
vi y re
ANS: A
Many mentally ill, especially elderly, people were inappropriately placed in nursing homes
with personnel who were not trained to care for these people. OBRA prevented this practice.
State mental health facilities, residential treatment centers, and homeless shelters were not
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addressed in the OBRA of 1987.

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18. In the late 1980s, government funding for mental health care dwindled, and most insurance
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companies __________ coverage for psychiatric care.

a. Withdrew
b. Increased
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c. Decreased
d. Added
ANS: A
Unfortunately, insurance companies followed the trend of the national government to the
point of actually dropping coverage for psychiatric care.


19. In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey
and grading of state mental health care for adults and learned that the overall grade for care
was:
a. “A”
b. “B”
c. “C”
d. “D”
ANS: D
The NAMI gave a grade of “D” to the mental health care system based on poor funding,
limited availability of care, and patients’ lack of access to mental health care.

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20. Which of the following persons has the greatest risk for developing ineffective coping
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behaviors?
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a. The middle-aged man whose diet is high in saturated fat and who has a 20-year
history of tobacco use
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b. The single 30-year-old female facing the death of her father
c. The 19-year-old college student with a family history of schizophrenia
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d. The 9-year-old whose parents are nurturing but provide chores and responsibilities
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ANS: C
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Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and
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life circumstances. The risk for developing ineffective coping behaviors increases when
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problems exist in any one of these areas.

OBJ: 2 TOP: Introduction KEY: Nursing Process Step: Assessment
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MSC: Client Needs: Psychosocial Integrity

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21. In the early 1900s the first theory of mental illness that showed behavior could be changed is
attributed to:
a. Beers
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b. Dix
c. Freud
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d. Pinel
ANS: C
Freud was the first person who succeeded in explaining human behavior in psychological
sh
terms and in demonstrating that behavior can be changed under the proper circumstances.

OBJ: 5 TOP: Psychoanalysis

MULTIPLE RESPONSE
1. The humoral theory of disease embraced by Hippocrates required a balance of which

elements? (Select all that apply.)
a. Fire
b. Water
c. Light
d. Air
e. Earth
ANS: A, B, D, E
Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental
elements of air, fire, water, and earth. Each basic element had a related humor or part in the
body.

OBJ: 2 TOP: Greece and Rome
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2. Which aspects of adult mental health care systems did the National Alliance on Mental Illness
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survey focus on? (Select all that apply.)
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a. Availability of care
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b. Access to care
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c. Regulation of medications
d. Increased funding
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ANS: A, B, D
In 2006, the National Alliance
NUonRMental Illness
B.C(NAMI) conducted the “first comprehensive
survey and grading of state adult SINGhealth
mental T OMsystems
care conducted in more than 15 years”
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(NAMI, 2006). Their results revealed a fragmented system with an overall grade of D.
aC s
Recommendations focused on increased funding, availability of care, access to care, and

vi y re
greater involvement of consumers and their families.

OBJ: 9 TOP: Twenty-first century
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3. Mental health is said to be influenced by which of the following factors? (Select all that
apply.)
a. Diet and nutritional intake
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b. Inherited characteristics
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c. Activities of daily living

d. Childhood nurturing
e. Life circumstances
sh
ANS: B, D, E
Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and
life circumstances. The risk for developing ineffective coping behaviors increases when
problems exist in any one of these areas.


COMPLETION
1. During the middle ages, mentally ill patients often were burned at the stake and were greatly
mistreated. In an attempt to treat mentally ill people more humanely, Bethlehem Hospital,
more commonly called ___________, was created.
ANS:
Bedlam
Bedlam was the nickname for Bethlehem Hospital, which prevented burning of mentally ill
people at the stake but provided poor care for the mentally ill.

OBJ: 3 TOP: Mental Illness in the Middle Ages
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Chapter 02: Current Mental Health Care Systems

MULTIPLE CHOICE
1. Because mental health care is not covered in Australia under the basic health plan, which
citizens are more likely to receive mental health care?
a. Wealthy
b. Homeless
c. Disabled
d. Low-income
ANS: A
Wealthy citizens, as well as those with private insurance, are more likely to receive mental
health care in Australia because they are better able to afford the care than are homeless,
disabled, or low-income citizens on the basic health plan with no mental health care coverage.
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OBJ: 1 TOP: Mental Health Care in Australia
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2. Mental health care is available under the universal health care system in Britain, which is
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funded primarily by:
a. Employers
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b. Private donations
c. Small businesses
d. Tax revenues NURSINGTB.COM
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ANS: D
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Tax revenues are the primary funding source for Britain’s universal health care system. All
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aspects of health care, except for eye care and limited dental care, are covered under the
standard benefit package for citizens of Britain.

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OBJ: 1 TOP: Mental Health Care in Britain

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3. The __________ model views clients holistically with the goal of creating a support system
designed to encourage independence in the client with a mental health disorder.
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a. Community support systems

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b. Case management
c. Multidisciplinary health care team
d. Client population
sh
ANS: A

The community support systems (CSS) model works by coordinating social, medical, and
psychiatric services. Case management refers to individual management of clients and takes
into consideration psychosocial rehabilitation, consults, referrals, therapy, and crisis
intervention. A multidisciplinary health care team is made up of all of the professionals who
work within a mental health care system, and client population simply refers to individuals
who may potentially seek mental health care.

OBJ: 3 TOP: Outpatient Care
4. The home mental health nurse visits a female client to assess her ability to care for herself at
home after discharge from an inpatient setting. Which component of the case management
system does this demonstrate?
a. Consultation
b. Crisis intervention
c. Resource linkage
d. Psychosocial rehabilitation
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ANS: D
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Psychosocial rehabilitation assists clients in gaining independence in activities of daily living
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to the best of their individual capabilities. Consultation refers to assistance obtained from
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specialists, such as a psychiatrist; crisis intervention refers to care provided during a crisis
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event; and resource linkage indicates referral to community resources.
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OBJ: 5 TOP: Case Management Systems
NURSINGMSC:
KEY: Nursing Process Step: Intervention TB.C OM Needs: Health Promotion and Maintenance
Client
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5. A client with a severe, treatment-resistant mental illness has been assigned to an assertive
aC s
community treatment (ACT) team. An ACT treatment strategy that helps to prevent recurrent
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hospitalizations for mental health reasons is to meet with the client in the community setting:
a. Once per week
b. Two to four times per week
c. Five to six times per week
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d. Seven to eight times per week

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ANS: B
The continuous care team that meets with a client two to four times per week has been found
to be effective in directing the client’s treatment on a more continuous basis, resulting in
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greater stability for the client who is living in the community with the help of appropriate
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systems.

OBJ: 5 TOP: Case Management Systems
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KEY: Nursing Process Step: Intervention

MSC: Client Needs: Safe and Effective Care Environment
6. Which member of the multidisciplinary mental health care team is primarily responsible for
evaluating the family of the client, as well as the environmental and social surroundings of the
client, and plays a major role in the admission of new clients?

a. Psychiatric nurse
b. Clinical psychologist
c. Psychiatrist
d. Psychiatric social worker
ANS: D
These are the primary responsibilities of the psychiatric social worker. The psychiatric nurse’s
primary responsibilities include assisting with the client’s activities of daily living and
managing individual, family, and group psychotherapy. The clinical psychologist is involved
in the planning of treatment and diagnostic processes, and the psychiatrist is the leader of the
team.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 15-16

OBJ: 6 TOP: Multidisciplinary Mental Health Care Team
7. It is estimated that approximately _____million adults in the United States experience some
form of mental or emotional disorder.
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a. 35.5
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b. 61.5
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c. 28.2
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d. 59
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ANS: B
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Although exact statistics are unavailable, it is estimated that at any given time at least 61.5
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million adults in the United States suffer from mental-emotional disorders. “Approximately
18.1% of American adults—aboutNURS42IN GTB.C
million M
people—live with anxiety disorders” (National
Alliance on Mental Illness, 2014).
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aC s

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OBJ: 7 TOP: Impact of Mental Illness

8. A male client with a diagnosis of bipolar disorder is admitted to an inpatient unit during a
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severe manic episode. As a result of guidelines implemented by the Health Care Financing
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Administration in 1983, the client’s Medicare will pay for his stay in this unit for:
a. The length of time necessary for his condition to be stabilized
b. Up to 6 months with appropriate documentation
c. A pre-determined length of time based on the diagnosis
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d. 2 to 4 weeks
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ANS: C
Medicare payment guidelines are based on the diagnosis, which is classified under a
diagnosis-related group (DRG), and specify a pre-determined payment for a particular
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diagnosis. This cost containment strategy has also been adopted by some private insurance
companies. After the pre-determined time, the facility is responsible for additional costs
incurred by the client’s stay.

OBJ: 1 TOP: Economic Issues of Mental Illness

9. A female client was given the diagnosis of schizophrenia and recently has lost her job. She
tells the nurse that she has enough money for only two more house payments, and if she does
not find a job, she fears she will become homeless. The nurse knows that this client falls into
the group of nearly __________ of U.S. citizens who live below the poverty level.
a. 1%
b. 6%
c. 12%
d. 25%
ANS: C
Approximately 12% of Americans (or 33 million people) live below the poverty level. Living
in poverty often precipitates mental disorders, or mental disorders may occur while an
individual is living in poverty.

OBJ: 7 TOP: Social Issues of Mental Illness
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10. Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of
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psychotherapeutic drugs is associated with:
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a. Permanent psychotic states
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b. Bipolar disorder
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c. Generalized anxiety disorder
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d. Obsessive-compulsive disorder
ANS: A N R I G B.C M
Permanent psychotic states areUoccurring
S N in T mental
O health clients who combine their
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psychotherapeutic medications with the abuse of recreational drugs. The combination of these
aC s
two types of drugs is not commonly associated with bipolar disorder, generalized anxiety
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disorder, or obsessive-compulsive disorder.

OBJ: 7 TOP: Social Issues of Mental Illness
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11. A female client who is undergoing therapy for depression is divorced and has two children,
ages 2 and 4. She has just enrolled in a local community college and is worried about
providing food and clothes for her family while holding down a minimum wage job and
is
devoting the time needed to be successful in school. The nurse determines that the best
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community resource for assisting this client to meet these needs is:
a. A shelter for victims of domestic violence
b. Women, Infants, and Children (WIC)
c. A family-planning agency
sh
d. A family recreation center

ANS: B

WIC gives assistance to low-income women and children up to the age of 5 who are at
nutritional risk by providing foods to supplement the diet and information on healthy eating
habits. The other options do not address her situation because she has not voiced needs related
to domestic violence or family planning, and a family recreation center will not meet her
financial needs.
PTS: 1 DIF: Cognitive Level: Application REF: p. 13

OBJ: 4 TOP: Delivery of Community Mental Health Services
12. The home care nurse is providing care to an older adult client with a diagnosis of depression
who is caring for his wife with Alzheimer’s disease. He states that he hardly has enough
energy to cook and clean the house. The couple has no children, and no relatives live within a
close distance. Which community agency would be of greatest benefit to this client?
a. A recreational club
b. An adult education program
c. A day care center for the elderly
d. Meals on Wheels
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ANS: D
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By providing food, Meals on Wheels would remove one responsibility for this client. A
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recreational club or an adult education program is appropriate, but the priority need for this
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couple is food. A day care center for the elderly may be necessary in the future, but it is not a
priority at this time.
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OBJ: 4 NURSofIN
TOP: Delivery GTB.COMental
Community M Health Services
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aC s
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13. A 9-year-old girl is given the diagnosis of depression. She has low self-esteem, does not enjoy
group therapy, and does not show her emotions. The nurse has had difficulty establishing
rapport with this client and decides to ask for assistance from another treatment team member.
Which team member would best assist in this situation?
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a. Psychiatric assistant
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b. Dietitian
c. Occupational therapist
d. Expressive therapist
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ANS: D
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Expressive therapists work well with children who have difficulty expressing their thoughts
and feelings. Expressive therapists use creative methods that appeal to children. The dietitian
would not be the best team member to meet the needs of the client at this time. The
psychiatric assistant, or technician, assists the nurse with daily activities and in monitoring
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clients during leisure activities. The occupational therapist works primarily with
rehabilitational therapy, such as socialization and vocational retraining.


14. Nearly __________ of all countries in the world have no clear governmental policy that
addresses mental health issues.
a. 7%
b. 26%
c. 50%
d. 75%
ANS: C
In addition to nearly half of the countries in the world that have no policy on mental health
issues, approximately one third have no program for coping with the increasing numbers of
mental health disabilities.

OBJ: 1 TOP: Current Mental Health Care Systems
15. A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose. The
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primary rationale for her admission is to:
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a. Have limited supervision by health care personnel
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b. Maintain responsibility for her own behavior
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c. Receive treatment in the least restrictive manner
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d. Provide her with a safe and secure environment
ANS: D rs e
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The most important advantage of inpatient psychiatric care is that it provides clients with a
safe and secure environment N
where
brought them there. URSthey
INGcan focus on
TB.C OM and work with the problems that
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OBJ: 2 TOP: Inpatient Care

KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity
16. A client suffering from chronic mental illness often forgets to take her medication and needs
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to be reminded to take care of daily hygiene. She does not have family or other support
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persons living in the area. The care delivery most beneficial for this client is:
a. Emergency departments
b. Residential program
c. Community mental health center
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d. Psychiatric home care

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ANS: B
Residential programs offer the protected, supervised environment this client needs to be
compliant. Emergency care has stabilization and crisis as its focus, psychiatric home care
sh
works with clients and families in transition, and community mental health centers deal with
crisis, counseling, and education.

OBJ: 4 TOP: Community Mental Health Care Delivery

17. A 35-year-old client with a long history of schizophrenia who often forgets to take his
medication is admitted to an inpatient unit after police find him threatening passengers on a
bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example
of:
a. Recidivism
b. Symptom exacerbation
c. Noncompliance
d. Rejection
ANS: A
Unable to cope in the community setting, people with chronic psychiatric problems often
return to institutions or use community services on a revolving-door basis. This behavior
pattern is known as recidivism and means a relapse (return) of a symptom, disease, or
behavior

OBJ: 4 TOP: Outpatient Care
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18. When arranging community resource linkages for a client and her children who are victims of
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domestic violence, which resource is the most immediately appropriate?
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a. Adult education program
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b. Family recreation center
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c. Mediation group
d. Women’s shelter
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ANS: D
A women’s domestic abuse shelter
NURSisIthe
NGmost
TB.C OM
appropriate resource for the immediate safety
needs of the family. While education programs, family recreation centers, and mediation
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groups also provide benefit to the family, they do not address the initial safety of the woman
aC s
and her children.

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OBJ: 4 TOP: Case Management: Resource Linkages
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MULTIPLE RESPONSE
1. Which principles characterize mental health care in Canada? (Select all that apply.)
is
a. Portability
b. Universality
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c. Accessibility
d. Comprehensiveness
e. Private insurance models
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f. Public administration
ANS: A, B, C, D, F

Portability refers to retaining services in the event of moving; universality means that
everyone in the nation of Canada is covered; accessibility indicates that everyone has access
to health care; comprehensiveness means that all necessary treatment is covered; and public
administration reveals that the health care system is publicly run and accountable. Private
insurance models are the types of insurance provided in the United States.

OBJ: 1 TOP: Mental Health Care in Canada
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
2. In the United States, which factors determine whether a client requires inpatient rather than
outpatient care? (Select all that apply.)
a. Severity of the illness
b. Level of dysfunction
c. Suitability of the setting for treating the problem
d. Anticipated diagnosis
e. Level of client cooperation
f. Ability to pay
m
ANS: A, B, C, E, F
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These options are the determining factors for inpatient mental health care. If a client meets the
co
criteria, the diagnosis does not matter in the determination of whether the client requires
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inpatient or outpatient care.
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PTS: 1
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DIF: Cognitive Level: Comprehension REF: pp. 11-12
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OBJ: 2 TOP: Care Settings
MSC: NURSICare
Client Needs: Safe and Effective NGTEnvironment
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3. Which client populations are at greater risk for the development of mental health disorders?
aC s
(Select all that apply.)

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a. Homeless
b. Clients infected with HIV or AIDS
c. Those in crisis
d. Nurses
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e. Clients living in rural areas

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f. Older adults
g. Psychiatrists
h. Children
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ANS: A, B, C, E, F, H
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These individuals are considered to be at high risk for various reasons. Nurses and
psychiatrists are not considered at high risk for developing mental health disorders.

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OBJ: 7 TOP: Client Populations

4. The case management for a client requiring community mental health services would include
which of the following? (Select all that apply.)
a. Advocacy

b. Crisis intervention
c. Provision of referrals to a shelter
d. Administration of psychotropic medications
e. Developing a client’s plan of care
ANS: A, B, C
Case management is a system of interventions designed to support mentally ill clients living
in the community. The major components of case management are psychosocial
rehabilitation, consultation, resource linkage (referral), advocacy, therapy, and crisis
intervention. Administration of medications is performed by an individual, not a system, and
clients are involved in planning their care.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 14-15

OBJ: 5 TOP: Case Management
COMPLETION
1. The __________ therapist of the mental health team uses methods such as pet therapy and
m
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music therapy when working with clients and is responsible for providing leisure-time
activities and for teaching inpatient clients useful ways to pass time.
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ANS:
o.
Recreational
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These are the primary responsibilities of the recreational therapist, who has an advanced
degree and specialized training
N inRrecreational
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Chapter 03: Ethical and Legal Issues

MULTIPLE CHOICE
1. A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get
drunk. The client’s friends see nothing wrong with their drinking habits. The client states that
he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has
never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of
transmission best describes how this client’s particular value was formed?
a. Moralizing
b. Modeling
c. Reward-punishment
d. Laissez-faire
ANS: B
Modeling best describes how the teenage client developed this value because his parents not
only discussed this issue but behaved in a way for the teen to copy. Moralizing sets standards
of right and wrong with no choices allowed; the reward-punishment model rewards valued
behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction
or direction on choices.

OBJ: 1 TOP: Acquiring Values
2. A female client becomes combative when the nurse attempts to administer routine
medications. The nurse would like to ignore the client but chooses to talk with the client to
calm her. The nurse is successful in calming the client, and the client takes her medications.
What process best describes how the nurse decided on the course of action taken?
a. Values clarification
b. Nurse’s rights
c. Beliefs
d. Morals
ANS: A
Values clarification consists of the steps of choosing, prizing, and acting. This most accurately
describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed
the choice, and then enacted the choice. The nurse’s rights were not violated, and beliefs and
morals do not describe the entire decision-making process that occurred.

OBJ: 1 TOP: Values Clarification
3. Twenty-three states have enacted mental health parity laws. The most accurate description of
these laws is that they require insurance companies to:
a. Include coverage for mental illness
b. Include coverage for substance abuse treatment

c. Include coverage for mental illness that is equal to coverage for physical illness
d. Include coverage for outpatient therapy for individuals with substance abuse
ANS: C
The mental health parity laws require insurance companies to include coverage for mental
illness that is equal to coverage for physical illness. Only nine states include treatment for
substance abuse in their parity laws.

OBJ: 2 TOP: Client Rights
4. The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be
ordered. The nurse informs the client that the medication can be administered only every 4
hours and was given 3 hours ago. The nurse promises to give the client the medication as soon
as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication.
Which ethical principle did the nurse violate?
a. Fidelity
b. Veracity
c. Confidentiality
d. Justice
ANS: A
Fidelity refers to the obligation to keep one’s word. The nurse violated this principle in this
situation, which leads to mistrust from the client. Veracity is the duty to tell the truth,
confidentiality is the duty of keeping the client’s information private, and justice indicates that
all clients must be treated fairly, equally, and respectfully.

OBJ: 3 TOP: Ethical Principles
5. A male client is seeking help in a mental health clinic for anger management problems. He
voices that he is fearful that his wife may divorce him because of his anger problem, and he is
willing to do “whatever it takes” to control his anger. Later in the week, the client’s wife also
seeks assistance because she is going to divorce her husband. The nurse who is caring for both
of these clients tries to decide the correct action to take. The nurse is experiencing:
a. A moral dilemma
b. Value clarification
c. An ethical conflict (or dilemma)
d. A breach of confidentiality
ANS: C
This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both
clients but must maintain confidentiality for each. Use of guidelines for ethical decision
making can assist the nurse in making an ethical decision. A moral dilemma is simply a
dilemma associated with making a decision between right and wrong. Value clarification is a
process that helps to identify an individual’s values.

OBJ: 3 TOP: Ethical Conflict

6. The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the
nurse is unsure whether this is something within the scope of practice. Where can the nurse
find the answer to her question?
a. National nurse practice act
b. State nurse practice act
c. Regional nurse practice act
d. Community nurse practice act
ANS: B
Each state’s board of nursing determines the scope of practice in that state through a series of
regulations that are called nurse practice acts. It is the nurse’s responsibility to know his or her
scope of practice. The other options do not exist.

OBJ: 4 TOP: Legal Concepts in Health Care
7. An order written by a physician is reviewed by the nursing staff, and no one is familiar with
the treatment instructions. A nurse who was recently hired knows that this treatment is
covered by the state’s nurse practice act. What is the nurse’s best course of action?
a. Call the physician to ask for clarification
b. Check the state’s nurse practice act again
c. Contact the nursing supervisor for approval to carry out the treatment
d. Refer to the facility’s policy and procedure to determine the course of action
ANS: D
Because this treatment is covered under the state’s nurse practice act, the next step is to refer
to the facility’s policy and procedure manual to determine whether the ordered treatment is
allowed by the facility. Calling the physician is not necessary because there was no question
about how the order was written, and the state’s nurse practice act has already been checked.
Contacting the nursing supervisor would be acceptable only after the facility’s policy has been
checked.

8. Standards of nursing practice for mental health can best be described as helping to ensure:
a. That certain clients receive care
b. Quality and effectiveness of care
c. Proper documentation
d. Proper medication administration
ANS: B

Most health care disciplines have standards of practice documented as guidelines with
measurable criteria that can be used to evaluate the quality and effectiveness of care provided.
All clients have the right to receive care, so standards of nursing practice would not address
who receives care. Although proper documentation and proper medication administration
might be part of the evaluation process, they do not provide complete evaluation of quality
and effectiveness of care.

KEY: Nursing Process Step: Evaluation
9. If a client is involuntarily committed to a mental health care facility indefinitely, the law
requires that the case must be reviewed every:
a. 3 months
b. 6 months
c. 12 months
d. 15 months
ANS: C
Although the case is being reviewed constantly by the mental health care team, the court must
review the indefinite commitment on a yearly basis.

OBJ: 5 TOP: Adult Psychiatric Admissions
10. A male client is being argumentative during a group therapy session. The psychiatric
technician warns the client that if he does not cooperate with the nurse, he will be physically
restrained and taken to his room for the remainder of the day. For which action could the
technician be held liable?
a. Assault
b. Battery
c. Privacy
d. Fraud
ANS: A
The technician is engaging in assault, which is any act that threatens a client. Battery of a
client occurs when any physical act of touching occurs without the client’s permission.
Privacy refers to issues related to the body and confidentiality, and fraud is giving false
information.

OBJ: 6 TOP: Areas of Potential Liability
11. Which of the following circumstances, when it occurs on an inpatient mental health unit,
would be considered false imprisonment?
a. An alert and oriented client is confined to his room after being loud and
argumentative with another client in the recreation area.

b. Restraints are placed on a client who has been admitted in a lethargic state because
of misuse of medications and who has fallen three times since admission.
c. A client is housed in a private room with visual monitors after attempting suicide
at home on the previous day.
d. An alert and oriented client who was admitted for a 72-hour involuntary
commitment is prevented from leaving the facility 2 days after admission.
ANS: A
The client cannot be confined to his room if he did not pose a threat to himself or others, or if
no contract was made with the client regarding consequences for inappropriate behavior. All
of the other options are appropriate because they follow guidelines for client safety.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 27

12. The nurse often assists in the process of obtaining informed consent from the client for
treatment and/or procedures. Who has the responsibility of providing information to the client
so he can give informed consent?
a. Social worker
b. Nurse
c. Physician
d. Facility’s legal representative
ANS: C
The physician is responsible for providing the client with the information necessary to give
informed consent, including expectations and risks involved. The nurse can assist by obtaining
the written documentation necessary for informed consent.

OBJ: 8 TOP: Care Providers’ Responsibilities
13. An important responsibility of the nurse in a mental health facility is to ensure that clients do
not __________ from the facility without a discharge order, by carefully supervising and
accurately documenting client behaviors and therapeutic actions.
a. Escape
b. Abandon
c. Flee
d. Elope
ANS: D
The appropriate terminology used when a client runs away from a facility without a discharge
order is elopement. In the event of elopement, the caregiver can be held liable if a client
becomes injured.


14. If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-
husband, what is the nurse’s best action?
a. Try to talk with the client to convince her not to harm the girlfriend
b. Have the client sign a contract with you stating that she will not harm the girlfriend
c. Inform the ex-husband of the intentions of the client
d. Inform the girlfriend of the intentions of the client
ANS: D
Health care providers have a duty to warn others when serious harm may occur as the result of
actions taken by the client. This does not breach confidentiality because providers have an
obligation to protect the public as well as the client. In addition to warning the client, the
nurse should inform the client’s physician and the nursing supervisor and must document the
situation and actions taken. The other options are not adequate to meet the duty to warn or to
prevent harm to the girlfriend.

15. A female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic
medication for schizophrenia, has any side effects. Which response by the nurse would violate
the ethical concept of veracity?
a. “I am not sure, but I will find out.”
b. “Risperdal has no documented side effects.”
c. “Risperdal does have some side effects.”
d. “Let’s talk to your physician about potential side effects.”
ANS: B
The ethical concept of veracity refers to the duty of being truthful with the client, within the
scope of one’s practice. Stating that the drug has no side effects is not a truthful statement
because the medication does have side effects.

OBJ: 3 TOP: Ethical Principles
16. The charge nurse on a busy inpatient psychiatric unit is concerned because a nurse and
nursing assistant have called out for the shift. Upon calling the nursing office, the charge nurse
is informed that there is no one to replace them. In addition, the emergency call button at the
nurse’s station is malfunctioning. This charge nurse sees this as a violation of
a. Legal rights
b. The patient’s bill of rights
c. Care provider rights
d. Ethical principles
ANS: C

Care provider rights provide for respect, safety, and competent assistance. The patient’s bill of
rights deals with provision for client rights. Legal rights are not impacted, and although
ethical principles serve as behavior guidelines, it is not the most appropriate response in this
case.

OBJ: 1 TOP: Care Provider Rights
17. The nurse encounters a client crying in her room. Upon talking to the client it is discovered
that she is upset because a new nursing assistant made her go out for a walk with the group
even though the client informed her that she waits for her daughter to go for her walk. This is
a potential violation of which ethical principle?
a. Beneficence
b. Autonomy
c. Confidentiality
d. Nonmaleficence
ANS: B
Autonomy refers to the right of people to act for themselves and make personal choices. The
principle of beneficence refers to actively doing good, and maleficence refers to doing no
harm. Confidentiality is not violated in this situation.

OBJ: 1 TOP: Ethics: Ethical Principles
18. A client preparing for discharge from an inpatient unit asks a nurse which psychiatrist she
would recommend to use for follow-up as an outpatient. The nurse responds, “There are
several good physicians on your list. Make sure you do not use Dr. Smith. I have heard some
terrible things about his methods of treatment.” This is an example of which type of potential
liability?
a. Slander
b. Invasion of privacy
c. Assault
d. Libel
ANS: A
Slander is verbal defamation, which is false communication, and can result in harm to the
psychiatrist’s practice. Libel is written defamation, and assault is threat of bodily harm.
Invasion of privacy pertains to confidential information and is not pertinent in this case.


19. A client frequently wanders around the unit, and the staff frequently needs to reorient the
client to the environment and remind her not to walk into the rooms of other clients on the
unit. Due to short staffing, the decision is made to use a restraint device to prevent this from
occurring. This action may constitute:
a. Assault
b. Defamation
c. False imprisonment
d. Negligence
ANS: C
The application of protective devices and restraints may constitute false imprisonment.
Restraints must be used only to protect the client, not for staff convenience. All less restrictive
measures should first be attempted and documented.

MULTIPLE RESPONSE
1. If a person is perceived to be a threat to himself or others, who can implement an involuntary

commitment to a mental health facility? (Select all that apply.)
a. Family members
b. Police
c. Physicians
d. Social workers
e. Representatives of a county administrator
ANS: B, C, E
Police, physicians, and representatives of a county administrator are the only individuals who
can implement an involuntary admission to a mental health facility. An involuntary admission
can last from days to years, depending on the need. A court order is necessary for extended
involuntary admissions.

OBJ: 5 TOP: Adult Psychiatric Admissions
2. For a nurse or health care provider to be found negligent, what requirements must the
provider’s misconduct meet? (Select all that apply.)
a. The provider owed a duty to the client.
b. The provider breached a duty to the client.
c. The provider had intent to harm the client.
d. The provider caused injury to the client by action or inaction.
e. The provider caused loss or damage through his or her actions.
ANS: A, B, D, E

These four criteria must be present for an act of a health care provider to be considered
negligent. Intent to harm would be considered a criminal action rather than an action of
negligence.

3. The use of protective devices may be considered false imprisonment. In order to assure the
rights of the client are not violated, which practices must be implemented when using a
device? (Select all that apply.)
a. A written medical order must be on the medical record
b. Client must be confined to bed.
c. Restraints must be removed and limb exercised every 2 hours.
d. Restraints must be implemented in the event of short staffing as a preventive
measure.
e. Client must be assessed and monitored every 15 minutes.
ANS: A, C, E
Restraints must be used only to protect the client, not for staff convenience. All less restrictive
measures should first be attempted and documented. A written medical order for restraints
must be on file in the client’s chart. Once restraints have been applied, the caregivers have an
increased obligation to observe, assess, and monitor the client every 15 minutes. The restraints
must be removed, one limb at a time, and the limb exercised every 2 hours. All observations
and actions must be documented. Restraints are removed as soon as the client’s behavior is
under control.

COMPLETION
1. The term __________ describes an individual’s attitudes, beliefs, and values and helps a
person distinguish between what is considered right and wrong behavior.
ANS:
Morals
Morals are developed through learned behavior, teachings of others, and experience.

OBJ: 1 TOP: Values and Morals
2. The nurse documents on the medication administration record that a medication has been
given as ordered on a daily basis, but the medication actually has been out of stock for a week.
This nurse is guilty of __________.

ANS:
Fraud
This nurse is committing fraud by giving false information. Not only is this illegal, but it
could bring harm to the client in several ways.

3. __________ is either omitting or committing a duty that a reasonable and prudent person
would or would not do that brings harm to an individual in a health care environment.
ANS:
Negligence
Malpractice
Negligence on the part of a professional is called malpractice.


Chapter 04: Sociocultural Issues

MULTIPLE CHOICE
1. An older Asian female with a diagnosis of depression is cared for by her granddaughter. Her
granddaughter is very attentive to the client’s needs, attends every therapy session, and is
active in the planning and implementing of the treatment plan. The granddaughter’s valuing of
her grandmother is most likely due to her:
a. Ethnicity
b. Cultural beliefs
c. Religion
d. Stereotype
ANS: B
Cultural beliefs develop over many generations and are a learned set of values, beliefs, and
behaviors. Asian cultures commonly value their elderly family members. Ethnicity and
religion do not explain the granddaughter’s behavior in that ethnicity describes customs and
m
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socialization patterns, and religion refers to an organized form of worship. Stereotyping is a
preconceived belief about another cultural group, so it does not apply to this situation.
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OBJ: 1 TOP: Characteristics of Culture
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2. A traditional Arab female client is brought to the emergency department by her husband. She
NURSand
complains of feeling very anxious INshort
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of breath
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be a hindrance to the care of this client?

a. The emergency department physician is female.
aC s
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b. Her husband asks if he can stay with his wife.

c. One of the emergency department nurses is of Arab descent.
d. The only caregivers available in the emergency department are male.
ANS: D
ed d
In some traditional Arab cultures, a woman will not make eye contact with any man except
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her husband and may not be touched by another man. Having only male staff in the
emergency department on this shift would block necessary care. Arrangements would have to
be made to have a female staff member come to the emergency department to assist in client
is
care. The other options should not cause a problem.

Th

KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
sh
3. Disease is defined as:

a. Social dysfunction
b. Emotional dysfunction
c. Physical dysfunction
d. Intellectual dysfunction

ANS: C
Disease differs from illness in that disease is an abnormal physical function, whereas illness
refers to social, emotional, and intellectual dysfunction. Illness is affected by culture, but
disease is not.

OBJ: 4 TOP: Health and Illness Beliefs
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity
4. The nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks English, but
she is accompanied by her mother, who does not. The client has a history of mental illness,
and through the interpreter, the nurse learns that the mother, who has traditional Puerto Rican
cultural beliefs, believes that the client’s mental illness is caused by:
a. Witchcraft
b. Stress
c. Chemical imbalances
d. A trance
ANS: A
m
It is a common traditional Puerto Rican cultural belief that mental illness is caused by
er as
witchcraft, magic, or evil spells, as opposed to more traditional Western medicine, which
co
believes that stress and chemical imbalances play a role in mental illness. A trance is
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considered a state of consciousness in some cultures.
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PTS: 1
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DIF: Cognitive Level: Comprehension REF: p. 33
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NURSINGTB.COM
5. A client is continually late for his appointment at the mental health clinic. What is a likely
o
reason for his lack of punctuality?

aC s
a. Need for environmental control

vi y re
b. Time orientation
c. Space comfort zone
d. Territorial needs
ed d
ANS: B
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Mental dysfunction can lead to incorrect perception of time, causing the client to be
continually late. In addition, some cultures do not see schedules and specific appointment
times as important, causing the client to be continually late in the eyes of the caregiver.
Environmental control refers to an individual’s need to control his or her perception of the
is
environment. Comfort zones are highly culture based, meaning that individual interpretation
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of personal space varies among cultures. Territorial needs provide a sense of identity and
security for some clients.

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OBJ: 5 TOP: Space, Territory, and Time in Cultural Assessment

6. Which client communication problem can the nurse most easily correct?
a. Age differences
b. Altered cognition

c. Cultural differences
d. Gender differences
ANS: C
The nurse can easily correct communication problems caused by cultural differences in a
number of ways, including learning what cultural beliefs and practices are important to the
client and being accepting of those beliefs. Communication problems due to age and gender
differences and altered cognition cannot be corrected by the nurse.

OBJ: 5 TOP: Communication in Cultural Assessment
7. What is the social orientation among most middle-class American families?

a. Extended
b. Friends
c. Significant others
d. Nuclear
ANS: D
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The nuclear family is the social orientation of family that is seen most frequently in this
group. The extended family is seen as the social orientation for cultures such as some
co
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Alaskan, traditional Chinese, and Mexican cultures. Friends and significant others are not
identified as a social orientation of family.
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PTS: 1 rs e
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OBJ: 5 TOP: Social Organization in Cultural Assessment
U S N T O
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8. It is important for the nurse to be familiar with the religious practices of clients cared for most
aC s
often in a particular region because attitudes toward health and illness, death and burial, food,
vi y re
and procreation have a strong impact on a client’s beliefs and practices. The nurse knows that
the religion practiced most often around the world is:
a. Buddhism
b. Jehovah’s Witness
ed d
c. Christianity
ar stu
d. Ahmadiyya
ANS: C
More than 2 billion individuals throughout the world are practicing Christians. Although these
is
religions are seen in large numbers worldwide, it is important for the nurse to be familiar with
the religions most frequently seen in the client populations with whom he works within his
Th
own area.

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OBJ: 6 TOP: Social Organization in Cultural Assessment

9. The metabolism of psychotropic medications is most likely to be affected by:

a. Ethnicity
b. Religion
c. Culture

d. Values
ANS: A
Ethnicity is a determining factor in a person’s genetic makeup. Religious and cultural
practices could play a role in the metabolism of medications as a result of food or alternative
treatment interactions with medications, but the metabolism is more closely related to the
genetic makeup. Values have little to do with the metabolism of medications.

OBJ: 5 TOP: Biological Factors in Cultural Assessment
10. A Hmong man from Laos is a client at an outpatient mental health clinic and is being seen for
his diagnosis of bipolar disorder. The importance of lithium testing was stressed in his
discharge plans; however, it is discovered that he has had his lithium level checked only once,
rather than the three scheduled times. What is the nurse’s best action?
a. Remind the client about the importance of lithium level testing.
b. Make scheduled appointments for the client to get his lithium level tested.
c. Give the client written information regarding the importance of lithium level
m
testing and written instructions on how to make appointments for testing.
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d. Talk with the client to see if there is a reason that he is not getting his lithium
co
levels checked as outlined in his discharge plans.
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ANS: D
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In the Hmong culture, it is believed that loss of blood leads to decreased body strength, which
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can cause the soul to leave the body, resulting in death. If the nurse did not discuss why the
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client was not getting his blood levels tested and gave him additional instructions as listed in
NURSnot
the other options, the nurse would INunderstand
GTB.COand M would not be able to incorporate the
client’s cultural beliefs into the plan of care. The nurse and the client can now make revisions
o
that will be acceptable while meeting the needs of the client.

aC s
vi y re

OBJ: 5 TOP: Biological Factors in Cultural Assessment
ed d
11. Culture includes common beliefs and practices in areas such as religion, economics, diet,
ar stu
health, and:
a. Genetics
b. Occupations
c. Patterns of communication
is
d. Stereotypes
Th
ANS: C
In addition to shared beliefs and practices in religion, economics, diet, and health, a person’s
cultural integration consists of patterns of communication, politics, art, and kinship. The other
sh
three options are not part of a person’s culture.

12. What is the usual approach to care for individuals who practice folk medicine?

a. Fragmented
b. Impersonal
c. Disjointed
d. Personalized
ANS: D
Folk medicine is highly personalized; the descriptors fragmented, impersonal, and disjointed
more often are associated with the Western medicine approach to health care.

13. A Navajo Native American is traveling across the country and becomes ill. He visits a
hospital emergency department and appears very uncomfortable in the surroundings. The
nurse knows that traditional Navajo Native Americans typically receive health care in:
a. Homes
b. Small hospitals
c. Physicians’ offices
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d. Outpatient clinics
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co
ANS: A
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Many traditional Native Americans receive health care in their homes, community settings, or
social places. The emergency department setting would be very uncomfortable for this client.
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PTS: 1 rs e
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U S N T O
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14. A client seen in the mental health clinic feels her depression is the result of being “punished”
aC s
due to becoming pregnant as an adolescent and giving the infant up for adoption against her
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family’s wishes. This view of her depression is considered:

a. Exaggerated
b. Naturalistic
c. Personalistic
ed d
d. Stress
ar stu
ANS: C
Naturalistic illnesses are caused by impersonal factors without regard for the individual.
Forces that exist outside the individual cause mental illness. Personalistic illnesses are seen as
is
aggression or punishment directed toward a specific person.

Th

sh
15. The nurse in the emergency department finds a woman collapsed on the floor and crying
loudly. The woman’s husband was in a car accident and is being attended to by the medical
staff. Which statement by the nurse best demonstrates acting in a culturally competent
manner?
a. “You need to control yourself. Your husband was not injured that badly.”
b. “Let me take you to a room with more privacy so we can talk.”

c. “I am concerned about how you are acting right now. No one else here is acting
like this.”
d. “We will call the psychiatrist to see if medication can be ordered for you.”
ANS: B
The nurse is demonstrating cultural competence and using cross-cultural therapeutic health
care skills by offering to allow the client to express herself. The nurse is imposing personal
beliefs on expected behavior in the other options.

OBJ: 2 TOP: Cultural Assessment
16. A 45-year-old married man comes to the community mental health center after he is
suspended from his job for fighting. Upon talking to him, the nurse discovers he and his wife
recently moved to the United States and his wife needs to work to pay bills. He is angry and
embarrassed that he cannot be the sole provider for his family. His behavior may be the result
of:
a. Cultural stereotyping
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b. Gender role conflict
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c. Religious beliefs
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d. Territoriality conflicts
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ANS: B
o.
Traditional roles for men and women are in conflict with societal expectations of Western
rs e
society in this situation. Men tend to demonstrate more violent and abusive behaviors as
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mental health problems with this conflict. Cultural stereotyping is imposed by someone
NURand
outside the culture, and religious SIterritoriality
NGTB.COconflicts
M do not apply to this circumstance.
o

aC s
OBJ: 4 TOP: Social Organization: Gender Roles

vi y re
17. A nurse preparing to interview a client in the client’s room begins to move newspapers off a
chair to sit down. The client requests that the nurse sit in another chair and leave the
ed d
newspapers where they were. The client is demonstrating:

ar stu
a. Personal space
b. Paranoia
c. Manipulation
d. Territoriality
is
ANS: D
Th
Territoriality is the need to gain control over an area of space and claim it for oneself, as it
helps to provide a sense of identity, security, autonomy, and control over the environment.
Personal space is the distance maintained between people. Manipulation and paranoia are not
sh
demonstrated in this case.

OBJ: 5 TOP: Cultural Assessment: Space, Territoriality, Time

MULTIPLE RESPONSE
1. A male client is visiting his family in the United States and experiences what his family
describes as a “breakdown.” His family takes him to a stress treatment center at a local mental
health clinic. The client is a follower of traditional folk medicine practices and is agitated
when he learns that he must see a licensed psychiatrist. Which care providers is this client
most likely accustomed to? (Select all that apply.)
a. Healers
b. Shamans
c. Nurse practitioners
d. Spiritualists
e. Lay unlicensed therapists
ANS: A, B, D, E
Individuals who practice folk medicine for care typically do not see licensed health care
providers, such as nurse practitioners and physicians. Folk medicine beliefs regarding the
causes of disorders and treatments are different from Western medicine beliefs.
m
er as
co
eH w
2. Which areas comprise the DSM-IV-TR cultural assessment tool for clients? (Select all that
o.
apply.)
rs e
a. Cultural identity of the client
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b. Overall cultural assessment
c. Cultural explanation of the illness
NU
d. Cultural factors relating to RSING
previous TB.C
mental OM
illness
o
e. Cultural factors relating to psychosocial environment

f. Cultural elements of relationship between client and care provider
aC s
g. Cultural factors related to level of functioning

vi y re
ANS: A, B, C, E, F, G
The six categories of cultural identity of the client, cultural explanation of the illness, cultural
factors relating to psychosocial environment, cultural factors relating to level of functioning,
ed d
cultural elements of the relationship between client and care provider, and overall cultural
ar stu
assessment constitute the cultural assessment tool, which allows mental health care providers
to learn how clients perceive their world and how they cope, according to their culture.
Previous mental illness would be found in the history section of a client’s assessment.
is

Th
OBJ: 5 TOP: Cultural Assessment

3. Refugees frequently experience depression, anxiety, and stress-related disorders caused by

sh
their particular circumstances. Therefore, in addition to a cultural assessment, what is

important for the nurse to assess? (Select all that apply.)
a. Immigration history
b. History of arrival in the new country
c. How long the refugee has been in the new country
d. Whether anyone or anything was lost in coming to the new country

e. What type of medical insurance the refugee will be seeking to obtain

ANS: A, B, C, D
A refugee is a person who flees from his or her home or country, usually because of war or
persecution in the homeland. The refugee has experienced trauma not only in his life
experiences, but also in the process of fleeing from home. Therefore, a more accurate
assessment can be performed if these questions are answered. The type of medical insurance
obtained is of little concern to this person at this time.

OBJ: 7 TOP: Culture and Mental Health Care
4. Cultural assessments allow the health care provider to understand the unique beliefs a client
may have regarding mental illness and how they cope. Key areas to assess include which of
the following? (Select all that apply.)
a. Communication
b. Space and territory
c. Biological orientation
m
d. Defense mechanisms
er as
e. Social orientation
co
eH w
ANS: A, B, C, E
The six areas of cultural assessment on various tools include: communication, environmental
o.
control, space and territory, time, social orientation, and biological factors. Defense
rs e
mechanisms do not pertain to cultural assessments.
ou urc
PTS: 1 DIF: Cognitive
NURSILevel:
GTComprehension
B.COM REF: p. 34
OBJ: 5 TOP: Culture and N
Mental Health Care
o
aC s
vi y re
COMPLETION
1. A __________ is a simplified or standardized belief or conception regarding people who

belong to another culture.
ed d
ar stu
ANS:
Stereotype
is
Stereotyping can be negative or positive but can cause a mental health client to resist care if
he feels he is being stereotyped by his caregiver. Extreme stereotyping is referred to as
Th
prejudice.

sh
2. __________ is a term that divides people into groups based on biological characteristics,
including skin color, features, hair texture, and self-identification.
ANS:

Race
Race differs from ethnicity in that ethnicity refers to similar characteristics but is better
defined socially.

OBJ: 1 TOP: Nature of Culture
3. When a person believes that there is a power greater or higher than any human being, he is
referring to his __________.
ANS:
Spirituality
This is an important concept for many individuals in terms of the progression of their illness
and the plan of care.
m
OBJ: 1 TOP: Nature of Culture
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 05: Theories and Therapies

MULTIPLE CHOICE
1. A male client who has a diagnosis of generalized anxiety disorder (GAD) is seen in the
emergency department with complaints of chest pain, shortness of breath, and inability to
concentrate, along with feelings of overwhelming anxiety. The nurse uses Maslow’s theory to
triage the client’s complaints, knowing that which complaint must be addressed first?
a. Inability to concentrate
b. Shortness of breath
c. Overwhelming anxiety
d. Chest pain
ANS: B
According to Maslow’s hierarchy of needs, the nurse first must address shortness of breath,
followed by chest pain, and then feelings of overwhelming anxiety and inability to
concentrate. Even though, based on his diagnostic history, this client may be having a panic
m
er as
attack, the nurse cannot ignore basic needs that are not being met first.
co
eH w
OBJ: 4 TOP: Humanistic Theories and Therapies
o.
KEY: Nursing Process Step: Implementation
MSC:
rs e
Client Needs: Psychosocial Integrity
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2. According to Freud’s theory, a baby who is crying in response to wanting to be held by his
NUpart
mother is an example of which RSofINthe
GTpersonality’s
B.COM control over behavior?
o
a. Id
b. Ego
aC s
c. Superego
vi y re
d. Self-control
ANS: A
According to Freud, the id is the pleasure center of the brain that seeks immediate pleasure or
ed d
avoids pain, without regard for possible outcomes. The ego is reality based and has more
ar stu
control than the id; the superego is not developed in early childhood because it includes a
conscience. Self-control is not a component of Freud’s theory of personality.
is

OBJ: 2 TOP: Psychoanalytical Theories
Th
3. According to the theorist Erik Erikson, an individual strives to actualize his identity, is most
productive, and demonstrates guidance of and concern for others with a core task of caring
sh
during which stage of psychosocial development?

a. Young adulthood (18 to 25 years)
b. Maturity (65 years to death)
c. Middle adulthood (25 to 65 years)
d. Puberty (12 to 18 years)
ANS: C

The characteristics of striving to actualize identity, being most productive, and demonstrating
guidance of and concern for others, according to Erikson, are seen during middle adulthood.
Individuals who do not achieve the core task of caring become stagnant, self-indulgent, and
absorbed in themselves. The core task of young adulthood is love; the core task of maturity is
wisdom; and the core task of puberty is fidelity.

OBJ: 3 TOP: Developmental Theories and Therapies
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
4. During a therapy session, a client is asked to respond to a word with the first word or phrase
that comes to mind. What term is commonly used to refer to this technique?
a. Transference relationship
b. Dream analysis
c. Free association
d. Psychoanalysis
ANS: C
Free association is a technique that is used to interpret the real meaning behind word
m
association. Dream analysis is a technique that is used to interpret the meaning of an
er as
individual’s dreams as they relate to their unconscious conflicts. Psychoanalysis is the form of
co
therapy developed by Freud, and transference relationship is the technique used during
eH w
therapy when the client transfers to the therapist emotions associated with significant people
o.
in his life.
rs e
ou urc
OBJ: 2 TOP: Psychoanalytical Therapies
NURSINGMSC:
KEY: Nursing Process Step: Assessment TB.C OM Needs: Psychosocial Integrity
Client
o
5. Carl Jung was the founder of analytical psychotherapy; he differed from Freud in that he
aC s
believed that the mind was divided into three levels: the conscious ego, the personal
vi y re
unconscious, and the:

a. Extroverted personality
b. Introverted personality
c. Psyche
ed d
d. Collective unconscious
ar stu
ANS: D
The collective unconscious stores experiences from the person’s ancestral past and is part of
what Jung believed was the third level of the mind. Extroversion and introversion were parts
is
of the personality that Jung identified. Psyche is the mental or spiritual part of a person.
Th

OBJ: 2 TOP: Analytical Psychotherapy
sh
6. Jean Piaget’s theory of cognitive development identifies an interrelationship between the

__________ and the __________ functions in the development of one’s personality.
a. Id, ego
b. Intellectual, emotional
c. Anxiety, affective

d. Personified, cognitive
ANS: B
Piaget believed that growth and development occurred as a result of the interrelationship
between intellectual (cognitive) and emotional (affective) development. The id and the ego are
part of Freud’s beliefs regarding personality development. Anxiety is a vague feeling of
uneasiness. Personification is a term developed by the theorist Sullivan to describe distorted
images of certain relationships that occur in development of the personality.

7. How many stages of the human life cycle did Erik Erikson identify?
a. Two
b. Four
c. Six
d. Eight
ANS: D
m
er as
Erik Erikson identified eight stages of the human life cycle that form one’s personality; each
stage is marked by a developmental task that must be confronted and resolved. Erikson’s
co
eH w
theory is commonly used in health care today.
o.
OBJ: 3 rs e
TOP: Developmental Theories and Therapies
ou urc
U unit
8. A 4-year-old client in a pediatric
N R I G B.C M
S isN imitating
T Othe actions of the nurse. The nurse knows,
o
according to Erik Erikson’s theory, that this child is displaying a characteristic seen during
aC s
which developmental stage?

vi y re
a. Genital-locomotor
b. Latency
c. Oral-sensory
d. Anal-muscular
ed d
ANS: A
ar stu
The genital-locomotor stage (preschool years) is characterized by exploration of the

environment, cooperative play, fantasy, and imitation of adults. Initiative and guilt are core
tasks of this stage. The latency stage occurs during the school-age years (6 to 12 years old),
is
the oral-sensory stage occurs from birth to 1 year of age, and the anal-muscular stage occurs
during early childhood.
Th

sh
9. Humanistic theories are important to health care because these theories serve as the
foundation for the concept of:
a. Assertiveness training
b. Behaviorism
c. Holistic care

d. Behavior modification
ANS: C
Humanistic theories emphasize the total person, which serves as the basis of holistic care.
Assertiveness training refers to teaching a person to express his needs in nonaggressive ways.
Behaviorism is the belief that all behavior is learned, and behavior modification is a therapy
that teaches clients new behaviors that can be used to replace dysfunctional behavior.

OBJ: 3 TOP: Humanistic Theories and Therapies
10. During a conversation with a male client, he voices that he really appreciates his family, likes
his job, and enjoys groups in which he volunteers. According to Maslow’s theory, what is this
client experiencing?
a. Symbolization
b. Self-actualization
c. Equilibrium
d. Identification
m
er as
ANS: B
In Maslow’s hierarchy of needs theory, a person is said to have reached the highest human
co
eH w
need of self-actualization when all basic needs are met, the individual is self-directed, and the
individual has reached the highest potential. Symbolization and identification are common
o.
defense mechanisms, and equilibrium is a state wherein all body systems are in balance.
rs e
ou urc
OBJ: 4 TOP: Humanistic Theories
NURSINGTB.COM and Therapies
o
aC s
11. The nurse knows that the major concept of the systems theory is that individuals are viewed as
vi y re
functioning:
a. Within a set of interacting and related units
b. According to activities of attention, language, and imagery
c. According to unmet needs
ed d
d. Within accepted social aspects of behavior

ar stu
ANS: A
The interacting and related units are called systems, and both open and closed systems have
been identified. Activities of attention, language, and imagery are components of cognitive
is
theories. Met and unmet needs correspond to Maslow’s hierarchy of needs theory, and social
aspects of behavior are seen in sociocultural theories.
Th

OBJ: 5 TOP: Systems Theories
sh
12. Group therapy, which assists in relieving emotional distress and encourages psychological and
behavioral changes, was developed following World War II as a result of a:
a. Study of the benefits of group therapy
b. Decreasing number of mental health facilities
c. Shortage of psychiatrists

d. Grant from the federal government

ANS: C
A shortage of psychiatrists prompted the need for group therapy in the 1940s. Mental health
facilities did not begin to decrease in number until psychotherapeutic drugs were introduced in
the 1950s. No federal grant was provided for group therapy.

OBJ: 10 TOP: Group Therapies
13. Betty Neuman developed the nursing theory that promotes nursing interventions to assist
individuals in reaching and maintaining the highest level of wellness possible. What is this
theory known as?
a. Adaptation model
b. Interpersonal model
c. Systems model
d. Self-care deficit model
ANS: C
m
er as
Betty Neuman developed this model with a focus on reducing stress as a means of assisting in
reaching high-level wellness. The adaptation model was developed by Myra Levine. Peplau
co
eH w
developed the interpersonal model, and Orem developed the self-care deficit models.
o.
OBJ: 9 rs e
TOP: Nursing Theories
ou urc
Udaughter,
14. Following an argument with his
N R I G B.C M
S N Ta fatherOtakes away her phone privileges. He later
o
feels guilty about the argument and asks her if she would like to go shopping for new clothes.
aC s
What is this defense mechanism known as?

vi y re
a. Compensation
b. Displacement
c. Rationalization
d. Restitution
ed d
ANS: D
ar stu
Restitution involves engaging in an activity that helps to resolve feelings of guilt.

Compensation is an attempt to overcome feelings of inferiority. Displacement involves
redirecting energy to another person or object, and rationalization is a way of explaining
is
something in a good, although not true, way.

Th

sh
15. A female client with low self-esteem tries to dress and act like the nurse who cares for her in
an outpatient clinic setting. This behavior is an example of which defense mechanism?
a. Identification
b. Symbolization
c. Displacement
d. Projection

ANS: A
Identification occurs when an individual takes on personal characteristics of someone she
admires, especially when she has low self-esteem or poor self-concept. Symbolization
involves the use of unrelated objects to represent a hidden idea. Displacement involves the
redirecting of energies to another person or object; projection occurs when an individual
projects onto another person his or her unacceptable thoughts or emotions.

16. During group therapy, certain group change mechanisms may be observed. When an
individual engages in helping others, resulting in improvement in his or her own self-esteem,
which group change mechanism has the individual experienced?
a. Altruism
b. Feedback
c. Expressiveness
d. Communion
m
er as
ANS: A
Altruism occurs when not only recipients benefit from assistance, but the individual who is
co
eH w
giving assistance also benefits through improvement in his own self-esteem. Feedback refers
to receipt of information about how one is perceived by others. Expressiveness is a group
o.
change mechanism in which group members share positive and negative emotions, and
rs e
communion occurs in a group when members feel a sense of belonging.
ou urc
NURSILevel: Comprehension REF: p. 52
OBJ: 10 TOP: Group NGTB.COM
Therapies
o
aC s
vi y re
17. A client is granted permission to watch a favorite television show in the evening because she
participated in an occupational therapy activity. Her therapist bases this on ______ theory.
a. Psychoanalytic
b. Humanistic
ed d
c. Behavioral
ar stu
d. Developmental
ANS: C
Behavioral theory believes behavior is a result of rewards to enforce desired behaviors.
is
Psychoanalytic theory explores the unconscious, humanistic theory deals with the whole
person, not just behavior, and developmental theory focuses more on life tasks at particular
Th
points.

OBJ: 3 TOP: Behavioral Theories
sh
18. A client does not participate in group sessions due to feeling inferior to others in the group.
Based on cognitive theory, he would be directed to:
a. Review his previous relationship with his parents
b. Participate in group to receive extra privileges

c. Suppress negative thoughts about the group

d. Recognize and change his negative thoughts
ANS: D
Cognitive theory and therapy stress self-regulation and control to change behavior. Reviewing
relationships with parents is indicative of psychoanalysis. Behavior change for reward is
based on behavioral theory, and suppression of thoughts is a negative means of coping.

OBJ: 5 TOP: Cognitive Theories and Therapies
19. Which of the following assessment parameters is a priority in a biobehavioral model of

practice?
a. Blood chemistry
b. Physiologic needs
c. Coping mechanisms
d. Psychosocial level
ANS: A
m
er as
Biobehavioral theories follow the medical model, which states that illness is the result of
abnormalities in the structure, function, or chemistry of the body. A history, physical
co
eH w
examination, laboratory tests, imaging techniques, and electroencephalograms (EEGs; brain
wave recordings) are used to assist in diagnosis. Blood chemistry is the only option providing
o.
for this structure, function, or chemical abnormality.
rs e
ou urc
OBJ: 8 TOP: Biobehavioral Theories
NURSINGTB.COM
o
20. The nurse who feels the most beneficial part of the client’s inpatient stay is the establishment
aC s
vi y re
of an interpersonal relationship with the nurse is an example of which nursing theorist?

a. Orem
b. Watson
c. Peplau
ed d
d. Roy
ar stu
ANS: C
Peplau’s goal of nursing is to develop interpersonal interaction between the client and nurse.
Orem’s goal is to help the client attain self-care, Watson’s goal is to promote and restore
is
health, and Roy’s goal is to identify demands on clients and adaptation.

Th

OBJ: 9 TOP: Nursing Theories
sh
MULTIPLE RESPONSE
1. Freud’s psychoanalytical theory states that an adult is more likely to be mentally healthy if
there is a balance between which parts of the mind? (Select all that apply.)
a. Id

b. Ego
c. Superego
d. Conscience
ANS: A, B, C
Freud believed that if there was a dynamic balance between the id, the ego, and the superego,
an adult’s personality would develop in a healthy manner. The conscience is part of the
superego.

2. Psychobiology theory considers the causes of mental illness to be which of the following?
a. Genetics
b. Neurotransmitter activity
c. Immune system dysfunction
d. Social setting
m
e. Unmet needs
er as
co
ANS: A, B, C
eH w
Psychobiological theories about the causes of mental illness relate to genetics,
neurotransmitter activity, viruses, fetal development, and immune system dysfunction.
o.
PTS: 1 rs e
ou urc
OBJ: 8 TOP: Psychobiologic Theories
N R I GMSC: B.CClient
U S N T O
o
COMPLETION
aC s
vi y re
1. Freud believed that an individual’s personality developed through stages of sexual instinct
from birth to adulthood. This is known as the __________ theory of personality development.
ANS:
ed d
Psychosexual
ar stu
Freud believed that all individuals experience certain stages of psychosexual development to
some degree. He believed that if these stages were not psychologically completed and
is
released, a person could be emotionally halted in development, resulting in the excessive use
of defense mechanisms to avoid anxiety produced during these stages.
Th

sh
2. Dr. Sigmund Freud believed that a person’s unconscious thoughts and emotions affect his or
her behavior. The now well-known therapy that he developed to explore an individual’s
unconscious thoughts is referred to as ____________.
ANS:

Psychoanalysis
Freud developed an approach to therapy of individuals based on exploration of the

unconscious, which is known as psychoanalysis.

OTHER
1. Good problem-solving is necessary for the mentally healthy individual. Place the steps of the
problem-solving process in order. (Separate letters by a comma and space as follows: A, B, C,
D, E, F, G)
a. Examine all possible options
b. Examine outcomes of the option’s application
c. State the problem
d. Evaluate and revise actions based on outcomes
m
e. Collect information about the problem
er as
f. Choose the best option, and apply it to the problem
co
g. Identify the causes or patterns of the problem
eH w
o.
ANS:
C, E, G, A, F, B, D
rs e
ou urc
First, the problem must be identified; then information regarding the problem must be
collected if causes or patternsNof
URtheSIproblem
NGTB.C OMbe identified. Options then can be
are to
o
examined for choice of the best option, and possible outcomes of options can be determined.
Finally, evaluation of the entire process is necessary to determine whether any revisions are
aC s
necessary.
vi y re

OBJ: 5 TOP: Cognitive Theories and Therapies
ed d
ar stu
is
Th
sh


Chapter 06: Complementary and Alternative Therapies

MULTIPLE CHOICE
1. For a client with a sleep disorder, which CAM therapy could be used safely without
interference with any allopathic methods of treatment?
a. Progressive relaxation
b. Dietary supplements
c. Herbal supplements
d. Aromatherapy
ANS: A
Progressive relaxation is noninvasive in that it uses deep breathing and conscious muscle
relaxation and therefore would not interfere with allopathic methods of treatment. Dietary and
herbal supplements can interfere with other medications (allopathic therapy) that may be taken
by this client. Aromatherapy could interfere with this client’s allopathic treatment if he is
being treated for allergies.
m
er as
co
OBJ: 8 TOP: CAM Approaches to Mental Health Care
eH w
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
o.
rs e
2. A female client would like to use biofield therapy for her addiction to nicotine. Which form of
ou urc
therapy would she most likely choose?
a. Aromatherapy
b. Acupuncture NURSINGTB.COM
o
c. Nicotine patches
d. Group therapy
aC s
vi y re
ANS: B
Acupuncture is a form of biofield therapy, which is a form of energy medicine. Aromatherapy
is a CAM that is a biologically based practice. Nicotine patches would be considered
allopathic, and group therapy is socioculturally based therapy.
ed d
ar stu

OBJ: 7 TOP: Energy Medicine
is
3. A male client experiences a phobia of enclosed spaces (claustrophobia) and is seeking an

Th
energy-based therapy that he can practice and initiate on his own when he experiences
symptoms. Which therapy will the nurse recommend?
a. Music and sound therapy
b. Relaxation and visualization
sh
c. Hypnosis therapy
d. Spiritual healing
ANS: B

Although all of these therapies are considered energy-based, the one that would be best suited
for these circumstances is relaxation and visualization. The other choices would be difficult to
initiate in a claustrophobic situation.

OBJ: 6 TOP: Mind-Body Medicine
4. Which theory best describes energy medicine?

a. There is a harmony within the body, nature, and the world.
b. The body has a natural ability to heal itself.
c. There is a vital, life-force energy that flows through an individual’s body.
d. The mind and spirit affect body functions and influence illness.
ANS: C
Energy medicine is best described as the belief that there is a vital energy that flows through
an individual’s body. The theory that there is harmony within the body, nature, and the world
describes holistic care. The theory that the body has a natural ability to heal itself describes
body-based CAM therapies, and mind-body medicine followers believe that the mind and
m
spirit affect body functions and influence illness.
er as
co
eH w
o.
rs e
5. A female client is receiving therapy for severe depression that consists of repetitive
ou urc
transcranial magnetic stimulation. This form of therapy is considered to be:
a. Energy medicine NURSINGTB.COM
b. Illegal according to FDA regulations
o
c. A form of expressive therapy

aC s
d. A biofield therapy
vi y re
ANS: A
Repetitive transcranial magnetic stimulation is a form of energy medicine in the category of
electromagnetic field therapies. This therapy is not considered to be illegal. Expressive
ed d
therapy is the use of creative activities such as dance and music to express emotions, and
ar stu
biofield therapy is another form of energy medicine.

is
Th
6. A 70-year-old male client tells the nurse that he is using chelation therapy to prevent
Alzheimer’s disease. Which adverse effect is the client most likely to experience?
a. Allergic reactions
sh
b. Low potassium levels

c. Elevated blood glucose levels
d. Interactions with other medications
ANS: B

Although adverse effects of CAM therapy cannot be predicted in any individual, the most
likely adverse effect of chelation therapy is a low potassium level because EDTA binds with
heavy metals, causing potassium depletion. This therapy is controversial, and its effectiveness
has not been proved scientifically.

OBJ: 10 TOP: Adverse Effects
7. A male client of Indian origin practices meditation and yoga, uses herbs and follows specific
diet practices, and practices controlled breathing and exposure to sunlight. Which type of
CAM therapy is this individual practicing?
a. Traditional Chinese medicine
b. Homeopathy
c. Ayurveda
d. Reiki
ANS: C
Ayurveda is a body-based CAM therapy that often is practiced by Indian cultures with a
m
central focus on being knowledgeable of how to live. Homeopathy uses natural substances to
er as
heal, and traditional Chinese medicine deals with a balance between yin and yang, “laying on
co
of hands” to promote relaxation and healing.
eH w
o.
OBJ: 4
rs e
TOP: Whole Medical Systems
ou urc
8. What is the main function ofNURNational

the SINGTCenter
B.CO MComplementary and Alternative
for
Medicine (NCCAM)?
o
a. To seek scientific validation of and be a resource for the public for CAM therapies
aC s
b. To investigate and develop new CAM therapies

vi y re
c. To produce a monthly newsletter on new CAM therapies

d. To monitor the production of dietary and herbal supplements used in CAM
therapies
ed d
ANS: A
ar stu
The function of the NCCAM is to seek scientific validation of and be a resource for the public
for CAM therapies. The other options are not representative of the functions of NCCAM.

is
OBJ: 3 TOP: National Center for Complementary and Alternative Medicine

Th
9. The Food and Drug Administration (FDA) does not impose the same guidelines on
__________ as it does on prescription drugs.
sh
a. Chiropractic treatment
b. Dietary supplements
c. Homeopathic treatments
d. Hypnotic therapy
ANS: B

The Dietary Supplement Health and Education Act of 1994 (DSHEA) addresses dietary
supplements but does not include the same guidelines that govern prescription drugs.
Guidelines are less stringent for dietary supplements; therefore, the safety of use of these
products with prescription drugs is one of the concerns associated with such supplements.
Dietary supplements include, but are not limited to, vitamins, minerals, and herbs. The FDA
does not govern chiropractic treatment, homeopathic treatment, or hypnotic therapy.

OBJ: 5 TOP: Biologically Based Practices
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
10. A 45-year-old male client uses a treatment method that focuses on the relationship between an
individual’s body structure and its function. This mode of treatment is:
a. Naturopathic
b. Homeopathic
c. Chiropractic
d. Acupuncture
ANS: C
m
Chiropractors use manipulation therapy of the spine to improve the relationship of the body
er as
structure (spine) to its function, which is thought to aid the body in healing various conditions,
co
such as migraine headache. Naturopathic therapy, homeopathic therapy, and acupuncture do
eH w
not have this focus.
o.
PTS: 1
rs e
ou urc
OBJ: N/A TOP: Body-Based Practices
NURSINGTB.COM
11. Massage therapy manipulates muscles and connective tissue and has been found to be very
o
successful as a CAM method in the treatment of which disorder(s)?

aC s
a. Schizophrenia
vi y re
b. Bipolar disorder
c. PTSD and OCD
d. Depression and anxiety
ed d
ANS: D
ar stu
Massage therapy has been frequently reported to assist in the relaxation of clients with a
diagnosis of depression and anxiety disorder. No documentation of massage therapy for
schizophrenia, bipolar disorder, or PTSD and OCD is available.
is

Th

sh
12. Which type of therapy has yielded positive results for psychological functioning and is
considered one of the safest treatment modalities?
a. Mind-body medicine
b. Chiropractic treatment
c. Dietary supplements
d. Herbal therapy

ANS: A
Mind-body medicine (music and dance therapy, expressive therapy, meditation) has been
found effective in improving psychological functioning. It is considered safe because it is
noninvasive. Chiropractic treatment, herbal therapy, and dietary supplements are more
invasive and can interfere with medicines and cause alterations in body systems.

OBJ: 6 TOP: Mind-Body Medicine
13. A therapy that once was denounced by the scientific community but now is being used to
successfully treat victims of the events of 9/11, Hurricane Katrina, and the South Asian
tsunami of 2004 and that helps the rational left side of the brain bond with a traumatic
memory from the emotional right side of the brain is known as:
a. Hypnosis therapy
b. Eye Movement Desensitization and Reprocessing (EMDR)
c. Shiatsu
d. Doshas
m
ANS: B
er as
EMDR is thought to help clients who have experienced a horrific trauma to process the event
co
so they can deal with their emotions. The other therapies are not being used widely for
eH w
treatment following these events.
o.
PTS: 1
rs e
ou urc
NURSINGTB.COM
14. __________ is a form of therapy that has been used for over 2000 years to successfully treat
o
clients with drug addiction; it is believed to restore the energy balance in the body and to
aC s
stimulate the release of certain neurotransmitters and hormones.

vi y re
a. Yoga
b. Meditation
c. Therapeutic touch
d. Acupuncture
ed d
ar stu
ANS: D
Acupuncture is of Oriental origin and has been used for over 2000 years. It has been found to
be successful as adjunctive therapy for drug addiction. Yoga, meditation, and therapeutic
touch are also forms of energy medicine, but they are more focused on relaxation and on
is
understanding of the inner self.

Th

sh
15. Color therapy has been found to be especially effective in the treatment of:
a. Seasonal affective disorder
b. Bipolar disorder
c. Drug addiction
d. Generalized anxiety disorder

ANS: A
Color therapy involves the use of high-intensity light therapy and is highly effective in
improving the symptoms of seasonal affective disorder. Color therapy is not an effective
therapy for bipolar disorder, drug addiction, or generalized anxiety disorder.

16. A client experiencing symptoms of anxiety would benefit from which therapy?
a. Chelation
b. Phototherapy
c. Therapeutic touch
d. Magnetic therapy
ANS: C
Therapeutic touch is effective in stress-related conditions such as migraine headaches and
anxiety. Chelation is effective against atherosclerosis, phototherapy is used in depression, and
magnetic therapy is used primarily for pain.
m
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OBJ: 8 TOP: Energy Medicine: Stress reduction and relaxation
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o.
17. A child who is the victim of domestic violence refuses to talk about the experience. He is
rs e
doing poorly in school and having trouble sleeping. Which therapy would he benefit from?
ou urc
a. Massage
b. Biofeedback NURSINGTB.COM
c. Aromatherapy
o
d. Art therapy
aC s
vi y re
ANS: D
Art, or expressive, therapy is indicated to release inner conflicts and repressed emotions.
Massage uses manipulation to relax muscles, biofeedback monitors physical responses during
relaxation, and aromatherapy uses scents to promote well-being. None of these provide for the
ed d
expression of repressed emotions.

ar stu

OBJ: 6 TOP: Mind Body Medicine: Expression Therapy
is
18. Which CAM therapy would a nurse be most concerned about if used by a client being treated
Th
with antipsychotic medications?

a. Biologically based practices
b. Body-based practices
sh
c. Mind-body practices
d. Technology-based practices
ANS: A
Biologically based practices include dietary supplements and herbal therapies that may have
adverse or unwanted effects in combination with pharmacotherapy. None of the other
practices have the potential to interact with pharmacologic agents.


19. An allopathic mental health practitioner would most likely recommend which treatment for a
client suffering from anxiety?
a. Expressive therapy
b. Acupuncture
c. Antianxiety agents
d. Dietary supplements
ANS: C
Allopathic practitioners use medical and surgical methods to treat disease and injury. The
other therapies are CAM agents.

m
er as
MULTIPLE RESPONSE
co
eH w
1. Which treatments are used in biologically based practice? (Select all that apply.)
o.
a. Dietary supplements
b. Aromatherapy
rs e
ou urc
c. Herbal supplements
d. EDTA
NURSINGTB.COM
ANS: A, B, C
o
Dietary supplements, aromatherapy, and herbal supplements fit the category of biologically
aC s
based practice. EDTA is a body-based practice that involves moving the body into an
vi y re
improved state of function.

ed d

ar stu
MSC: Client Needs: Physiological Integrity
2. Which of the following principles best describes the beliefs of naturopathic practitioners?
is
a. Treatment of the whole person should occur.

Th
b. Prevention of diseases/disorders is a key concept.

c. The doctor is the teacher.
d. Use of wavelengths is beneficial for client treatment.
sh
ANS: A, B, C
In naturopathy, treatment of the whole person should occur, prevention of disease is a key
concept, and the doctor is the teacher. Some of the treatments used in naturopathic medicine
include acupuncture, colonic irrigation, hydrotherapy, and counseling. Use of wavelengths is
part of energy-based therapy.

OBJ: 4 TOP: Whole Medical Systems

3. Self-help groups provide support to individuals who are dealing with or who have had similar
experiences. Which of the following are characteristics of self-help groups? (Select all that
apply.)
a. Groups are informal, nonprofit, and free of charge
b. Membership requires referral from a physician or counselor
c. Meetings are facilitated by trained counselors
d. Groups provide support, education, and encouragement to members
e. Groups benefit individuals who are dealing with life-altering events such as
addiction
ANS: A, D, E
Self-help groups are informal, nonprofit, and free of charge; provide support, education, and
encouragement to members; and benefit individuals who are dealing with life-altering events.
Membership is voluntary, and meetings usually are facilitated by a survivor or someone with
experiences similar to those of the group.
m
er as
OBJ: 9 TOP: CAM Mental Health Therapies
co
eH w
4. Which of the following CAM mental health therapies are indicated for a client with PTSD?
o.
rs e
ou urc
a. Diet
b. Aromatherapy
NURSINGTB.COM
c. Eye movement desensitization
d. Yoga
o
e. Biofeedback
aC s
vi y re
ANS: C, D, E
Treatments indicated for posttraumatic stress disorder (PTSD) include eye movement
sensitization, yoga, and biofeedback. Aromatherapy and diet are indicated for stress and sleep
disorders.
ed d
ar stu

OBJ: 8 TOP: CAM Mental Health Therapies
is
COMPLETION
Th
1. CAM is an acronym for __________.
ANS:
sh
Complementary and alternative medicine
This therapy comprises two basic groups: body-based CAM and energy-based CAM. It is
important for health care providers to be familiar with CAM therapies so they can incorporate
these into the plan of care when appropriate or necessary.


OBJ: 1 TOP: Complementary and Alternative Therapies
2. New approaches to mental health care that include telemedicine, telephone counseling, and
radio psychiatry are known as _______________ approaches.
ANS:
Technology-based
Technology-based approaches are increasing because of factors such as ease of accessibility

for a wide range of people, a greater number of people seeking CAM approaches to mental
health care, and increased use of the Internet.

OBJ: N/A TOP: Technology-Based CAM Applications ok
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co
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o.
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NURSINGTB.COM
o
aC s
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is
Th
sh


Chapter 07: Psychotherapeutic Drug Therapy

MULTIPLE CHOICE
1. During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant
(TCA) to not expect to see a difference in mood or anxiety level for up to:
a. 5 days
b. 2 to 3 weeks
c. 4 to 5 weeks
d. 6 weeks
ANS: B
It is important that the client understand that TCAs typically take 2 to 3 weeks to take effect
so he will not become discouraged when he does not see immediate results.

OBJ: 4 TOP: Antidepressant Medications
m
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co
2. A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor
eH w
(MAOI). Which is the most important teaching point the nurse must include in his care plan?
o.
a. Avoid foods high in sodium content
rs e
b. Avoid alcoholic beverages
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c. Ensure that protein intake is 60 grams per day
d. Take a potassium supplement
NURSINGTB.COM
ANS: B
o
This client should be given a list of foods and beverages that are restricted when taking
aC s
MAOIs, such as some alcoholic beverages, sausage and bologna, and some cheeses. Sodium,
vi y re
protein, and potassium are not factors when MAOIs are taken.

ed d
KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity
ar stu
3. A female client is 3-days postoperative and has been receiving meperidine (Demerol) for pain
control. The family mentions to the nurse that the client has been taking phenelzine (Nardil)
for years for her depression. The client did not list this medication on admission. What signs
is
and symptoms should the nurse look for in case of reaction between these two medications?
Th
a. Increased pulse and respirations

b. Hyperactivity and difficulty concentrating
c. Increased tearing and increased urinary output
d. Sedation, disorientation, and hallucinations
sh
ANS: D
Nardil is a monoamine oxidase inhibitor; therefore, symptoms of CNS depression such as
sedation, disorientation, and hallucinations, rather than increased vital signs, hyperactivity and
difficulty concentrating, and increased tearing and urination, most likely would occur as a
reaction between these two medications.


4. The nurse is aware that he or she may be administering the new antianxiety medication
pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating:
a. Depression
b. Psychotic episodes
c. Neuropathic pain
d. Bipolar disorder
ANS: C
Pregabalin (Lyrica) has been found to be effective for the treatment of neuropathic pain, as
well as seizure disorders. This medication is not used for any of the other options listed.

OBJ: 3 TOP: Antianxiety Medications
5. Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice
m
er as
for the treatment of depression because:
co
a. The side effects are more manageable than with other antidepressants.
eH w
b. They are the only class safe for long-term therapy.
c. This is the oldest class of antidepressants.
o.
rs e
d. They are fast-acting medications.
ou urc
ANS: A
The side effect most commonly NUreported,
RSINGT gastrointestinal
B.COM (GI) upset, usually can be avoided if
the client takes the medication with food. SSRIs can be used for both short- and long-term
o
therapy; they are not the oldest class of antidepressants; and they usually take a few weeks
aC s
before onset of effect.

vi y re

ed d
6. In preparing discharge planning for a client who has been prescribed lithium for the treatment
ar stu
of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the
need to monitor his or her diet for intake of:
a. Potassium
is
b. Carbohydrates
c. Protein
Th
d. Sodium
ANS: D
Lithium is a salt that is absorbed into the bloodstream and is excreted by the kidneys at a
sh
faster rate than sodium. Therefore, clients must monitor their sodium and fluid intake, as well
as their activity level. The other options are not a concern when lithium is taken.

OBJ: 5 TOP: Antimanic Medications

7. A female client calls the clinic for advice after forgetting to take her morning dose of
twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?
a. Take the dose immediately, and then take the second dose 3 hours late.
b. Take half of a dose now, and then take the second dose at the normal time.
c. Eliminate the dose missed, and take the second dose at the normal time.
d. Immediately take the missed dose, and take the second dose at the normal time.
ANS: C
Because lithium should be taken at the same time each day and the therapeutic range is
narrow, 5 hours after the first dose was missed would be too close to take the second dose to
try to make it up. Altering the schedule for one missed dose could cause more problems with
future doses.

8. A female client who has had bipolar disorder for several years decides to stop all of her
m
medications because she is tired of the side effects. She also cancels all appointments with her
er as
therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client
co
is considered:
eH w
a. Depressed
o.
b. Noncompliant
rs e
c. Suffering from an anxiety disorder
ou urc
d. Possessing obsessive-compulsive tendencies
ANS: B NURSINGTB.COM
Noncompliance occurs with many individuals with mental health disorders because of the
o
ways the side effects of the medication affect an individual as well as other factors. It is
aC s
important to work with clients to prevent noncompliance. Depression, anxiety disorder, and
vi y re
obsessive-compulsive tendencies are not indicated in the situation described.

OBJ: 9 TOP: Noncompliance
ed d
ar stu
9. A male client with schizophrenia lives in an assisted-living complex for individuals with
mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his
antipsychotic medication and therefore stops taking his medication after much discussion with
is
his treatment team. He is progressively withdrawing from reality but is not a safety risk at this
Th
point to himself or others. What is the best response of the nurse and treatment team?
a. Try to coerce him into taking his medication.
b. Ensure that the client and those around him are safe, and monitor for additional
symptoms of his schizophrenia while maintaining trust with the client.
sh
c. Crush his antipsychotic medications and put them in his food to stop the process of
his withdrawal from reality.
d. Speak to his family about seeking an involuntary emergency hold in a mental
health facility to get him back on his medications.
ANS: B

The Patient Self-Determination Act states that individuals who are not in an emergency or
safety-threatening situation cannot be coerced, forced, or talked into following a suggested
course, such as taking medication against their will. All three remaining options go against the
Act. In addition, an involuntary emergency hold in a mental facility is not reasonable because
the client is not a threat to himself or others.

OBJ: 9 TOP: Informed Consent
10. An adult female client has been diagnosed recently with mild depression but opts not to take
the medication prescribed by her physician after talking with the physician about the benefits,
risks, possible outcomes, and side effects. She decides to investigate alternative treatments.
This client is making this decision based on the premise of:
a. Informed consent
b. Noncompliance
c. Client education
d. Right to privacy
m
ANS: A
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Informed consent most accurately describes the situation because all aspects of taking the
co
medication were discussed with the client before she made the decision to not take the
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medication. If she had already been in agreement with the regimen rather than seeking other
o.
alternatives, she would have been considered noncompliant. Client teaching, such as how and
rs e
when to take the medication, would occur if she decided to take the medication. The client’s
ou urc
right to privacy is not addressed in this scenario.
PTS: 1 NURSILevel:
DIF: Cognitive NGTApplication
B.COM REF: p. 77
o
OBJ: 9 TOP: Informed Consent

aC s

vi y re
11. The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia.
The nurse would expect to see which medication ordered for this client?
a. Lithium
ed d
b. Depakene
ar stu
c. Neurontin
d. Risperdal
ANS: D
is
Risperdal is an antipsychotic medication that is used for schizophrenia. The other options are
Th
all antimanic medications.

OBJ: 2 TOP: Antipsychotic (Neuroleptic) Medications
sh
12. Psychotropic medications can cause a parasympathetic and/or sympathetic response from the
autonomic nervous system. Which of the following is considered a sympathetic response?
a. Pupil dilation
b. Increased saliva production

c. Decreased heart rate

d. Constricted airway
ANS: A
Pupil dilation is a sympathetic response. All the other options are examples of a
parasympathetic response.

OBJ: 1 TOP: How Psychotherapeutic Drug Therapy Works
13. While completing the history portion of an admission assessment of a client with
schizophrenia, the nurse notices that the client is continually moving in the chair and
frequently stands and then sits back down. The nurse knows that this client most likely is
experiencing the side effect of:
a. Drug-induced parkinsonism
b. Dystonia
c. Akathisia
d. Akinesia
m
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ANS: C
Akathisia is an extrapyramidal side effect (EPSE) of antipsychotic drugs that causes an
co
eH w
individual to be unable to sit still. The other options are also EPSEs but are not evident in the
scenario.
o.
PTS: 1 rs e
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M Needs: Physiological Integrity
U S N T O
o
14. __________ is a side effect that can occur while a client is taking an antipsychotic
aC s
medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.
vi y re
a. Drug-induced parkinsonism
b. Neuroleptic malignant syndrome (NMS)
c. Tardive dyskinesia
d. Dystonia
ed d
ANS: B
ar stu
NMS is a very serious side effect of antipsychotic drugs that can lead to coma and death.
Muscle rigidity is usually the first symptom, with symptoms progressing rapidly after the
onset and reaching peak intensity in 3 days. The other options are also side effects of
is
antipsychotics but do not describe NMS.

Th

sh
15. The __________ constitute a class of drugs that are commonly prescribed for cardiac
arrhythmias but also have been found to be effective treatment for social phobias.
a. Benzodiazepines
b. Tricyclics
c. Azaspirones
d. Beta-blockers

ANS: D
In the past, beta-blockers were strictly cardiac drugs, but new research has found this class of
drugs to be successful as adjunctive treatment for social phobias. The other options are
antianxiety and antidepressant medications; they are not used for cardiac arrhythmias.

16. Valium is administered to a client anxious about impending surgery. Which of the following
side effects is the client at risk for?
a. Seizures
b. Falls
c. Hypertensive crisis
d. Tachycardia
ANS: B
Orthostatic hypotension from use of benzodiazepines places the client at risk for falls. MAOIs
may cause hypertensive crisis, seizures, and tachycardia.
m
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co
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o.
rs e
17. When educating a client being treated with lithium, which item(s) in his or her diet should be
ou urc
monitored or avoided?
a. Fresh fruit
b. Whole milk NURSINGTB.COM
o
c. Hot dogs and ham

aC s
d. Fresh vegetables
vi y re
ANS: C
Lithium and sodium compete for elimination from the body through the kidneys. An increase
or decrease in salt affects proper elimination of lithium from the body. Processed foods like
hot dogs and ham contain larger amounts of sodium.
ed d
ar stu

OBJ: 5 TOP: Guidelines for clients taking lithium
is
18. The CMA is administering an antianxiety medication to a client. Monitoring side effects is the
Th
responsibility of which member of the health care team?

a. Nurse
b. CMA
c. Physician
sh
d. Therapist
ANS: A
While all care providers should be aware of the actions and side effects of the client’s
medication, the nurse remains responsible for monitoring drug effectiveness and adverse
reactions.


OBJ: 7 TOP: Drug Administration
19. Careful assessment for changes in attitude and suicidal gestures should
be monitored in a client taking which medication?
a. Lithium
b. Ativan (lorazepam)
c. Librium (chlordiazepoxide)
d. Paxil (paroxetine)
ANS: D
Clients taking Paxil (an antidepressant) should be assessed for changes in attitudes and
suicidal gestures. All other medications are antianxiety agents.

m
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co
MULTIPLE RESPONSE
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o.
1. Which of the following are basic responsibilities of nurses who administer psychotherapeutic
rs e
drugs? (Select all that apply.)
ou urc
a. Monitoring and evaluating the client’s response to the medication
b. Continually assessing the client’s condition
NURS
c. Adjusting medication dosages INGTB.C
according OM
to therapeutic levels
d. Assisting in the coordination of the client’s care
o
e. Teaching clients about their medications

aC s
vi y re
f. Administering prescribed medications

ANS: A, B, D, E, F
These responsibilities require nurses to be cognizant of all aspects of medication
administration. Adjusting medication dosages is not within the nurse’s scope of practice.
ed d
ar stu

OBJ: 7 TOP: Client Care Guidelines
is
Th
2. The nurse is developing a teaching plan for a client who has been diagnosed recently with a
mental health disorder and has been prescribed a psychotropic medication. Which
interventions regarding the medication should the nurse include in the teaching plan? (Select
all that apply.)
sh
a. Teach signs and symptoms of side effects and what to do if these occur
b. Provide written information regarding the purpose, dosage, route, and dosing
schedule
c. Ask the client and significant other to verbally explain when it is necessary to
contact the physician should side effects occur
d. Provide written information regarding how the client should decrease dosages in

response to side effects or improvement in symptoms

ANS: A, B, C
The nurse should teach signs and symptoms of side effects, provide information about the
drug, and have the client and significant other verbally explain when it is necessary to call the
physician. The nurse should never provide written information about decreasing dosages
without contacting the physician. The physician will determine whether side effects can be
controlled, or if dosage adjustments are necessary. In addition, improvement in symptoms is
most likely the desired effect of the medication and ensures that the dosage and medications
are correct.

OBJ: 8 TOP: Client Teaching
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step:
Evaluation MSC: Client Needs: Physiological Integrity
3. Clients diagnosed with Type I-Positive Schizophreniasymptoms respond better to

antipsychotic medications. Manifestations of Type I Schizophrenia include which of the
following? (Select all that apply.)
m
a. Delusions
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b. Hallucinations
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c. Apathy
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d. Anhedonia
o.
e. Illusions
ANS: A, B, E rs e
ou urc
Type I: Positive symptoms include delusions, illusions, and hallucinations and have a good
response to medications. TypeNUII:RNegative
SINGTB.C M include anhedonia, apathy, and flat
symptoms
O
affect and usually do not respond well to antipsychotic medications.
o
aC s

vi y re
OBJ: 6 TOP: Positive and Negative Symptoms of Schizophrenia

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COMPLETION
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1. __________ side effects can occur when antipsychotic medications are taken that manifest as
abnormal movements such as akathisia and pseudo-Parkinson symptoms.
is
ANS:
Extrapyramidal
Th
These side effects occur as a result of an imbalance of neurotransmitters in the brain.

Additional extrapyramidal side effects (EPSEs) include dyskinesia, akinesia, and dystonia.
sh

2. The four classes of psychotherapeutic medications include antianxiety agents, antidepressants,

antimanics, and __________.

ANS:
Antipsychotics
Antipsychotics treat individuals with psychotic disorders by helping to control symptoms

associated with loss of reality, such as hallucinations.

OBJ: 2 TOP: Classifications of Psychotherapeutic Drugs
3. Lithium levels are considered toxic when they become higher than __________ mEq/L.
ANS:
1.5
Lithium therapy must be closely monitored because the therapeutic range is narrow and
toxicity can be life threatening. Anything higher than 1.5 mEq/L is considered toxic.
m
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co
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o.
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ou urc
NURSINGTB.COM
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aC s
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ar stu
is
Th
sh


Chapter 08: Principles and Skills of Mental Health Care

MULTIPLE CHOICE
1. An adult female client becomes combative with the nurse during routine medication
administration. What is the nurse’s primary responsibility in this situation?
a. To ensure that the client takes her medications
b. To ensure that the client is placed in physical restraints to protect the safety of the
staff and other clients
c. To ensure that chemical restraints are used in the future until the client displays
more appropriate and compliant behavior
d. To ensure that the client is kept safe while trying to protect staff safety and to
reason with the client to try to de-escalate the combative behavior
ANS: D
The “Do no harm” principle of mental health care applies to this situation. Client and staff
safety are imperative. Ensuring that the client takes her medications is not of greatest concern
in this situation because this most likely would cause increased combativeness. Physical
restraints and chemical restraints are not reasonable options in the care of this patient.

OBJ: 2 TOP: Do No Harm
2. A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action
by the nurse is going to best promote development of a mutually trusting relationship?
a. At the beginning of the shift, the nurse promises to play a game of cards with the
client at some point during that day and does so before the end of the shift.
b. The nurse promises to play a game of cards with the client on the following day.
c. The nurse leads a group discussion with clients about ways to develop trust in a
relationship.
d. The nurse gives the client written information about the medications he is taking.
ANS: A
Developing mutual trust is one of the principles of mental health care. The nurse most likely
would be able to carry out plans on a daily basis rather than trying to make plans for the next
day. Making plans with the client is a very effective way to develop trust, as long as the plans
can be carried out. Leading a group discussion and giving written information are helpful to
clients but are not going to promote development of trust in the same way that making plans
and carrying them out would do.

OBJ: 3 TOP: Develop Mutual Trust
3. An adult female client is exhibiting behavior that the nurse interprets as anger toward another
client. What is the nurse’s best action?
a. Continue to monitor the client’s behavior and document it as anger directed toward

another client
b. Talk with the client about the observations made, and ask whether she was
displaying anger toward the other client
c. Ask the other client if she felt that the client was angry at her
d. Ask the client to write in a journal the emotions she was feeling at that time
ANS: B
Asking the client is an effective way of understanding the meaning of her behavior and is one
of the principles of mental health care. Documentation of the nurse’s interpretations without
clarification would not be appropriate, nor would involving another client by asking for her
interpretation of the situation. Asking the client to write in a journal is fine, but not in this
circumstance.

OBJ: 3 TOP: Explore Behaviors and Emotions
4. A nurse and an adolescent female client develop a plan of care together that addresses the
client’s difficult relationship with her parents. The client says that her parents just don’t
understand her, and she is always getting privileges taken away for not doing things that she is
supposed to do. What is the nurse’s best action?
a. Talk with the client about how important it is that she carry through with actions
that her parents feel are important
b. Identify two priority responsibilities that are agreed upon between the client and
her parents, and monitor her ability to comply with the plan for 1 week
c. Discuss with the parents what responsibilities they feel are important, to determine
what actions should be planned with the client
d. Identify what the client feels are reasonable responsibilities
ANS: B
Responsibility is one of the principles of mental health care that should be fostered. It is
important to work in conjunction with all involved parties to set a realistic goal and plan of
action. Remaining options do not include all parties and do not set a realistic goal or plan.

OBJ: 3 TOP: Encourage Responsibility
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step:
Evaluation MSC: Client Needs: Psychosocial Integrity
5. __________ coping mechanisms are means of successfully solving a problem or reducing

one’s stress level.
a. Defensive
b. Maladaptive
c. Constructive
d. Individual
ANS: C
Constructive, or adaptive, coping mechanisms are effective because they deal with the
problem to attempt to solve it and in turn reduce stress. Defensive and maladaptive
mechanisms do not deal with the problem effectively. Individual coping mechanisms may or
may not be effective.


OBJ: 3 TOP: Encourage Effective Adaptation
6. A married woman, who is the mother of two children, has been in an abusive relationship for
4 years. She decides to leave her husband after suffering an episode of severe physical abuse.
She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurse’s
priority intervention?
a. Offer immediate emotional support
b. Refer her to a woman’s domestic abuse center
c. Begin to develop a treatment plan for the client and her children
d. Thoroughly assess the situation from the most recent abusive episode to 2 weeks
prior to this incident
ANS: A
All of the options are steps in the crisis intervention process, but emotional support is the first
priority for helping to reduce high anxiety levels.

OBJ: 5 TOP: Crisis Intervention
7. A male client with the diagnosis of depression has not attended his last two group meetings.
The nurse provides a printed schedule of meeting dates and times to the client the next time
she sees him. The nurse’s actions can be described as:
a. Insight
b. Self-awareness
c. Empathy
d. Client advocacy
ANS: D
Advocacy is when the nurse works on behalf of the client by providing him with the tools
needed to make decisions. It is especially important to be an advocate for clients with mental
health disorders because it often is difficult for them to make informed decisions. Insight
refers to the ability to see intuitively, self-awareness is looking into and analyzing oneself, and
empathy encompasses the ability to understand and enter into another person’s emotions. All
of the options listed are skills needed if mental health care workers are to practice effectively.

OBJ: 9 TOP: Caring KEY: Nursing Process Step: Intervention
8. An adolescent female client continually displays a negative attitude toward everyone she
comes into contact with and toward life in general. Which action should the nurse implement
first that will be helpful in assisting this client to develop a more positive attitude?
a. Helping the client recognize negative thoughts, emotions, and attitudes
b. Pointing out every negative behavior that the client displays
c. Assisting the client to replace negative thoughts by frequently repeating positive
statements
d. Praising positive behavior exhibited by the client
ANS: A

The nurse must help the client to identify negative thoughts, emotions, and attitudes before the
client can concentrate on changing this behavior. Pointing out every negative behavior would
not be therapeutic, and assisting the client to replace negative thoughts and praising positive
behavior promote development of a positive attitude but do not constitute the first step.

OBJ: 10 TOP: Positive Outlook
9. A caregiver is said to be practicing __________ care not only when she takes into
consideration the client’s actual or potential problems but also when she considers the client’s
family, work responsibilities, and social aspects of life. Which of the following best describes
this caregiving concept?
a. Competent
b. Complete
c. Holistic
d. Crisis
ANS: C
Holistic care encompasses all aspects of an individual. Competent care and complete care are
essential, but neither is the best choice to answer the description in this question. Crisis
intervention components are not addressed in this scenario.

OBJ: 3 TOP: Accept Each Client as a Whole Person
10. A client is believed to have adapted to a situation when he or she exhibits which
characteristic?
a. The client has become accustomed to his or her surroundings.
b. The client has shown improvement in behavior as evidenced by the ability to carry
out activities normal to his or her life.
c. The client has accepted his or her current behavior patterns.
d. The client has established a trusting relationship with the caregivers who are
providing care.
ANS: B
Adaptation, in mental health terms, is best shown in the client’s improved behavior and ability
to carry out activities normal to his or her life; this displays effective coping skills. The other
options do not show complete adaptation.

11. One of the goals of therapy established with a client on a mental health unit who has been
given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of
stability in his environment. Much of his OCD behavior manifests as cleanliness and control
of germs. Which nursing intervention most likely would help this client to feel more stable in
his environment?
a. Encouraging visits from family members and friends

b. Rewarding him for acceptable behavior by increasing the number of times he is

allowed to clean his bathroom daily
c. Encouraging him to participate in group activities
d. Allowing him to wash his hands only for an agreed upon number of times daily
ANS: D
Setting limits for clients with mental health disorders helps them to feel more stable in their
environment because these clients often are incapable of setting limits on their own.
Encouraging family visits may be beneficial for needs of comfort and love but not for
stability. Rewarding this client by allowing him to increase the number of times he may clean
the bathroom does not provide for stability because it fosters inconsistency in rules and
routines. Encouraging group activities is beneficial for diversional purposes and love and
belonging needs but does not best address the stability issue.

OBJ: 6 TOP: Provide Consistency
12. Which is the best way that a nursing unit manager can assist his or her staff in maintaining a
professional commitment to their job and profession?
a. Frequently offering and requiring a specific number of hours of in-service training
on new care modalities within the facility
b. Requiring out-of-facility continuing education hours twice a year
c. Encouraging staff to subscribe to nursing journals to keep up-to-date on new
information
d. Keeping nursing journals on the unit for easy access to staff
ANS: A
Professional commitment is accomplished by keeping current with developments within one’s
profession, improving therapeutic effectiveness, and seeking out new knowledge. Offering
and requiring in-service training is the easiest way to seek new knowledge and remain current
in the profession, while at the same time making the staff accountable to attend a certain
number of sessions.

OBJ: 9 TOP: Commitment
13. The nurse is working with a male client to instill a feeling of self-commitment, to improve his
self-esteem. From which of the following interventions would the client most benefit?
a. Having the client promise himself that he will do the best he can in a particular
situation, knowing that failure is a possibility
b. Encouraging the client to do the best he can in any given situation, while
reminding him that failure is a possibility
c. Ensuring that the client limits activities to those in which he is sure to be
successful
d. Allowing the client to set goals that are nearly impossible to achieve but giving
him the opportunity to try his best to meet these goals
ANS: A

Having the client promise himself, with the knowledge that failure is a possibility, is the most
beneficial option because it is making the client active in the process and is also the most
realistic approach. Simply encouraging the client does not make the client active in the
situation. Ensuring that the client limits activities to those in which he will be successful is too
protective. Allowing the client to set nearly impossible goals is setting him up for failure.

OBJ: 7 TOP: Risk Taking and Failure
14. The nurse is working with a health care team with the philosophy of reality therapy. The nurse
is aware that the team’s belief is centered around:
a. Reorientation of the client to his or her environment
b. Describing clients as irresponsible rather than mentally ill
c. Looking at the client’s past in determining how it has affected present behavior
d. Accepting the client’s perceptions of right and wrong behavior in the development
of his treatment plan
ANS: B
Reality therapy focuses on responsibility and does not accept the premise of mental illness.
Reality therapists look at the present and future and do not look to the past for excuses for
behavior. Reality therapy also emphasizes the morality of behavior and does not allow the
client’s own interpretation of right and wrong.

OBJ: 6 TOP: Encourage Responsibility
15. A busy community mental health center treats a client who is in crisis. The client is provided
with instruction on relaxation exercises, but throws them away. Two weeks later the staff is
dismayed when the client returns with her condition worsened. This lack of success after the
previous visit is due to which of the following factors?
a. Disorganization
b. Pseudoresolution
c. Self-awareness
d. Lack of commitment
ANS: B
The client and health care provider did not address the cause and opportunity for growth. This
is termed pseudoresolution. Disorganization is preoccupation with the crisis situation. Self-
awareness and lack of commitment are not considered in crisis.

16. A client is monopolizing a group session, not allowing other members to participate. What is
the most appropriate way to address the client?
a. “You are not allowed to speak for the remainder of the session.”
b. “You are selfish and must leave now.”
c. “You are very rude when you act this way.”

d. “You need to stop this behavior. Let’s see what others have to say.”
ANS: D
Accepting the client does not mean accepting the behavior. Communication must focus on
correcting the behavior and not the person. The other options focus on the person and not the
behavior.

OBJ: 3 TOP: Skills for Mental Health Care: Acceptance
17. The night before her final exam, the nursing student cannot sleep and is convinced she will
fail. Which of the following actions will help to promote a more positive outlook?
a. Continue to study rather than attempting to sleep
b. Accept the possibility of failure and plan to repeat the course
c. Use the negative thoughts as motivation
d. Visualize staying relaxed during the exam and successfully passing
ANS: D
One of the actions in maintaining a positive attitude is to visualize a positive image. Actual
level of confidence grows each time an image of self-assurance is projected. The other options
do not project positive self-image.

OBJ: 10 TOP: Positive Outlook: Develop a Positive Attitude
18. A client with frequent re-admissions to the inpatient unit refuses to eat or participate in
activities. The nurse functions as the client advocate by which of the following actions?
a. Respecting the client’s wishes by taking food away and leaving the room door
closed
b. Scolding the client as a way to motivate a change in behavior
c. Providing consistent encouragement to attend activities and having food available
d. Ignoring the client and encouraging other health care team members to do the same
ANS: C
Advocacy is the process of providing the client with information, support, and feedback
needed to make a decision, and the obligation to act in the best interest of the client. The other
options to do not demonstrate advocacy and caring behaviors.

OBJ: 3 TOP: Skills for Mental Health Care: Caring
MULTIPLE RESPONSE
1. Identify the stages experienced by a person in a crisis. (Select all that apply.)
a. Recovery
b. Adaptation
c. Disorganization
d. Crisis

e. Denial
f. Reorganization
g. Perception
h. Exhaustion
ANS: A, C, D, E, F, G
These are the typical stages that a person in crisis experiences. The stages usually occur in the
order of perception, denial, crisis, disorganization, recovery, and reorganization.

2. Which of the following are signs that indicate that the mental health nurse is becoming overly
involved with a client’s care? (Select all that apply.)
a. Knowing when to help and when not to help a client
b. Showing greater levels of concern for one client over all other clients
c. Feeling that the nurse is the only caregiver who understands the client
d. Being committed to providing competent health care at all times
ANS: B, C
Showing greater levels of concern for one client over all other clients and the nurse’s feeling
that he or she is the only caregiver who understands the client are signs that indicate the
development of a co-dependency with a client that can result from over-involvement of the
practitioner with a particular client. The other options describe qualities needed to provide
effective health care.

OBJ: 8 TOP: Boundaries and Overinvolvement
3. An important component of providing good care is for health caregivers to take care of, or
nurture, themselves. Which of the following are ways that effectively assist health caregivers
to nurture themselves? (Select all that apply.)
a. Be supportive of colleagues
b. Recognize and accept one’s own limitations, and strive to improve
c. Take pride in oneself
d. Accept all challenges presented
e. Be responsible and accountable for one’s own actions
ANS: A, B, C, E
Caregivers are constantly serving as client advocates, but they must be careful to avoid
expending their energies without renewing energy. A caregiver cannot provide quality health
care unless he first takes care of himself. One does not have to take on all challenges
presented to him because this can be exhausting to an individual.

OBJ: 10 TOP: Principles and Practices for Caregivers

4. A recently widowed 74-year-old male is seen in the mental health clinic for sleep disorders
and depression. Which of the following nursing actions demonstrate caring? (Select all that
apply.)
a. Providing a private place to interview the client
b. Delegating other tasks to a colleague while speaking to the client
c. Addressing the client as “honey” to provide comfort
d. Asking about the client’s daily activities and hobbies during the interview
e. Listening intently to the client’s responses and not being distracted by his
nonverbal communication
ANS: A, B, D
Providing a private place to talk and making oneself available with no distractions are ways of
demonstrating caring. In addition, showing interest in the whole person, not only the
diagnosis, is a therapeutic action. Addressing the client as “honey” without being instructed to
by the client does not convey respect and caring. Watching for nonverbal messages, not
ignoring them, is also therapeutic.

OBJ: 3 TOP: Principles and Practices for Caregivers: Caring
COMPLETION
1. __________ mechanisms are thoughts or actions that are used to help individuals handle or
reduce stress.
ANS:
Coping
Coping mechanisms provide a way for people to deal with stress. Coping mechanisms are
effective as long as they are not continually used by an individual when faced with stressful
situations.

OTHER
1. Place in the proper order the steps in the process of growing as a result of failure.
a. Consider one’s failure as a learning experience
b. Give oneself permission to fail
c. Understand that failure is a necessary part of change
d. Discover opportunities that are created by failure
ANS:
C, B, A, D

For a person to grow, he or she must take risks. Taking risks allows the possibility that failure
may occur. It is important to educate clients and to ensure that they understand that failure is
not a negative occurrence; rather, it provides the opportunity for change.

OBJ: 7 TOP: Risk Taking and Failure

Chapter 09: Mental Health Assessment Skills

MULTIPLE CHOICE
1. The nurse asks the client a series of questions upon entry into a mental health care system.
This action is an example of which phase of the nursing process?
a. Evaluation
b. Assessment
c. Intervention
d. Planning
ANS: B
Assessment is the phase of the nursing process during which data collection occurs. It is
performed not only upon admission into a facility but throughout the care of the client.
Evaluation is the phase during which goals are evaluated to determine whether they have been
met, partially met, or not met at all; intervention is the phase of the nursing process when
planned interventions are actually implemented; planning is the phase of the nursing process
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when client goals are set and interventions are planned.
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OBJ: 2 TOP: Nursing Therapeutic Process
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2. A nurse administers antidepressant medication to a client in an assisted-living facility. This is
an example of which phase of the nursing process?
a. Intervention
b. Assessment
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c. Planning
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d. Diagnosis
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ANS: A
Intervention is the phase of the nursing process during which planned interventions are
actually implemented. Assessment is the phase of the nursing process when data collection
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occurs. Planning is the phase of the nursing process when client goals are set and
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interventions are planned. Diagnosis is the phase of the nursing process following assessment
when the client’s problem is identified.

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3. Following completion of a male client’s series of group therapy sessions, the nurse
periodically talks with the client to determine whether he has any signs of relapse of his
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previous problems. This action by the nurse is an example of:

a. Planning
b. Assessment
c. Intervention
d. Diagnosing
https://www.coursehero.com/file/28033073/chapter-9-metal-health-assessmentdoc/

ANS: B
In this situation, the nurse is assessing for any signs of relapse. Assessment is a continuous
process. Planning is the phase of the nursing process when client goals are set and
interventions are planned; intervention is the phase of the nursing process when planned
interventions are actually implemented; and diagnosis is the phase of the nursing process
following assessment when the client’s problem is identified.

4. During a session with a female client with a diagnosis of social phobia, she talks about how
proud she is of herself because she was finally able to shop at the grocery store. The nurse
documents the events and knows that this would be considered which phase of the nursing
process?
a. Assessment
b. Planning
c. Intervention
d. Evaluation
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ANS: D
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This client has accomplished a goal; therefore, this would be considered evaluation.
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Assessment is the phase of the nursing process when data collection occurs; planning is the
phase of the nursing process when client goals are set and interventions are planned; and
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intervention is the phase of the nursing process when planned interventions are actually
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implemented.

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KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
aC s
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5. The treatment team meets with a client for the first time and determines, with the client’s
input, a nursing diagnosis, goal, and steps to reach this goal. In addition to a nursing
diagnosis, the treatment team has completed which phase of the nursing process?
a. Evaluation
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b. Intervention
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c. Planning
d. Assessment
ANS: C
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During the planning phase, goals are established and a plan is developed. Evaluation is the
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phase in which goals are evaluated to determine whether they have been met, partially met, or
not met at all; intervention is the phase of the nursing process when planned interventions are
actually implemented; and data collection occurs during the assessment phase.
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KEY: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

6. Without assessment of six specific aspects of an individual’s being, the mental health nurse’s
scope of care is narrow and limited in effectiveness. These aspects include social, physical,
cultural, intellectual, emotional, and spiritual areas of a person’s life, known as a __________
assessment.
a. Complete
b. Accurate
c. Holistic
d. Psychiatric
ANS: C
Although the other options do address some of these aspects, holistic more accurately
describes these six aspects of an individual’s life. The psychiatric assessment tool specifically
addresses the problems that are being experienced, coping mechanisms, and resources of the
client.

OBJ: 4 TOP: About Assessment
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7. The nurse is reviewing information regarding a female client that was obtained with the
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psychiatric assessment tool. The client’s ability to provide food and shelter for herself is
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included in which area of the assessment?
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a. Appraisal of health and illness
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b. Coping responses, discharge planning needs
c. Knowledge deficits
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d. Previous psychiatric treatment
ANS: B
The client’s ability to care for herself outside of the facility would be considered when her
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discharge planning needs are assessed, to determine whether other resources will be necessary.
aC s
The other options are included in the psychiatric assessment tool but do not focus on
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discharge planning. Appraisal of health and illness focuses on the client’s perception of health
care and identification of problems and goals; knowledge deficits focus on areas such as
medications and coping skills; and previous psychiatric treatment focuses on the client’s
psychiatric history, including family history.
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OBJ: 4 TOP: Assessment Process
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8. During an interview with a 15-year-old female client admitted for depression, the nurse is
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disappointed to learn that the client recently became pregnant and had an abortion. The nurse
is contradicting the effective interview guideline of:
a. Paying close attention to the client’s nonverbal communication
b. Avoiding making assumptions
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c. Avoiding one’s personal values that may cloud professional judgment

d. Setting clear client goals
ANS: C

This is an example of the nurse allowing his or her personal values to cloud professional
judgment and is an ineffective interview technique that leads to a negative nurse-client
relationship. The other options are good interview techniques but do not represent this
situation.

OBJ: 5 TOP: Effective Interviews
9. A male client with a history of schizophrenia was admitted to the mental health facility after
he was found on the street confused and uncooperative when approached by the police. One of
the first assessments that should be performed on this client upon admission is a:
a. Physical assessment
b. Sociocultural assessment
c. Psychosocial assessment
d. Psychiatric assessment
ANS: A
Physical problems frequently are overlooked when someone has a diagnosed mental health
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disorder. These physical problems often can be the cause of symptoms and may be easily
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treated. For example, low blood sugar, rather than schizophrenia, could be a cause of the
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symptoms described in this scenario. For this reason, physical examinations are always
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performed on admission to a mental health facility, followed by the other options listed.
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PTS: 1
OBJ: 6 rs e
DIF: Cognitive Level: Application
TOP: Physical Assessment
REF: p. 96
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10. During the mental status examination, the nurse observes that the client rapidly changes from
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one idea to another related thought. Which disordered thinking process is the client
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displaying?
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a. Delusions
b. Perseveration
c. Confabulation
d. Flight of ideas
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ANS: D
It is difficult to follow a conversation with an individual who is experiencing flight of ideas
because the conversation follows his rapidly changing thought pattern. Delusions result in
false beliefs that cannot be corrected by logical explanations or reasoning; perseveration
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occurs when the client repeats the same word response to different questions; and with
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confabulation, the client uses untrue statements to fill in gaps of memory loss.

OBJ: 9 TOP: Thinking KEY: Nursing Process Step: Assessment
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11. When reviewing the nursing notes from the previous shift, the nurse notices notations
indicating that the client was experiencing a somnolent level of consciousness. The client’s
behavior would be described as:
a. “Falling asleep easily and only awakening with strong verbal stimuli”

b. “Frequently sleeping and awakening only to strong physical stimuli”

c. “Unresponsive to any verbal or painful stimuli”
d. “Having alternating periods of excitability and drowsiness”
ANS: A
Falling asleep easily and waking only to strong verbal stimuli describes the level of
consciousness known as somnolent, which also can be called a state of drowsiness. Frequently
sleeping and waking only to strong physical stimuli describes a stuporous state,
unresponsiveness to verbal or painful stimuli is a comatose state or unconsciousness, and
alternating periods of excitability and drowsiness describes a lethargic state.

OBJ: 9 TOP: Sensorium and Cognition
12. During the mental status assessment, the nurse hands the client a piece of paper that reads
“Please raise your left hand.” If the client follows the command, the nurse has just assessed
which ability of the client?
a. Abstract thinking
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b. Reading
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c. General knowledge
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d. Memory
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ANS: B
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This is an easy method of assessing the client’s reading ability and is less anxiety provoking
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than having the client read aloud. Abstract thinking is assessed by methods such as assessing
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the ability of the client to understand similarities; general knowledge can be assessed by
asking questions such as how many months are in a year or discussing current events; and
memory can be assessed by testing immediate, recent, and remote memory.
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aC s

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OBJ: 9 TOP: Sensorium and Cognition

13. A nurse educates a client on medication side effects and verbal feedback of understanding is
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given by the client. Which phase of the nursing process is being described?
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a. Planning
b. Intervention
c. Assessment
d. Evaluation
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ANS: D
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This phase determines the effectiveness of the care. Clients are encouraged to become partners
in their care.

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14. Components of the sociocultural assessment include a history interview for the purpose of
obtaining information about a client’s background and:
a. Observing the client’s appearance, behaviors, and attitudes

b. Eliciting answers related to general health, past illnesses, and hospitalizations

c. Encouraging description of lifestyle and activities of daily living
d. Reviewing physical assessment data and various diagnostic examinations
ANS: A
The sociocultural assessment focuses on the cultural, social, and spiritual aspects of an
individual. During the history interview, the care provider obtains information about a client’s
background and observes the client’s appearance, behaviors, and attitudes.

OBJ: 1 TOP: Sociocultural Assessment
15. A client with a history of delusions demonstrates which of the following behaviors?
a. Shifts from laughing to crying with no apparent cause
b. Insists the government is out to harm him
c. Has trouble remembering what he had for breakfast
d. Expresses a constant fear of dying
ANS: B
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Delusions are false beliefs that cannot be corrected by reasoning or explanation. A constant
fear of dying is an example of an obsession, shifting from laughing to crying for no reason
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demonstrates the inappropriate response of being labile, while having trouble remembering is
indicative of amnesia.
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PTS: 1 rs e
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OBJ: 8 TOP: Disorders of Thinking
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16. A client complains to the nurse that he has been fired from his fourth job in 10 months
because his bosses and co-workers “didn’t understand him.” While he once had a few close
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friends, he no longer associates with them for the same reason. His level of functioning on the
Global Assessment of Functioning Scale would be:
a. 71-80; transient symptoms
b. 61-70; some mild symptoms
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c. 41-50; serious symptoms

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d. 1-10; persistent danger of hurting self or others

ANS: C
The Global Assessment of Functioning Scale score of serious symptoms (41-50) is defined as
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a serious impairment in social, occupational, or school functioning; no friends; and an

inability to keep a job.
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OBJ: 8 TOP: Disorders of Thinking
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17. The nurse suspects the client is experiencing a manic episode based on which of the following
observations?
a. Clothing is very colorful and mismatched, and client cannot sit in chair during
interview
b. Hair is not combed, clothing is dirty, and client has no interest in surroundings

c. Client repeatedly washes her hands and picks at a button on her shirt
d. Client expresses fear that someone is waiting outside the room to harm her
ANS: A
It is not uncommon for manic clients to dress in colorful clothing and have excessive body
movement. Clients who look unkempt and neglected are more common in depression.
Repeated behaviors and picking at clothing are often seen in obsessive-compulsive disorders.

OBJ: 8 TOP: Mental Status Assessment: General Appearance
18. A client seen in the emergency department is noted to be stuporous. Which of the following
assessment findings would be of most concern?
a. Elevated blood pressure
b. Elevated cholesterol levels
c. New exercise routine
d. Painting furniture in a windowless room
ANS: D
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Assessing lifestyle, occupational/lifestyle factors of chemicals such as paint in the workplace
can impact function. Elevated blood pressure, elevated cholesterol, and exercise would not
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result in stupor in the client.
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OBJ: 9 rs e
TOP: Mental Status Assessment: Health History for Mental Health Clients
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MULTIPLE RESPONSE
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aC s
1. Upon entrance into a mental health care system, clients are thoroughly assessed, and this is
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followed by the development of a mental health treatment plan. Which of the following are
purposes of the treatment plan? (Select all that apply.)
a. Proof of care for insurance reimbursement purposes
b. A means of monitoring the client’s progress
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c. An instrument for communication and coordination of care

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d. A guide for planning and implementation of care

e. Evaluating the effectiveness of interventions
ANS: B, C, D, E
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Purposes of the treatment plan include serving as a means of monitoring the client’s progress,
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acting as an instrument for communication and coordination of care, serving as a guide for
planning and implementation of care, and providing a way to evaluate the effectiveness of
interventions. Documentation for reimbursement purposes is not a primary goal of the
treatment plan.
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OBJ: 1 TOP: Mental Health Treatment Plan

2. The assessment phase of the nursing process refers to the phase when data collection occurs.
Which methods does the nurse use to collect data? (Select all that apply.)
a. Interpreting client behaviors
b. Interviewing the client and significant others
c. Observing client behavior
d. Performing physical assessment
e. Reviewing diagnostic testing results
ANS: B, C, D, E
Interviewing the client and significant others, observing client behavior, performing a physical
assessment, and reviewing diagnostic testing results are effective ways of collecting data.
Interpreting a client’s behavior should never occur without clarification because interpretation
often is incorrect.

OBJ: 3 TOP: Data Collection
3. During the sociocultural assessment of a client who is entering a mental health program, the
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nurse focuses on which information related to the client? (Select all that apply.)
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a. Education
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b. Income
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c. Ethnicity
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d. Age
e. Gender
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f. Medications
g. Previous diagnoses
h. Belief system
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ANS: A, B, C, D, E, H
aC s
Medications and previous diagnoses are not part of the sociocultural assessment.
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4. Short-term memory loss is seen in which of the following disorders? (Select all that apply.)
a. Depression
b. Dissociative disorder
c. Conversion disorder
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d. Alzheimer’s
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e. Anxiety
ANS: A, D, E
Loss of recent memory is seen in persons with Alzheimer’s disease, anxiety, and depression.
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Dissociative and conversion disorders cause long-term memory loss.


COMPLETION
1. __________ is how the client displays his or her emotions through facial, vocal, or gestural
behavior.
ANS:
Affect
A person’s affect usually is termed appropriate, inappropriate, pleasurable, or unpleasurable

by determining whether the affect matches the emotions of the states he or she is feeling.

OBJ: 8 TOP: Emotional State
OTHER
1. List the five steps of the nursing process in proper order.
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ANS:
Assessment, nursing diagnosis, planning, intervention, evaluation
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The steps of the nursing process provide a means of addressing problems identified as
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affecting the client. Assessment is ongoing, the nursing diagnosis is the identification of client
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problems, and client goals are set during the planning phase. Interventions are determined and
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then implemented. Lastly, goals are evaluated to determine whether they have been met,
partially met, or not met at all. In the latter two evaluation results, the plan of care must be
reevaluated and revised.
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KEY: Nursing Process Step: Intervention MSC: Client Needs: Health Promotion and Maintenance
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Chapter 10: Therapeutic Communication

MULTIPLE CHOICE
1. A male client with a diagnosis of schizophrenia begins to have hallucinations during a

conversation with the nurse; this prevents him from receiving the message that the nurse is
trying to communicate to him. According to Ruesch’s theory of communication, this
unsuccessful interaction is called:
a. Disturbed communication
b. Nontherapeutic communication
c. Blocked communication
d. Therapeutic communication
ANS: A
Ruesch called this type of interrupted communication disturbed communication. In addition to
interference with receiving a message, as in the case of this client, the term applies to
interference with the sending of messages, problems in language between people, insufficient
information, and lack of the opportunity for feedback. Ruesch’s theory did not coin the term
nontherapeutic or blocked communication, and this interaction would not be considered
therapeutic.

OBJ: 1 TOP: Ruesch’s Theory
2. The theorist Eric Berne theorized that an individual’s three ego states of parent, child, and
adult make up one’s:
a. Conscience
b. Personality
c. Thought processes
d. Ability to communicate
ANS: B
The three ego states, according to Berne, make up an individual’s personality. The parent ego
focuses on rules and values, the child ego focuses on emotions and desires, and the focal point
of the adult ego is previous observations. He did not address any of the other three options.

OBJ: 1 TOP: Transactional Analysis
3. The nursing student is assigned a client to interview and is asked to practice the therapeutic
communication technique of sharing perceptions. Which statement made by the student nurse
best describes this technique?
a. “I noticed that you pace the halls, and you have a tense look on your face. I sense
that you are anxious about something.”
b. “Can you tell me more about how you feel when you are arguing with your
daughter?”
c. “I would like to talk with you about your plan of care.”

d. “Tell me if I understand you correctly.”

ANS: A
Sharing perceptions lets the client know that you are listening and ensures that you understand
what he or she is communicating. Asking the client to describe how he or she feels when
arguing with his or her daughter describes focusing. Speaking to the client about the plan of
care describes informing, and the nursing student is using clarification when asking whether
he or she understands the client correctly.

OBJ: 7 TOP: Interacting Skills
4. The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The
client alludes to the fact that he started to drink again after a fight with his wife. The nurse
uses clarification to ensure an accurate understanding of the client. Which statement is the
best example of clarification?
a. “You said that the fight you had with your wife caused you to start drinking
again?”
b. “Let’s discuss what made you feel the need to drink.”
c. “Could you tell me again when and what happened that you feel caused you to
start drinking again?”
d. “Tell me what your childhood was like.”
ANS: C
Clarification helps to confirm feelings, ideas, and perceptions. The other options are examples
of restating, focusing, and changing the topic.

5. A female client discusses her feelings of jealousy regarding the relationship between her
mother and her daughter. The nurse responds in a nontherapeutic way by making a statement
that is defensive and challenging. Which statement is the best example of a defensive and
challenging nontherapeutic response?
a. “Tell me more about the feelings you have regarding their relationship.”
b. “I think that you should tell them how you feel.”
c. “Let’s not talk about that right now.”
d. “Don’t you think that you should be thankful that your daughter has a good
relationship with her grandmother?”
ANS: D
Defensive, challenging statements such as this one will block communication with the client
because she will feel that she needs to respond defensively and answer to the nurse for her
feelings. The therapeutic communication response that includes a broad opening statement is
used when the nurse asks the client to tell more about her feelings. When the nurse tells the
client that she should tell the mother and daughter how she feels, it describes giving advice.
The nurse uses the nontherapeutic technique of belittling the client when the nurse states that
the client’s feelings are childish.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 111-112

OBJ: 7 TOP: Nontherapeutic Messages

6. A female client has been attending group therapy for support regarding an abusive relationship
with her husband. The client voices concern about her 10-year-old daughter growing up in this
environment but states that she just can’t find the strength to leave her husband. The nurse
responds by using the nontherapeutic technique of reassuring. Which statement is the best
example of this nontherapeutic technique?
a. “I can’t believe that you would want your daughter to grow up in this
environment.”
b. “I understand your concern. Let me give you some information on our local
council for domestic abuse.”
c. “I’m sure it won’t be that bad to be out on your own. I know you can do it.”
d. “I think you should not think about leaving and should just do it.”
ANS: C
This is an example of the nontherapeutic technique of falsely reassuring the client. It
dismisses the client’s concerns and does not support her. The nurse is showing disapproval in
stating that she “can’t believe” that the client would want her daughter to grow up in such an
environment. The nurse gives an appropriate therapeutic statement when she acknowledges
the client’s concern and then provides the client with helpful information. The nurse is giving
advice in offering her thoughts that the client should just leave.

7. Therapeutic communication techniques support effective communication between the client

and the nurse. Which group of therapeutic techniques is most likely to be effective when one
is conversing with a client?
a. Broad openings, restating, and advising
b. Clarification, focusing, and confrontation
c. Listening, silence, and reflection
d. Humor, informing, and reassuring
ANS: C
The techniques of listening, silence, and reflection are all therapeutic. Advising, confronting,
and reassuring are all examples of nontherapeutic techniques.

8. While the nurse is talking with a female client, the client becomes silent for several seconds.
Which is the nurse’s best response?
a. To interpret this action as an indication that the client is finished with the
conversation
b. To ask the client a question so the interaction can continue
c. To remain silent and be attentive to the client’s nonverbal communication
d. To tell the client that help can be more effective if she shares her feelings
ANS: C

This is an example of the therapeutic communication technique of silence. It allows the client
time to collect her thoughts. Although most people want to talk away the silence, it is
important for the caregiver to become comfortable with the effective technique of silence. The
three incorrect options prevent silence from occurring.

9. A client who usually is very active in her therapy group tells the nurse that she really does
“not feel well today” and would “rather not attend the group therapy session.” Which is the
nurse’s most appropriate response?
a. “You don’t feel like attending the group therapy today?”
b. “I will just stay with you for a while.”
c. “It’s okay to skip a session every once in a while.”
d. “Why don’t you want to attend group therapy?”
ANS: A
The nurse is restating what the client said, which verifies what the client communicated and
lets the client know that the nurse listened and understood her. The client did not ask the nurse
to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session
is giving advice and is not conveying an understanding of what the client really said. Asking
the client why she doesn’t want to attend group therapy clearly conveys that the nurse did not
listen to what the client communicated.

10. The nurse is talking with a male client with a diagnosis of schizophrenia who often
experiences auditory hallucinations. For this communication to be most effective, the nurse
should:
a. Sit with the client and encourage him to not verbalize
b. Do most of the talking
c. Discuss several different topics to keep the client’s attention
d. Use simple, concrete language
ANS: D
Because this client has been given the diagnosis of schizophrenia and frequently has auditory
hallucinations, his perception of the communication must be considered. Use of simple,
concrete language will assist the client in following the conversation without having to
interpret what the nurse means during the interaction. Encouraging the client not to verbalize
and doing most of the talking do not allow the client to express himself, and discussing
several different topics will be confusing and may cause the client undue stress during the
interaction.

OBJ: 8 TOP: Verbal Communication

11. The nurse’s ability to interpret communication effectively in the mental health setting depends
mostly on:
a. How well the client communicates
b. The nurse’s relationship with the client
c. The nurse’s understanding of mental health disorders
d. The nurse’s ability to listen to and observe the client’s verbal and nonverbal
messages
ANS: D
Accurate interpretation of the client’s communication cannot occur if the nurse does not listen
to and observe the client. It is not dependent on how well the client communicates because the
nurse has no control over the client. The nurse’s relationship with the client and understanding
of mental health disorders are important but will not supersede good observation and
listening.

OBJ: 6 TOP: Therapeutic Communication Skills
12. Which nurse response is the best example of the therapeutic principle of respect?
a. “I’m interested in what you have to say.”
b. “Describe how you are feeling for me.”
c. “I hear how worried you are about your future and can imagine how you feel.”
d. “You signed a contract stating that you would let me know when you have those
thoughts.”
ANS: C
Although all of these responses are examples of therapeutic principles, this option best
describes respect because it shows consideration and acceptance. The other options convey
interest, the principle of concreteness, and honesty.

13. A female client is being discharged from an inpatient mental health unit after receiving
treatment for bipolar disorder. She has responded well to treatment but voices concern about
going home and maintaining balance in her life. The client would benefit most by a response
from the nurse that conveyed the therapeutic communication principle of:
a. Permission
b. Respect
c. Interest
d. Protection
ANS: D
A protective response, such as “Let’s look together again at what we have planned for you
when you go home,” will help the client feel more confident in her ability to do well once she
is discharged. The other options are examples of therapeutic principles but do not address the
needs of this client at this time.


14. A nurse has just graduated from nursing school and has been hired on a mental health unit.
The nurse wants to practice good communication skills with clients but knows that a mistake
made by many new nurses in trying to communicate effectively involves:
a. Focusing
b. Parroting
c. Restating
d. Clarifying
ANS: B
Parroting is the extreme form of the therapeutic communication skill of restating. It becomes
very annoying to clients when the nurse continually repeats the client’s statements in an
attempt to show understanding of the client’s message. The other options are therapeutic
communication skills.

15. A client has difficulty in communicating as a result of his illness. He displays a rapid,
confusing delivery of speech patterns. Which term best describes this difficulty in
communicating?
a. Aphasia
b. Dyslexia
c. Speech cluttering
d. Incongruent communications
ANS: C
Rapid, confusing delivery of speech patterns is called speech cluttering and can result in the
client’s inability to focus on verbal communication as the main form of interaction. Aphasia
refers to the inability to speak, dyslexia refers to the mixing of letters when reading that
sometimes results in the mixing of syllables when speaking, and incongruent communications
occur when verbal messages do not match nonverbal messages.

OBJ: 8 TOP: Problems with Communication
16. When practicing therapeutic communication with a client, the nurse demonstrates which of
the following listening skills?
a. Finishing the client’s sentences to indicate listening
b. Not clarifying messages to avoid interrupting
c. Avoiding taking notes to detract from listening
d. Changing the environment to decrease distractions
ANS: D
Effective listening improves the ability to meet client needs. Changing the environment to
decrease distractions is a practice important to listening skills. Finishing the client’s sentences,
not clarifying messages, and avoiding taking notes are barriers to listening and may prevent
the nurse from picking up hidden messages, minimizing misunderstandings.


OBJ: 7 TOP: Problems with Communication
17. The nurse asks a client how she is feeling, and the client provides a detailed description of
everything she is experiencing. This is an example of:
a. Echolalia
b. Circumstantiality
c. Neologism
d. Perseveration
ANS: B
Circumstantiality is a speech pattern in which the client describes in too much detail and
cannot be selective. Echolalia is repeating the last word heard, neologism is the coining of
new words or expressions, and perseveration is the repeating of a single activity and the
inability to shift from one topic to another.

OBJ: 8 TOP: Speech Patterns Associated with Psychiatric Problems
18. The client tells the nurse that she believes there is no improvement in her manic episodes. Her
clothing matches and her makeup is more subdued. She sits quietly in the chair during the
session. What does this indicate?
a. Verbal communication takes priority
b. Verbal communication is not congruent with nonverbal communication
c. Nonverbal communication indicates the client is lying
d. Nonverbal communication should take priority
ANS: B
Verbal and nonverbal communication send and receive messages on every interaction. Neither
verbal nor nonverbal communication takes priority over the other. In this case the verbal
communication of the client that her episodes are not improving is belied by the obvious
improvement in her dress and behavior (nonverbal communication).

OBJ: 8 TOP: Levels of Communication
19. When asking the adolescent client about the magazine she is reading, she responds, “It’s an
article about my favorite movie star. Did you see all the stars out last night? I used to be afraid
of the dark at night.” Which speech pattern is this an example of?
a. Echolalia
b. Flight of ideas
c. Loose association
d. Neologism
ANS: C
Loose association is a pattern in which the speaker shifts between loosely related topics such
as a movie star, stars in the sky at night, and darkness at night.

OBJ: 8 TOP: Speech Patterns Associated with Psychiatric Problems

MULTIPLE RESPONSE
1. Which elements must be present for communication to occur? (Select all that apply.)
a. Feedback
b. Transmission
c. Sender
d. Clarification
e. Receiver
f. Focusing
g. Context
ANS: A, B, C, E, G
Feedback, transmission, sender, receiver, and context are the five elements that must be in
place for communication to occur. The sender transmits the message to the receiver, resulting
in feedback between them. The context, or setting, is where the communication takes place.
Clarification and focusing are types of therapeutic communication.

OBJ: 3 TOP: Process of Communication
2. Which interventions assist the nurse to effectively communicate with clients from other
cultures? (Select all that apply.)
a. The nurse adapts his or her behavior to accommodate the difference in
communication styles.
b. The nurse identifies and clarifies confusion during the interaction.
c. The nurse recognizes the difference between communication styles and assists the
client to change to the nurse’s communication style.
d. The nurse uses a limited number of slang terms when communicating with the
client.
ANS: A, B
Adaptation of behavior to accommodate differences in communication is effective because it
is less difficult for the nurse to adapt to differences in communication, as with the use of an
interpreter. Identifying and clarifying confusion prevents misinterpretation during the
interaction. Recognizing differences in communication style is correct, but assisting the client
to change to the communication style of the nurse is incorrect. Using a limited number of
slang words indicates that some slang terms are acceptable; however, no slang terms should be
used because these may block communication.

OBJ: 5 TOP: Intercultural Difference
3. Which nurse responses could block effective communication with a client? (Select all that
apply.)
a. “This is what I think you should say…”
b. “Don’t stress over it. Everything will turn out fine.”

c. “Why did you do that?”

d. “Most people in your circumstance…”
ANS: A, B, C, D
All of these options are nontherapeutic and should be avoided. When the nurse offers what she
thinks the client should say, she is giving the client advice. Telling the client not to stress is
giving the client false reassurance. Asking the question “Why did you do that?” will make the
client defensive. When the nurse says “Most people in your circumstance...,” she is
generalizing.

4. In order to be therapeutic when communicating with a client living in a homeless shelter, it is

important to apply which techniques? (Select all that apply.)
a. Show acceptance and respect
b. Avoid clarifying terms
c. Use medical terminology to avoid talking down
d. Consider the client’s environment
e. Assess the client’s pattern of verbal and nonverbal communication
ANS: A, D, E
Showing acceptance and respect, considering the client’s environment, and assessing verbal
and nonverbal patterns of communication are effective ways of communicating with clients of
different social classes. Avoiding clarifying terms and using medical terminology provide
barriers to communication.

OBJ: 6 TOP: Communicating with Clients of Different Social Classes
COMPLETION
1. __________ is the transferring between people of information, including ideas, beliefs,

feelings, and attitudes.
ANS:
Communication
For communication to be effective, information must be understood by all parties. Therapeutic

communication is necessary if the interaction between the nurse and the client is to achieve
successful outcomes.

OBJ: 1 TOP: Therapeutic Communication
OTHER

1. During the process of communication, a chain of events occurs as soon as the message is sent.
Steps in this chain include transmission, perception, and evaluation. Place these steps in
proper order.
a. Transmission
b. Perception
c. Evaluation
ANS:
B, C, A
Perception of the message happens first because it is the step when recognition of a message
occurs. Vision, hearing, and touch are used to perceive the message. Evaluation occurs next
and is the internal assessment of the message. The last step, transmission, consists of
conscious and unconscious responses to the message.

OBJ: 3 TOP: Process of Communication

Chapter 11: The Therapeutic Relationship

MULTIPLE CHOICE
1. The nurse is attempting to develop trust with a newly admitted female client for the purpose
of establishing a therapeutic relationship. The nurse is currently administering medications to
all clients on the unit. The newly admitted client asks the nurse to sit and talk with her for a
while. What is the nurse’s best response?
a. “I am busy right now, but I will come back later.”
b. “Give me just a few more minutes to finish passing medication to the other
clients.”
c. “I will return in 20 minutes so we can talk.”
d. “I have to finish giving all the clients their medications, but I will then come back
so we can talk.”
ANS: D
This is an honest statement that lets the client know exactly what the nurse is doing and helps
to build trust in that the nurse is not making up excuses or making false promises. The nurse’s
statement that she is busy right now would make the client feel unimportant. The nurse would
be making false promises if she were to say that she will be back in only a few minutes or
even in 20 minutes, because most likely it will take more than this amount of time to finish
giving out medications.

OBJ: 2 TOP: Trust KEY: Nursing Process Step: Intervention
2. A nurse is working with a male client in a mental health outpatient clinic. The client voices a
desire to become more autonomous. Which goal will assist the client in becoming more
autonomous?
a. The client will check his calendar each night to plan for commitments scheduled
on the following day.
b. The nurse will remind the client weekly of his appointment at the clinic for the
following week.
c. The client will ask the nurse to call him to remind him of his appointment.
d. The nurse will complete the client’s calendar of daily commitments scheduled for
the week.
ANS: A
Autonomy refers to the ability to direct and control one’s activities and destiny. Working
toward this goal is a simple way to begin to develop control over one’s life. Reminding the
client and completing the client’s calendar are nursing goals rather than client goals. If the
client asks the nurse to call him to remind him, no responsibility is placed on the client.

OBJ: 2 TOP: Autonomy KEY: Nursing Process Step: Planning

3. An important aspect of developing a therapeutic relationship with a mental health client is for
the nurse to show that she cares about the client. The nurse who is working on an inpatient
unit can show signs of caring by:
a. Telling a client several times a day that he or she cares about him or her
b. Asking a client what his or her favorite movie is and then showing that movie
during a movie night on the unit
c. Giving a client a card that has a sentiment that says the nurse cares about him or
her
d. Telling a client that he or she is the favorite client
ANS: B
Showing a favorite movie is a safe way of showing the client that you are aware of him or her
as an individual, rather than as just another client. If the nurse only tells the client that she
cares about him or her, it does not prove to the client that the nurse cares. Giving a client a
card or telling the client that he or she is a favorite is too personal and may mislead the client
regarding the development of a social relationship.

OBJ: 2 TOP: Caring KEY: Nursing Process Step: Intervention
4. The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of
many treatment methods, the one treatment that the client and the team have found to be most
effective is the medication lithium. The client voices concern about her future with this
diagnosis. Which nurse response best represents the concept of hope?
a. “You need to take your lithium unless you want to relapse.”
b. “You are doing so well that there is nothing you can’t do if you put your mind to
it.”
c. “You are doing very well since we found that lithium helps. You should do well as
long as you continue your therapy and medication.”
d. “A lot of people are much worse off than you are, so you should be thankful that
you are doing as well as you are.”
ANS: C
This option is realistic and provides hope without providing false hope. Stating that the client
will relapse if she discontinues medication suggests that the nurse is threatening the client,
which provides no hope. Telling the client that “there is nothing that you can’t do” may be
providing false hope. Reminding the client that others are worse off is disregarding the client’s
feelings.

OBJ: 2 TOP: Hope KEY: Nursing Process Step: Intervention
5. A male client with schizophrenia has lost his job and home and has been living in a homeless
shelter. He voluntarily admits himself into a mental health treatment facility. The client’s
current living situation and lack of a job at this time likely will contribute to his having
difficulty with which dimension of hope?
a. Affective
b. Contextual
c. Temporal

d. Affiliative
ANS: B
Although all the dimensions of hope listed in these options may be difficult for this client, the
dimension that is representative of the living and job situation for this client is contextual,
because this refers to inadequate physical, financial, and emotional resources.

OBJ: 2 TOP: Hope KEY: Nursing Process Step: Evaluation
6. A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient

setting and is attending group therapy sessions. She is working on controlling the compulsion
of touching her head three times every time she talks. To maintain the therapeutic relationship
established with the client, by which action can the nurse show acceptance?
a. Ignoring the compulsion during the group therapy session and talking with the
client privately about the behavior
b. Asking the group to remind the client every time she touches her head to help her
consciously stop the compulsion
c. Pointing out the compulsion to the group each time the client exhibits the behavior
d. Asking the client to stop talking during the group session until she has learned to
control her compulsion
ANS: A
Ignoring the behavior in group therapy shows acceptance of the behavior because the nurse
does not embarrass the client in front of the group. Talking with her privately shows
compassion for the client. Asking the group to remind the client of the compulsion and
pointing out the compulsion to the group could belittle the client. Asking the client to stop
talking would defeat the purpose of the support of belonging to a therapeutic group.

OBJ: 4 TOP: Acceptance KEY: Nursing Process Step: Intervention
7. The characteristic of genuineness helps in establishing a therapeutic relationship with a client.

Which nurse response is the best example of a display of genuineness to a client who is going
through a difficult divorce?
a. “I know exactly how you feel. My husband and I divorced 2 years ago because of
his infidelity.”
b. “Divorcing my husband was the best thing I ever did.”
c. “I have friends who have gone through a divorce. It must be difficult for you.”
d. “I am sorry that you have to go through this difficult time.”
ANS: C
This response shows the client sincerity and honesty, which are components of being genuine.
The nurse should not offer too much personal information, such as providing information
about her own divorce. When the nurse says that she is sorry that the client is experiencing the
difficult time, it is an example of a sympathetic response.

OBJ: 4 TOP: Genuineness KEY: Nursing Process Step: Intervention

8. During the preparation phase of a therapeutic relationship with a client, what is the main task
to be completed by the nurse?
a. To establish with the client the purpose of the relationship
b. To gather and review all possible information regarding the client
c. To build trust with the client
d. To obtain agreement from the client to work in conjunction with the nurse
ANS: B
The main task during the preparation phase is to gather and review all possible information
regarding the client; this can be accomplished by obtaining data from past and current medical
records and from the client’s significant others. The other options are tasks that occur during
the orientation phase.

OBJ: 6 TOP: Phases of the Therapeutic Relationship
9. When should the nurse begin preparations for the termination phase of a therapeutic
relationship?
a. During the orientation phase
b. Prior to the last meeting
c. During the last meeting
d. After all goals have been met
ANS: B
Preparing for termination of the relationship should begin prior to the last meeting to allow for
review of whether goals have been met and to prepare for client independence. The
orientation phase is too early in the relationship to prepare for termination, and the last
meeting is too late. Unfortunately, not all goals are always met, so preparing for termination of
the relationship after goals have been met may not be a possibility.

10. The nurse is preparing an adult male client, who has been successfully treated for a social
phobia, for the termination phase of the therapeutic relationship. During their last meeting, the
client told the nurse that he noticed he has developed a nervous habit that started a few days
ago of checking his door at home several times a day to be sure it is locked. This client is
exhibiting the client response to termination known as:
a. Continuation
b. Regression
c. Withdrawal
d. Confabulation
ANS: A

Continuation sometimes occurs when a client is fearful of ending the therapeutic relationship.
This response is characterized by a client’s trying to continue the relationship by bringing up
new problems or having the caregiver solve his problems. Regression and withdrawal are also
client responses to termination, but they do not fit the description in this situation.
Confabulation is not a response to termination. It refers to the making up of answers by a
client who is experiencing a memory loss.

11. When a caregiver becomes a role model for a client during a therapeutic relationship, the
caregiver is functioning in the role of a:
a. Teacher
b. Therapist
c. Technician
d. Change agent
ANS: D
Serving as a role model is one of the many functions of a change agent. The role of a change
agent also includes promoting a climate of anticipation of positive change for the client and
serving as a socializing agent. The other options are roles of the caregiver, but role model is
not included in those roles.

OBJ: 7 TOP: Roles of the Care Giver
12. A male client is being discharged from a mental health facility and is worried about what to
tell his friends and co-workers regarding his time away. The nurse helps the client plan what
to say to others about his disease. The nurse is functioning in the role of:
a. Change agent
b. Teacher
c. Therapist
d. Technician
ANS: B
This is an example of a teaching opportunity that the nurse is involved in during a therapeutic
relationship. Other teaching opportunities include teaching the client how to cope with
stressors, early signs of relapse, and effects of medications and providing public education
regarding mental illness. The other options do not incorporate the teaching role as a function.

13. A female client is admitted with suicidal tendencies. The client is placed in suicide
precautions for the first 24 hours of her stay. Ensuring client safety is included in the
therapeutic role of:
a. Change agent
b. Teacher

c. Therapist
d. Technician
ANS: D
In addition to ensuring safety, the role of technician includes medication management,
management of medical problems in the mental health environment, and management of
environmental factors. These responsibilities are not a function of the other roles.

14. The nurse who is caring for a client begins to have very protective feelings toward the client
that are interfering with the therapeutic relationship between the nurse, the client, and the
client’s family. This is an example of a problem that is encountered in some therapeutic
relationships and is known as:
a. An environmental problem
b. Resistance
c. Transference
d. Countertransference
ANS: D
Countertransference, the inappropriate emotional response of a caregiver to a client, is
occurring in this relationship. Environmental problems refer to items such as privacy and
noise levels, resistance is a behavior of the client that demonstrates unwillingness to change or
accept the need for change, and transference is the client’s inappropriate feelings or behaviors
directed toward the caregiver.

OBJ: 8 TOP: Problems with Care Providers
15. A 19-year-old male client is being treated for a drug addiction. He continually voices his dread
of being discharged because he knows he will have to live with his parents and follow their
rules until he can earn enough money to live on his own. He is showing increasing resistance
to treatment measures, such as attending group sessions, and is refusing to acknowledge that
he has an addiction or that he needs treatment. Which behavior is the client demonstrating?
a. Transference
b. Primary resistance
c. Secondary resistance
d. Tertiary resistance
ANS: C
This is an example of secondary resistance in view of the fact that the client is displaying
behaviors that will prolong his discharge from the facility, in an attempt to avoid his
perception of the unpleasant living situation that awaits him upon discharge. Transference is a
client’s emotional response, based on earlier relationships, to the care provider. Primary
resistance refers to simple avoidance of change or admitting the need for change. Tertiary
resistance is not a used term.

OBJ: 8 TOP: Problems with Clients

16. A client response to the termination phase of the therapeutic relationship is withdrawal. This
response most often is manifested by client behaviors such as:
a. Bringing up new problems
b. Being absent from appointments
c. Returning to maladaptive behavior
d. Having increased anxiety
ANS: B
Being absent from appointments is a behavior that is commonly seen when clients are
withdrawing from the termination phase of the relationship. It actually is a response that
occurs because the client does not want the therapeutic relationship to end. Bringing up new
problems refers to the continuation response, and returning to maladaptive behavior and
having increased anxiety refer to the regression response.

17. A 22-year-old woman with depression misses her scheduled meeting with the nurse. Although
they have established a contract to meet on an agreed upon schedule, the nurse understands
that the client is still testing the relationship and working on trusting her care provider. This
behavior usually manifests itself during which phase of the therapeutic relationship?
a. Termination
b. Orientation
c. Working
d. Preparation
ANS: B
Testing is an important step during the orientation phase in establishing trust in the therapeutic
relationship. Although clients may not appear for scheduled appointments, may use profane
language, or may resist sharing their feelings, the caregiver must demonstrate a willingness to
continue the therapeutic relationship.

18. The new nurse confides to his supervisor, “I am feeling frustrated. Mr. J has been doing so
well in dealing with his issues over the last month, and today he refused to discuss anything
productive in our session.” What is the most appropriate response?
a. “You are still in the preparation phase and need to check the medical record for
information.”
b. “The orientation phase is a time where the client is building trust and testing you.”
c. “During the working phase the client may have growth and resistance.”
d. “The termination phase is a difficult one for both nurse and client.”
ANS: C

The working phase of the therapeutic relationship has periods of growth accompanied by
episodes of resistance. Changing one’s behavior is very hard work. It requires energy and self-
disclosure. Clients often feel self-conscious, shameful, and vulnerable during this time.

19. Which of the following actions indicates that the nurse has gone beyond the boundaries of the
client-caregiver relationship?
a. The nurse consciously focuses on the client during meetings.
b. The nurse works to establish a trusting relationship with the client.
c. The nurse instills a sense of hope in the client.
d. The nurse defends the client to her family and the staff.
ANS: D
Defending the client to health care providers and the client’s family is a behavior which
demonstrates a blurring of the therapeutic relationship. Trust, hope, and therapeutic use of self
are essential to the therapeutic relationship.

OBJ: 8 TOP: Problems with Care Providers
20. As the nurse begins to discuss discharge plans for a 45-year-old female client hospitalized for
anxiety, the client states, “You never really cared whether I get better! Why not stop this
charade?” The nurse recognizes this to be
a. Transference
b. Secondary gain
c. Countertransference
d. Insecurity
ANS: A
Transference is a client’s emotional response based on earlier relationships.
The most outstanding characteristic of transference is the inappropriateness of the client’s
responses. Secondary gain occurs when clients profit or avoid unpleasant situations by
remaining ill. Countertransference is based on a caregiver’s inappropriate response.

OBJ: 8 TOP: Problems with Clients
MULTIPLE RESPONSE
1. For which roles is the caregiver responsible in a therapeutic relationship? (Select all that
apply.)
a. Teacher
b. Therapist
c. Technician
d. Friend
e. Change agent

f. Confidante
ANS: A, B, C, E
These are the typical roles of the caregiver in mental health services. The caregiver should
avoid becoming friends with clients because this can cause strain on the professional
relationship. The caregiver also should avoid becoming a confidante of the client because this
term usually describes someone whom a person trusts with secret or private matters. This is
not a role that the caregiver can play, given that caregivers have a responsibility to share with
other team members information pertinent to the client’s care.

2. Which of the following are characteristics of a therapeutic relationship? (Select all that apply.)
a. Acceptance
b. Rapport
c. Problem solving
d. Genuineness
e. Therapeutic use of self
f. Mutual support
ANS: A, B, D, E
The focus of the therapeutic relationship is on the client. It is consciously directed as the care
provider establishes a connection with the client to help him or her cope with life demands.
Acceptance, rapport, genuineness, and therapeutic use of self are the characteristics used to
accomplish this. Problem solving on the part of the care provider does not help the client to
cope. Support is provided for the client; it is not mutual.

COMPLETION
1. __________ refers to the ability of the nurse to establish a meaningful connection with a
client.
ANS:
Rapport
Rapport is necessary if a therapeutic relationship is to be established with a client. It involves

being accepting, caring, and compassionate and showing a genuine interest in the client.

OBJ: 3 TOP: Characteristics of the Therapeutic Relationship
2. The acronym TEACH represents the components of a therapeutic relationship: __________,

__________, __________, __________, and __________.

ANS:
Trust, empathy, autonomy, caring, hope
Trust, empathy, autonomy, hope, caring
Trust, empathy, hope, autonomy, caring
Trust, hope, empathy, autonomy, caring
Empathy, trust, autonomy, caring, hope
Empathy, trust, autonomy, hope, caring
Empathy, trust, hope, autonomy, caring
Empathy, hope, trust, autonomy, caring
Autonomy, trust, empathy, caring, hope
Autonomy, trust, empathy, hope, caring
Autonomy, trust, hope, empathy, caring
Autonomy, hope, trust, empathy, caring
Caring, trust, empathy, autonomy, hope
Caring, trust, empathy, hope, autonomy
Caring, trust, hope, empathy, autonomy
Caring, hope, trust, empathy, autonomy
Hope, trust, empathy, autonomy, caring
Hope, trust, empathy, caring, autonomy
Hope, trust, caring, empathy, autonomy
Hope, caring, trust, empathy, autonomy
These components serve as the framework for the development of a therapeutic relationship
between caregiver and client.

OBJ: 2 TOP: Characteristics of the Therapeutic Relationship
OTHER
1. A therapeutic relationship has four phases. Place these phases in proper order.
a. Orientation
b. Termination
c. Preparation
d. Working
ANS:
C, A, D, B
Each of the phases of the therapeutic relationship has identifiable tasks and goals that must be
met before advancement to the next phase.


Chapter 12: The Therapeutic Environment

MULTIPLE CHOICE
1. Crisis stabilization provides care to clients in treatment settings with the purpose of
reestablishing homeostasis; it usually lasts for:
a. 1 to 2 days
b. 2 to 4 days
c. 4 to 6 days
d. 6 to 8 days
ANS: A
Intensive counseling is given to assist clients with the immediate problem that is causing the
crisis. This usually is accomplished within 1 to 2 days, and the client is discharged with
follow-up care.

OBJ: 1 TOP: Crisis Stabilization
2. Which is an accepted criterion for inpatient admission to a mental health facility?

a. The client likes the security and comfort of the mental health facility.
b. The client feels that he is no longer able to cope with life stressors or maintain
control of his behavior.
c. A client’s behavior becomes unusual.
d. The client suffers from depression.
ANS: B
This situation meets the criteria for an inpatient admission. Other criteria include being a
threat to one’s safety or the safety of others and having people who are a part of the client’s
environment who are not willing or able to support him. The other options do not meet the
criteria.

OBJ: 1 TOP: Use of the Inpatient Setting
3. A male client with a diagnosis of schizophrenia refuses to take his medication because of his
paranoia that the medication may be poisoned. Frequent inpatient readmissions to the facility
occur as a result. Which term is given to repeated inpatient admissions?
a. Milieu
b. Chronicity
c. Noncompliance
d. Recidivism
ANS: D

Recidivism often occurs as a result of noncompliance with prescribed therapy, as in the case
of this client who is not taking his medications. Adequate community resources help to
prevent recidivism. Milieu refers to the mental health care environment; chronicity refers to a
long duration, such as occurs with a chronic illness like schizophrenia; and noncompliance
describes a situation in which the client does not follow the prescribed plan of care, often
resulting in recidivism.

OBJ: 2 TOP: The Chronically Mentally Ill Population
4. An adult female inpatient client with a diagnosis of paranoid schizophrenia will not take her
medications from the nurse. She states, “I know you are poisoning that medicine.” Which
nursing action is most appropriate?
a. Promise the client that the staff would not do anything to harm her.
b. Let the client watch the medication preparation process.
c. Administer medications to the client in unit dose packages so that she can open the
packages herself.
d. Allow the client to retrieve the medications out of the medication cart with
supervision.
ANS: C
Administering medications in unit dose packages would help to prevent the client from
thinking that the nurse is poisoning the medications. The client would be allowed to open the
packages herself. Promising the client that the staff would not harm her will not alleviate her
paranoia. Letting the client watch the medication preparation process may help, but if she
feels that the poisoning is happening when the nurse is placing the medication in the cup, the
client will remain paranoid. Allowing the client to retrieve medications from the medication
cart would go against facility policy.

OBJ: 3 TOP: Physiological Needs
5. A male inpatient client who is experiencing depression has no interest in eating. He skips
meals frequently and has been losing weight. What is the best nursing action in this situation?
a. Ask the client to “Please eat one meal for me.”
b. Leave food with the client at mealtime and offer snacks frequently.
c. Give the client information on the benefits of good nutrition.
d. Remove client privileges every time the client doesn’t eat.
ANS: B
Trying not to make an ordeal out of mealtime and food may allow the client to choose to eat,
especially as his condition improves. Asking the client to “please eat one meal for me” is not
an appropriate request and does not focus on the need to discover which, if any, medications
are effecting a desire to eat as well as how the client’s mood may be affecting the interest in
eating. Giving the client information about nutrition is not important to this client; his refusal
to eat is not related to good or bad nutrition. Removing client privileges each time the client
doesn’t eat goes against the client’s rights.


6. Encouragement for clients to practice good hygiene habits not only meets basic physiological
needs, but it also meets the hierarchal need of:
a. Love and belonging
b. Safety and security
c. Infection control
d. Self-care
ANS: A
Good hygiene meets the need for love and belonging by conveying to others a willingness for
social interaction. Safety and security needs relate more to the client’s feeling secure in his
environment and providing measures to keep clients safe; infection control and self-care are
not actually needs, but the concepts fall into the category of physiological needs.

7. With regard to the environment, it is important for the nurse to be aware of lighting for some
clients. Clients with a diagnosis of schizophrenia may be bothered by lights that are flickering
because this may trigger:
a. Overstimulation
b. Hallucinations
c. Aggressive behaviors
d. Photophobia
ANS: B
The flickering of a lightbulb can trigger hallucinations and delusions; therefore, it is important
for the nurse to monitor the physical environment. Overstimulation, aggressive behaviors, and
photophobia usually occur when light is too bright.

8. A female client on the mental health unit experiences periods of psychosis at intervals. She
often asks what day she came to the facility and what day it is now, and she seems never to be
aware of the time. Which nursing intervention would help this client the most?
a. Remind her of the time of day every time she asks.
b. Assist her to keep a written schedule, including her day of admission, on a
calendar posted in her room and a clock beside the calendar.
c. Tell her it doesn’t really matter what day she came to the facility; what matters is
what day and time it is now.
d. Instruct the staff to not answer her repetitive questions because she has been told
numerous times her day of admission, and there is a clock on the wall.
ANS: B

A written schedule in her room and a clock will assist her in learning to monitor this
information on her own, and this will help to keep her oriented and will foster independence.
Reminding her of the time will not help the client monitor the time on her own; it allows the
ineffective cycle to continue. Telling the client that it doesn’t matter when she entered the
facility and instructing the staff not to answer her questions are belittling to the client.

OBJ: 3 TOP: Safety and Security Needs
9. A 15-year-old female client is noted to often sit alone in the activity room of the facility while
watching television. She often begins to join in activities on the unit but then retreats back to
her room. Which intervention is most appropriate in this situation?
a. Encourage her to join in on a group activity and actively participate in the activity
with her until she feels more comfortable on her own
b. Keep encouraging her to participate in the group activity
c. Offer her rewards, such as extended television privileges, for joining in a group
activity
d. Offer her support as she tries to become more involved in activities
ANS: A
Encouraging the client to join the activity and participating with her will offer her security and
will help her to meet others in the group and feel less alone. Love and belonging needs are
met by socializing with others. Offering encouragement to participate in the group activity and
supporting her as she tries to become more involved are helpful, but these actions do not give
her the same sense of security as she receives with encouragement and participation in the
group activity until she is comfortable. Offering her rewards defeats the purpose of instilling
motivation and the improvement in self-esteem that results from participating according to her
own desire.

OBJ: 6 TOP: Love and Belonging Needs
10. The nurse can assist a client best in meeting his or her needs for self-esteem and/or self-
actualization by:
a. Setting rules and regulations
b. Allowing the client to set rules and regulations for the inpatient unit
c. Informing the client what the treatment team has decided regarding the plan of care
d. Allowing the client to make choices involving his or her care when appropriate
ANS: D
Self-esteem needs must be met before self-actualization can occur, but this is also a part of
self-actualization. This intervention allows the client to practice decision-making skills and
assists in improving his or her self-esteem. Rules and regulations are necessary for limit
setting, but the nurse can include the client and improve his or her self-esteem by informing
the client of the rules and regulations, so the client is able to follow them. Allowing the client
to set rules is difficult in that the ability for limit setting often is lacking in clients with mental
health disorders. Sharing with the client should reflect a combined effort between the client
and the treatment team.


OBJ: 3 TOP: Self-Esteem Needs
11. The nurse is aware that during the admission process to a mental health facility, the anxious
client:
a. Is acutely aware of his or her surroundings
b. Often forgets some of what is said in the unfamiliar surroundings
c. Has a keen memory in his or her heightened state of awareness
d. Frequently has no recollection of what is said by the staff during admission
ANS: B
High levels of anxiety can prevent an individual from remembering things that he has been
told. It is helpful to limit the amount of information thrust on a client during the early
admission process. Written information about rules, regulations, and expectations on the unit
is often helpful. The anxious client is not acutely aware of his or her surroundings and does
not have a keen memory during this time. Having no recollection of what the staff has said is
an extreme reaction.

OBJ: 7 TOP: Admission and Discharge
12. Bright colors in the environment of the client are often:

a. Depressing
b. Stimulating
c. Calming
d. Frightening
ANS: B
Colors are important to consider, depending on the needs of the client. Bright colors can be
stimulating to clients. Mental health settings often have warm, more neutral colors because
these colors promote calm emotions and behavior. Dark colors are considered more
depressing. Color usually is not associated with eliciting fright.

13. The nurse should monitor the temperature of the environment of a client who becomes easily
agitated, with awareness that increased temperatures sometimes may cause the client to
become:
a. Calm
b. Confused
c. Cooperative
d. More distressed
ANS: D
Increased environmental temperatures often cause easily agitated clients to become more
agitated. It is important for the nurse to monitor a client’s individual response to his or her
environment.


14. A male client is in the process of being admitted to a mental health facility. He is sure that the
nurse is the administrator of the hospital, despite the nurse’s insistence that he is a staff nurse
on the unit. This client is experiencing:
a. Acute confusion
b. Visual hallucinations
c. Delusions
d. Auditory hallucinations
ANS: C
Delusions are thoughts or beliefs that cannot be changed by rational explanations. Acute
confusion is seen as disorientation to person, place, time, or purpose. A visual hallucination
involves seeing something that is not there, and an auditory hallucination is hearing something
that is not present.

OBJ: N/A TOP: Admission and Discharge
15. When establishing a client’s level of consciousness, the nurse is aware that this is determined
by assessing the client’s:
a. Level of awareness
b. Ability to tell the nurse where he or she is at any given time
c. Accuracy in expressing the current month, date, or year
d. Capability to explain why he or she is in the facility
ANS: A
Level of awareness determines the client’s level of consciousness. The other options refer to
other aspects of the client’s level of orientation.

OBJ: N/A TOP: Admission and Discharge
16. A 16-year-old client is in the lounge with other clients on the inpatient unit when he suddenly
becomes agitated. Which action by the nurse would be most appropriate in this situation?
a. Turn up the volume on the television to distract the client
b. Bring him to sit at the nurses’ station while the staff is doing shift report
c. Keep him in the lounge and attempt to converse with him
d. Accompany him to a room where soft music is playing
ANS: D
High noise levels can lead to distorted perceptions, altered thinking, and sensory overload.
Calm music, the sound of ocean waves, or a light rain can produce relaxation. When noise
levels become too intense, clients tend to become distracted and agitated. Turning up the
volume on the television, bringing the client to a crowded nurses’ station, and keeping the
client in the lounge do not decrease noise levels and may increase the client’s agitation.

OBJ: 4 TOP: Therapeutic Environment and Client Needs

17. The goal in treating a client with a chronic mental illness is to prevent recidivism. Which
factor is crucial in this effort?
a. Increased use of psychotherapeutic medications
b. Increased lengths of stay on the inpatient unit
c. Increased commitment to the plan of care by the client
d. Group residential homes with vocational training
ANS: D
One of the most important factors in preventing recidivism is adequate community resources
where clients receive support and educational and vocational opportunities. With the focus on
the “least restrictive environment,” many chronically mentally ill clients now live in small,
homelike, sheltered group settings within the community.

OBJ: 2 TOP: The Chronically Mentally Ill Population
18. The use of therapeutic touch as a relaxation technique in the mental health setting is beneficial
for clients displaying which symptoms?
a. Aggression
b. Paranoia
c. Depression
d. Anxiety
ANS: C
People with suspicious feelings usually feel more comfortable when caregivers are outside
their intimate space. Depressed persons may need touch and physical contact—an excellent
opportunity for therapeutic touch. Aggressive clients may interpret the close presence of a
caregiver as threatening. Touch must be used cautiously as a therapeutic tool and with the
client’s best interest in mind.

19. A 22-year-old woman is brought to the inpatient unit for attempting suicide. Her clothes are
clean and her general appearance is neat and well groomed. She appears to be well nourished.
In considering Maslow’s hierarchy of needs, which is a priority for this client?
a. Physiologic
b. Love and belonging
c. Self-actualization
d. Safety and security
ANS: D
The safety and security of the therapeutic environment is one of the most important factors in
mental health care. Safety and security needs within the therapeutic environment include the
feeling of physical safety, the security of a limited setting, and the ability to feel secure with
others. For clients who are depressed or suicidal, the therapeutic environment offers special
protection from self-harm and with the client’s best interest in mind.


MULTIPLE RESPONSE
1. Inpatient services provide care mainly for mental health clients who are experiencing which
conditions? (Select all that apply.)
a. Acute mental or emotional problems
b. Chronic mental or emotional problems
c. Depression
d. Crisis
e. Bipolar disorder
ANS: A, B, D
Inpatient services provide intensive therapy and support for clients with acute and chronic
mental health disorders as well as those in crisis situations, and they usually require short
stays. The goal is to transition the client from the facility to the community. Depression and
bipolar disorder are specific disorders that are not necessarily seen more frequently than other
disorders within an inpatient setting.

OBJ: 2 TOP: Use of the Inpatient Setting
2. Which are common causes for client noncompliance in the plan of care? (Select all that
apply.)
a. Financial concerns
b. Lack of support by family
c. Staff dislike of a client
d. Inability to understand the treatment plan
e. Lack of access to treatment services
ANS: A, B, D, E
Financial concerns, lack of family support, and lack of access to treatment often make the
client feel that he or she is unable to continue in the planned treatment. The social worker is
the best person to contact in these instances because he or she is aware of programs that may
meet needs in these problem areas. Education and involvement of other caregivers will assist
the client in eliminating the problem of inability to understand the treatment plan. Staff dislike
of a patient should never be a reason for client noncompliance.

OBJ: 8 TOP: Compliance KEY: Nursing Process Step: Evaluation
3. Admission to an inpatient mental health unit is often a stressful event. Which actions on the
part of the health care provider will help to decrease the anxiety of the client? (Select all that
apply.)
a. Conduct the admission interview with a team of health care providers
b. Answer any questions the client may have

c. Support the client in being oriented to the unit

d. Provide simple, clear instructions and repeat if needed
e. Communicate concern for the client
ANS: B, C, D, E
People with high anxiety levels seldom remember what was said, especially when they are
in an unfamiliar setting. Therefore, approach clients in a calm and respectful manner. Give
simple but clear explanations, and repeat them as necessary. Provide simple written
instructions that allow clients to read about the rules after their anxiety decreases. Answer any
questions the client may have. Make sure that the client is more important than the admission
form you must complete. Take the time to behaviorally communicate that you are concerned
for his or her welfare. Make efforts to support the client in becoming familiar with the
therapeutic environment. Having one person perform the initial admission interview prevents
confusion and added stress for the client.

OBJ: 8 TOP: Compliance KEY: Nursing Process Step: Evaluation
COMPLETION
1. __________ describes the setting or environment in which mental health care is provided.
ANS:
Milieu
Milieu describes an environment that is pleasant and safe with structured activities.

OBJ: 3 TOP: The Therapeutic Environment
2. __________ refers to the process of achieving one’s full potential in life.
ANS:
Self-actualization
Self actualization
Individuals who are self-actualized are independent, self-directed, and autonomous. Not
everyone reaches his or her full potential, but the nurse can assist the client in meeting his or
her fullest potential.

OBJ: 3 TOP: Self-Actualization Needs
3. Discharge planning for an inpatient mental health facility client begins on __________.
ANS:
The day of admission

Inpatient stays in facilities often are relatively short in duration, so it is important for the nurse
to begin to plan for discharge arrangements on the day the client is admitted.

OBJ: 7 TOP: Admission and Discharge

Chapter 13: Problems of Childhood

MULTIPLE CHOICE
1. Social and emotional development occurs at a more simple level in the child who is:
a. 5 years old
b. 8 years old
c. 10 years old
d. 12 years old
ANS: A
A child’s reasoning is simple and uncomplicated until the nervous system completely
develops; therefore, the younger child’s social and emotional development moves from simple
to complex with age.

OBJ: 1 TOP: Normal Childhood Development
m
er as
co
2. A 10-year-old male client is 20 pounds overweight. Which intervention by the nurse is the
eH w
most effective in this situation?
o.
a. Place the client on a strictly controlled calorie-restricted diet
rs e
b. Talk to the client about why he is so overweight
ou urc
c. Teach the client and his parents about healthy eating habits and choices
d. Make a list of foods that are to be restricted in the client’s diet
NURSINGTB.COM
ANS: C
o
Early intervention and education are the best interventions for the treatment and prevention of
aC s
childhood obesity. Teaching about healthy eating habits provides the tools necessary to
vi y re
correct the problem with long-term success. Placing the client on a strictly controlled
calorie-restricted diet provides no education and most likely will cause a rebound effect.
Talking to the client about why he is overweight may be an intervention that would occur later
in the treatment process after further assessment is completed. Making a list of restricted
ed d
foods also may cause a rebound effect.

ar stu

OBJ: 1 TOP: Common Behavioral Problems of Childhood
is
Th
3. A couple comes to the sleep disorder clinic because their 3-year-old daughter has problems
falling asleep every night. The parents say that it takes their daughter 1 to 2 hours each night
to fall asleep, and one of the parents ends up having to lie down with her. Which intervention
should the nurse first suggest?
sh
a. The parents should alternate responsibility each night for seeing the daughter to
bed.
b. The daughter could start falling asleep in the parents’ bed and then could move to
her own bed
c. Place the child in bed at the same time each night, and don’t allow her to get out of
bed

d. Follow a bedtime ritual each night, such as reading one book

ANS: D
One of the first steps in dealing with problems with sleep is following a bedtime ritual each
night so as to establish a restful sleep pattern. Additional interventions include limiting
watching television. The other options do not establish a restful bedtime ritual that will
encourage sleep.

4. The parents of a 2-year-old boy seek assistance at a family therapy clinic because their son
throws a temper tantrum every time he is not allowed to throw his food on the floor during
meals. Which therapeutic intervention does the nurse suggest?
a. Leave him during the tantrum, so that he feels isolated from others as a result of
his behavior
b. Try to distract him when he becomes frustrated, and reward him for positive
behavior
m
c. Hold the child down until the tantrum stops
er as
d. Put him in the corner for punishment while he is having the tantrum
co
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ANS: B
Distracting the child may lessen his frustration and prevent the tantrum from occurring, and
o.
rewarding positive behavior encourages future positive behavior. Leaving him may frighten
rs e
him and/or he could hurt himself during the tantrum. Holding the child down will increase his
ou urc
frustration, and putting him in the corner is not effective during a tantrum because his
behavior is out of control, soN
heUwon’t
RSINunderstand
GTB.COthe M importance of the punishment.
o

aC s

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5. Poverty influences the growth and development of children and is often a precursor to mental
health disorders in children. Nearly __________ of children in the United States come from
ed d
families that live at the poverty level.

ar stu
a. 10%
b. 20%
c. 30%
d. 40%
is
ANS: B
Th
Children who live in poverty score lower on IQ tests and exhibit higher rates of anxiety,
unhappiness, and fearfulness than do children who are not living in poverty.
sh

OBJ: 2 TOP: Environmental Problems
6. During the interview process with a homeless client, which is an appropriate nursing action?
a. Wait until later in the interview to ask questions such as address or nearest relative
b. Ask the client early in the interview what is his or her highest education level

c. Ask the client where he or she planned to sleep that night

d. Encourage the client to bathe as soon as possible
ANS: A
Asking these questions later in the interview will allow for some development of rapport and
trust, so the client will more freely discuss these topics. In addition, the client may be ashamed
to admit to not having an address. Asking the client about his or her highest level of education
early in the conversation would make the client feel inadequate and would prevent the
establishment of good rapport with the client. Asking the client about a sleeping location
would occur during discharge planning, and encouraging immediate bathing would belittle the
client.

OBJ: 2 TOP: Homelessness
7. Adult disorders such as chronic anxiety and depression often are associated with childhood:
a. Illnesses
b. Fears
m
c. Education
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d. Abuse
co
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ANS: D
Abuse experienced as a child often is assessed in adults with physical, behavioral, and
o.
emotional disorders. Illnesses, fears, and education are not typical causes of adult depression
and chronic anxiety. rs e
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NURSILevel:
OBJ: 2 TOP: Abuse NGTKnowledge
B.COM
and Neglect
REF: p. 143
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8. For children older than 4 years, separation anxiety should last for no longer than:
a. A few days
b. A few weeks
c. A few months
ed d
d. 1 year
ar stu
ANS: B
If separation anxiety (a child’s fear of being apart from his parents) lasts longer than a few
weeks, it is likely that there is a problem, and treatment should be sought. High levels of
is
anxiety in children sometimes result in obsessive-compulsive behaviors.

Th

OBJ: 3 TOP: Anxiety KEY: Nursing Process Step: Assessment
sh
9. The parents of a 9-year-old girl with mental retardation voice concerns to the nurse regarding
their child’s eating insects and leaves. The parents report that this behavior has been occurring
for almost 4 months. From what is this child most likely suffering?
a. Pica
b. Rumination disorder
c. Enuresis

d. Encopresis
ANS: A
Pica is an eating disorder that is most commonly seen in children with mental retardation,
pervasive developmental disorders, such as autism, or severe vitamin or mineral deficiencies.
Treatment is aimed at keeping the child away from the items consumed and/or replacing the
consumed item with a healthy food product. Rumination disorder describes a disorder in
infants in which regurgitation and rechewing of the food occur. Enuresis is bedwetting, and
encopresis is repeated defecation in inappropriate places.

OBJ: 1 TOP: Eating Disorders
10. As the caregiver for a male client whose mental retardation level is classified at a moderate
level, the nurse’s most appropriate action is to:
a. Encourage him to work in a supervised setting at a fast food restaurant
b. Persuade him to look for an apartment in which he can live on his own
c. Find a group home that he would adjust well to
m
d. Seek placement for him in a long-term setting for clients with cognitive disabilities
er as
co
ANS: A
eH w
A client at a moderate level of mental retardation has good communication skills, functions
academically at a second grade level, benefits from vocational training by becoming
o.
employed in supervised settings, and is successful in living in the community with
rs e
supervision. Living in an apartment alone applies to a client with mild retardation; living in a
ou urc
group home applies to a client with severe retardation; and placement in a long-term setting
NURSIapplies
for clients with cognitive disabilities NGTB.C OM with profound retardation.
to a client
o

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OBJ: 6 TOP: Mental Retardation

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11. A 12-year-old female client with a normal IQ has difficulty with math at school. She performs
well in all subjects except math, for which she is unable to earn above a grade of “D,” no
ed d
matter how much she studies. What is this client most likely suffering from?
ar stu
a. Mental retardation
b. A learning disorder
c. Pervasive developmental disorder
d. An anxiety disorder
is
ANS: B
Th
Because this client performs well in all other areas and has a normal IQ, she most likely has a
learning disorder. Learning disorders typically affect a child’s thinking, reading, writing,
calculating, spelling, or listening abilities. The client does not have mental retardation because
sh
her IQ is normal; pervasive developmental disorder indicates difficulties with social

interactions and communication skills; and an anxiety disorder refers to a vague feeling of
uneasiness that persists.

OBJ: 7 TOP: Learning Disorders

12. The parents of a 3-year-old boy are concerned because their son seems to speak very slowly
and has an odd rhythm to his speech pattern. What is this child most likely experiencing?
a. Reading disorder
b. Phonological disorder
c. Stuttering disorder
d. Expressive language disorder
ANS: D
An expressive language disorder is a disorder of communication that is of concern if the
problem persists or interferes with the child’s daily activities or ability to learn and function at
the expected academic level. A reading disorder most likely would be difficult to determine at
this age; a phonological disorder refers to an inability to use sounds and speech as expected at
a given age; and a stuttering disorder refers to frequent repetition of sounds or portions of
words.

OBJ: 1 TOP: Communication Disorders
m
er as
13. A 7-year-old male client displays behaviors such as an inability to make eye contact with
co
others, inappropriate facial expressions, difficulty in making friends, and showing little
eH w
emotion with family members. He talks with adults but is awkward in his conversation. Given
o.
these behaviors, what is this client most likely experiencing?
rs e
a. Childhood disintegrative disorder
ou urc
b. Asperger’s syndrome
c. Dyslexia
d. Rett syndrome NURSINGTB.COM
o
ANS: B
aC s
These classic behaviors are associated specifically with Asperger’s syndrome. Childhood
vi y re
disintegrative disorder describes a condition in which the child regresses in various areas after
2 years of normal development. Dyslexia is a learning disorder in which individuals have
difficulty integrating visual information. Rett syndrome refers to problems with motor,
language, and social development between the ages of 5 months and 4 years.
ed d
ar stu

OBJ: 8 TOP: Pervasive Developmental Disorders
is
14. The Denver II is a tool that is used for assessment of early childhood development. What is
Th
this tool used to assess?

a. Temperament
b. Maturation
c. Gross and fine motor skills
sh
d. Speech development
ANS: C

In addition to motor skill assessment, the Denver II assesses language and social skills.
Temperament is assessed with several tools, such as the Toddler Developmental Scale and the
Middle Childhood Questionnaire; maturation is assessed with the Preschool Readiness
Screening Scale tool; and speech development is assessed with the Early Language Milestone
Scale.

OBJ: 9 TOP: Therapeutic Actions—Provide Opportunities
15. The emotional developmental task of industry vs. inferiority that occurs in childhood is
characteristic of which age group?
a. Infancy: birth to 1 year old
b. Early childhood: 1 to 3 years old
c. Preschool age: 3 to 6 years old
d. School age: 6 to 12 years old
ANS: D
Industry vs. inferiority is the developmental task of school-age children. The developmental
m
task of infancy is trust vs. mistrust; of early childhood is autonomy vs. shame and doubt; and
er as
of preschool-age children is initiative vs. guilt.
co
eH w
o.
rs e
ou urc
16. Breath-holding spells typically occur when a child becomes extremely frustrated, cries, and
NURSIN
either intentionally or unintentionally GTB.C
holds M breath. This rarely occurs in children
his orOher
younger than the age of __________.
o
a. 6 months
aC s
b. 12 months
vi y re
c. 18 months
d. 24 months
ANS: A
ed d
Breath holding usually does not occur prior to this age, but it can occur until approximately 5
ar stu
years of age. Breath holding resolves itself in 30 to 60 seconds. After the first incident, the
child should be examined by a physician, but if no problems are identified, the best
intervention for future incidents is ignoring the behavior.
is

Th

17. A mother of a 9-year-old is concerned because her child complains of frequent stomach aches
sh
in the morning before leaving for school. No medical reason has been found for this condition.
The family has recently moved to the area after the woman and her husband divorced, and the
child is attending a new school. What is the most appropriate response the nurse can give to
this mother?
a. Ignore the child’s complaints and send the child to school
b. Allow the child to stay home from school when this occurs

c. Provide support and reassurance to the child as the child adjusts

d. Take away computer privileges to stop this behavior
ANS: C
A somatoform disorder is one in which the child (or adult) has the signs or symptoms of
illness without a traceable physical cause. Somatic symptoms are common in school-age
children. They are thought to be expressions of stress, anxiety, or underlying conflict. It is
important to remember that children with somatoform disorders need understanding and
reassurance rather than punishment or concessions. The child should not be ignored.

18. The school nurse meets with the parents of a 7-year-old child who frequently shows a lack of
respect for his teacher and the rules of the classroom. His parents report that he fights with his
siblings and has tried to run away from home when they have attempted to take away
privileges. Based on this assessment, what does the nurse understand about his future?
a. He is experiencing a normal developmental task and will grow out of it.
m
b. His prognosis for recovery will be good if he is not punished.
er as
c. Due to his age, his future prognosis is poor.
co
d. He should be allowed to set his own limits.
eH w
ANS: C
o.
The long-term outlook for children with conduct disorders is poor if the problems are present
rs e
before the child is 10 years old. This behavior is not typical, and relaxing rules and discipline
ou urc
will not aid in his recovery.
NURSINGTB.COM
o
OBJ: 5 TOP: Disruptive Behavioral Disorder

aC s
vi y re
19. Due to the proximal to distal physical development of the child, which of the following motor
skills is able to be accomplished by the toddler?
a. Tying shoes
ed d
b. Buttoning a shirt
ar stu
c. Eating finger foods

d. Cutting food with a fork and knife
ANS: C
is
Eating finger foods is a gross motor skill. Tying shoes, buttoning shirts, and cutting with a
knife require fine motor development.
Th

sh
20. The parents of a 5-year-old are concerned because he has recently starting wetting himself
during the day while at school. They inform their pediatrician about this when they bring their
newborn daughter in for her first immunizations. After ruling out any physical cause, the
pediatrician informs the parents that this is due to:
a. Primary nocturnal enuresis

b. Secondary enuresis
c. Encopresis
d. Disobedience
ANS: B
Secondary enuresis develops when a bladder-trained child becomes incontinent. Usually it
follows a stressful event, such as the birth of a sibling or a divorce.

MULTIPLE RESPONSE
1. The parents of a 9-year-old boy have been told by the child’s teacher that he exhibits
symptoms of attention-deficit/hyperactivity disorder (ADHD). Which specific behaviors may
the child exhibit for this diagnosis to be made? (Select all that apply.)
a. Frequently interrupts or intrudes on others
b. Is easily distracted by outside stimuli
m
er as
c. Has feelings of restlessness or frequently fidgets with hands and/or feet
d. Exhibits an excellent short-term memory
co
eH w
e. Often leaves tasks incomplete
o.
ANS: A, B, C, E
rs e
These are a few of the behaviors displayed in children with ADHD. Symptoms of ADHD
ou urc
include 14 possible behaviors. For a diagnosis to be made, the client must exhibit at least eight
of these behaviors for at least 6 months. An excellent short-term memory is the opposite of
NURSINGTB.COM
what is seen in clients with ADHD.
o

aC s
OBJ: 4 TOP: Attention-Deficit/Hyperactivity Disorder

vi y re
2. Before the diagnosis of mental retardation can be made, which factors must be present?
ed d
a. IQ of 70 to 100
ar stu
b. Inability to communicate effectively

c. Poor adaptation to social situations
d. IQ less than 70
is
e. Inability to care for self appropriate to age

f. Maladaptive coping skills
Th
ANS: B, C, D, E, F
The criteria for the diagnosis of mental retardation include an IQ below 70 and the child’s
adaptive functioning level. How well the child copes with everyday life situations is the most
sh
accurate indicator of mental retardation.

OBJ: 6 TOP: Mental Retardation

3. A fifth grade teacher is concerned that one of his students is at risk for violent behavior.
Which signs will the school nurse advise him to be aware of ? (Select all that apply.)
a. Enjoys contact sports
b. Engages in risk-taking behaviors
c. Has frequent angry outbursts
d. Threatens classmates
e. Isolates self from others
f. Damages school property
ANS: B, C, D, F
Risk-taking behaviors, frequent loss of temper, announcing threats, and vandalizing or
damaging property are all warning signs of violence. Engaging in contact sports is a normal
activity for school-age children. Isolation from others is more indicative of depression.

OBJ: 5 TOP: Warning Signs of Violence
COMPLETION
m
er as
1. __________ is a disorder that involves an individual’s ability to communicate, interact with
co
eH w
others, use the imagination, and display appropriate behavior.
o.
ANS:
Autism rs e
ou urc
Autism is a disorder, rather than
NURa S disease,
INGTthat B.Cresults
M from a problem in the development of
the nervous system. There are different types andO degrees of autism, and the disorder can
o
affect the child for the rest of his or her life.

aC s
vi y re

OBJ: 8 TOP: Pervasive Developmental Disorders
ed d
2. The developmental period of middle childhood is considered to encompass the ages of

ar stu
__________ to __________ years.
ANS:
6, 10
is
Each developmental period has specific developmental expectations that must be met for
Th
growth and development to continue.

sh



Chapter 14: Problems of Adolescence

MULTIPLE CHOICE
1. The child in early adolescence experiences developmental issues with his or her identity as
evidenced by:
a. Feeling stable with his or her self-esteem
b. Conforming to group norms
c. Being very self-centered
d. Being idealistic
ANS: B
Acceptance and rejection of peers are very important to this age group, so conforming to
norms is frequently seen. Feeling stable with one’s self-esteem refers to late adolescence (17
to 20 years old), and being self-centered and idealistic applies to middle adolescence (14 to 17
years old).
m
er as
OBJ: 1 TOP: Psychosocial Development
co
eH w
o.
2. Internal developmental problems are seen as a causative factor for some behavioral and family
rs e
problems during adolescence. Psychological developmental issues that can lead to problems
ou urc
during late adolescence (17 to 20 years old) include:
a. Wide mood swings
b. Tendency to withdraw when NURupset
SINGTB.COM
o
c. Intense daydreaming
d. Concealing of anger
aC s
vi y re
ANS: D
Even though adolescents in this age group experience few mood swings, they tend to conceal
their anger to a greater extent than do adolescents from other developmental periods. Wide
mood swings are typical of the early adolescent period (11 to 14 years old), and the tendency
ed d
to withdraw when upset and intense daydreaming refer to middle adolescence (14 to 17 years
ar stu
old).

is

Th
3. A male adolescent client tells the nurse that he is almost positive that he is homosexual. This
realization most likely has occurred during the developmental period of:
a. Late childhood
sh
b. Early adolescence
c. Middle adolescence
d. Late adolescence
ANS: C

Usually by the age of 14 to 17 years, most adolescents have discovered their sexual
preference.

4. Environmental problems often lead to mental health problems among adolescents.

Approximately __________ million children and adolescents must cope with the issue of
having a parent in jail or on parole.
a. 3
b. 7
c. 11
d. 14
ANS: B
These adolescents have to deal with the many issues associated with having a parent in this
circumstance while maintaining the energy necessary to focus on the typical growth and
development issues that adolescents experience.
m
er as
co
OBJ: 1 TOP: External (Environmental) Problems
eH w
o.
5. The nurse is working with a 15-year-old girl and her parents on a treatment plan for her
rs e
diagnosis of attention-deficit/hyperactivity disorder (ADHD). The nurse should be sure to:
ou urc
a. Encourage the parents to seek teachers for their daughter who are going to be
NURSINbecause
lenient with assignment schedules GTB.C of OM diagnosis.
her
b. Remind the parents to determine ahead of time consequences/punishment that they
o
will give their daughter when she is not listening to them and/or teachers.
aC s
c. Teach the parents how to structure and enforce limits on their daughter’s behavior
vi y re
that are appropriate to her condition.

d. Inform the client and her parents that medications typically used for ADHD are
very safe and have few side effects.
ed d
ANS: C
ar stu
Consistent limit setting is helpful to teens with ADHD because it is difficult for them to set
limits for themselves. Encouraging lenient teachers violates this principle. The parents should
seek teachers who are understanding of their daughter’s condition but remain consistent in
setting limits in their course. Positive reinforcement for appropriate behavior is more effective
is
than punishment, and many medications for ADHD react with other medications and
Th
sometimes have serious side effects.

OBJ: 3 TOP: Behavioral Disorders
sh
6. The nurse is working with a teen in whom conduct disorder was diagnosed and his family on
developing a plan of care for treatment. What is the nurse’s first intervention?
a. Assessing and/or stabilizing the home environment
b. Teaching effective communication skills to the client and family members

c. Advocating behavior modification for the client to gain self-control

d. Teaching effective discipline techniques
ANS: A
After the home environment has been assessed and stabilized, the other interventions can be
implemented in the order necessary according to priority of need.

OBJ: 3 TOP: Behavioral Disorders
7. Adolescents and young adult women account for __________% of Americans affected by
eating disorders.
a. 25 to 30
b. 55 to 60
c. 70 to 75
d. 85 to 90
ANS: D
This high percentage is thought to be due to society’s influence on what constitutes being
m
er as
attractive.
co
eH w
o.
rs e
ou urc
8. In a research study of eating disorders, it was found that the most frequent weight loss method
used by female high school students was:
a. Exercising
NURSINGTB.COM
o
b. Skipping meals
aC s
c. Using diet pills

vi y re
d. Vomiting
ANS: B
Forty-nine percent of high school females in this study used skipping meals as a weight loss
ed d
method, followed by exercising, using diet pills, and vomiting.

ar stu

is
9. A 15-year-old girl is being admitted to an inpatient mental health clinic with the diagnosis of
Th
anorexia nervosa. The nurse knows that the most common personality characteristic of teens
affected with this disorder is:
a. Excessive cooperation
b. Underachievement
sh
c. Normal body weight

d. Positive self-esteem
ANS: A

Characteristics of the personality of female teens with anorexia nervosa include being
excessively cooperative and achievement oriented and having a body image of being
overweight. Underachievement and positive self-esteem are opposite traits to those seen in a
teen with anorexia nervosa, and normal body weight may characterize a teen with a healthy
self-concept, or it may be a characteristic of bulimia.

10. When one is developing the care plan for a female adolescent with an eating disorder, the
primary issue to consider as the underlying cause is:
a. Control
b. Body image
c. Self-esteem
d. Coping skills
ANS: A
Although any of the issues listed in these options can be an underlying cause, control is the
m
primary issue with an eating disorder. The client often feels that this is the only thing in her
er as
life over which she has complete control.
co
eH w
o.
rs e
KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity
ou urc
11. One of the major goals of therapy for adolescents with chemical dependency is:
NURSIN
a. Replacing the use of the chemical GTeffective
with B.COMcoping skills
b. Placing the chemically dependent adolescent in a residential treatment program
o
c. Finding a group home setting to which the adolescent will be able to adjust
aC s
d. Isolating the adolescent from family and friends during withdrawal from the
vi y re
chemical
ANS: A
This is the overall goal of therapy, so the adolescent will not feel the need to depend on the
ed d
chemical for coping with stressors. A residential treatment program or a group home setting
ar stu
may be a necessary intervention in some cases, but it is not a goal of therapy. Isolation during
withdrawal is not necessary.

is
OBJ: 6 TOP: Chemical Dependency

Th
12. Personality disorders in the adolescent are characterized by:

a. Onset usually in middle childhood
sh
b. Impulsivity
c. Flexibility
d. High self-esteem
ANS: B

Behavior is typically impulsive, leading to poor decision-making skills. Onset of personality

disorder usually occurs in adolescence or early adulthood. These individuals tend to be
inflexible when dealing with others, and their self-esteem is generally low.

OBJ: 1 TOP: Personality Disorders
13. The parents of a 13-year-old girl are concerned that their daughter has a gender identity
disorder. Which sign or symptom most indicates that their concern is correct?
a. Their daughter is playing sports typically considered boys’ sports.
b. Their daughter has more male friends than female friends.
c. Their daughter does not like to change her clothes in front of anyone.
d. Their daughter frequently wears clothes designed for males.
ANS: D
This behavior is more indicative of gender identity disorder than the other options. This
behavior fulfills the need for this girl to identify with the male gender. Playing sports typically
considered boys’ sports and having more male friends are not considered behaviors of gender
m
identity disorders unless other characteristic behaviors of the disorder occur. Not wanting to
er as
change clothes in front of anyone is a common behavior that reflects a 13-year-old’s need for
co
privacy.
eH w
o.
OBJ: 1
rs e
TOP: Sexual Disorders
ou urc
NURSINoften
14. Signs and symptoms of schizophrenia GTB.C OMseen in:
are first
a. Early childhood
o
b. Adolescence
aC s
c. Early adulthood
vi y re
d. Middle adulthood
ANS: B
The onset of schizophrenia usually occurs during adolescence. The individual usually has had
ed d
a normal childhood but then begins to display behaviors associated with loss of contact with
ar stu
reality, such as hallucinations, delusions, and paranoid feelings.

OBJ: 1 TOP: Psychosis KEY: Nursing Process Step: Assessment
is

Th
15. The rate of attempted suicide in adolescents is __________times higher with females than
with males.
a. 3
sh
b. 6
c. 9
d. 12
ANS: A

Although the rate of attempted suicide is three times higher among females, males are more
successful in committing suicide because of the more lethal methods that they choose to use.
The suicide rate in teens doubled between 1960 and 2000, and the rate increased by 18% in
2004.

OBJ: 7 TOP: Suicide KEY: Nursing Process Step: Evaluation
16. A teenage girl’s boyfriend of 1 year ended their relationship and began to date someone else,
resulting in the girl’s attempting suicide by taking an overdose of her mother’s sleeping
medication. What is the most likely cause of this girl’s suicide attempt?
a. Depression
b. Serious mental illness
c. The need to influence others
d. An anxiety disorder
ANS: C
This is an example of her need to influence others by getting back at the boyfriend.
m
Depression and serious mental illness are other reasons frequently noted as causative factors
er as
when adolescents attempt suicide. An anxiety disorder is not typically a causative factor.
co
eH w
o.
rs e
ou urc
17. A 16-year-old teenage boy who is bullied at school has recently started staying in his room
NURSIHis
and not associating with his friends. NGgrades
TB.CareOMdropping and he refuses to eat dinner with
his family. What actions should his parents be advised to take?
o
a. Accept this as a normal part of adolescent behavior and do not interfere

aC s
b. Take the door off his room and scold him for his behavior
vi y re
c. Realize that his peer group will handle this as he needs to break away from family
d. Set limits with him in a respectful manner and assist him to problem-solve
ANS: D
ed d
Adolescents who are bullied are at high risk for suicide. Health care providers who work with
ar stu
adolescents must assess every teen for his or her suicidal risk. The goals of treatment for
suicidal adolescents are to protect them from harm, build trusting therapeutic relationships,
and assist them in developing self-awareness and alternate coping skills.
is

Th

18. One of the developmental tasks of adolescence is to establish intimacy and relationships. By
sh
the age of 14, what percentage of teens have experienced sexual intercourse?
a. 10%
b. 25%
c. 50%
d. 85%
ANS: C

During adolescence, interest in people of the opposite gender begins to increase. By age 14
years, teens explore the concepts of “sex appeal” and “being in love.” More than 50% of them
have experienced sexual intercourse by this age.

OBJ: 1 TOP: External (Environmental) Problems
19. By the ages of 14 to 17, teens are able to demonstrate problem-solving skills using concepts,
generalizations, and being flexible in planning actions and goals. What is this an example of?
a. Concrete operations
b. Pre-operational thinking
c. Operational thinking
d. Abstract thinking
ANS: D
By the middle teens (14 to 17), abstract thinking (adaptable, flexible thinking that uses
concepts, generalizations, and problem solving) is well entrenched, along with a feeling of
power and self-centeredness. Many believe that they can change the world by just thinking
m
about it. At about 17, teens’ abstract thinking becomes more realistic and they become able to
er as
plan reachable actions, goals, and careers.
co
eH w
o.
rs e
ou urc
20. A 15-year-old female started going to parties earlier in the year where drinking and drug use
NURthat
occurred. Her friends now notice SIshe
NGT B.COlooks
actively M for a party every weekend and attends
even when her friends are not invited. If they suggest an alternate activity, she refuses to go
o
with them, and she is avoiding them at school. What stage of chemical dependency is she
aC s
exhibiting?
vi y re
a. Burnout
b. Actively seeking
c. Experimentation
d. Preoccupation
ed d
ar stu
ANS: B
In the actively seeking stage, the teen looks forward to and actively seeks out the mood
changes brought about by the chemicals; the teen becomes expert in the use of chemicals to
regulate moods; schoolwork and relationships with family erode; and friends become limited
is
to other teens who “use.”

Th

OBJ: 6 TOP: Stages of Chemical Dependency
sh
MULTIPLE RESPONSE
1. Which of the following are common signs and symptoms of the eating disorder bulimia?
a. Intake of less than 1000 calories per day

b. Purging after meals

c. Body weight greater than 20% under normal
d. Consumption of 5000 to 20,000 calories per day
e. Erosion of tooth enamel
ANS: B, D, E
Purging commonly occurs after bingeing, and this causes erosion of tooth enamel. Intake of
less than 1000 calories per day and body weight at least 20% less than normal are typical of
anorexia nervosa. Body weight is often kept normal or within 20% of normal with bulimia.

2. Social development and forming an identity are important tasks for the adolescent. Which of
the following is true regarding the function of a peer group? (Select all that apply.)
a. Provides stability during change
b. Helps loosen ties to family
c. Serves as standard for dress and behavior
m
d. Helps to define future roles
er as
e. Learns to doubt self-made choices
co
eH w
ANS: A, B, C, D
Peer groups help to loosen family ties, provide stability during times of change, and help
o.
adolescents define present and future social roles, learn to trust their own choices, and
rs e
establish behavioral and dress standards.
ou urc
NURSILevel:GTKnowledge
B.COM REF: p. 155
OBJ: 1 TOP: Functions ofNPeer Groups
o
aC s
vi y re
COMPLETION
1. Adolescence is defined as beginning at age __________ years and ending at age

____________ years.
ed d
ar stu
ANS:
11, 21
is
These are the ranges of the beginning and end of adolescence. Physical, sexual, and
psychological growth are greatest during these years.
Th

OBJ: 1 TOP: Problems of Adolescence
sh
2. Obesity is defined as body weight that is __________% above average, based on the
individual’s height and build.
ANS:
20

Obesity is a growing problem in the United States.

OTHER
1. Adolescents who become chemically dependent progress through four stages. Place these
stages in order of occurrence.
a. Burnout
b. Active seeking
c. Preoccupation
d. Experimentation
ANS:
D, B, C, A
m
er as
Experimentation involves using the drug for the first time with peers and enjoying the effects
co
of the drug. Active seeking refers to looking forward to using the drug and wanting the feeling
eH w
that one experiences when using the drug; relationships then begin to become affected, and
the teen’s only friends are the ones who also take the drugs. During the preoccupation stage,
o.
rs e
the adolescent believes that he or she has to use the drug to cope with life, and relationships
ou urc
fall apart. The last stage, burnout, is characterized by drug use as the primary focus of the
teen’s life, along with addiction and withdrawal symptoms when the drug is not used.
NURSINGTB.COM
o
OBJ: 6 TOP: Chemical Dependency

aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 15: Problems of Adulthood

MULTIPLE CHOICE
1. The nurse is caring for an adult male client who lacks a strong sense of personal identity. With
which area of development will this client most likely struggle the most?
a. Social
b. Intellectual
c. Emotional
d. Vocational
ANS: A
If an individual has little or no sense of identity, it is difficult to establish relationships with
others. Lack of personal identity will not affect the other areas of development as strongly as
it does social development. Vocation is not one of the areas of development; choosing a
vocation or career is a core task of young adulthood.
m
er as
OBJ: 2 TOP: Adult Growth and Development
co
eH w
o.
2. __________ is a major challenge for adults because energies are not concentrated on the self,
rs e
and the demands can create feelings of anxiety, isolation, inadequacy, and helplessness.
ou urc
a. Adulthood
b. Adolescence
c. Childhood NURSINGTB.COM
o
d. Parenting
aC s
ANS: D
vi y re
Most of a parent’s energy is focused on the child or children every minute of every day. The
responsibility is immense and can cause various emotions, especially if the parent works
outside the home. Adulthood, adolescence, and childhood do not have a primary focus on
others as parenting does.
ed d
ar stu

is
3. An adult male client is admitted to a mental health facility with the diagnosis of depression
Th
following the breakup of a long-term engagement. He states that he couldn’t “commit to

marriage.” In conducting his admission assessment, the nurse learns that during his childhood
he did not feel guided, nurtured, or accepted by his parents. One of the goals for this client is
to help him develop a positive personal identity. Which intervention should the nurse
sh
implement to meet this goal?

a. Improve his strength in the ability to adapt to new situations
b. Develop the ability to establish and maintain an intimate relationship
c. Discern his feelings about relationship choices and level of commitment
d. Outline his life’s dream

ANS: C
Discerning his feelings about relationship choices and commitment best meets the needs of
this client at this time in his life. Improving his ability to adapt and developing his ability to
establish and maintain an intimate relationship are not indicated in the scenario as an issue.
Outlining his life’s dream assists in building a positive personal identity but is too broad a task
for this client at this time.

OBJ: 4 TOP: Personal Identity
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention
4. The term “sandwich generation” best describes adults:

a. Caught between adulthood and late adulthood
b. Caring for their children and aging parents
c. Caring for their children and grandchildren
d. Caught between young adulthood and adulthood
ANS: B
m
This generation can be a problem for many adults in that they face multiple responsibilities,
er as
resulting in increased levels of stress.
co
eH w
OBJ: 5 TOP: Internal (Development) Problems
o.
rs e
ou urc
5. An increasing number of ______ are the head of the household of families in the United
States. NURSINGTB.COM
a. Married couples
o
b. Single women
aC s
c. Single men
vi y re
d. Relatives
ANS: B
This statistic sometimes can lead to stress-related mental health disorders caused by the
ed d
pressure of multiple responsibilities.

ar stu

OBJ: 5 TOP: Guiding the Next Generation
is
6. The nurse is caring for a client who is a single mother of two young children, has no financial
Th
or parental support from her ex-husband, is troubled by her financial circumstances and
future, and works at a local fast-food restaurant. She is seeking help for depression. What is
the nurse’s best action?
sh
a. Assist the client in seeking educational and/or vocational programs for single
parents
b. Encourage the client to explore her feelings related to the reasons for her divorce
c. Persuade the client to contact her ex-husband for financial and parental support
d. Share information with the client regarding support groups for single mothers
ANS: A

Assisting the client in finding programs for single parents helps the client by giving her
support as she tries to better her financial situation in a way that will improve her self-esteem,
independence, and personal identity and will help her to secure her financial future. Exploring
feelings related to the divorce and having the client contact her ex-husband are not going to
help her depression at this time. Sharing information about support groups will be helpful in
the future but does not meet her immediate need.

OBJ: 6 TOP: Education KEY: Nursing Process Step: Intervention
7. An adult female calls a crisis hotline stating that she moved a few months ago to seek a new
job “in a big city.” She is crying and says that she doesn’t think she can stand being so lonely
anymore but doesn’t want to move back to her small hometown and face her family and
friends as a “failure.” What is the nurse’s first response?
a. “Would you like me to call your family to assist you in deciding what is best for
you to do?”
b. “I am sure you will make friends once you find a steady job that you like.”
c. “Can you tell me what you mean by your statement that you don’t think you can
m
er as
stand being lonely anymore?”
d. “Let me give you a list of some social groups that might be of interest to you.”
co
eH w
ANS: C
o.
The nurse must first clarify what the client’s statement is referring to so as to eliminate the
rs e
possibility that the client is thinking of harming herself. Once this is clarified, and if it is not
ou urc
what the client is indicating, a list of social groups might be supplied later in the conversation.
Offering to call the client’s family and assuring her that she will make friends are disregarding
NURS
what the client is telling the nurse
I feels.
she N
GTB.C OM
Social isolation is not a healthy state for an
o
individual.
aC s
vi y re

OBJ: 7 TOP: Health Care Interventions
ed d
8. AFRAIDS is a condition that most likely would be seen in:

a. The homosexual population
ar stu
b. Sexually promiscuous heterosexuals

c. Individuals in a heterosexual monogamous relationship
d. Persons who have a chemical dependency on illegal intravenous drugs
is
ANS: C
Th
This term stands for acute fear regarding acquired immunodeficiency syndrome (AIDS). It is
seen in individuals whose behaviors based on their lifestyle put them at very little risk of
contracting HIV/AIDS. Individuals in a heterosexual monogamous relationship most likely
would demonstrate AFRAIDS. The other populations are at higher risk for contracting the
sh
disease based on the behaviors associated with their lifestyle.

OBJ: 8 TOP: Acquired Immunodeficiency Syndrome

9. How many people in the United States have a severe mental illness?
a. 500,000
b. 1.3 million
c. 5.4 million
d. 10 million
ANS: C
It is important for the nurse to realize that the number of individuals needing care for mental
health issues is growing.

OBJ: N/A TOP: Mental Health Problems of Adults
10. When the nursing care plan for a client with a mental health disorder is developed, what is the
most likely reason that interventions are ineffective and goals are not met?
a. The client sees his goals as less important.
b. The client’s family is not supportive.
c. The client’s disorder is difficult to treat.
m
d. The client’s medications are being adjusted.
er as
co
ANS: A
eH w
Unrealistic goals set the client up for failure. Even the best interventions will not be successful
in this circumstance. The nurse must be sure to accurately assess the client’s life situation
o.
when working with the client to set realistic goals. The other options must be considered when
rs e
a care plan is being developed, but if taken into consideration, they do not hinder the outcome
ou urc
as much as the client not seeing importance in his goals. Therapeutic actions will have greater
NUtoRS
results if goals are as important IN
the GTB.COM
client.
o

aC s

vi y re
11. A 42-year-old male client continues to enter into business deals that cause him to lose large
amounts of money. He subsequently seeks mental health care for stress-related disorders.
ed d
Which characteristic of a successful adult is this client lacking?

ar stu
a. Acceptance of self
b. Finding a balance between giving and taking
c. Making sound decisions
d. Learning from past decisions
is
ANS: D
Th
Making sound decisions and learning from past decisions describe this client’s situation, but
learning from past decisions applies the most in that he has made the wrong decision
numerous other times in the past. Acceptance of self is not addressed in this scenario, and
sh
finding a balance between giving and taking refers to maintaining a balance between caring
for others and taking care of oneself.
PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 171


12. A 68-year-old woman tells the nurse that since she retired a few months ago, she has been
“taking it easy” by sleeping later and staying around the house to rest. She has recently
noticed that she is having a little trouble with remembering things. The nurse is aware that
intellectual development is continuous and suggests to the client:
a. “You might think about volunteering somewhere to keep your mind sharp.”
b. “You are probably just tired from all those years at work.”
c. “After you have gotten used to being at home, I am sure your memory will
improve.”
d. “Sometimes we must accept the fact that as we get older, we sometimes become
more forgetful.”
ANS: A
To maintain intellectual development, individuals must engage in productive activities at all
ages.

m
13. A 49-year-old woman who has been the owner of a successful large business for several years
er as
decides to sell her business and move to a remote island to open a small dress shop. She most
co
likely has made this decision based on her need to:
eH w
a. Avoid becoming stagnant in her life
o.
b. Earn more money
rs e
c. Prevent another company from taking over her business
ou urc
d. Improve her social development
ANS: A NURSINGTB.COM
Making a dramatic change in one’s adult life prevents an individual from becoming dormant
o
in his or her daily life. People who are unhappy tend to develop mental health disorders.
aC s
vi y re

ed d
14. A 37-year-old client who has been divorced for several years recently lost joint custody of a
ar stu
10-year-old daughter because of drug and alcohol use, along with nonpayment of child
support. The client is referred to the clinic as the result of a court order. When arriving at the
clinic, the client has been on a drinking binge for 2 days. What is the most appropriate nursing
diagnosis for this client?
is
a. Health-seeking behaviors
Th
b. Family processes, readiness for enhanced

c. Coping, ineffective
d. Hopelessness
sh
ANS: C
This client is using drugs and alcohol as coping mechanisms. It is unlikely that the client is
choosing these actions as a health-seeking mechanism. The client is not ready to work on
family processes, and there is not enough evidence to suggest hopelessness.


15. A 45-year-old woman is admitted to an inpatient mental health facility with the diagnosis of
severe depression. She lives by herself and has been very active in her community for many
years. During the past 6 months, she has become increasingly withdrawn from her family and
friends and was terminated from her job because of excessive absenteeism. When she arrives
on the unit, she makes little eye contact with the nurse, has a flat affect, and answers with one
or two words. What is the most appropriate nursing diagnosis for this patient?
a. Diversional activity, deficient
b. Coping, ineffective
c. Fatigue
d. Hopelessness
ANS: D
The complete picture of this client indicates hopelessness as the most accurate nursing
diagnosis at this time. The other three options may apply to her at a later time after further
evaluation.
m
OBJ: 9 TOP: Mental Health Problems of Adults
er as
co
eH w
16. __________% of the adult population in the United States has a mental health disorder.
o.
a. 5
b. 11
rs e
ou urc
c. 25
d. 39
NURSINGTB.COM
ANS: C
o
This percentage refers to diagnosable mental health disorders.

aC s
vi y re

OBJ: N/A TOP: Mental Health Problems of Adults
ed d
17. A 35-year-old woman in a managerial position has had a number of employees under her
ar stu
supervision resign or transfer to other departments over the past year. In addition, she has
rarely had a close personal relationship for more than a few months. She feels other people
“just don’t measure up to my expectations.” Her situation is the result of a possible:
a. Cognitive disorder
is
b. Somatoform disorder
Th
c. Anxiety disorder
d. Personality disorder
ANS: D
sh
Problems with interpersonal relationships can extend to work and social environments.
Individuals who have little or no ability to see how their attitudes and behaviors affect other
people often have difficulties with long-term relationships. They become superficial and
unwilling to consider the feelings of others. Small problems with social relationships can
balloon into serious mental health problems.


18. A newly married couple residing in a large city is expecting the birth of their first child in
three months. The wife wishes to maintain her career and remain in their apartment. The
husband has expressed the desire to relocate to a more suburban setting to raise their child.
Their ability to successfully face this challenge depends upon their ability to:
a. Negotiate a mutually satisfying solution
b. Employ appropriate coping mechanisms
c. Avoid conflict by dealing with the issue at a later time
d. Maintain a firm sense of individuality
ANS: A
Compromise involves a willingness to negotiate and enter into interactions in which neither
person wins or loses. Conflicts are resolved by defining and solving the problem. The focus is
kept on the issue. Couples who compromise, communicate openly, listen carefully, and try to
understand their partner’s point of view find that their relationship is respected and cherished.
m
er as
co
eH w
19. An obese woman is seen in the emergency department complaining of headaches. Her blood
pressure is 150/92. Also present are her 4-year-old son and 2-year-old daughter. When the
o.
rs e
nurse offers to call a family member to pick up the children, the woman states that they are
living alone in a women’s shelter. What is the most appropriate action for the nurse to take?
ou urc
a. Instruct the client on proper nutrition and educate her regarding the dangers of
hypertension. NURSINGTB.COM
b. Make a referral for the client to a weight loss center.
o
c. Assist the client to plan better coping strategies.

aC s
d. Assess the family’s daily living needs and consult social work for community
vi y re
resources.
ANS: D
It is crucial to learn about the client’s living conditions and work within the reality of their
ed d
situation. Instruction on nutrition and health practices and development of coping strategies
ar stu
cannot be addressed until basic needs for food, clothing, and shelter are met.

is
Th
20. The parents of a 21-year-old who attended church services on a consistent basis are concerned
when their child returns home from college and announces she is converting to another
religion. This individual is most likely experiencing:
sh
a. A personality disorder
b. The need to challenge a value and belief system
c. Instability due to dysfunctional parenting
d. Regression to an unresolved developmental task
ANS: B

Development within the spiritual dimension focuses on defining one’s value system and belief
system. Young adults often challenge their current religious practices by changing churches or
refusing to attend services. This is not seen as a personality disorder or a result of
dysfunctional parenting. This task is expected during this phase of development.

MULTIPLE RESPONSE
1. Which statements describe the adult who has achieved the successful emotional development
of adulthood? (Select all that apply.)
a. The adult is able to function effectively in a stressful environment.
b. The adult possesses effective intellectual and abstract problem-solving skills.
c. The adult is able to adapt to growing older.
d. The adult sets realistic personal and professional goals.
ANS: A, C, D
m
er as
These are characteristics of an individual who has achieved the expected emotional
development of adulthood. Possessing effective intellectual and abstract problem-solving
co
eH w
skills refers to intellectual development of adulthood.
o.
OBJ: 3
rs e
TOP: Adult Growth and Development
ou urc
2. One of the ways in which the social N TN R I G B.C M

U S developmentOof adults can be assessed is by observing the
o
individual’s ability to effectively communicate with whom? (Select all that apply.)
aC s
a. His or her significant other

vi y re
b. His or her physician

c. His or her children
d. His or her co-workers
ANS: A, C, D
ed d
These are people with whom the adult interacts on a daily basis, so effective communication
ar stu
will confirm that one aspect of the social task of adulthood is achieved. It would be unfair to
base this on how effectively the client communicates with his or her physician because this
interaction does not occur on a daily basis and often occurs during stressful times.
is

Th

3. Therapeutic interventions are effective in the prevention of mental and emotional disorders
sh
and assisting the client to cope. Which of the following interventions assist in providing for a
positive personal identity? (Select all that apply.)
a. Continue to define identity in terms of role in nuclear family
b. Develop career path and goals
c. Recognize how emotions influence achievement of goals and relationships
d. Maintain personal distance in relationships

ANS: B, C
The individual is assisted to develop a positive personal identity by differentiating self from
the nuclear family, developing occupational goals, assessing how emotions influence
achievement and relationships, and deciding on relationship choices and level of commitment.

OBJ: 2 TOP: Therapeutic Interventions for a Positive Personal Identity
COMPLETION
1. Adulthood is defined as beginning at age __________ years and ending at age ____________
years.
ANS:
18; 65
These are the age ranges of the beginning and end of adulthood.
m
er as
co
OBJ: 1 TOP: Adulthood KEY: Nursing Process Step: Assessment
eH w
o.
rs e
2. The __________ environment defines stressful or anxious situations.
ou urc
ANS:
Internal NURSINGTB.COM
o
Problems with the internal and external environment can lead to physical and psychological
aC s
problems in adults who are unable to cope effectively. The external environment includes
vi y re
jobs, education, and living conditions.

OBJ: 4 TOP: Common Problems of Adulthood
ed d
ar stu
is
Th
sh


Chapter 16: Problems of Late Adulthood

MULTIPLE CHOICE
1. __________% of older adults are living at poverty level.

a. 12
b. 18
c. 26
d. 23
ANS: A
This is similar to the economic status of other ages.

OBJ: 1 TOP: Facts and Myths of Aging
m
2. A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing:
er as
a. Ageism
co
b. Gerontophobia
eH w
c. An age phobia
o.
d. Elder phobia
ANS: B rs e
ou urc
This term also includes refusal to accept the elderly into the mainstream of society. Ageism is
NURdependent,
stereotyping the elderly as weak,
S INGTB.C M
and nonproductive.
O Age phobia and elder phobia
are not used terms.
o
aC s

vi y re
OBJ: 1 TOP: Facts and Myths of Aging

3. Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow
ed d
after one reaches the age of approximately:

ar stu
a. 35
b. 45
c. 65
d. 85
is
ANS: D
Th
Signs of aging continue to show themselves until around 85 years. Physical aging is affected
by genetics, health care, lifestyle, and attitude.
sh

OBJ: N/A TOP: Physical Health Changes
4. An elderly man has serious vision problems and is no longer allowed to obtain a driver’s
license. He has been very independent until this time. Which nursing diagnosis is most
appropriate for this situation?

a. Confusion, chronic
b. Coping, ineffective
c. Self-esteem, risk for situational low
d. Grieving, dysfunctional
ANS: C
“Self-esteem, risk for situational low” is most appropriate because of his previous
independence. The other options are also nursing diagnoses, but the situation does not lend
itself to these diagnoses.

OBJ: 2 TOP: Physical Adaptations
KEY: Nursing Process Step: Diagnosis MSC: Client Needs: Health Promotion and Maintenance
5. The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who
is on a fixed income. He was discharged from the hospital a few weeks ago with his newly
prescribed medication to keep his BP under control. His BP measurements have been
gradually increasing over the last few visits, with no other changes in status assessed. Which
nurse statement would be most appropriate?
m
a. “Have you been taking your medication as often as you are supposed to?”
er as
b. “I don’t understand why your BP is up.”
co
c. “Maybe I should check your BP at another time.”
eH w
d. “I hope you are taking your medication. Otherwise, I am wasting my time.”
o.
ANS: A
rs e
Clients on fixed incomes often take less of their medications so they will last longer. None of
ou urc
the other options meets the need of the situation, and saying that the client is wasting the
nurse’s time is an inappropriate
NUstatement.
RSINGTB.COM
o

aC s
OBJ: 3 TOP: Psychosocial Adaptations

vi y re
6. A 2015 survey estimates the average number of elderly who are abused is _______.
a. 2,150,000
ed d
b. 3,250,000
ar stu
c. 1,850,000
d. 1,500,000
ANS: A
is
Today, it is estimated that the average number of elderly who are abused is 2,150,000 (NCEA,
2015).
Th

OBJ: 5 TOP: Elder Abuse KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance
sh
7. Which intervention will be most effective when one is teaching a client about his or her
medications and their administration?
a. Pointing out the colors of the medications for easier identification
b. Referring to medications by name and providing written instructions
c. Quizzing the client on each medication’s purpose, side effects, and drug

interactions
d. Encouraging the client to hold all questions until the end of the discussion so the
nurse will not have to repeat information
ANS: B
Referring to the medications by name and providing written instructions will lead to less
confusion. Pointing out colors can be a problem if there is visual impairment; quizzing the
client is not necessary; and encouraging the client to hold questions may cause questions to be
forgotten.

OBJ: 8 TOP: Age-Related Interventions
8. The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics
nurse before retiring. Despite her dementia, she still remembers terms and procedures and
basic nursing care interventions from her past career. This is an example of:
a. Working memory
b. Reasoning
m
c. Information processing
er as
d. Crystallized intelligence
co
eH w
ANS: D
Crystallized intelligence is specialized accumulated knowledge, and it is common for
o.
individuals to remember this specialized information, even if they experience dementia.
rs e
Working memory is the random access memory to which one refers. Reasoning is the ability
ou urc
to solve problems and make choices, and information processing is the ability to relate to,
NURSINGTB.COM
store, and retrieve information.
o

aC s
OBJ: 2 TOP: Mental Health Changes

vi y re
9. An elderly client states that she paid $10,000 to a “nice repairman” for fixing her broken
window and fence. This is an example of elder abuse known as:
ed d
a. Violation of rights
ar stu
b. Exploitation
c. Psychological abuse
d. Neglect
is
ANS: B
It is estimated that approximately 10% of the elderly population are victims of this type of
Th
abuse.

sh

10. The nurse must be aware of physical signs and symptoms of depression because these are
often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of
depression include:
a. Decreased or slowed memory

b. Fatigue
c. Changes in appetite
d. Abdominal pain
ANS: D
Abdominal pain, muscle aches, and dry mouth are common physical symptoms of depression
in the older adult. Other physical causes of these symptoms must be ruled out, and further
assessment of other signs of depression must be noted. Decreased or slowed memory is
cognitive; fatigue is emotional; and change in appetite is behavioral.

OBJ: 6 TOP: Depression KEY: Nursing Process Step: Evaluation
11. The nurse is implementing validation therapy with an elderly male client to assist him in
resolving old conflicts and making peace with himself. Which is one of the techniques used?
a. Sympathy
b. Empathy
c. Helping the client write a paragraph about his life
m
d. Contacting old acquaintances for their interpretation of the client’s life
er as
co
ANS: B
eH w
Empathy and several other interventions constitute validation therapy. The other options are
not used in validation therapy.
o.
PTS: 1 rs e
ou urc
OBJ: 9 TOP: Depression KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial
N Integrity
R I G B.C M
U S N T O
o
12. It is important for the nurse to be aware that __________% of individuals over 45 years old
aC s
take prescription medications, over-the-counter medications, or a combination of these

vi y re
medications.
a. 35
b. 55
c. 75
ed d
d. 95
ar stu
ANS: C
Seventy-five percent of individuals over 45 years old take prescription medications,
over-the-counter medications, or a combination of medications. This is important to know
is
when one is planning interventions.

Th

OBJ: 4 TOP: Substance Abuse
sh
13. One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring
of:
a. DSM-IV-TR standards
b. State boards of health
c. Standards of geriatric nursing practice
d. State nurse practice acts

ANS: C
Standards of geriatric nursing practice were developed to specifically address the needs of the
elderly population.

OBJ: 7 TOP: Standards of Geriatric Care
14. It is projected that by 2050, the population of those aged 65 and over will be _______ million.
a. 83.7
b. 61.3
c. 43.8
d. 56.5
ANS: A
By “2050, the population aged 65 and over is projected to be 83.7 million, almost double its
estimated population of 43.1 million in 2012” (U.S. Census Bureau, 2014).
m
er as
OBJ: 1 TOP: Overview of Aging
co
eH w
o.
15. The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that
rs e
she is losing weight. While performing an assessment, the nurse discovers that the client’s
ou urc
dentures are ill-fitting and this makes eating painful. The client claimed she informed her
daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned
that this is a possible sign of:NURSINGTB.COM
o
a. Abuse
b. Neglect
aC s
vi y re
c. Domestic violence
d. Depression
ANS: B
Neglect is defined as failing to meet basic physical needs. Abuse and domestic violence are
ed d
evidence of actual physical harm. This situation does not describe depression.
ar stu

is
Th
16. The nurse is completing an admission interview with an older adult on a busy medical unit.
What action is most appropriate for the nurse to take?
a. Complete the admission interview with the client’s son
b. Shout at the client so he or she can hear
sh
c. Provide pen and paper and let the client write his answers
d. Allow the client time to respond to the questions regarding health history
ANS: D
Information processing speed decreases with age, and it may take longer for the client to
retrieve the information and respond.


OBJ: 2 TOP: Mental Changes of Aging
17. A 70-year-old woman who was recently widowed expresses a desire to go back to school and
finish the degree she started before her children were born. What response is most
appropriate?
a. “Why would you want to stress yourself at your age?”
b. “That may not be possible. As you age, your ability to learn decreases.”
c. “Going back to school will keep you engaged and active.”
d. “Let’s do a cognitive function test to see if you are eligible.”
ANS: C
It is important for older adults to stay active and engaged. Encouraging the woman in her
pursuit is an appropriate response. The other options may all discourage the client from
remaining engaged in society.

OBJ: 2 TOP: Mental Changes of Aging
m
er as
co
18. A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears
eH w
to be confused and combative at times. Her daughter is concerned because her mother was
alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is
o.
related to:
rs e
a. The onset of Alzheimer’s disease
ou urc
b. Alteration in oxygenation
c. Family neglect NURSINGTB.COM
d. Dysfunctional coping
o
aC s
ANS: B
vi y re
Physical problems can lead to changes in mental status. Early assessment and intervention are
key for keeping an older adult’s minor problems from becoming major ones. An alteration in
oxygenation can affect a client’s behavior.
ed d

ar stu
OBJ: 2 TOP: Physical Adaptations

is
MULTIPLE RESPONSE
Th
1. Which conditions most commonly place older adults at risk for overdose from medications
and severe reactions? (Select all that apply.)
a. Depression
b. Higher rate of metabolism
sh
c. Interaction with other medications

d. Problems with sight and memory
ANS: C, D

Older adults often are taking numerous medications prescribed by several specialists, and
sight and memory can cause errors in taking medications. Depression is not a common cause
of overdose, and metabolism is usually slower in this age group.

OBJ: 4 TOP: Substance Abuse
2. Which emotional signs and symptoms of depression in the elderly must the nurse be aware of
and monitor for? (Select all that apply.)
a. Increased anxiety or dependence
b. Fatigue
c. Feels he or she has no purpose
d. Withdraws from people
ANS: A, B, C
Increased anxiety or dependence, fatigue, and feelings of purposelessness are emotional signs
and symptoms of depression. Withdrawal from people is a behavioral sign of depression.
m
er as
OBJ: 6 TOP: Depression KEY: Nursing Process Step: Assessment
co
eH w
3. To respectfully and effectively provide health teaching to the older adult, which of the
o.
following actions should be employed? (Select all that apply.)
rs e
a. Speak very loudly and in high-pitched tones.
ou urc
b. Ask clients to repeat your message.
c. Break complex tasks intoNsmall,
URSI NGTB.C
pertinent OM
steps.
d. Refer to medications by color.
o
aC s
ANS: B, C
vi y re
When teaching older adults, it is important to have them repeat your message back to you to
ensure that they understand. It is also helpful to break complex tasks into smaller manageable
steps to help the client remember. Speaking loudly and in high-pitched tones will not assist
the client in learning. A nurse should refer to medications by name rather than color.
ed d
ar stu

OBJ: 8 TOP: Age-Related Interventions
is
COMPLETION
Th
1. __________ refers to a state of wholeness or quality of one’s character.
ANS:
sh
Integrity
Elders who have developed a good sense of personal integrity deal with aging better than
those who have not.

OBJ: 2 TOP: Mental Health Changes

2. Although __________ is often a desire of older adults, it can bring loss of income and loss of
opportunities for socialization.
ANS:
Retirement
Retirement is a major life-changing event.

OBJ: 2 TOP: Common Problems of Older Adults
m
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 17: Cognitive Impairment, Alzheimer’s Disease, and Dementia

MULTIPLE CHOICE
1. A 75-year-old male client is brought to the clinic by his son. The son states, “Ever since Mom
died, Dad hasn’t been the same. At first he just seemed sad, but now he seems to get mixed up
about everything.” The nurse is aware that based on the client’s history, the source of
confusion is most likely:
a. Dementia
b. Depression from the loss of his wife
c. Hypoxia of the brain
d. Delirium from medications
ANS: B
Depression in the elderly population is often a cause of confusion. The son’s description of
the behaviors of his father since his wife’s death indicate that he became depressed, which has
been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of
m
er as
brain injury, and delirium is sudden. Even though it appears that the confusion is caused by
the depression, a thorough examination is warranted to confirm the cause.
co
eH w
o.
OBJ: 2 TOP: The Five “Ds” of Confusion
rs e
ou urc
2. Vascular dementia is more common in individuals living in:
a. The United States NURSINGTB.COM
o
b. Japan
c. France
aC s
vi y re
d. Australia
ANS: B
The incidence of vascular dementia is more common in Japan for unknown reasons. Japanese
citizens who move to the United States have been found to have a decreased rate of vascular
ed d
dementia.
ar stu

OBJ: 5 TOP: Causes of Dementia
is
Th
3. A newly admitted elderly client seems to become confused and agitated every evening after
dinner. This client most likely is suffering from:
a. Alzheimer’s disease
b. Acute dementia
sh
c. Sundown syndrome
d. Delirium
ANS: C

Sundown syndrome typically occurs during the late afternoon, evening, or night when an
elderly person is in unfamiliar surroundings. The other three options occur at any time of day,
evening, or night. The symptoms often disappear when the client is back in familiar
surroundings.

OBJ: 5 TOP: Symptoms of Dementia
4. The elderly spouse of a 74-year-old male client states that she has noticed that her husband
“doesn’t remember as well as he used to.” She explains that he has been putting on his coat
before his shirt, and that he can never get their checkbook to balance as it did in the past. The
client is exhibiting signs and symptoms typical of:
a. Vascular dementia
b. Alzheimer’s disease
c. Acute delirium
d. Aging
ANS: B
m
The person with Alzheimer’s disease commonly shows deficits in familiar tasks. Vascular
er as
dementia and acute delirium relate more to confused states, and dementia symptoms should
co
not be assumed to be part of normal aging.
eH w
o.
OBJ: 6
rs e
TOP: Alzheimer’s Disease
ou urc
5. The affective losses of Alzheimer’s

NURSI disease
NGTB.Crefer O
toMlosses noticed in the individual’s:
a. Personality
o
b. Thought processes
aC s
c. Ability to make and carry out plans

vi y re
d. Self-care
ANS: A
Affective losses result in personality changes in the individual with Alzheimer’s disease.
ed d
Thought processes and self-care do not relate to the individual’s personality, and the ability to
ar stu
make and carry out plans is referred to as conative loss.

OBJ: 6 TOP: Symptoms and Course of Alzheimer’s Disease
is
Th
6. The average time that a person with Alzheimer’s disease lives after diagnosis is:
a. 2 years
b. 8 years
sh
c. 10 years
d. 20 years
ANS: B
Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the
disease.


OBJ: 6 TOP: After the Diagnosis
7. For those family members who desire to care at home for loved ones who have been given a
diagnosis of Alzheimer’s disease, it is important for the nurse to ensure that the family is
aware of which caregiver skills and responsibilities will be necessary. What is one of the
responsibilities of the caregiver during the middle stage of the disease?
a. Helping the loved one with memory and communication problems
b. Providing a stable, routine environment
c. Providing complete assistance with physical care
d. Adapting to the changing personality and behavior of the loved one
ANS: D
The middle stage is when personality changes begin to occur. It is difficult for the family to
see the loss of their loved one’s personality. Helping with memory and communication
problems and providing a stable, routine environment occur in the early stage, and complete
assistance with physical care is typically a responsibility of the caregiver during the severe
stage.
m
er as
co
OBJ: 6 TOP: Stages of Alzheimer’s Disease
eH w
o.
rs e
8. The nurse is answering questions from a client and his family regarding a recent diagnosis of
Alzheimer’s disease. The client asks how effective medication is in treating the disease. What
ou urc
is the nurse’s best response?
NURS
a. “There is no cure or treatment forIAlzheimer’s
NGTB.COdisease.”
M
b. “Medications have shown little improvement in symptoms.”
o
c. “Medications for the disease have been found to improve thinking abilities,
aC s
behavior, and daily functioning in some clients.”

vi y re
d. “Alternative therapies, such as co-enzyme Q-10 and Ginkgo biloba, are more
effective than any of the prescription medications used to treat the symptoms.”
ANS: C
ed d
The most accurate statement is to say that medications have been found to improve thinking
ar stu
abilities, behavior, and daily functioning in some clients. Although no cure for the disease is
known, it is inaccurate to say that there is no treatment. To say that medications have
produced little improvement in symptoms is misleading because it sounds as though
medications are not effective. Stating that alternative therapies are more effective is inaccurate
is
because these therapies are still under investigation for determination of their effectiveness in
Th
treating symptoms of the disease.

OBJ: 6 TOP: Interventions with Alzheimer’s Disease
sh
KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity
9. Which of the following is an effective communication technique that should be included in

the teaching plan for the family members of a woman in whom Alzheimer’s disease has been
diagnosed recently?
a. Use simple, familiar words, along with short and simple sentences.

b. If the client tends to pace a lot, be sure to encourage her to sit during interactions.
c. If she doesn’t understand the communication, change key words.
d. Use hand gestures when speaking to try to explain what is being said.
ANS: A
Alzheimer’s affects cognitive ability, so it is best to use words and phrases that do not require
a great deal of thought to be understood. Having the client sit when she likes to pace may
increase her anxiety and block communication. Repeat key words to assist in understanding;
changing the key words may further confuse the client. Hand gestures may further confuse the
troubled thought processes.

10. The elderly spouse of a female Alzheimer’s client states that his wife seems to wander
aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in
the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what
he can do to help her. What is the nurse’s best response?
m
a. “Keep rooms well lit.”
er as
b. “Keep the home environment simple and user-friendly for her.”
co
c. “Have clocks and calendars with large letters in several rooms of the house.”
eH w
d. “Place large signs on doors or entryways that identify the room.”
o.
ANS: D
rs e
All of these options will assist her in keeping her orientation to the environment, but because
ou urc
she is wandering to the wrong rooms to look for items, signs on the doors and entryways
would be most helpful to herNasUshe
RSfinds
INGthe
TB.C OM room.
appropriate
o

aC s

vi y re
11. The nurse performs a functional assessment of a client upon admission to a home health
service. The purpose of this assessment is to determine the client’s:
ed d
a. Level of consciousness
ar stu
b. Ability to perform activities of daily living

c. Degree of reasoning, judgment, and thought processes
d. Level of functioning memory
is
ANS: B
This is an important point of assessment if the nurse is trying to determine the level of care
Th
necessary for this client. The other options also may be assessed at some point in the
admission, but they do not make up the functional assessment.
sh

OBJ: N/A TOP: Assessment KEY: Nursing Process Step: Assessment
12. A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes
to her room and cries because she misses her children. This client could benefit most from
which intervention?

a. Life review
b. Doll therapy
c. Comfort touch
d. Audio presence therapy
ANS: D
Because missing her children brings sadness to this client, she may benefit from hearing their
voices on tape and recalling pleasant family memories. The other interventions are effective
therapies for clients with dementia, but they do not address this client’s immediate need.

13. The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of
Alzheimer’s disease. When administering this particular medication, the nurse should be
especially alert to assess the client for:
a. Weight changes
b. Tremors
m
c. Increased sweating
er as
d. Alterations in blood pressure
co
eH w
ANS: D
This medication may cause high or low blood pressure. The other options typically are not
o.
seen with donepezil (Aricept) but sometimes are seen with other Alzheimer’s medications.
rs e
ou urc
OBJ: 7 TOP: Interventions with
NURSINGTB.COM Alzheimer’s Disease
o
14. Which symptom of Alzheimer’s disease is associated with disorientation to time and place?
aC s
vi y re
a. Forgetting in what order to put clothes on

b. Forgetting simple words
c. Forgetting where one lives
d. Becoming suspicious of others
ed d
ANS: C
ar stu
Additional examples of disorientation to time and place include a person’s getting lost on the
street where he or she lives and forgetting how he or she got to places. Forgetting in what
order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple
is
words relates to problems with language; and becoming suspicious of others relates to
changes in personality.
Th

OBJ: 6 TOP: Stages of Alzheimer’s Disease
sh
15. An elderly woman is brought to the clinic by her daughter. The client states that she has had a
cold for several days. Her daughter states that her mother has been confused about when her
routine medications are to be taken and that her mother has never experienced confusion about
her medications before. Based on this information, it is important that the nurse ask the client
whether:

a. There is a history of mental illness in the family.

b. She has been given a diagnosis of a mental health disorder in the past.
c. She can recall her last visit to a physician.
d. She has taken any over-the-counter medications for her cold.
ANS: D
Over-the-counter cold medications can cause confusion in the elderly population. Because this
client has had a cold recently, it would be important to determine whether she has been taking
any of these types of medications. There is no indication that the other options have any
significance in relation to the acute confusion.

OBJ: 3 TOP: Medications and the Elderly Population
16. The daughter of an elderly nursing home resident is crying outside her father’s room. When
the nurse comforts her, she states, “It is so hard to come here to visit when my father doesn’t
even know who I am.” The nurse knows the client is in which stage of Alzheimer’s disease?
a. Early stage
m
b. Intermediate stage
er as
c. Severe stage
co
d. End stage
eH w
ANS: B
o.
Visual agnosia, the loss of recognition of previously known or familiar people, is a
rs e
manifestation of the intermediate stage of Alzheimer’s disease.
ou urc
NURSILevel:
OBJ: 6 TOP: Stages NGTApplication
B.COM
of Alzheimer’s Disease
REF: p. 196
o
aC s
vi y re
17. A 75-year-old man finds that he continually misplaces items he uses every day. In addition,
his wife becomes annoyed when he asks the same question several times because he does not
remember the answer. What advice is the most appropriate for his health care provider to give
him?
ed d
a. These symptoms are a normal part of aging and he should accept it.
ar stu
b. He has Alzheimer’s disease and nothing can be done to help him.

c. Further assessment is needed to determine the cause of these symptoms.
d. Admission to a nursing home for more intensive care is needed.
is
ANS: C
Multiple factors influence how one ages mentally. Culture, education, general health,
Th
genetics, and living conditions all have an influence on one’s cognitive (intellectual) abilities.
We all age individually, but one thing is certain: confusion is not normal. Although it most
often occurs in older adults, individuals of any age can become confused. No matter what the
sh
age, confusion demands investigation.

OBJ: 1 TOP: Normal Changes in Cognition

18. The most common severe cognitive impairment in the United States is Alzheimer’s dementia.
What percentage of the population over the age of 85 are at risk for getting the disease?
a. 30%
b. 50%
c. 70%
d. 90%
ANS: B
The incidence of dementia increases with age. Alzheimer’s dementia is the most common
severe cognitive impairment in the United States. “For people age 85 years or older, the risk
of getting Alzheimer’s Dementia approaches 50%” (Small, 2010).

19. Which client exhibits signs and symptoms of delirium and not dementia or depression?
a. The onset is sudden and acute.
b. The cognitive changes are hidden by the client.
m
c. The client demonstrates apathetic demeanor or flat affect.
er as
d. The client’s ability to perform ADLs is intact.
co
eH w
ANS: A
Cognitive changes that occur with delirium are sudden in nature. Clients with dementia may
o.
attempt to hide cognitive changes in the early stages, and they are able to perform ADLs in
rs e
the early stage as well. Clients suffering from depression often display apathy or a flat affect.
ou urc
NURSILevel:
GTApplication
B.COM REF: p. 193
OBJ: 4 TOP: Clients withN
Delirium
o
aC s
vi y re
MULTIPLE RESPONSE
1. The nurse anticipates that the normal aging process of losing neurons and shrinkage of brain
size will result in which assessment findings in older adults? (Select all that apply.)
ed d
a. Confusion
ar stu
b. Slower response times

c. Depression
d. Deficiencies in short-term memory
is
ANS: B, D
Th
These are normal occurrences in aging. Confusion and depression are not considered normal
responses to aging and should be investigated further.

sh
OBJ: 1 TOP: Normal Changes in Cognition

2. Which characteristics are commonly seen in clients with dementia? (Select all that apply.)
a. Gradual onset
b. Poor short-term memory

c. Problems with judgment

d. Fast onset
e. Poor remote memory
f. Difficulty with abstract thinking
g. Personality changes
ANS: A, B, C, E, F, G
These are all signs and symptoms of dementia, regardless of whether it is classified as
Alzheimer’s or non–Alzheimer-type dementia.

3. Which interventions will help to lessen the effects of sundown syndrome? (Select all that
apply.)
a. Provide activity which stimulates the client’s interest
b. Assist in toileting to prevent incontinence
c. Turn on lights before the room gets dark
m
d. Provide companionship
er as
e. Prepare client for sleep by turning off lights
co
f. Reduce environmental stimulation at dinner
eH w
g. Maintain client’s familiar routine
o.
ANS: B, C, D, F, G
rs e
Sundown syndrome is associated with physical and social stressors including the decrease of
ou urc
visual and social cues. Interventions include meeting the client’s basic needs and maintaining
NURSchanges
a consistent routine without abrupt INGTB.C OMdecreasing lighting, withdrawing
such as
companionship, and changing or increasing stimulation.
o
aC s

vi y re

ed d
COMPLETION
ar stu
1. __________ refers to thinking and thought processes.
ANS:
is
Cognition
Th
Cognition relates to intelligence, judgment, reasoning, knowledge, understanding, and

memory.

sh
OBJ: 1 TOP: Confusion Has Many Faces

2. __________ is a progressive, degenerative disease that affects the brain and causes impaired
memory, cognition, and behavior.

ANS:
Alzheimer’s disease
The disease was discovered in 1907. Pathological findings include abnormal tangles of nerve
fibers in the brain, degenerated nerve endings, and shrunken brain tissue.

OBJ: 6 TOP: Alzheimer’s Disease
3. The causes of confusion are grouped into five categories known as the five D’s. These
categories consist of damage, delirium, dementia, depression, and __________.
ANS:
Deprivation
Deprivation refers to sensory deprivation related to poor vision or hearing.
m
OBJ: 2 TOP: The Five “Ds” of Confusion
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 18: Managing Anxiety

MULTIPLE CHOICE
1. When a client has a mild level of anxiety, his or her emotional response is:
a. Relaxed and calm
b. Energized
c. Feeling overloaded
d. Helplessness with loss of control
ANS: A
Mild anxiety results in relatively comfortable feelings. An energized emotional response
describes feelings of moderate anxiety. Feeling overloaded is characteristic of severe anxiety,
and feeling helpless with loss of control refers to the highest level of anxiety, which is panic.

OBJ: 1 TOP: Continuum of Anxiety Responses
m
er as
co
2. A female college student is seeking help from the counseling center for test anxiety. She
eH w
reports that during an exam, she “freezes,” and says, “It feels like the time I have to take the
exam is racing by, and I can’t answer any of the questions when I know the answers.” Which
o.
rs e
level of anxiety is the client experiencing?
ou urc
a. Mild
b. Moderate
c. Severe
d. Panic
o
aC s
ANS: C
vi y re
These are typical symptoms when someone experiences a severe level of anxiety. During mild
anxiety, the perceptual field is broad; moderate anxiety is the best state for problem solving
and learning because perception is focused; panic results in totally scattered or closed
perception, and problem solving is nearly impossible.
ed d
ar stu

OBJ: 1 TOP: Levels of Anxiety
is
3. A learned response to an anticipated event, such as when a person who does not like to fly
Th
experiences nausea and sweaty palms before boarding an airplane, is best described as:
a. A normal anxiety response
b. Signal anxiety
c. An anxiety state
sh
d. An anxiety trait
ANS: B
https://www.coursehero.com/file/28033203/chp-18-mental-healthdoc/

This response occurs as the individual anticipates a stress-provoking event. A normal anxiety
response does not best meet the description in this situation; an anxiety state refers to when a
person’s coping abilities have become overwhelmed and the person has lost emotional
control; and an anxiety trait is part of an individual’s personality that occurs as an overreaction
to situations.

OBJ: 1 TOP: Types of Anxiety
4. A client tells the nurse that exercising in the gym helps him keep his stress level reduced.
Which type of coping mechanism best describes this situation?
a. Spiritual
b. Emotional
c. Intellectual
d. Physical
ANS: D
Stress-release activities such as exercise, jogging, and yoga are considered physical coping
m
mechanisms. Spiritual coping mechanisms include prayer, faith, and rituals. Emotional coping
er as
mechanisms consist of crying, talking, and defense mechanisms. Intellectual coping
co
mechanisms are observed when an individual changes his or her perceptions of a threat to
eH w
make it less meaningful.
o.
PTS: 1
OBJ: 2 rs e
DIF: Cognitive Level: Comprehension
TOP: Coping Methods
REF: p. 205
ou urc
5. The charge nurse is angry with another nurse who has arrived one hour after the shift begins.
o
Rather than expressing her anger, the nurse avoids confrontation by denying approval of the
aC s
nurse’s requested vacation day. What does this behavior demonstrate?

vi y re
a. Substitution
b. Restitution
c. Suppression
d. Rationalization
ed d
ar stu
ANS: A
Substitution is defined as disguising motivations by replacing an inappropriate behavior with
one that is more acceptable. Restitution is defined as doing something to resolve guilt
feelings; suppression is removing anxiety about a conflict from consciousness; and
is
rationalization uses a good, but unreal, reason to make an excuse for an action.
Th

OBJ: 2 TOP: Defense Mechanisms
sh
6. The nurse is aware that several theories have been proposed to explain anxiety. Which theory
explains anxiety as a result of interactions with others?
a. Biological model
b. Psychodynamic model
c. Interpersonal model

d. Behavioral model
ANS: C
The basis of this theory is that the anxiety response develops in early childhood as a result of
interactions with others. The biological model relates to neurochemicals in the brain. The
psychodynamic model is Freud’s theory that anxiety results from conflict between the ego and
the id. The behavioral model describes anxiety as a learned response.

OBJ: N/A TOP: Interpersonal Model
7. Adolescents who ineffectively cope with anxiety often express their anxiety through:
a. Inappropriate behaviors
b. Calm behavior
c. Psychotic behavior
d. Suicide
ANS: A
Behaviors such as defiance, experimenting with drugs, aggressiveness, and manipulation are
m
er as
examples of these behaviors. The other options are responses that are not commonly seen
among adolescents with ineffective coping skills.
co
eH w
o.
OBJ: 3 TOP: Anxiety in Adolescence
rs e
ou urc
8. What is the term for physical expression of anxiety by an individual in ways such as nausea or
headaches?
o
a. Compensation
b. Somatization
aC s
vi y re
c. Denial
d. Fantasy
ANS: B
Often when an individual denies his or her feelings of anxiety, the anxiety is expressed
ed d
physically. The other options are examples of defense mechanisms.

ar stu

OBJ: 3 TOP: Anxiety in Older Adulthood
is
Th
9. Which term best describes an individual’s feelings of anxiety that are broad, long-lasting, and
excessive?
a. Generalized anxiety disorder
b. Panic attack
sh
c. Phobic disorder
ANS: A

This diagnosis is given to individuals with these symptoms. Panic attacks last a short time,
phobias relate to excessive fear of a specific object or situation, and obsessive-compulsive
disorder is a constant thought and behavior.

OBJ: 4 TOP: Generalized Anxiety Disorder
10. A client has constant thoughts about locking his front door every time he leaves his house.
This client is experiencing a/an:
a. Compulsion
b. Phobia
c. Obsession
d. Anxiety reaction
ANS: C
Obsession is constantly thinking about something, and compulsion is acting it out. Phobia is
irrational fear, and anxiety reaction is not a used term.
m
er as
OBJ: 5 TOP: Obsessive-Compulsive Disorder
co
eH w
11. Which is a typical symptom of posttraumatic stress disorder?
o.
a. Constant use of defense mechanisms
b. Flashbacks rs e
ou urc
c. Distressing persistent thoughts
d. Irrational fear
o
ANS: B
Flashbacks are vivid recollections of the trauma. Constant use of defense mechanisms is
aC s
vi y re
simply a maladaptive way of coping. Distressing, persistent thoughts represent obsession, and
irrational fear is a phobia.

ed d
OBJ: 6 TOP: Posttraumatic Stress Disorder

ar stu
12. The treatment team and a male client in whom obsessive-compulsive disorder associated with
hand washing has been diagnosed decide on a treatment plan for the disorder. The nurse
is
begins to implement the plan by having the client gradually extend the time between hand
washes. This intervention is an example of which type of therapy?
Th
a. Behavior modification
b. Desensitization
c. Flooding
sh
d. Pharmacological therapy
ANS: B
This method gradually desensitizes the anxiety reaction, replacing it with effective coping
skills. Behavior modification replaces maladaptive behavior with positive behavior; flooding
is the complete opposite of desensitization; and pharmacological therapy is the use of
medications.


OBJ: 9 TOP: Therapeutic Interventions
13. A female client is taking a benzodiazepine for her anxiety disorder. She complains of anorexia
and nausea since she started taking the medication a few days ago. What is the nurse’s best
response?
a. “Be sure to take the medicine on an empty stomach to avoid these symptoms.”
b. “It takes a while to get used to the medicine. Give it a couple of weeks.”
c. “Try taking the medication with food or milk, and see if the symptoms improve.”
d. “Stop taking the medication immediately, and I will notify your doctor.”
ANS: C
Taking the medication with food or milk usually alleviates GI side effects of this class of
drugs. An empty stomach will intensify the side effect. It is not true to say that it takes a while
to adjust to the medication. Completely stopping the medication is not necessary.

m
er as
co
eH w
14. A male client has had agoraphobia for several years. In the past 2 years, he has not left his
home, and he only speaks to people on the phone occasionally. Which nursing diagnosis has
o.
the highest priority in this situation?
a. Social isolation rs e
ou urc
b. Thought processes, disturbed
c. Coping, ineffective individual
d. Powerlessness
o
aC s
ANS: A
vi y re
All of the nursing diagnoses apply, but given the length of time of isolation, “Social isolation”
is most appropriate.

ed d

ar stu
15. Of individuals who suffer from panic attacks, __________% are women.
a. 20
is
b. 30
c. 50
Th
d. 70
ANS: D
Other demographics include individuals who are separated or divorced and individuals
sh
between the ages of 24 and 44 years.

OBJ: 4 TOP: Panic Disorders

16. Symptoms of obsessive-compulsive disorder can occur in children as young as:

a. 3 years old
b. 5 years old
c. 7 years old
d. 9 years old
ANS: A
Symptoms can occur at this age, but in most cases, symptoms either do not occur or are not
diagnosed until adolescence.

OBJ: 5 TOP: Obsessive-Compulsive Disorder
17. An adolescent caught stealing a classmate’s laptop says that he needed it to write his paper
and that the classmate “has enough money to buy another one anyway.” This adolescent is
demonstrating which of the following defense mechanisms?
a. Denial
b. Restitution
m
c. Rationalization
er as
d. Conversion
co
eH w
ANS: C
The adolescent is using the reason of the classmate’s financial advantage as a rationalization
o.
for stealing the laptop. Denial is refusal to acknowledge conflict, restitution deals with giving
rs e
back to resolve guilt, and conversion is the channeling of unbearable anxiety into physical
ou urc
signs and symptoms.

o
OBJ: 2 TOP: Common Defense Mechanisms

aC s
vi y re
18. On the morning of a final exam, a student is feeling tense and excited, with her heart rate and
breathing slightly increased. She is feeling energized and alert, with her attention focused on
the exam. Based on these findings what advice can the student be given?
ed d
a. Practice deep breathing and do some exercise to stabilize vital signs.

ar stu
b. Request to take the exam at a later date when anxiety decreases.

c. Take the exam more seriously and treat it with more concern.
d. The level of anxiety described should allow for a positive outcome.
is
ANS: D
Moderate anxiety provides focus, alertness, and a narrowed perception. It also allows the
Th
individual to engage in competitive activity and learn new skills through feelings of readiness
and being energized.

sh

KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Safety
19. A 6-year-old is preparing to have a dental procedure. His anxious mother is in the room with
him. When the child asks if everything will be okay, she assures him it will but continues to
pace and wring her hands. What is the most appropriate action for the dentist to take?

a. Give the mother a seat near the child and continue to assure the mother.
b. Request that the mother wait in the waiting room.
c. Allow the mother to verbalize what her concerns are.
d. Tell the child to ignore his mother.
ANS: B
Children learn to cope with anxiety by imitating and learning from others. In this case, the
mother is demonstrating emotional/behavioral manifestations of anxiety. By allowing the
mother to remain in the room in her current emotional state, anxious behavior is reinforced to
the child as a method of coping.

KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Safety
20. The nurse is meeting with a client suffering from agoraphobia who recently moved to the
United States from a country where acts of violence and civil unrest are common. The
theoretical model that links anxiety to the uncontrollable events the client experienced in his
previous country is the ____________ model.
m
a. Behavioral
er as
b. Interpersonal
co
c. Environmental
eH w
d. Psychodynamic
o.
ANS: C
rs e
The environmental model ties anxiety with uncontrollable events or situations such as fires,
ou urc
floods, and assaults and human-induced traumas. The behavioral model considers anxiety a
learned response, the interpersonal model explains anxiety in terms of interactions with
others, and the psychodynamic model states anxiety is a result of conflict between the ego and
o
the id.
aC s
vi y re

OBJ: 1 TOP: Theories Relating to Anxiety
ed d
MULTIPLE RESPONSE
ar stu
1. Which statements best describe an anxiety disorder? (Select all that apply.)
a. Anxiety is expressed in ineffective ways.
is
b. Coping mechanisms are used to deal with anxiety.

c. Coping mechanisms do not relieve anxiety.
Th
d. Defense mechanisms are used occasionally.

ANS: A, C
Maladaptive coping mechanisms do not relieve stress, which constitutes an anxiety disorder.
sh
Using coping mechanisms to deal with anxiety and using defense mechanisms occasionally
are effective ways of dealing with anxiety.

OBJ: 4 TOP: Anxiety Disorders

2. Which symptoms may be seen in a person who is having a panic attack? (Select all that
apply.)
a. Shortness of breath
b. Fear of dying
c. Recurrent persistent thoughts
d. Palpitations
e. Chills
f. Feelings of depersonalization
ANS: A, B, D, E, F
A person is considered to be having a panic attack if he or she is experiencing intense fear or
discomfort that happens suddenly and peaks within 10 minutes. There are 13 possible
symptoms, and the diagnosis is made if the client experiences 4 of the 13.

OBJ: 4 TOP: Panic Disorders
m
3. Which of the following activities are examples of addictive behaviors? (Select all that apply.)
er as
a. Gambling
co
b. Shopping
eH w
c. Working
d. Excessive sexual activity
o.
e. Flashbacks
rs e
ou urc
f. Coping
ANS: A, B, C, D
Obsessive-compulsive activities may take the form of certain addictive behaviors such as
o
gambling, shopping, working, or engaging in excessive sexual activity. Flashbacks are vivid
aC s
recollections of a traumatic event. Coping is not an addictive behavior.

vi y re

OBJ: 5 TOP: Behavioral Addictions
ed d
ar stu
COMPLETION
1. __________ refers to a vague, uneasy feeling of uncertainty and helplessness.

is
ANS:
Th
Anxiety
This is an emotion that is felt in response to a real or imagined threat or stressor.

sh

2. When an individual uses psychological strategies to cope with stressors in an attempt to

decrease anxiety, this person is using a __________.

ANS:
Defense mechanism
Most defense mechanisms, also called ego mechanisms, are used by most people at some
time. Defense mechanisms are not a problem unless they become the only coping skills used
by an individual.

3. __________ is a defense mechanism that is characterized by redirecting one’s energy to

another person or object.
ANS:
Displacement
An example of this defense mechanism is the teenager who has had a fight with her boyfriend
m
and becomes angry and shouts at her mother for no justified reason.
er as
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
is
Th
sh

Chapter 19: Illness and Hospitalization

MULTIPLE CHOICE
1. The abnormal process in which aspects of the social, physical, emotional, or intellectual
function of a person are diminished or impaired is called:
a. Health
b. Illness
c. Recovery
d. Homeostasis
ANS: B
Illness is a state of imbalance that is compared with the person’s condition prior to
development of the present condition. Health is when an individual experiences homeostasis,
or a state of balance; recovery refers to improvement after an illness.
m
OBJ: 1 TOP: The Nature of Illness
er as
co
eH w
2. The client feels unwell. She knows that she would be better off if she rested today, but
o.
important matters at work are waiting. She stops at the drugstore on her way to work and
rs e
purchases several over-the-counter cold remedies. Her behaviors are related to the stage of
ou urc
illness experience called:
a. Symptom experience
b. Medical care contact NURSINGTB.COM
o
c. Assuming the sick role

d. Dependent patient role
aC s
vi y re
ANS: A
The first stage of the illness experience is discovering that something is wrong. The other
three options are the other stages: medical care contact is stage three, seeking professional
advice; assuming the sick role is stage two, seeking support for the sick role; and dependent
ed d
patient role is the fourth stage, acceptance of treatment.

ar stu

OBJ: 2 TOP: Stages of Illness Experience
is
Th
3. If illness or hospitalization results in a change in physical appearance, it is likely to have a

strong impact on the person’s:
a. Attitude
b. Body image
sh
c. Confidence
d. Acceptance of the problem
ANS: B

Threats to body image occur with surgery, extensive diagnostic procedures, and acute and
chronic illness. Changes in physical appearance also may affect attitude, confidence, and
acceptance of the problem, but not as heavily as they affect body image.

OBJ: 4 TOP: Impacts of Illness
4. For most people, being hospitalized is seen as a/n:

a. Crisis
b. Annoyance
c. Chance to rest
d. Expensive hotel
ANS: A
The crisis of hospitalization involves being removed from one’s familiar home environment to
be cared for by strangers in an impersonal, uncomfortable setting.
m
OBJ: 4 TOP: Situational Crisis
er as
co
eH w
5. The client has been admitted to the medical unit for unexplained weight loss and fatigue. He
does not speak except to answer questions, and he refuses to interact with other people except
o.
when necessary. Which coping mechanism is he using to deal with his hospitalization?
a. Anger rs e
ou urc
b. Shock
c. Anxiety NURSINGTB.COM
d. Withdrawal
o
aC s
ANS: D
vi y re
Many hospitalized clients withdraw into themselves and interact only when necessary. Clients
do this to focus their attention inward and replace the energies that have been drained by
illness, crisis, and hospitalization.
ed d

ar stu
OBJ: 5 TOP: Stages of Hospitalization

6. The most important reason for performing a crisis assessment on hospitalized clients is that it
is
allows the care provider to:

a. Implement appropriate care measures
Th
b. Encourage clients to share their concerns

c. Identify the requirements for additional supplies and personnel
d. Identify problems before a crisis develops and plan preventive interventions
sh
ANS: D
Problems are much easier to address and treat before they become a crisis situation. The other
options are not necessarily directly related to a crisis situation.

OBJ: 6 TOP: Psychosocial Care

KEY: Nursing Process Step: Assessment | Nursing Process Step: Intervention

7. The caregiver is encouraging a mother to participate in bathing her daughter, who is in

traction for a fractured femur. The caregiver is recognizing the family’s:
a. Physical need to work
b. Social need to stay with the client
c. Intellectual need to control the situation
d. Emotional need to be involved in caring for the client
ANS: D
A client’s family has a significant impact on the outcome of the client’s illness and provides
emotional support.

OBJ: 7 TOP: Supporting Significant Others
8. The process that helps clients cope with illness or surgery after leaving the institution is
m
called:
er as
a. Client education
co
b. Preventative care
eH w
c. Discharge planning
d. Role change planning
o.
ANS: C rs e
ou urc
Discharge planning should begin on the day of admission. Client education and preventative
care are part of discharge planning;
N R role
I Gchange
B.Cplanning
M is not.
U S N T O
o

aC s
OBJ: 9 TOP: Discharge Planning

vi y re
9. Which is the best way for the nurse to assist clients in managing their pain?
a. By setting mutual goals
ed d
b. By focusing on nursing care

ar stu
c. By administering narcotic analgesics

d. By telling the clients to think of something else
ANS: A
is
Setting mutual goals helps both nurses and clients to set realistic, attainable goals for pain
management. Focusing on nursing care is not client centered; administering narcotic
Th
analgesics should not be a focus of pain management; and telling the clients to think of
something else does not address the problem of pain.

sh
OBJ: 9 TOP: Pain Management

10. The stage of hospitalization during which the client reestablishes personal identity and
becomes self-centered is the time when the client is:
a. Going to be discharged

b. Feeling overwhelmed
c. Becoming emotionally stabilized
d. Adapting to the environment
ANS: C
During the stabilization stage, the hospitalized person gradually gains the strength to
reestablish some personal identity. Some clients become self-centered at this time because
they are focusing on their illness. The time when the client is going to be discharged is not
considered a stage of hospitalization; feeling overwhelmed is the first stage, and adapting to
the environment is the third stage.

11. The nurse begins discharge planning measures with a hospitalized client:
a. Near the time of discharge
b. At the time of admission
c. 3 days into the hospital stay
m
d. On the day before discharge
er as
co
ANS: B
eH w
Discharge planning should be initiated as soon as possible after the client is admitted so ample
time is allowed to make necessary plans for discharge to home or to another facility. The other
o.
options will not allow sufficient time for this to occur.
rs e
ou urc
OBJ: 9 TOP: Discharge Planning
NURSINGTB.COM
o
aC s
12. During a crisis assessment due to the diagnosis of a terminal illness, the nurse is trying to
vi y re
determine what the client’s history is with regard to losses. Which question will best assess
this area?
a. “How easily do you adapt to new situations?”
b. “What is your understanding of the current situation?”
ed d
c. “Who or what has helped you through crisis situations in the past?”
ar stu
d. “How is this situation affecting your family?”

ANS: C
This question will help one to determine how this client has dealt with crises in the past.
is
Asking the client about adaptation to new situations assesses for other risk factors, and asking
about the client’s understanding of the situation or how the situation is affecting the client’s
Th
family assesses what the illness means to the client.

sh

13. A male client has been diagnosed recently with a chronic illness. His family tells the nurse
that they have noticed that he has not been attending his weekly card game night with his
friends and does not return their calls. What reaction is this client most likely experiencing?
a. Anxiety

b. Withdrawal
c. Shock
d. Anger
ANS: B
Withdrawal is a common response to illness. The individual removes himself from others and
refuses to interact. The other options are also common emotional responses to illness: anxiety
is described as feelings of uneasiness and apprehension; shock refers to an overwhelmed
feeling with inability to process information; and anger is an emotional response that may be
directed inward or outward.

14. The nurse is admitting a male client so he can undergo testing for diagnostic purposes. The
nurse explains how the equipment in the room works and how to order meals. After the nurse
leaves the room, the client yells for the nurse because he can’t remember how to use the call
light. What emotional response is the client experiencing?
m
a. Denial
er as
b. Withdrawal
co
c. Shock
eH w
d. Anger
o.
ANS: C
rs e
Shock is a common response to illness experienced by clients and their families. The
ou urc
individual experiences an overwhelmed feeling with an inability to process information. The
other options are also commonNUemotional
RSINGTresponses
B.COMto illness: denial is described as refusal to
acknowledge a situation; withdrawal is characterized by an individual’s removing himself or
o
herself from others and refusing to interact; and anger is an emotional response that may be
aC s
directed inward or outward.

vi y re

ed d
ar stu
15. A female client admitted to a mental health facility for depression is frequently asking for help
in deciding which foods to choose for her meals as well as which activities she should
participate in. Which stage of illness is she experiencing?
a. Dependency
is
b. Symptoms
Th
c. Recovery and rehabilitation

d. Sick role
ANS: A
sh
Dependency is stage 4 of the stages of illness and is characterized by relying on and accepting
the attention of others. The appearance of symptoms is the first stage of illness and refers to
notice of an undesirable change and awareness that something is not right; recovery and
rehabilitation constitute stage 5 of illness; and the sick role is the second stage of illness, in
which an individual accepts the illness and focuses on treatment and/or recovery.


16. The nurse is talking with a male client recently admitted to a mental health facility. He is very
anxious to begin his treatment for alcohol and drug addiction because he states that he “really
wants to get well this time.” Which stage of illness is the client experiencing?
a. Dependency
b. Symptoms
d. Sick role
ANS: D
The sick role is the stage of illness in which an individual accepts the illness and focuses on
treatment and/or recovery. Dependency is stage 4 of illness and is characterized by relying on
and accepting the attention of others. The appearance of symptoms is the first stage of illness
and refers to notice of an undesirable change and awareness that something is not right;
recovery and rehabilitation constitute stage 5 of illness.
m
er as
co
eH w
17. An individual notices that he is experiencing periods of feeling very depressed followed by
periods of elation and increased energy. He knows that something is wrong and talks with his
o.
rs e
family about what he should do. This is an example of the stage of illness called:
ou urc
a. Dependency
b. Symptoms
NURSINGTB.COM
d. Sick role
o
aC s
ANS: B
vi y re
During stage 1 of illness, the individual notices an undesirable change, is aware that
something is not right, and seeks the advice of others. Dependency is stage 4 of illness and is
characterized by relying on and accepting the attention of others. Recovery and rehabilitation
is stage 5 of illness, and assuming the sick role is the stage of illness in which an individual
ed d
accepts the illness and focuses on treatment and/or recovery.

ar stu

is
Th
18. A business owner is hospitalized after suffering a heart attack. The staff finds him very
demanding and angry toward all personnel and noncompliant in his therapy and treatment
plan. What is the best strategy for the nurse to employ with this patient?
a. Give him an ultimatum to cooperate or face a longer recovery period.
sh
b. Allow him to continue this behavior due to his role outside the hospital.
c. Provide him with necessary information to actively participate in goal setting.
d. Request that a health care provider with a stronger personality take care of him.
ANS: C

Loss of control and dependence on health care providers are feelings shared by hospitalized
clients. Providing necessary information to make decisions in his own care allows the client
some control over the hospitalization.

OBJ: 4 TOP: Situational Crisis
19. A 72-year-old woman from the Dominican Republic is hospitalized after fainting while
visiting her daughter. The staff has voiced complaints regarding the family ignoring hospital
rules regarding visiting hours and number of visitors allowed in the room. In addition, the
daughter brings food to the mother from home which is not a part of the client’s prescribed
diet. How can the staff deal with these issues in a professional manner?
a. Meet with the patient and family to determine how to provide support for cultural
practices.
b. Have security remove the family and focus on the client’s care and needs.
c. Accept the food from the family and throw it out without informing them.
d. Allow family presence to take priority over treatments and therapies.
m
ANS: A
er as
An individual’s family is an important group in one’s life. Family members should be
co
included and consulted for details about the client’s care. In this case the family is also in
eH w
crisis and needs support and the satisfaction that their loved one is receiving good care. All
o.
other options seek to exclude the family from this support.
rs e
ou urc
NURSINGMSC:
KEY: Nursing Process Step: Assessment TB.C OM Needs: Psychosocial Integrity
Client
o
20. A woman arrives at the hospital to deliver her first child. She has no previous history of
aC s
hospitalization or serious illness. During her stay, the client is highly anxious and demands to
vi y re
be informed of all information documented on her medical record. The client’s husband
informs the nurse that the client’s mother died in the hospital 10 months ago after a brief
battle with lung cancer. The most probable reason for the client’s current reaction is:
a. Obsessive fear of dying
ed d
b. Reluctance in becoming a mother

ar stu
c. Symbolic meaning of the hospital

d. Ambivalence regarding the sick role
ANS: C
is
The client’s reaction is due to the symbolic meaning this hospital has for her.
Th

sh
21. The client being transferred to a rehabilitation center following hospitalization for surgical
repair of a fractured hip is portrayed by the nurse in the hospital setting as being very involved
and making good progress in his physical therapy sessions. However, the nurse in the
rehabilitation facility observes that the client is withdrawn, and he often asks to defer his
physical therapy sessions. Which statement best describes the change in patient behavior?

a. The patient is suffering from delirium due to the unfamiliar surroundings.

b. The patient has adapted to the recovery role and does not need rehabilitation.
c. The patient enjoyed the dependency role in the hospital setting.
d. The patient is adjusting to a new environment and is in a vulnerable position.
ANS: D
In dealing with his hospitalization the client has regained personal identity and adapts;
however, for persons transferred to another institution, the crisis begins again. This does not
indicate that the patient does not require rehabilitation. His behavior in the hospital was not
reflective of a dependency. This client is not exhibiting behaviors indicative of delirium.

MULTIPLE RESPONSE
1. How does the experience of entering a psychiatric treatment facility differ from
hospitalization for physical reasons? (Select all that apply.)
m
a. The client may fear other clients’ behaviors.
er as
b. The client receives a negative diagnostic label.
co
eH w
c. The client can enjoy the attention of caregivers.
d. The client must cope with the stigma of mental illness.
o.
e. The client must cope with the stigma of physical illness.
rs e
f. Insurance companies may deny payment for treatment.
ou urc
g. Insurance companies never deny payment for treatment.
ANS: A, B, D, F NURSINGTB.COM
o
Because of stereotyping of mental illness, clients often fear mental health facilities and the
stigma of being in one. In addition, some insurance companies have not added mental health
aC s
vi y re
treatment to their plans or have limited treatment coverage.

OBJ: 6 TOP: Psychiatric Hospitalization
ed d
ar stu
2. Which natural remedies may the nurse use to assist clients in alleviating pain? (Select all that
apply.)
a. Distraction
is
b. Pain patches
c. Massage
Th
d. Visualization
e. PCA pumps
ANS: A, C, D
sh
Natural remedies are less invasive and should be attempted prior to administration of
medication, such as pain patches and PCA pumps.

OBJ: 8 TOP: Psychosocial Care

3. Which functions of a person are diminished or impaired during illness? (Select all that apply.)
a. Social
b. Medical
c. Emotional
d. Physical
e. Intellectual
ANS: A, C, D, E
Illness is defined as an abnormal process in which aspects of the social, physical, emotional,
or intellectual condition and function are diminished or impaired. Medical is not a human
function.

OBJ: 1 TOP: The Nature of Illness
COMPLETION
m
er as
1. __________ is a continually changing state of well-being that encompasses an individual’s
physical, social, and mental well-being.
co
eH w
ANS:
o.
Health
rs e
ou urc
Health also comprises the absence of disease or abnormal conditions.

N R I G B.C M
U S Level:
N TKnowledgeO REF: p. 218
o
OBJ: 1 TOP: Illness and Hospitalization

aC s
vi y re
2. A psychological defense mechanism that allows a person to block painful feelings associated
with a problem is known as __________.
ed d
ANS:
Denial
ar stu
This defense mechanism allows an individual time to collect his or her thoughts, make plans,
and restore himself or herself to a more comfortable state of functioning.
is

Th

sh


Chapter 20: Loss and Grief

MULTIPLE CHOICE
1. The client is 21 years old and has just been given the diagnosis of terminal cancer. She is
coping with a(n) ____ loss.
a. Expected
b. Imagined
c. Internal
d. Temporary
ANS: C
Internal losses are personal and include losses that involve the self. Expected loss occurs
gradually; imagined loss is perceived; and temporary loss is reversible.

OBJ: 1 TOP: Characteristics of Loss
m
er as
co
2. The group best able to accept their losses and grow from their experiences is:
eH w
a. Adults
o.
b. Toddlers
c. Adolescents
rs e
ou urc
d. School-age children
Adults who have experienced loss learn to accept their losses and learn from their
o
experiences.
aC s
vi y re

OBJ: 2 TOP: Loss Behaviors Throughout the Life Cycle
ed d
3. The set of emotional reactions that accompany a loss is called:

ar stu
a. Grief
b. Anxiety
c. Mourning
d. Bereavement
is
ANS: A
Th
Grief is the set of emotional reactions that accompany a loss. Anxiety is a vague, uneasy
feeling that is not specifically related to a loss. Mourning refers to the process of resolving a
loss, and bereavement refers to the thoughts, feelings, and activities following a loss.
sh

OBJ: 3 TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: N/A
4. The behavioral state of thoughts, feelings, and activities that follow a loss is called:
a. Grief

b. Anxiety
c. Mourning
d. Bereavement
ANS: D
This state is different with every person. Grief is the set of emotional reactions that
accompany a loss. Anxiety is a vague, uneasy feeling that is not specifically related to a loss.
Mourning is the process of working through or resolving one’s grief.

OBJ: 3 TOP: The Nature of Grief and Mourning
5. Persons may refuse to acknowledge that a loss has occurred during the first stage of:
a. Crisis
b. The grieving process
c. The rage reaction
d. The denial process
ANS: B
m
er as
The first step in the grieving process is denial.
co
eH w
OBJ: 3 TOP: Stages of the Grieving Process
o.
rs e
ou urc
6. The client lost her husband of 50 years 10 months ago. She now sees every day as a gray fog
with no light. She has begun to experience changes in eating, sleeping, and activity levels;
NURSINtoGconcentrate
angry, hostile moods; and an inability TB.COMor complete work tasks. What is the
o
client experiencing?
aC s
a. Complicated grief
vi y re
b. A normal grief reaction

c. Complicated depression
d. Bereavement-related depression
ed d
ANS: D
With bereavement-related depression, the griever feels the loss so intensely that despair and
ar stu
worthlessness overwhelm everything. This is not considered a normal grief reaction.

Complicated grief refers to a constant yearning for the deceased without symptoms of
depression. Complicated depression is not a grief reaction.
is

Th
OBJ: 4 TOP: Unresolved Grief

7. The last stage of growth and development is called:

sh
a. Dying
b. Old age
c. Wisdom
d. Maturity
ANS: A

Dying is the last stage of growth and development.

OBJ: 7 TOP: The Dying Process KEY: Nursing Process Step: N/A
8. The concerns of children in whom terminal conditions have been diagnosed focus on how the
illness affects the child’s:
a. Loss of a future
b. Family and friends
c. Social activities
d. Activities of daily living
ANS: D
Immediate concerns focus on how the illness affects the activities of daily living and limits the
child’s abilities. As individuals mature, concerns turn to the remaining three options.

OBJ: 5 TOP: Age Differences and Dying
m
er as
9. To make the remainder of a terminally ill person’s life as meaningful and comfortable as
co
eH w
possible is the goal of:
a. Hospice care
o.
b. The stages of dying
c. The grieving processrs e
ou urc
d. Institutional care
ANS: A
NURSINGTB.COM
o
The goal of hospice care is to make the remainder of a terminally ill person’s life as
aC s
meaningful and comfortable as is humanly possible. Hospice focuses not only on care of the
vi y re
client but on the family as well.

OBJ: 9 TOP: Hospice Care
ed d
ar stu
10. When care is provided for a dying client in pain, addiction to analgesics is:
a. Not an issue
b. To be evaluated daily
is
c. To be carefully avoided
d. To be prevented with pain management techniques
Th
ANS: A
Addiction is not an issue when care is provided for the terminally ill; the goal is to make the
client comfortable and pain free.
sh

OBJ: 9 TOP: Meeting the Needs of Dying Clients
11. Decisions about a terminally ill client’s remaining time belong to the:

a. Person
b. Family members
c. Medical care team
d. Spiritual advisor
ANS: A
In a “good death,” a person controls his or her own destiny.

12. To assist them with their grief experiences, many health care facilities offer caregivers who
work with dying clients:
a. Extra income
b. Support groups
c. Time off from work
d. Peer evaluation groups
ANS: B
m
er as
Many health care facilities offer support groups for caregivers who work with dying clients to
help them work through their own grief experiences.
co
eH w
o.
OBJ: 9 TOP: Caregivers’ Grief
rs e
ou urc
13. The father of three young children dies. The wife expresses how worried she is about how to
U S the
raise the children on her own without
N R I G B.C M
N support
T Oof her husband. She finds herself crying and
o
living through each day without accomplishing anything. In which grieving stage is this
aC s
behavior typically experienced?

vi y re
a. Denial
b. Depression and identification
c. Acceptance and recovery
d. Yearning
ed d
ANS: D
ar stu
This is the second stage of grieving, in which the person longs for the deceased and feels
overwhelmed by the loss. Denial is the first stage of grieving, when the person is in shock and
rejects the loss of another; depression and identification is the third stage of grieving,
is
characterized by depressed feelings followed by a period of sharing memories and seeking

support from others; and acceptance and recovery is the phase of the grieving process during
Th
which individuals begin to focus their energies toward the living and their lives begin to
stabilize.
sh

OBJ: 3 TOP: The Grieving Process

14. Three years after the loss of her husband of 35 years, the widow has a full-time job but finds
that she cannot sleep well at night, has frequent mood changes, and attends the couple’s night
out with friends that she and her husband attended. Upon seeking counseling, she discovers
that she is exhibiting symptoms of:
a. Bereavement-related depression
b. Complicated grief
c. Anticipatory grief
d. Caregiver grief
ANS: B
These are characteristic symptoms of complicated grief in which an individual experiences
persistent yearning for the deceased person without signs of depression. Bereavement-related
depression refers to depression following a loss that consumes every aspect of a person’s life;
anticipatory grief refers to grief felt in anticipation of a loss; and caregiver grief refers to grief
felt by health care providers.

m
er as
15. The 39-year-old daughter of a client with a terminal illness tells the nurse that she thinks
co
something is wrong with her because she frequently cries, is often sad, and can’t imagine
eH w
losing her mother. The nurse assures the daughter that these are normal feelings associated
o.
with:
rs e
a. Bereavement-related depression
ou urc
b. Complicated grief
c. Anticipatory grief
d. Caregiver grief NURSINGTB.COM
o
ANS: C
aC s
These symptoms are typically experienced with grief that is felt in anticipation of a loss.
vi y re
Bereavement-related depression refers to depression following a loss that consumes every

aspect of a person’s life; complicated grief is displayed as persistent yearning for the deceased
person without signs of depression; and caregiver grief refers to grief experienced by health
care providers.
ed d
ar stu

is
16. A family experiences the loss of their wife and mother to a car accident. Which family
Th
member is most likely to react by asking “When is mommy coming back?”

a. The 17-year-old son
b. The 11-year-old daughter
c. The 4-year-old son
sh
d. The 7-year-old daughter

ANS: C
Because of their sense of time, preschoolers cannot understand a permanent loss such as
death. School-age and adolescent children have an adult concept and understanding of loss
and death.


17. A 10-year-old patient on a children’s oncology unit has had an unsuccessful bone marrow
transplant. The family is distraught but remains positive in front of the child. One night the
child asks the nurse about death and dying. What counseling should the nurse give to the
parents?
a. Avoid talking about death in front of the child.
b. Change the subject if the child asks about dying.
c. Allow the child to have an honest discussion about dying.
d. Allow the physician to discuss this with the child.
ANS: C
Children are remarkably observant and have an intuitive ability to understand the seriousness
of their illness and its outcomes. Whenever possible parents should be encouraged to
communicate with the dying child. Open discussions of the illness and its outcomes help
children cope with feelings of isolation, anxiety, and guilt over causing distress in the family.
m
The other options continue to isolate the child and encourage suppression of feelings.
er as
co
eH w
OBJ: 7 TOP: Age Differences and Dying
o.
rs e
18. Throughout the life cycle, which age group has the most difficult time relating to their own
ou urc
death?
a. Toddler NURSINGTB.COM
b. Preschool
o
c. Adolescent
aC s
d. Adult
vi y re
ANS: C
Death is particularly difficult to accept during adolescence because the developmental task at
this age is to define who one is and to establish an identity. Threats of loss at this age may
ed d
make a person stand out from his or her peer group.

ar stu

OBJ: 4 TOP: Loss Behaviors Throughout the Life Cycle
is
19. A person with terminal cancer makes a call to a family member she has not spoken to in 30
Th
years in order to make amends. According to Kübler-Ross, what stage of dying is this person
in?
a. Denial
sh
b. Working
c. Resistance
d. Acceptance
ANS: B

In the working or review stage, the individual begins to deal with unfinished business. In the
denial or resistance phase the individual fights the issue, and in the acceptance stage the
individual is comfortable with death.

OBJ: 7 TOP: Stages of Dying
MULTIPLE RESPONSE
1. Which of the following are therapeutic interventions for unresolved grief? (Select all that
apply.)
a. Listening
b. Providing emotional support
c. Keeping the griever medicated
d. Referring to appropriate resources
e. Forcing the client to eat properly
f. Telling the client that he or she must learn to cope
m
g. Encouraging return to work as soon as possible
er as
ANS: A, B, D
co
eH w
Listening, providing emotional support, and referring to appropriate resources are
interventions for unresolved grief.
o.
PTS: 1 rs e
ou urc
NURSINGTB.COM
o
2. Loss of which of the following can result in the individual’s experiencing external losses?
aC s

vi y re
a. Spouse
b. Possession
c. Career
d. Limb
ed d
e. Favorite piece of jewelry

ar stu
f. Friendship
ANS: A, B, E, F
External losses are considered losses that occur outside of the individual and include objects,
is
possessions, the environment, loved ones, and support. Loss of career or limb is an internal
loss that is more personal and involves some part of oneself.
Th

OBJ: 1 TOP: The Nature of Loss
sh
3. According to Glaser and Strauss, the closed awareness model can be applied to family,
friends, care providers, and the dying individual. Which of the following statements are true
of the closed awareness model? (Select all that apply.)
a. Medical personnel and family keep the condition secret from the client.
b. Caregivers and client know about impending death but do not talk about it.

c. Caregivers and client accept death and have open conversations.

d. Dying client feels isolated from the ability to share with family.
e. Dying client becomes suspicious of the truth, and information is tightly controlled
by family.
ANS: A, D, E
The closed awareness model is one in which the goal of care providers and family is to keep
the truth from the client. The belief centers around the rationale that telling the client the
seriousness of the condition would be too upsetting. As the client begins to realize the
seriousness of his condition, caregivers limit and control information. The mutual pretense
model is one in which both client and family know about the pending death but do not discuss
it. In the open awareness model, the client and family have open communication and accept
death.

OBJ: 7 TOP: Stages of Dying
OTHER
m
er as
1. Place the steps of grieving in proper order.
co
eH w
a. Acceptance and recovery
b. Depression and identification
o.
c. Denial
d. Yearning rs e
ou urc
ANS: NURSINGTB.COM
C, D, B, A
o
aC s
Not all individuals move through this process step-by-step. They may skip a step or may
vi y re
move back and forth between steps. If grieving is dysfunctional, an individual may skip a step
completely.

ed d

ar stu
COMPLETION
is
1. __________ occurs when an individual who has experienced a loss is working through or
Th
resolving his or her grief.
ANS:
Mourning
sh
This period can be intense and painful, and its duration varies among individuals.


2. Following the funeral of her husband, the widow is seen crying and holding his picture. She is
demonstrating __________.
ANS:
Bereavement
Bereavement is the behavioral state of the thoughts, feelings, and activities following a loss.

m
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 21: Depression and Other Mood Disorders

MULTIPLE CHOICE
1. A prolonged emotional state that influences one’s whole personality and life functioning is
called:
a. Mood
b. Feeling
c. Attitude
d. Intellectual response
ANS: A
This is the definition of mood. Moods range from elation to despair and can be either adaptive
or maladaptive.

OBJ: 1 TOP: Theories Relating to Emotions and Their Disorders
m
er as
co
2. The moods of adolescents:
eH w
a. Are stable
o.
b. Vary widely
c. Develop slowly
rs e
ou urc
d. Are not related to growth and development
The moods of adolescents commonly swing from depression to elation. This is a time of
o
hormonal changes and a time when teens are trying to develop their identity and both gain
aC s
control over and express their emotions.

vi y re

OBJ: 3 TOP: Emotions in Adolescence
ed d
ar stu
3. Depression in the elderly is:

a. Rare
b. Common
c. Nonexistent
is
d. Seen occasionally
Th
ANS: B
Major depression affects as many as 40% of older Americans and is seen most often in
women, persons with medical illnesses, and those individuals who are living in long-term care
sh
facilities.

OBJ: 3 TOP: Depression in Older Adulthood
4. Theories that view depression as a group of learned responses are called ____ theories.

a. Social
b. Behavioral
c. Biological
d. Psychoanalytical
ANS: B
Behaviorists view depression as a group of learned responses. Social theorists view depression
as the result of flawed social interactions; biological theory focuses on causes of depression
such as biochemical imbalances and genetics; and psychoanalytical theorists believe that
mood disorders occur as a result of anger turned inward.

OBJ: 2 TOP: Theories Relating to Emotions and Their Disorders
5. Severe, prolonged depression affects a person’s risk for physical illness by ____ the risk.
a. Decreasing
b. Increasing
c. Not affecting
m
d. Having little effect on
er as
co
ANS: B
eH w
Severe, prolonged depression results in many physical changes and increases one’s risk for
illness by lowering an individual’s immune response.
o.
PTS: 1 rs e
ou urc
OBJ: 4 TOP: Major Depressive Disorder
N R I GMSC: B.CClient
U S N T O
o
6. A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n)
aC s
____ disorder.
vi y re
a. Anxiety
b. Bipolar
c. Dysthymic
d. Major depressive
ed d
ANS: C
ar stu
A dysthymic disorder is daily moderate depression that lasts for longer than 2 years. Anxiety
refers to a vague uneasy feeling; bipolar disorder is manic-depressive disorder; and major
depressive disorder refers to severe depression.
is

Th
OBJ: 4 TOP: Dysthymic Disorder

7. The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The
sh
client’s diagnosis is most likely:

a. Bipolar disorder
b. Major depression
c. An anxiety disorder
d. Dysthymic disorder

ANS: A
The hallmark of a bipolar disorder is sudden and dramatic shifts in emotional extremes.

OBJ: 5 TOP: Bipolar Disorders
8. Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is
most effective in improving symptoms in people who are experiencing:
a. Bipolar disorder
b. Moderate depression
c. Postpartum depression
d. Seasonal affective disorder
ANS: D
Daily exposure to full-spectrum light reduces the symptoms of seasonal affective disorder,
which is also known as winter depression and typically occurs from October to April.
m
OBJ: 6 TOP: Other Problems With Affect
er as
co
eH w
9. The goal of treatment during the first phase of depression is to:
a. Develop a plan for treatment
o.
b. Reduce uncooperative behaviors
rs e
c. Help the client to adjust to antidepressants
ou urc
d. Reduce symptoms and inappropriate behaviors
ANS: D
NURSINGTB.COM
o
The goal during the first phase (acute phase) is to reduce symptoms and inappropriate
aC s
behaviors. This phase may last 6 to 12 weeks and may require hospitalization. Developing a
vi y re
treatment plan and helping the client to adjust to antidepressants refers to the second phase,
which is known as the continuation phase; and reducing uncooperative behaviors may or may
not occur with depression.
ed d

ar stu
OBJ: 9 TOP: Treatment and Therapies

10. The nurse must be alert to signs of suicidal thoughts with clients in whom major depressive
is
disorders have been diagnosed because approximately __________ die from suicide.
a. 5%
Th
b. 15%
c. 25%
d. 35%
sh
ANS: B
This figure makes it vitally important to monitor these individuals for suicidal thoughts.

OBJ: 4 TOP: Major Depressive Disorder

11. During the continuation phase of therapy, a client with a diagnosis of depression asks, “What
is the goal of therapy during this 4- to 9-month period?” What is the nurse’s best response?
a. “We are going to work together to try to reduce your symptoms.”
b. “Our goal is to determine the cause of your depression and cure it.”
c. “We want to prevent you from ever having any depressive episodes in the future.”
d. “Our goal is to prevent you from relapsing and experiencing distressing emotional
states.”
ANS: D
The continuation phase is the second phase of therapy for clients with depression. Working
together to try to reduce symptoms occurs during the acute phase of treatment. Determining
the cause of depression and preventing future depression most likely are not possible.

12. A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).
m
Which point will the nurse teach the client?
er as
a. “ECT treatments take about 1 hour.”
co
b. “You will most likely receive between 6 and 12 treatments over several weeks.”
eH w
c. “ECT often is used as one of the first treatments for major depression.”
d. “ECT treatments help your depression by decreasing levels of the neurotransmitter
o.
norepinephrine.”
rs e
ou urc
ANS: B
This is the normal duration forNUECTRSItreatments.
N GTB.CECT O M treatments usually take only about 15
minutes, so it is incorrect to tell the client that they will last 1 hour. ECT is an invasive
o
treatment that is usually a last resort rather than one of the first selected treatments. ECT
aC s
raises levels of norepinephrine rather than lowering them.

vi y re

ed d
ar stu
13. A client asks the nurse which types of antidepressants have the fewest side effects. What is the
nurse’s most accurate response?
a. “Tricyclic antidepressants”
b. “Nontricyclic antidepressants”
is
c. “Monoamine oxidase inhibitors (MAOIs)”

Th
d. “Selective serotonin reuptake inhibitors (SSRIs)”

ANS: D
SSRIs are the most widely prescribed antidepressants now because of their low incidence of
sh
side effects. MAOIs are the last group of choice because of their severe and potentially fatal
side effects.

OBJ: 8 TOP: Drug Therapies—Antidepressants

14. A male client with bipolar disorder who takes lithium tells the nurse that he has been
“nauseous a lot lately”, “feels tired”, and has had “some blurry vision.” The client most likely
is suffering from what level of lithium toxicity?
a. Insignificant
b. Mild
c. Moderate
d. Severe
ANS: C
These are signs of symptoms of moderate lithium toxicity, with blood serum levels of 1.5 to
2.5 MEq/L. Additional signs and symptoms of moderate toxicity include ringing in the ears,
irregular tremors, and frank muscle twitching. “Insignificant” is not a level of toxicity. Mild
and severe levels of toxicity have signs and symptoms different from those of moderate
toxicity.

OBJ: 8 TOP: Drug Therapies—Antimanics
m
15. Which one of the following is a biological cause of mood disorders?
er as
a. Anger turned inward
co
b. Impaired nurturing
eH w
c. Reaction to external stressors
o.
d. Imbalance of neurotransmitters
ANS: D rs e
ou urc
Biological evidence points to several links to mood disorders including neurotransmitters
which excite or inhibit brain N URSIinvolved
circuits NGTB.C OM regulation. When an imbalance occurs
in mood
with the neurotransmitters, depression can occur. Anger turned inward is a psychoanalytic
o
theory belief. Impaired nurturing and reactions to external stressors are supported by social
aC s
theorists.
vi y re

OBJ: 2 TOP: Biological Evidence
ed d
ar stu
16. A client seen in the community mental health clinic appears for one appointment in multiple
layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in
the waiting room about a date she had the previous evening. The next visit she is dressed in
old, drab clothes without makeup. She has flat affect and is not making eye contact. The most
is
probable cause of her behaviors is which of the following conditions?

Th
a. Bipolar I disorder
b. Psychosis
c. Bipolar II disorder
d. Major depressive episode
sh
ANS: A
Bipolar I disorder is characterized by episodes of depression alternating with episodes of
mania. Bipolar II disorder is characterized by episodes of depression alternating with episodes
of hypomania. Depression and psychosis are not characterized by the signs exhibited in the
scenario.


17. Which client would be a candidate for ECT?

a. A client with mild depression
b. A severely depressed client with congestive heart failure
c. A client with severe, long-lasting depression
d. A severely depressed client with history of a brain tumor
ANS: C
ECT is indicated for clients with severe long-lasting depression after attempts to stabilize with
other therapies are unsuccessful. It is contraindicated in clients with recent heart disease, high
or low blood pressure, stroke, or congestive heart failure.

OBJ: 9 TOP: Treatment and Therapy: Electroconvulsive Therapy
m
er as
18. Which client is suffering from a major depressive episode?
co
a. An adolescent who expresses feeling lost after the death of his mother last week
eH w
b. A 50-year-old who has been depressed for a month and is contemplating suicide
c. A 30-year-old female who is being treated for episodes of depression she has
o.
suffered since the age of 21
rs e
d. An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer
ou urc
given to her 8 days ago
ANS: B
NURSINGTB.COM
o
A major depressive episode is one in which the depression lasts more than two weeks and
encompasses every part of the person’s functioning. Suicide is entertained. Feeling lost one
aC s
vi y re
week after the death of a parent is considered minor depression. Major depressive episodes
that repeat for more than 2 years is considered a major depressive disorder.

ed d
OBJ: 4 TOP: Depression KEY: Nursing Process Step: Assessment

ar stu
MULTIPLE RESPONSE
is
1. Which statements regarding depression are correct? (Select all that apply.)
Th
a. It occurs in all age groups.

b. It rarely occurs in the elderly.
c. It occurs in men more often than in women.
d. It occurs in women more often than in men.
sh
e. It is rarely seen but is severe when it occurs.

f. It is common in those who must cope with illness.
g. It is one of the most common and treatable mental disorders.
ANS: A, D, F, G

These are common characteristics of depression. Depression often is seen in the elderly,
affecting as many as 40% of the elderly population, and it is not always severe. Depression
occurs in a greater number of women than men.

OBJ: 4 TOP: Emotions Throughout the Life Cycle
2. In which groups does postpartum depression occur more frequently? (Select all that apply.)
a. Older mothers
b. Younger mothers
c. Women who do not have a husband
d. Women who have had a difficult delivery
e. Women who experienced complicated pregnancies
f. Those who are also coping with illness
g. Women who are not emotionally prepared for motherhood
ANS: D, E, G
These women are at higher risk for postpartum depression. Postpartum depression is
m
connected to a hormonal imbalance. The incorrect options are not characteristic of postpartum
er as
depression.
co
eH w
o.
OBJ: 7 TOP: Other Problems With Affect
rs e
ou urc
3. A client is experiencing an episode at the level of mania. Which behaviors are characteristic of
NURSINGTB.COM
this level? (Select all that apply.)
a. Outgoing, happy, and worry free
o
b. Decreased ability to concentrate

aC s
c. Confident
vi y re
d. Disoriented
e. Unstable affect
f. Pressured speech
g. Poor hygiene
ed d
ar stu
ANS: E, F
Unstable affect and pressured speech are seen most frequently at the mania level of manic
behavior. Outgoing behavior, decreased ability to concentrate, and increased confidence are
seen at the level of hypomania; disorientation and poor hygiene are seen at the level of
is
delirium.
Th

sh
4. Which of the following statements are true regarding depression in the elderly? (Select all that
apply.)
a. The highest rates are among individuals who receive long-term care.
b. It is a normal consequence of aging.
c. Most depressed older adults volunteer to share their feelings.

d. Depression is higher in elderly women than elderly men.

e. Older adults express feelings of depression in more subtle ways than younger
persons.
ANS: A, D, E
Depression is highest in elderly persons who are women, medically ill, and receiving
long-term care. Many older adults do not complain or volunteer to share their feelings. It is
important to carefully assess and observe the older adult for signs of depression as they
express in subtler ways such as changes in daily routine and sleeping and eating patterns.

OBJ: 3 TOP: Emotions in Older Adulthood
5. Which group of medications for depression will the nurse tell the client to take at bedtime?
a. Tricyclic antidepressants
b. Nontricyclic antidepressants
c. Monoamine oxidase inhibitors (MAOIs)
m
d. Selective serotonin reuptake inhibitors (SSRIs)
er as
co
ANS: A, D
eH w
Tricyclic antidepressants often have the side effect of sedation soon after the dose is given, so
they should be taken at bedtime. SSRIs may also cause drowsiness and dizziness and should
o.
also be encouraged to be taken at bedtime. The other medications should be taken early.
rs e
ou urc
OBJ: 8 TOP: Drug Therapies—Antidepressants
NURSINGTB.COM
o
aC s
COMPLETION
vi y re
1. __________ is the electrolyte that the nurse must teach the client to monitor in his or her diet
when taking lithium.
ed d
ANS:
ar stu
Sodium
Clients must monitor sodium intake because of its relationship with lithium.
is

Th
OBJ: 8 TOP: Drug Therapies

sh


Chapter 22: Physical Problems, Psychological Sources

MULTIPLE CHOICE
1. The human physiological stress response mechanism is also called the ____ response.
a. Startle
b. Neuroleptic
c. Homeostasis
d. Fight-or-flight
ANS: D
The stress response is also called the fight-or-flight response (general adaptation response)
and occurs in an attempt to maintain homeostasis.

OBJ: 1 TOP: Role of Emotions in Health
m
er as
2. People who are able to recognize and defuse their stressors early ____ suffer from the
co
physical effects of stress.
eH w
a. Never
o.
b. Often
c. Always
rs e
ou urc
d. Seldom
ANS: D NURSINGTB.COM
People who are able to recognize and defuse their stressors early seldom experience the
o
physical effects of stress. It is nearly impossible to never experience or always feel the effects
aC s
of stress.
vi y re

OBJ: 2 TOP: Anxiety and Stress
ed d
ar stu
3. Most psychosomatic problems and somatoform disorders begin in:

a. Puberty
b. Adulthood
c. Childhood
is
d. Adolescence
Th
ANS: C
How an individual perceives and responds to stress is established in childhood.
sh

OBJ: 3 TOP: Childhood Sources
4. The physiological stress response has an effect on:

a. Many body systems
b. Only the nervous system

c. The gastrointestinal system

d. The cardiovascular and respiratory systems
ANS: A
When an individual perceives stress, the body initiates production of a cascade of
biochemicals that affect many body systems.

5. Several studies have demonstrated that significant ____ changes occur in people who display
hostile or negative behaviors.
a. Attitudinal
b. Behavioral
c. Gastrointestinal
d. Immune-mediated
ANS: D
Several studies have demonstrated that significant immune function and blood pressure
m
er as
changes occur in people who display hostile or negative behaviors during periods of conflict.
co
eH w
o.
rs e
ou urc
6. Somatization disorder is a polysymptomatic disorder, which means that the disorder is
associated with ____ symptoms.
a. Few signs and
NURSINGTB.COM
o
b. Polymorphic
aC s
c. Many signs and

vi y re
d. Specific signs and

ANS: C
Somatization is a polysymptomatic disorder (i.e., one associated with many signs and
ed d
symptoms).
ar stu

OBJ: 6 TOP: Somatization Disorder
is
7. The client recently witnessed a horrific auto accident. Now she is complaining of double
Th
vision, loss of balance, and a constant “lump in her throat.” She is exhibiting the signs and
symptoms of:
a. Anxiety reaction
b. Behavioral disorder
sh
d. Posttraumatic stress reaction
ANS: C

These are classic signs of a conversion disorder, which is a somatoform disorder that presents
as problems related to sensory or motor functions. These disorders most commonly are seen in
individuals of lower socioeconomic status who have little knowledge of health care.

OBJ: 6 TOP: Conversion Disorder
8. La belle indifference is a characteristic that most often is associated with:

a. Anxiety reaction
b. Conversion disorder
c. Depressive disorder
d. Posttraumatic stress reaction
ANS: B
La belle indifference is a lack of concern about the nature or the implications of the signs or
symptoms that are being experienced. The complete opposite reaction of dramatic and
hysterical behavior can be seen in conversion disorder.
m
er as
co
eH w
9. The client can acknowledge the possibility that she exaggerates her symptoms, but she
o.
continues to hold on to the belief that something is physically wrong, in the face of evidence
rs e
to the contrary. What is the client’s diagnosis most likely to be?
ou urc
a. Malingering
b. Hypochondriasis NURSINGTB.COM
c. A conversion reaction
o
d. Body dysmorphic disorder

aC s
vi y re
ANS: B
This describes the diagnosis of hypochondriasis and is seen most often in early adulthood with
individuals who were exposed to a serious illness or a life-threatening condition at an early
age. Malingering refers to a condition in which an individual is purposefully engaging in
ed d
factitious signs and symptoms of a disease. A conversion reaction refers to a somatoform

ar stu
disorder that presents as problems related to sensory or motor functions. Body dysmorphic
disorder refers to a disorder characterized by a preoccupation with one’s own physical
differences or defects.
is

Th
OBJ: 8 TOP: Hypochondriasis

10. A soldier arrives at the airport after completing a combat assignment. He reports a new-onset
sh
blindness but was able to identify his wife in the crowd awaiting passenger arrivals. He is
likely experiencing symptoms of:
a. Somatization
b. Hypochondriasis
c. Conversion Disorder
d. Malingering

ANS: C
Psychological factors are often associated with deficits affecting voluntary or motor function.
The problem cannot be fully explained by a neurological or general medical condition and is
not a culturally sanctioned behavior or experience.

OBJ: N/A TOP: Conversion Disorder
11. The main feature of a factitious disorder is that symptoms are purposefully produced to allow
the individual to:
a. Get out of work
b. Assume the sick role
c. Assume control of treatment
d. Get the attention of health care providers
ANS: B
The most important feature of a factitious disorder is that symptoms are purposefully
produced to enable the individual to assume the sick role.
m
er as
co
OBJ: 8 TOP: Factitious Disorders and Malingering
eH w
o.
12. The client complains of severe back pain and is excused from work. Later, he is seen water
rs e
skiing and jogging. These behaviors describe:
ou urc
a. Malingering
b. Somatization NURSINGTB.COM
c. Hypochondriasis
o
d. A factitious disorder
aC s
vi y re
ANS: A
People who are malingering purposefully produce the signs or symptoms of illness for some
form of gain.
ed d

ar stu

13. A client is admitted every month for the past four months to the psychiatric hospital with
is
complaints of suicidal thoughts and a plan when his monthly disability income has been spent.
This client is exhibiting signs of:
Th
a. Factitious Disorder
b. Conversion Disorder
c. Hypochondriasis
sh
d. Malingering
ANS: D

When engaged in malingering behaviors, the individual produces symptoms to avoid

responsibilities such as duty or obligations. Frequently, clients will produce symptoms with
the goal of receiving compensation, food, or shelter for the night. However, once the motive
becomes apparent to others, the symptoms usually disappear because they no longer serve a
purpose.

OBJ: 6 TOP: Malingering KEY: Nursing Process Step: Assessment
14. In the __________ culture, mental and emotional disorders are expressed as somatoform
complaints on the basis of the belief that the body is the property of the ancestors.
a. Japanese
b. Hispanic
c. Southeast Asian
d. Korean
ANS: D
Koreans believe that the body is the property of the ancestors. In the cultures of the Japanese
m
and Southeast Asians, emotional and mental distresses are also expressed through physical
er as
signs and symptoms, but the belief that the body is the property of the ancestors is not
co
associated with these cultures. In the Hispanic culture, physical complaints may be associated
eH w
with mal ojo (the evil eye). It is important to know how somatoform complaints may surface
o.
in different cultures. Each culture has its own set of beliefs and ways of expressing those
beliefs.
rs e
ou urc
OBJ: 5 NURSInfluences
TOP: Cultural INGTB.COM
o
aC s
15. A female client frequently complains of chest pain, has had extensive physiological testing
vi y re
with negative results, and sees several different medical doctors. This client is exhibiting signs
and symptoms characteristic of:
a. Hypochondriasis
b. Conversion disorder
ed d
c. Body dysmorphic disorder

ar stu
d. Factitious disorder
ANS: A
These are characteristic signs and symptoms of hypochondriasis. Factitious disorder is
is
intentional production of symptoms. Conversion disorder is a somatoform disorder with a

Th
presentation of problems related to sensory and motor functions. Body dysmorphic disorder is
characterized by a preoccupation with a physical difference or defect.

sh

16. Your client is a wife and mother who, in addition to doing most of the household tasks, has a
difficult time saying no to helping out with functions at school and church. Based on Fromm’s
psychodynamic theory, what illness is she more prone to develop?

a. Cardiac problems
b. High blood pressure
c. Alcoholism
d. Gastric ulcer
ANS: D
According to psychodynamic theory, certain personality types are more prone to certain
illnesses. The more aggressive personality is more prone to cardiovascular disease. The quiet,
uncomplaining, overburdened person may suffer from ulcers, joint problems, or skin rashes.

OBJ: 4 TOP: Theories of Psychophysical Disorders
17. Once the acute feelings of illness are resolved, what is an appropriate intervention when
treating a client with a psychosocial problem?
a. Avoid expression of feelings as this will provide a relapse of acute symptoms
b. Minimize secondary gains
c. Convey an attitude that such behavior is not acceptable
m
d. Assist the client to limit social network to avoid additional stress
er as
co
ANS: B
eH w
A key intervention for clients with psychosocial problems is to minimize the secondary gains
once the acute phase is resolved. It is recommended that the caregiver encourage expression
o.
of feelings rather than physical complaints. An accepting attitude is necessary to build trust.
rs e
Assisting the client in limiting a social network limits a potential support system.
ou urc
NURSILevel:GTApplication
B.COM REF: p. 259
OBJ: 9 TOP: Implications Nfor Caregivers
o
aC s
vi y re
18. A mother brings her 9-month-old son to the emergency department because he stopped
breathing at home. She demands that he receive a full diagnostic work-up. When asked for the
name of her pediatrician, she states she has not found one she is satisfied with. The nurse
suspects:
ed d
a. Projection
ar stu
b. Malingering
d. Munchausen’s syndrome by proxy
is
ANS: D
Factitious disorder by proxy (Munchausen’s syndrome by proxy) most often involve a
Th
caregiver who induces signs of illness in a child and presents the child for medical care.
Diagnosis is difficult because offenders commonly remove their victims as soon as the
disorder is suspected.
sh


19. A woman arrives at the hospital complaining of chest pains and shortness of breath. She has
come in several times over the past two weeks, and the staff is doubtful that her symptoms are
real. What is the first action for the health care team to implement?
a. Complete a history, physical, and diagnostics
b. Arrange for a psychiatric consult
c. Provide discharge instructions and arrange for a follow-up visit
d. Obtain a prescription for an antianxiety agent
ANS: A
The first goal of care in every case is to rule out the presence of any physical disease or
dysfunction.

MULTIPLE RESPONSE
1. Which of the following are characteristics of somatoform disorders? (Select all that apply.)
m
er as
a. Relieve anxiety
b. Decrease depression
co
eH w
c. Have no organic medical source
d. Are related to a medical condition
o.
e. Significantly impair one’s level of functioning
rs e
f. Often occur in those who must cope with illness
ou urc
g. Occur in clients who are unaware of or unable to express emotional distress
ANS: A, C, E, G NURSINGTB.COM
o
These are the criteria for the diagnosis of a somatoform disorder, which is defined as feeling
physical symptoms with no diagnosable organic medical condition.
aC s
vi y re

OBJ: 6 TOP: Criteria for Diagnosis
ed d
2. Which are the essential features of conversion disorders? (Select all that apply.)
ar stu
a. Preoccupation with fears of disease

b. Deficits in motor function
c. Long history of vague complaints
is
d. Deficits in sensory function

Th
ANS: B, D
Deficits in motor and sensory function are specific to conversion disorders. Preoccupation
with fears of disease is typical of hypochondriasis, and a long history of vague complaints is
common with somatization disorder.
sh

3. Which of the following are indicative of hypochondriasis? (Select all that apply.)

a. Symptoms most commonly appear in early childhood

b. First diagnosed following a severe stressor
c. More frequent in person exposed to a serious illness in childhood
d. Sufferers usually have strained interpersonal relationships
ANS: B, C, D
Hypochondriasis commonly occurs in early adulthood and is more frequent in persons
exposed to serious illness or a life-threatening condition in childhood. In some cases, initial
diagnosis follows a severe stressor such as a death of a loved one. Interpersonal relationships
are often strained due to the individual with hypochondriasis focusing exclusively on
themselves and expecting special treatment.

COMPLETION
1. __________ is the biochemical fight-or-flight response that is a survival tool against stressors.
m
er as
ANS:
co
General adaptation syndrome
eH w
o.
Hans Selye discovered this during studies of biochemical reactions to stress.
rs e
ou urc
NURSINGMSC:
KEY: Nursing Process Step: Assessment TB.C OM Needs: Physiological Integrity
Client
o
2. In the past, disorders that were emotionally related to physical problems were called
aC s
__________ illnesses.
vi y re
ANS:
Psychosomatic
ed d
This term is still used by many laypersons. The more recent term is psychophysical disorders.
ar stu

OBJ: 4 TOP: Common Psychophysical Problems
is
Th
sh


Chapter 23: Eating and Sleeping Disorders

Test Bank
MULTIPLE CHOICE
1. Trends that have contributed to the recent increase in eating disorders in the United States
include a(n):
a. More competitive workplace
b. Increase in the number of divorces
c. Focus on being thin as a measure of attractiveness
d. Increase in the number of nonnutritional foods consumed
ANS: C
In most modern societies, a high value is placed on a slim body.
DIF: Cognitive Level: Knowledge REF: p. 261 OBJ: 1

TOP: Eating Disorders KEY: Nursing Process Step: Assessment
m
er as
2. What is the main issue for adolescents with anorexia?
co
a. Anxiety
eH w
b. Control
c. Body image
o.
d. Appropriate behavior
rs e
ou urc
ANS: B
The main issue for teenage anorectics is control.
o

aC s
TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment

vi y re
3. Which disorder is associated with persons with a body weight that is normal or even slightly
above average?
ed d
a. Pica
ar stu
b. Bulimia
c. Obesity
d. Anorexia nervosa
is
ANS: B
Often, a bulimic has a body weight that is normal or even slightly above average. Pica is a
Th
disorder in which the individual is eating abnormal substances. Obese individuals are above
normal weight, and individuals with anorexia nervosa have less than normal weight.

sh
TOP: Bulimia KEY: Nursing Process Step: Assessment

4. The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles
that lasts for longer than 1 month is called:
a. Pica
https://www.coursehero.com/file/13027647/c23/

b. Bulimia
c. Rumination
d. Regurgitation
ANS: A
Pica is the persistent eating of nonfood items that persists longer than 1 month and often is
associated with a severe vitamin or mineral deficiency. Bulimia refers to an eating disorder
that is commonly characterized by bingeing and purging; rumination is a rare disorder that
refers to regurgitation and rechewing of food; regurgitation refers to partially digested food
brought up into the mouth.

TOP: Other Eating Disorders KEY: Nursing Process Step: Assessment
5. The main focus of medical management for anorexia is to:

a. Encourage rapid weight gain.
b. Encourage the client to eat voluntarily.
c. Teach more appropriate food choices.
m
d. Keep the client from developing additional problems.
er as
ANS: B
co
eH w
The main focus is to encourage the client to consume food voluntarily because this will allow
for continued normal food consumption. Too rapid weight gain will lead to a feeling of loss of
o.
control, which could induce inappropriate eating behaviors again. Teaching appropriate food
rs e
choices and keeping the client from developing additional problems occur as a part of the
ou urc
psychological management of the disorder.
DIF: Cognitive Level: Comprehension REF: p. 267 OBJ: 5

o
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning

aC s

vi y re
6. Although all age groups can be affected, sleep disorders occur most frequently in:
a. Adolescence
b. Later childhood
ed d
c. Older adulthood
ar stu
d. Middle adulthood
ANS: C
Sleep disorders occur more frequently in older adults.
is

Th
TOP: Sleep Disorders KEY: Nursing Process Step: Assessment

7. The inability to fall asleep or stay asleep is called:

sh
a. Insomnia
b. Narcolepsy
c. Hypersomnia
d. Nocturnal myoclonus
ANS: A

Insomnia is a disorder of not falling asleep or sustaining sound sleep. Narcolepsy refers to a
condition in which an individual repeatedly experiences periods of sleep, regardless of activity
or the situation; hypersomnia refers to prolonged sleep episodes; and nocturnal myoclonus
refers to an individual who moves limbs involuntarily during sleep and has symptoms or
problems related to this movement.

TOP: Dyssomnias KEY: Nursing Process Step: Assessment
8. A disorder that interrupts normal sleep patterns and is characterized by repeated, brief jerks of
the arms and legs that occur every 20 to 60 seconds during the beginning of sleep is called:
a. Insomnia
b. Narcolepsy
c. Hypersomnia
d. Nocturnal myoclonus
ANS: D
Nocturnal myoclonus consists of repeated, brief jerks, most often in the legs, that occur at the
m
beginning of sleep and disrupts the normal sleep pattern. These movements generally decrease
er as
during stage 4 NREM sleep.
co
eH w
DIF: Cognitive Level: Knowledge REF: p. 271 OBJ: N/A
o.
rs e
ou urc
9. Sleep disorders that are characterized by abnormal behavioral or physical events during sleep
are called:
a. Insomnia
o
b. Dyssomnias
aC s
c. Hypersomnia
vi y re
d. Parasomnias
ANS: D
Sleep disorders characterized by abnormal behavioral or physical events during sleep are
ed d
called parasomnias and are caused by inappropriate activation of certain centers of the brain
ar stu
that control physical and emotional functions. Insomnia is the inability to fall asleep;
dyssomnias are sleep disorders characterized by abnormal amounts, quality, or timing of
sleep; and hypersomnia is an abnormally increased amount of sleep.
is

TOP: Parasomnias KEY: Nursing Process Step: Assessment
Th
10. Sleep terrors usually occur only once a night, during stages 3 and 4 of NREM sleep. They are
sh
often accompanied by which physical sign?

a. Intense stress
b. Sexual arousal
c. Physical strength
d. Intense motor activity
ANS: A

Sleep terrors often are accompanied by physical signs of intense stress, such as increased heart
rate, respirations, and muscle tone.

TOP: Parasomnias KEY: Nursing Process Step: Planning
11. The first step in the treatment of sleep disorders is to:

a. Teach prevention.
b. Give hypnotics for sleep.
c. Evaluate sleeping patterns.
d. Teach clients to retire early.
ANS: A
The first step in the treatment of sleep disorders is to teach prevention. Giving the client
hypnotics is a last resort because these substances can be habit forming and/or may affect the
quality of sleep; evaluating sleeping patterns is a diagnostic tool; and teaching clients to retire
early may not be feasible.
m
DIF: Cognitive Level: Application REF: p. 272 OBJ: 9
er as
TOP: Guidelines for Intervention KEY: Nursing Process Step: Intervention
co
eH w
12. The collection of perceptions, thoughts, feelings, and behaviors that relate to one’s size and
o.
appearance is called:
a. Body image rs e
ou urc
b. Self-esteem
c. Self-concept
d. Body parameters
o
aC s
ANS: A
vi y re
This is the definition of body image.

ed d

ar stu
13. The average age for onset of anorexia nervosa is _____ years old.
a. 13
b. 17
is
c. 33
d. 40
Th
ANS: B
Anorexia nervosa usually is not seen before puberty, with an average age of onset of 17 years.
This disorder is seldom seen after the age of 40 years.
sh


14. The nurse who is caring for a 23-year-old client with bulimia knows that the most common
method of purging to monitor this client for is:
a.Vomiting
b.Starvation
c.Excessive enema use
d.Use of syrup of ipecac
ANS: A
Vomiting and the use of diuretics and laxatives are the most common methods of purging.
Less often used are enemas and syrup of ipecac. Starvation is a typical behavior of anorexia
nervosa.

15. The nurse who works in a sleep clinic knows that approximately _____% of adults suffer from
insomnia.
a. 10 to 20
m
b. 30 to 40
er as
c. 50 to 60
co
d. 70 to 80
eH w
ANS: B
o.
Thirty to forty percent of the adult population suffers from insomnia, and the incidence
rs e
increases with age and in women.
ou urc
o

aC s
vi y re
16. During an episode of binge eating, what type of food is usually taken in large amounts?
a. Fruits
b. Red meat
c. Fried or high fat content foods
ed d
d. Cakes, donuts, or sweets

ar stu
ANS: D
Binge eating is defined as consuming an amount of food that is definitely larger than most
individuals would eat in similar circumstances. During a binge an individual consumes large
is
quantities of certain foods, usually carbohydrates.

Th

sh
17. A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic
intervention is used with caution prior to stabilization and weight gain?
a. Establish rapport and trust
b. IV or tube feeding
c. Administering antidepressants
d. Daily weights

ANS: C
Administering antidepressants to clients with anorexia before they regain weight may be
hazardous if the individual has a history of cardiac problems or presently has a low serum
potassium level. Be sure to check the laboratory results of clients with eating disorders.

TOP: Guidelines for Intervention KEY: Nursing Process Step: Assessment
18. Which of the following persons is most likely a candidate for primary hypersomnia?
a. A 50-year-old who has wakeful periods during the night and naps during the day
following the death of her husband
b. A 6-year-old who wakes up in the middle of the night after having a nightmare and
is tired the next day
c. An obese 40-year-old who has snoring and periods of apnea at night and is tired
the next day
d. An 18-year-old college student whose mother complains he sleeps all night and
still naps during the day
m
er as
ANS: D
Primary hypersomnia begins between 15 and 30 years of age. Nighttime sleep may last from 8
co
to 12 hours and daytime naps may last for more than 1 hour, and are not caused by any other
eH w
physical or mental health disorder.
o.
rs e
ou urc
o
19. A police officer complains of feeling tired and not able to sleep for an extended period of time
after being assigned to work the night shift. He is most likely suffering from:
aC s
a. Circadian rhythm sleep disorder

vi y re
b. Primary hypersomnia
c. Narcolepsy
d. Obstructive sleep apnea syndrome
ed d
ANS: A
ar stu
Circadian rhythm sleep disorder is a sleep disruption that results from a mismatch between
body rhythms and environmental demands. Primary hypersomnia occurs when a person sleeps
during the night, but naps during the day. Narcolepsy results in repeated attacks of sleep, and
is
obstructive sleep apnea is a breathing-related sleep disorder and not a change in sleep time.
Th

sh
MULTIPLE RESPONSE
20. Which of the following conditions are eating disorders? (Select all that apply.)
a. Pica
b. Purging

c. Cataplexy
d. Binge eating
e. Hypersomnia
f. Nocturnal myoclonus
ANS: A, B, D
These are types of eating disorders. The other options describe sleeping disorders.

21. Which are key features of anorexia nervosa? (Select all that apply.)
a. Excessive laxative use
b. Purging
c. Severe weight loss
d. Introverted personality
e. Hunger is denied
ANS: C, D, E
m
er as
These are some of the key features of anorexia nervosa. Excessive laxative use and purging
are characteristic of bulimia.
co
eH w
o.
rs e
ou urc
22. What are the criteria for the diagnosis of bulimia? (Select all that apply.)
a. Occasional episodes of binge eating
o
b. Refusal to maintain body weight that is more than 15% below normal
c. Excessive emphasis placed on body shape and weight
aC s
vi y re
d. Eating binges at least twice per week for at least 3 months

ANS: C, D
These are two of the four criteria for the diagnosis of bulimia. Bulimia criteria include
recurring episodes of binge eating rather than only occasional episodes; refusal to maintain
ed d
body weight that is more than 15% below normal is a criterion for the diagnosis of anorexia
ar stu
nervosa.

is

Th
23. The death rate from anorexia is higher than any other mental illness. Death usually results
from: (Select all that apply.)
a. Dehydration
sh
b. Loss of critical muscle mass

c. Diabetes
d. Electrolyte imbalances
e. Suicide
ANS: A, B, D, E

The mortality rate for anorexia due to complications of starvation, cardiac arrest, or suicide is
approximately 5% per decade of follow-up. Death usually results from dehydration, loss of
critical muscle mass, electrolyte imbalances, or suicide, because often clients are not seen by
health professionals until the disorder has resulted in some physical problems.

COMPLETION
24. The medical term for a sleep test is a __________.
ANS:
polysomnogram
This test involves measurements of brain wave activity, muscle movement, and eye movement
during sleep.
m
er as
TOP: Sleep Disorders KEY: Nursing Process Step: Assessment
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
is
Th
sh

Chapter 24: Dissociative Disorders

MULTIPLE CHOICE
1. The father of a 6-month-old and a 3-year-old discovers that his wife, who is the mother of the
children, has abandoned the family and moved to another state. During this developmental
stage, this abandonment will have the strongest negative effect on the children’s:
a. Motor skills
b. Self-concept
c. Body image
d. Cognitive skills
ANS: B
Trust and consistency play a major role in the development of a child’s self-concept.
Abandonment provides neither. The mother’s absence may not affect the motor or cognitive
skills of the children. Body image is only one component of self-concept.

OBJ: 3 TOP: Self-Concept in Childhood
2. The father of a 6-month-old and a 3-year-old discovers that his wife, who is the mother of the
children, has abandoned the family and moved to another state. During this developmental
stage, this abandonment will have the strongest negative effect on the children’s:
a. Motor skills
b. Self-concept NURSINGTB.COM
c. Body image
d. Cognitive skills
ANS: B
Trust and consistency play a major role in the development of a child’s self-concept.
Abandonment provides neither. The mother’s absence may not affect the motor or cognitive
skills of the children. Body image is only one component of self-concept.

OBJ: 3 TOP: Self-Concept in Childhood
3. The hospice nurse notices that, following the death of his wife of 50 years, a surviving
husband’s affect is anxious, and he reports a feeling of detachment from his body, stating, “I
feel like I am seeing myself from outside of my body.” The caregiver knows that this client is
displaying the characteristics of the dissociative disorder of:
a. Dissociative fugue
b. Dissociative amnesia
c. Dissociative identity disorder
d. Depersonalization disorder
ANS: D
NURSINGTB.COM

Depersonalization serves as a defense mechanism in response to severe anxiety. The person

often is described as “working on automatic” or “functioning as a robot.” The characteristics
listed describe the behavioral or social signs and symptoms of depersonalized disorder. Fugue
is characterized by traveling that occurs suddenly and unexpectedly with no recall of the
traveling. Amnesia is the inability to remember personal information, and dissociative identity
disorder was formerly known as multiple personality disorder.

OBJ: 5 TOP: Depersonalization/Derealization Disorder
4. The nurse witnesses different personalities emerging in the client with dissociative identity
disorder (DID). The primary personality is referred to as the:
a. Host
b. Alter
c. Ego
d. Identity
ANS: A
Host is the term for the primary personality, which may not be aware of the alters (the other
personalities). Ego is one component of the three-part theory of the ego, id, and super-ego
identified by Sigmund Freud when referring to his belief of how personalities are structured.
Identity refers to how one sees oneself.

OBJ: 6 TOP: Dissociative Identity Disorder
NURSINGTB.COM
5. When developing the nursing care plan for a client with dissociative identity disorder (DID),
the nurse knows that one of the major goals of therapy is to assist the client in:
a. Naming all personalities for clarification
b. Integrating the personalities into one functional personality
c. Realizing when different personalities are about to emerge
d. Learning how to move from one personality to another
ANS: B
It is important for therapy to assist the client in combining the personalities into one, so that
the individual is able to function and cope effectively with daily stressors. Naming the
personalities might occur without thought but is not necessary. In addition, realizing when
alters are about to emerge and learning how to move among personalities are not goals of
treatment.

6. During a home visit, the client tells the nurse that she feels that her medication is no longer
helping her dissociative diagnosis of depersonalization disorder because she has noticed that
she is not thinking clearly, is having difficulty with her memory and judgment, and is often
disoriented to the time. The nurse knows that the doctor must be contacted and that this client
most likely will be:
NURSINGTB.COM

a. Admitted to a long-term care agency because she is a threat to herself

b. Admitted to a state-psychiatric facility for an extended period for intense therapy
c. Referred to a group home setting for better supervision
d. Admitted to the hospital for evaluation and possible adjustment of her medications
ANS: D
Admission to the hospital will be necessary to safely evaluate and/or adjust her medications.
Moving the client from her home to any type of long-term care or group home setting or
state-psychiatric facility is not warranted from her symptoms.

7. The care provider is aware that in addition to assessment, one of the first goals of therapy for
the client with a dissociative disorder is:
a. Revisiting of past traumas
b. Pharmacological therapy
c. Stabilization
d. Family therapy
ANS: C
Although revisiting of past traumas, pharmacological therapy, and family therapy are all
possible treatment components, stabilization must be implemented first for the client.
Stabilization consists of making the patient feel safe and able to trust the treatment team.

NURSINGTB.COM
8. Those who care for individuals with dissociative disorders must be aware that they often will
try to __________ the staff members who are caring for them.
a. Manipulate
b. Harm
c. Date
d. Persecute
ANS: A
As with many individuals with mental health disorders, clients with a dissociative disorder
frequently will try to manipulate the staff to benefit themselves. Harming, dating, or
persecuting the staff is not typical behavior of a person with a dissociative disorder.

9. Which of the following is considered a primary nursing diagnosis for a client with a
dissociative disorder?
a. Self-esteem, low
b. Personal identity, disturbed
c. Role performance, ineffective
d. Anxiety
NURSINGTB.COM

ANS: B
Although all of the nursing diagnoses listed are related to dissociative disorders, “Personal
identity, disturbed” is the only one listed that is a primary nursing diagnosis for these
disorders.

10. During assessment of a client with a dissociative disorder, the nurse notices that the client has
been cutting herself on both arms. After talking with the client, the nurse, along with other
members of the treatment team, decides that the best intervention at this time to prevent
further self-destructive behavior would be:
a. Establishing a signed contract with the client to tell a team member when she is
having self-destructive thoughts
b. Isolating the client from all other clients and activities until she is no longer having
self-destructive thoughts
c. Administering medications that will reduce the client’s anxiety levels
d. Involving the client in activities as a diversion from self-destructive thoughts
ANS: A
Contracts are effective in building trust between the client and the treatment team, as well as
in making the client responsible to seek assistance at crucial times. Isolating a client,
administering antianxiety medications, and providing diversional activities would not address
the self-destructive thoughts.

NURSILevel: Application REF: p. 283
OBJ: 9 TOP: Treatment NGTherapies
and TB.COM
11. A client with the diagnosis of depersonalization disorder notices that he experiences periods
of depersonalization when confronted with certain stressors. When developing the care plan,
the nurse is aware that one of the most helpful activities in self-control for this client is for the
client to:
a. Contact a treatment team member to discuss his thoughts and feelings every time
he is confronted with a stressor
b. Keep a daily journal of his thoughts and feelings, paying special attention to
thoughts and feelings during stressful times
c. Recall periods of stressful times in his life during his clinic visit
d. Join an exercise program that will help to decrease his stress level
ANS: B
Daily journals will allow the client to vent his feelings, will enable reflection on events that
led to depersonalization episodes, and will assist the treatment team in collaborating with the
client on self-control measures to help prevent episodes in the future. Contacting a team
member with every stressor or trying to recall episodes is unrealistic. Although an exercise
program may help to decrease stress levels, it does not deal directly with episodes.

NURSINGTB.COM

12. The 15-year-old son of a single, full-time working mother frequently is left at home alone to
care for himself. According to Erikson’s theory, the nurse is aware that this adolescent most
likely would have difficulty in developing a comfortable:
a. Body image
b. Self-ideal
c. Self-concept
d. Role performance
ANS: C
Body image, self-ideal, and role performance are all components of self-concept. Therefore,
the best answer to this question is the sum of all these parts. Adolescents have difficulty
developing a comfortable self-concept when they lack nurturing and guidance.

OBJ: 3 TOP: Self-Concept in Adolescence
13. A female client with a diagnosis of a dissociative disorder who attends group meetings at a
community mental health clinic often voices that her boss at work frequently complains that
she is working at a level below her capabilities. The client also states that she feels that she
“never gets anything done.” Which nursing diagnosis best addresses these issues?
a. Self-esteem, low
b. Social isolation
c. Body-image, disturbed
d. Memory, impaired
The client is exhibiting characteristics typical of low self-esteem. She is not isolating herself
from others, does not indicate a distorted perception of her body, and shows no sign of
problems with her memory.

14. What is the first nursing priority in a client with the nursing diagnosis of “Personal identity,
disturbed”?
a. Promote wellness
b. Assist the client to manage any threatening feelings
c. Assess causative and/or contributing factors
d. Determine which medications will work most effectively
ANS: C
Causative and/or contributing factors would be the first priority in guiding the rest of the care
planning process. The second priority for a client with this nursing diagnosis would be to
assist the client to manage any threatening feelings, followed by promoting wellness.
Determining which medications are effective is not a nursing priority for this nursing
diagnosis; rather, this is more of a physician-initiated action.

NURSINGTB.COM

15. A “spell” is a culturally defined mental health disorder or a dissociative “state” seen in
African Americans, Europeans, and Americans from southern U.S. cultures. This “state” is
characterized by:
a. Sudden collapsing with eyes open and inability to see, while still hearing and
understanding, without being able to move
b. Seizure activity and coma for up to 12 hours preceded by extreme excitement or
irrational behavior
c. A state in which spirit possession interferes with daily activities
d. Communication with deceased relatives or spirits that occurs during a trancelike
state
ANS: D
A “spell” is seen in these cultures and is characterized by the behaviors listed. Sudden
collapsing with eyes open and inability to see but ability to hear and understand describes the
state of “falling out” seen in members of some cultures living in the southern United States
and in certain Caribbean groups. Seizure activity and coma preceded by extreme excitement
or irrational behavior describes “piblokto,” seen in some Arctic and sub-Arctic Eskimos; a
state in which spirit possession interferes with daily activities describes “zar,” seen in cultures
of individuals originating from Egypt, Ethiopia, Iran, and Sudan.

OBJ: 5 TOP: Dissociative Disorders
16. The wife of a 70-year-old man is concerned that her husband refuses to participate in any
NURSINtwo
activities with her since his retirement GTyears
B.Cago.
OM He is often short tempered and sees any
type of hobby as a “waste of time.” Which intervention or activity would help him enhance
his feelings of self-worth?
a. Begin taking antidepressant medication
b. Move with his wife to an assisted living community
c. Get involved in a retired businessmen’s group providing assistance to new
companies
d. Taking up a less strenuous activity to decrease stress and information overload
ANS: C
A threat to the stability of one’s lifestyle (such as change in employment) can lead to changes
in self-concept, as it affects personal identity, self-esteem, and role performance. An activity
which allows the person to adapt to change and regain a sense of self-esteem and self-worth
will enhance the expression of self-concept. Taking antidepressants, moving to an assisted
living community, and taking up a less strenuous mental and physical activity do not provide
the same degree of expression of self-concept.

OBJ: 3 TOP: Self Concept in Older Adulthood
NURSINGTB.COM

17. A family adopts a 7-year-old boy from an international adoption agency with little
information on the child’s history. They bring the child to a therapist because the child is
withdrawn, destroys things in the house, and hits his adoptive siblings without provocation.
As the therapist develops a trusting relationship with the child, what type of intervention
would be initially used to gain input from the child?
a. Psychoeducation
b. Art therapy
c. Joint stabilization plan
d. Development of coping strategies
ANS: B
During the stabilization phase, the diagnosis is established as the client reveals the
complexities of his nature. In a child who is withdrawn, art therapy can be used as a means of
communication and expression. Psychoeducation would not be the strategy to use at this
stage. A joint stabilization plan and development of coping strategies occur after a trusting
relationship and client input occur.

18. A woman has had several episodes where she finds new clothes in her closet that are much
more colorful than the style she usually buys. Today, a co-worker approached her to thank her
for hosting a dinner party that she had no recollection of hosting. What is the most appropriate
nursing diagnosis for this client?
a. Self-esteem, low
b. Personal identity, disturbed
c. Body image, disturbed NURSINGTB.COM
d. Anxiety
ANS: B
Nursing diagnoses for clients with dissociative disorders are related to self-concept responses
and depend on identified problems of each client. In this case, the description the client gives
relates to personal identity. Low self-esteem and disturbed body image may be contributing
factors to this diagnosis.

19. Which dissociative disorder is a result of a disturbance of identity?

a. Dissociative amnesia
b. Dissociative identity disorder
c. Dissociative fugue
ANS: B
Dissociative identity disorder is a disturbance of identity. Dissociative amnesia and
dissociative fugue are disturbances of memory. Obsessive-compulsive disorder is a mood
disorder.
NURSINGTB.COM

OBJ: 5 TOP: Characteristics

MULTIPLE RESPONSE
1. A client with a dissociative disorder has the nursing diagnosis of disturbed body image.
Which nursing interventions would address the nursing priority of determining the coping
abilities and skills of this client? (Select all that apply.)
a. Assess the client’s current level of adaptation
b. Help the client differentiate between isolation and loneliness
c. Note the use of addictive substances
d. Identify previously used coping strategies and their effectiveness
ANS: A, C, D
The client’s current level of adaptation must be assessed as a baseline for the plan of care.
Noting the use of addictive substances may reflect dysfunctional coping mechanisms.
Identifying whether previously used coping strategies were effective will reveal whether any
of them can be used again. Helping the client differentiate between isolation and loneliness is
an intervention that is directed toward the nursing diagnosis of social isolation.

2. A male client with a dissociative disorder copes with his low self-esteem by displaying
behaviors associated with an exaggerated sense of self-importance. Which behaviors would
N (Select
this client most likely exhibit? U
RSIN GTB.C
all that OM
apply.)
a. Bragging about special abilities
b. Setting unrealistic goals
c. Having unrealistic dreams
d. Having a view of life that everything is either right or wrong
ANS: A, B, C
The client with an exaggerated sense of self-importance often brags about his special abilities,
sets unrealistic goals because he feels he is capable of anything, and sets unrealistic dreams
for himself for the same reason. The belief that everything in life is either right or wrong is a
polarized view that is seen in clients with a negative outlook about life.

3. A person’s self-concept, or how a person sees himself or herself, comprises which of the
following? (Select all that apply.)
a. Body image
b. Self-esteem
c. Identity diffusion
d. Self-ideal
e. Personal identity
NURSINGTB.COM

ANS: A, B, D, E
Body image (one’s feelings about his or her body), self-esteem (one’s judgment of his or her
own worth), self-ideal (one’s personal standards on appropriate behavior), and personal
identity (one’s awareness of himself as an individual) constitute a person’s self-concept.
Identity diffusion refers to a person’s not being sure of who he really is.

OBJ: 1 TOP: Self-Concept
4. Dissociative fugue is identified by which characteristics? (Select all that apply.)

a. Presence of two or more distinct personalities
b. Sudden travel with inability to recall the past
c. Behave normally during travel but confused by own identity
d. May assume a new life
ANS: B, C, D
The main characteristic of dissociative fugue is sudden, unexpected travel with an inability to
recall the past. This occurs in response to an overwhelmingly stressful or traumatic event.
Some individuals assume entirely new identities. The presence of two or more distinct
personalities is a characteristic of dissociative identity disorder, not dissociative fugue.

OBJ: 5 TOP: Dissociative Fugue
COMPLETION
NURSINGTB.COM
1. Of the four types of dissociative disorders identified by the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV-TR), the disorder that formerly was called “multiple
personality disorder” now is called __________.
ANS:
Dissociative identity disorder
The diagnosis of dissociative identity disorder (DID) is made when two or more identities can
be identified in an individual that have the characteristic of repeatedly controlling the person’s
behavior. This disorder formerly was known as multiple personality disorder.

2. When a person is unable to bring his various childhood identifications into one effective adult
personality, the individual is said to have identity _______________.
ANS:
Diffusion
NURSINGTB.COM

Identity diffusion prevents a person from knowing who he is or having a clear picture of
himself. These individuals have difficulty developing meaningful relationships or knowing
what they want to do with their lives.

NURSINGTB.COM
NURSINGTB.COM

Chapter 25: Anger and Aggression

MULTIPLE CHOICE
1. The use of inappropriate, harmful, or destructive behaviors to express current or past emotions
is defined as:
a. Anger
b. Assault
c. Acting out
d. Aggression
ANS: C
Acting out is the use of inappropriate, detrimental, or destructive behaviors to express current
or past emotions. Anger is a normal emotional response in certain situations; assault is a threat
for bodily injury; and aggression is a forceful attitude or action.
m
OBJ: 1 TOP: Anger and Aggression
er as
co
eH w
2. Toddlers often express their anger through:
o.
a. Crying
b. Manipulation
rs e
ou urc
c. Temper tantrums
d. Direct aggression
NURSINGTB.COM
ANS: C
o
Toddlers engage in temper tantrums when they learn to focus their aggression on what they
aC s
believe is responsible for their anger.

vi y re

OBJ: 2 TOP: Aggression Throughout the Life Cycle
ed d
ar stu
3. In the assault cycle, people are unable to listen to reason, follow directions, or engage in
mental exercises during the stage of:
a. Crisis
b. Trigger
is
c. Recovery
Th
d. Escalation
ANS: A
Assault is an aggressive behavior that violates another’s person or property. Crisis describes
sh
the behaviors in the question. Trigger refers to the phase when a stress-producing event
occurs; recovery is described as the cooling-down period of the assault cycle; and escalation is
characterized by a behavioral response that is approaching loss of control.

OBJ: 5 TOP: The Cycle of Assault

4. Crisis interventions are very successful if begun early in the assault cycle, in the ____ stage.
a. Crisis
b. Trigger
c. Depression
d. Escalation
ANS: B
Crisis intervention works best in this stage because coping mechanisms can be implemented
that are effective rather than allowing behavior to continue to the next phase of escalation.

5. Persons who naturally relate aggressively to others, seldom have empathy, and lack
appropriate guilt feelings are given the diagnosis of ____ disorder.
a. Conduct
b. Adjustment
m
c. Impulse-control
er as
d. Oppositional defiant
co
eH w
ANS: A
These are characteristics of conduct disorders. Adjustment disorders are characterized by a
o.
psychological response from an identifiable stressor or group of stressors that causes
rs e
significant emotional or behavioral symptoms that do not meet criteria for more specific
ou urc
disorders; impulse-control disorders are characterized by a failure to resist impulses or
temptations that are harmful N RSperson
to the INGTorB.C M and oppositional defiant disorder refers
to others;
U O
to a pattern of negative, aggressive behaviors that is seen most commonly in children who
o
focus on authority figures.

aC s
vi y re

OBJ: 6 TOP: Aggressive Behavioral Disorders of Childhood
ed d
6. Emotional or behavioral problems that develop in response to an identifiable source and last
ar stu
no longer than 6 months are called ____ disorders.

a. Conduct
b. Adjustment
c. Impulse-control
is
d. Oppositional defiant
Th
ANS: B
This is the criterion for adjustment disorders. Conduct disorders are characterized by
individuals who naturally relate aggressively to others, seldom have empathy, and lack
sh
appropriate guilt feelings; impulse-control disorders are characterized by failure to resist an

impulse, drive, or temptation; and oppositional defiant disorder refers to a pattern of negative,
aggressive behaviors that is seen most commonly in children who focus on authority figures.

OBJ: 6 TOP: Adjustment Disorders

7. Level one interventions for potentially assaultive clients should be practiced as:
a. Therapy
b. Control methods
c. Assessment measures
d. Preventive measures
ANS: D
Level one interventions focus on the prevention of violence.

OBJ: 8 TOP: Level One Interventions
KEY: Nursing Process Step: Planning
8. Interventions for assaultive clients that focus on protecting the client and others from potential
harm are level ____ interventions.
a. One
b. Two
m
c. Three
er as
d. Four
co
eH w
ANS: B
Level two interventions focus on protecting the client and others from potential harm. Level
o.
one interventions focus on preventing violence, and level three is the last level of
rs e
interventions that are implemented for clients whose behaviors reflect a loss of control.
ou urc
NURTwo Level: Knowledge REF: p. 294
OBJ: 8 TOP: Level SIInterventions
NGTB.COM
o

aC s

vi y re
9. Restrained clients must be monitored and their condition documented at least every ____
minutes.
a. 15
ed d
b. 30
ar stu
c. 60
d. 90
ANS: A
is
The use of restraints is governed by federal and state laws, institutional policies, and special
procedures.
Th

OBJ: 8 TOP: Level Three Interventions
sh
10. As long as the client is limiting her behaviors to verbal assaults and harmless physical
movements,
a. She is placed in seclusion.
b. The acting out may continue.

c. The caregiver is prepared to apply restraints.

d. She is reminded of the inappropriateness of her behavior.
ANS: B
Allow clients to act out as long as they limit their behaviors to verbal assaults and harmless
physical movements. However, it is important for the caregiver to maintain control of the
situation and set limits on the client’s behavior.

OBJ: 8 TOP: Level Two Interventions
11. Interventions that help caregivers the most in coping with their own anger focus on:
a. Learning to effectively interact with clients
b. Assessing which stressors and coping skills are being used
c. Learning to effectively control feelings of anger
d. Establishing a trusting therapeutic relationship via clear communications
ANS: C
m
er as
Although all these interventions are necessary when one is dealing with clients, this
intervention allows caregivers to be most effective in caring for individuals who express
co
eH w
emotions of anger.
o.
OBJ: 9
rs e
TOP: Therapeutic Interventions
ou urc
U S Naffect
12. Which situation would most negatively
N R I G B.C M
T a female
O client with a diagnosis of adjustment
o
disorder?
aC s
a. Marrying her partner she has lived with for 5 years

vi y re
b. Beginning college after graduating from high school 12 years ago

c. Being promoted in the company at which she has worked for the past 10 years
d. Meeting with a friend with whom she keeps in contact but has not seen for 8 years
ANS: B
ed d
Individuals with adjustment disorders have the greatest difficulty in adapting to new
ar stu
situations. Therefore, beginning college has the most stress potential because it has no familiar
aspect to it, as the other options do.
is

Th
13. A married couple is seeking counseling for domestic abuse issues. The husband states that he
can’t control his anger when his wife constantly nags at him. In the assault cycle, the wife’s
sh
behavior in this situation is the stage known as:

a. Recovery
b. Crisis
c. Escalation
d. Trigger

ANS: D
The nagging is the trigger to the assault in this situation. The trigger stage should not be
confused as being a justified reason for an assault to occur.

14. A male client is being seen for anger management issues following an incident in which he
was late for work, became angry at the driver in front of him for not driving faster, and
intentionally ran into the car at a stop sign. This client is displaying actions most typical of:
a. Intermittent explosive disorder
b. Passive aggressive behavior
c. Oppositional defiant disorder
d. Adjustment disorder with anxiety
ANS: A
The main characteristic of intermittent explosive disorder is the failure to resist aggressive
impulses that result in assault of another individual or property. Passive aggressive behavior,
m
oppositional defiant disorder, and adjustment disorder with anxiety do not result in injury or
er as
harm to persons or property.
co
eH w
OBJ: 6 TOP: Impulse-Control Disorders
o.
rs e
ou urc
15. An intramuscular injection of an antianxiety agent is administered to a client who has become
violent toward the staff in theNemergency
URSINGroom.
TB.CThis
OM is an example of what level of
therapeutic intervention?
o
a. One
aC s
b. Two
vi y re
c. Three
d. Four
ANS: C
ed d
Level three interventions also include seclusion and restraints and are used only for clients
ar stu
who are out of control. Level one is the prevention stage of interventions, and level two is
focused on protection of the client and others from potential harm. Level four does not exist.

is
OBJ: 8 TOP: Level Three Interventions

Th
16. Which of the following persons is exhibiting passive aggression?

a. The woman who willingly volunteers to help out at her child’s school play
sh
b. The woman who says no when asked to go to a charity event

c. The woman who asks a co-worker to cover her shift
d. The woman who agrees to cover a co-worker’s shift and complains to customers
that she is supposed to be home
ANS: D

A person demonstrating passive aggressive actions expresses anger in indirect ways. Instead
of declining to cover the shift, the person complains to others. The other examples do not
demonstrate this indirect anger.

OBJ: 1 TOP: Introduction KEY: Nursing Process Step: Intervention
17. Children in preadolescence have started to channel aggression through which positive
activity?
a. Fights in schoolyards
b. Organized sports
c. Joining gangs
d. Verbal abuse
ANS: B
By preadolescence, most children stop hitting and learn to channel their aggression into
physical activities, such as competitive sports or physical conditioning. Fighting, gangs, and
verbal abuse are not positive activities.
m
er as
co
eH w
o.
18. A 15-year-old female is seen in the clinic for episodes of cutting herself since her parents
rs e
divorced six months ago. Which nursing diagnosis is a priority for this client?
ou urc
a. Behavior, risk-prone health
b. Spiritual distress NURSINGTB.COM
c. Social interaction, impaired
o
d. Family processes, interrupted

aC s
vi y re
ANS: A
The client is demonstrating anger turned inward demonstrated by self-mutilation. The priority
would be to prevent the client from further harming herself. Dealing with spiritual distress,
impaired social interaction, and interrupted family processes is accomplished after this.
ed d
ar stu

is
19. A man who hit his wife yesterday, causing her to fall and break her arm, has called out of
work today to take care of her and buy her flowers. He repeatedly tells her how horrible he
Th
feels and promises this will never happen again. What stage of the assault is he
demonstrating?
a. Trigger stage
sh
b. Escalation stage
c. Recovery stage
d. Depression stage
ANS: D

The depression stage involves a period of guilt and attempts to reconcile (make up) with
others. Aggressors are aware of the assault and genuinely feel bad about it. They may
apologize frequently or provide loving care for the victim. The trigger stage occurs prior to
the assault, when the stress-producing event occurs. The escalation stage is when actions
move closer to a loss of control, and the recovery stage occurs after the violence and injuries
are assessed.

MULTIPLE RESPONSE
1. Which mental health problems are categorized as anger control disorders? (Select all that
apply.)
a. Conversion disorder
b. Conduct disorder
m
c. Dissociative disorder
er as
d. Impulse-control disorder
co
e. Dysthymic disorder
eH w
f. Adjustment disorder
o.
g. Oppositional defiant disorder
ANS: B, D, F, G rs e
ou urc
Conduct disorder, impulse-control disorder, adjustment disorder, and oppositional defiant
disorder are all examples of anger
N R control
I G disorders.
B.C M
U S N T O
o

aC s
OBJ: 6 TOP: Anger Control Disorders

vi y re
2. During the psychosocial portion of the assessment of a client with anger, aggression, or
violent behavior issues, the nurse will assess which of the following? (Select all that apply.)
ed d
a. Coping skills
ar stu
b. General appearance
c. Value and belief systems
d. Cultural, spiritual, and occupational interests
e. Potential for engaging in inappropriate behavior
is
ANS: A, C, D
Th
Assessing coping skills, whether the client has a value and belief system, and cultural,
spiritual, and occupational interests are components of the psychosocial portion of the
assessment. Assessing potential for engaging in inappropriate behavior and general
sh
appearance occur during the initial portion of the assessment and during the mental status
assessment, respectively.

OBJ: 7 TOP: Assessing Anger and Aggression

3. Which of the following psychosocial nursing diagnoses are related to anger and aggression?
a. Anxiety
b. Violence, risk for other-directed
c. Hopelessness
d. Violence, risk for self-directed
e. Coping ineffective, individual
f. Fear
ANS: A, C, E, F
Anxiety, hopelessness, ineffective coping, and fear are all potential nursing diagnoses related
to anger and aggression. Violence, risk for other-directed, and violence, risk for self-directed,
are diagnoses in the physical realm.

OBJ: 7 TOP: Assessing Anger and Aggression
COMPLETION
m
er as
1. __________ is a forceful attitude or action that does not take into consideration others’
co
eH w
feelings or needs and may be expressed verbally, physically, or symbolically.
o.
ANS:
Aggression rs e
ou urc
Aggressive behaviors usuallyNareRa result
I GofB.C
anger. M
U S N T O
o

aC s
OBJ: 1 TOP: Anger and Aggression

vi y re
2. __________ typically express anger and/or aggression with temper tantrums.

ed d
ANS:
Toddlers
ar stu
This is typical of the toddler years. Anger and aggression are expressed in some form from
infancy until death.
is

Th
OBJ: 2 TOP: Aggression Throughout the Life Cycle

3. The __________ theory explains aggression and violence as being caused by physical or
sh
chemical differences among people.
ANS:
Biological

In addition to the biological theory, the psychosocial theory and the sociocultural theory
attempt to explain the causes of anger and aggression.

OBJ: 4 TOP: Theories of Anger and Aggression
m
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 26: Outward-Focused Emotions: Violence

MULTIPLE CHOICE
1. Mr. Right employs 22 children in his clothing factory. Each child is no older than 10 years of
age and works 11 hours a day, 6 days a week. Mr. Right is practicing:
a. Abuse
b. Neglect
c. Violence
d. Exploitation
ANS: D
This describes the exploitation of children in providing a profit for Mr. Right. Abuse refers to
the intentional misuse of something or someone that results in harm; neglect is described as
causing harm to another’s health or welfare through failure to provide for basic needs or by
placing the person’s health or welfare at unreasonable risk; and violence is defined as physical
force that harms another.
m
er as
co
OBJ: 1 TOP: Definition of Terms
eH w
o.
rs e
ou urc
2. The theory that cites poverty, unemployment, and crime as sources of violence is known as
the ____ theory.
a. Feminist NURSINGTB.COM
o
b. Sociological
c. Anthropological
aC s
d. Psychiatric/mental illness
vi y re
ANS: B
Sociological theories consider environmental and social factors to be causes of violence in
society. Feminist theories describe violence directed toward women. Anthropological theory
ed d
is based on cultural patterns, social organizations, and sexual differences; and the
ar stu
psychiatric/mental illness theory refers to violence as a mental illness.

OBJ: 2 TOP: Theories of Violence
is
Th
3. What concept do feminist theories use to explain violence against women?

a. Machismo
b. Femininity
sh
c. Masculinity
d. Muscularity
ANS: A
Machismo is defined as compulsive masculinity that results in aggressive and violent behavior
directed toward women, which occurs as the result of socialization of this behavior throughout
childhood.


4. The term that describes repeated physical abuse, usually of a woman, child, or elder, is:
a. Neglect
b. Battering
c. Exploitation
d. Gender abuse
ANS: B
This is the definition of battering. Neglect is defined as causing harm to another’s health or
welfare through failure to provide for basic needs or by placing the person’s health or welfare
at unreasonable risk. Exploitation refers to using an individual for selfish purposes or for
profit. Gender abuse is described as various forms of abuse directed toward women.

OBJ: 5 TOP: Domestic Violence
m
er as
co
5. A male who, as a child, observed the women in his family being dominated is, in his own life,
eH w
more likely to:
a. Love
o.
b. Batter
c. Belittle rs e
ou urc
d. Order around
ANS: B
NURSINGTB.COM
o
The social learning theory considers this to be a contributing factor to a male who has become
aC s
a batterer.
vi y re

ed d
6. Whenever there is a history of unexplained lethargy, fussiness, or irritability in an infant,

ar stu
caregivers should suspect ____ syndrome.

a. Shaken baby
b. Drugged baby
is
c. Depressed infant
d. Feeding disorder
Th
ANS: A
Shaken baby syndrome should be suspected when an infant has unexplained or vague injuries.
This form of child abuse results when the child is vigorously shaken, leading to
sh
whiplash-induced bleeding in the brain.

OBJ: 5 TOP: Child Abuse KEY: Nursing Process Step: Assessment

7. Eating disorders, substance abuse, delinquent behaviors, posttraumatic stress disorder, and
suicide most commonly are seen as the result of abuse in this population:
a. Children
b. Adolescents
c. Adults
d. Elderly
ANS: B
These disorders most frequently are seen as the result of abuse of adolescents, and abuse of
this age group is the most overlooked type of family violence.

OBJ: 6 TOP: Adolescent Abuse
8. A physically or mentally impaired older woman who is living with a relative and has a history
of unexplained bruises or injuries, burns in unusual places, or poor personal hygiene is likely a
victim of:
a. Neglect
m
b. Child abuse
er as
c. Elder abuse
co
d. Adolescent abuse
eH w
ANS: C
o.
These are typical signs of elder abuse, which most typically occurs among family members.
rs e
ou urc
OBJ: 5 TOP: Elder Abuse
NURSINGTB.COM KEY: Nursing Process Step: Assessment
o
aC s
9. A rule of thumb for recovering from a rape or other violent experience states that the greater
vi y re
the force or brutality, the greater the psychological harm and:

a. Recovery time
b. Legal implications
c. Social dysfunction
ed d
d. Financial difficulty
ar stu
ANS: A
Recovery time is directly related to the level of the attack.
is

OBJ: 6 TOP: Rape: Trauma Syndrome
Th
10. Many victims of violence believe that their abusers may attempt to hurt them again, even as
they are seeking help. Recognizing this, the care provider:
sh
a. Does not leave the client alone

b. Posts security guards at the door
c. Leaves the client alone no longer than 15 minutes
d. Immediately gets the name and phone number of the perpetrator
ANS: A

The first priority of care for every victim of violence is to ensure safety and security.

OBJ: 8 TOP: Treating Victims of Violence
11. By law, what are health care providers required to do when they encounter incidents of
suspected or actual abuse or neglect?
a. Inspect
b. Investigate
c. Report to the authorities
d. Report to the client’s family
ANS: C
By law, health care providers are required to report violent incidents to the police. It is not
mandatory for health care providers to inspect clients if they have not given permission.
Investigation is the responsibility of law enforcement officials. Reporting to the client’s
family is a breach of confidentiality unless requested by the client.
m
er as
co
OBJ: 7 TOP: Special Assessments
eH w
o.
rs e
12. During the recoil stage of recovery from violence, the major characteristic is:
ou urc
a. Fear
b. Disorganization NURSINGTB.COM
c. Reconstruction
o
d. Struggle to adapt
aC s
vi y re
ANS: D
The recoil stage is when the individual becomes aware of the impact of the violence on his or
her life. Fear and disorganization occur during the impact stage, and reconstruction occurs
during the reorganization stage.
ed d
ar stu

OBJ: 6 TOP: Mental Health Disorders Related to Violence
is
13. A female who is physically abused by her husband arrives in the emergency department
following a serious battering incident. During this phase of the domestic abuse cycle, the
Th
nurse expects the client to:

a. Have experienced the battering episode a few days prior to the incident
b. Be very nurturing and compliant and seeking to please her husband
sh
c. Believe in the permanency of their relationship and believe that it will not happen
again
d. Ask the emergency department nurse to call the police immediately to arrest her
husband
ANS: A

This is typical of the second phase of the cycle of domestic violence following a serious
battering incident. The client may also lie about the cause of the incident. During this second
phase of the cycle the victim usually asks for the police not to be involved for fear of future
battering in retaliation. The client is usually nurturing and compliant in the first phase of the
cycle when tension is building. During the honeymoon phase (or third phase), the client
believes in the permanency of the relationship.

OBJ: 6 TOP: Mental Health Disorders Related to Violence
14. Child prostitution in Thailand is widespread, and it is estimated that __________% of these
children have AIDS.
a. 10
b. 25
c. 50
d. 75
ANS: C
m
There are nearly 500,000 child prostitutes in Thailand alone. This does not include the number
er as
in the remainder of Asia or the rest of the world.
co
eH w
o.
rs e
ou urc
15. Which signs and/or symptoms should alert the caregiver to a child who is suffering from
neglect? NURSINGTB.COM
a. Bruises and welts at various stages of healing
o
b. Consistently dirty, hungry, and inappropriately dressed

aC s
c. Child has torn, stained, or bloody underclothing

vi y re
d. Any fracture in a child younger than 2 years of age or fractures at various stages of
healing in a child of any age
ANS: B
ed d
These are only a few of the signs of neglect. Bruises and fractures are consistent with physical
ar stu
abuse, and torn, stained, or bloody underclothing is seen with sexual abuse.

OBJ: 5 TOP: Special Assessments
is
Th
16. When a functional family is faced with a crisis or unexpected situation, which of the
following behaviors do they exhibit to overcome it?
a. Avoid the conflict and focus on positive aspects of their lives
sh
b. Isolate the family and attempt to reach resolution without outside interference
c. Maintain clear and supportive communication to address the crisis
d. Look to the head of the family to resolve based on role
ANS: C

A functional family unit is described by what it does (processes) to achieve its goals. These
processes include clear and supportive communications among all family members. Isolating
the family does not allow them to use resources outside the family, avoidance of conflict does
not promote resolution, and assigning goal planning to one member does not describe the
actions of a functional family.

17. While an abused woman cannot be categorized to fit a specific profile, which of the following
traits is most commonly identified?
a. Trusting nature
b. Assertive personality
c. Accomplished in nontraditional female career
d. Suspicious nature
ANS: A
There is no “typical” abused woman, but the victims of violence do have some characteristics
m
in common. Perhaps the most common trait is a trusting nature, as opposed to a suspicious
er as
nature. Many women were raised to be nonaggressive and traditional, as opposed to assertive
co
and accomplished in nontraditional female careers.
eH w
o.
OBJ: 3
rs e
TOP: Gender Abuse
ou urc
NURSthe
18. Abuse during pregnancy endangers INhealth
GTB.C M
andOwell-being of the pregnant woman and her
fetus. Which complicating factor is seen twice as much in women experiencing abuse during
o
pregnancy?
aC s
a. Postpartum hemorrhage
vi y re
b. Preterm delivery
c. Maternal substance abuse
d. Delivery by caesarean section
ed d
ANS: B
ar stu
The number of women who are abused during pregnancy experiencing preterm delivery and
low birthweight infants has doubled. Women also postpone prenatal care until the third
trimester when it is too late to provide adequate care to treat problems. Hemorrhage after
delivery, substance abuse, and operative delivery are not noted as issues more prevalent in
is
abused pregnant women.

Th

OBJ: 4 TOP: Abuse During Pregnancy
sh
19. Which nursing diagnosis would be most appropriate for an adolescent client suffering from
test anxiety who was continually told by her mother that she was inferior to her siblings and
could never amount to anything?
a. Noncompliance
b. Denial, ineffective

c. Self-esteem disturbance, situational low/chronic low

d. Violence, risk for other-directed
ANS: C
Emotional abuse involves rejection, criticism, terrorizing, and isolation. The result is low
self-esteem, in which the adolescent doubts her abilities. The adolescent in this case is not in
denial and is not demonstrating behaviors that would alert the nurse to a violent nature.
Noncompliance is not an issue in this case.

MULTIPLE RESPONSE
1. Which are characteristics of a dysfunctional family? (Select all that apply.)

a. Occasional arguments
b. Setting goals
c. Inconsistent authority
m
er as
d. No clearly defined roles
e. Members are self-centered
co
eH w
f. Family boundaries are rigid
g. Clear and supportive communications
o.
ANS: C, D, E, F
rs e
ou urc
A dysfunctional family is described by its inability to fulfill its basic functions. All other
options represent a well-functioning family dynamic.
NURSINGTB.COM
o

aC s
vi y re
2. During the first phase of the domestic abuse cycle, the female victim of domestic violence
inflicted by a male usually displays which characteristics or behaviors? (Select all that apply.)
a. Denial of the seriousness of the problem
ed d
b. Feeling that she cannot control the man’s behavior

ar stu
c. Blaming alcohol and work for the man’s behavior

d. Feeling that she deserves minor abuse
ANS: A, C
is
The first cycle is the tension phase. During this phase, the woman feels that she can control
Th
the man’s behavior, and she feels that she does not deserve minor abuse.

sh
3. A 25-year-old woman expresses concern regarding some of her new boyfriend’s behaviors.
Which of the following statements might indicate that he has an abusive personality? (Select
all that apply.)
a. Even though they have been dating for less than 2 months, he wants to get married

as soon as possible.
b. He does not allow her to go out with friends unless he accompanies them.
c. He finds fault with her family and seeks to convince her that they are trying to
sabotage her relationship with him.
d. He has a poor relationship with his own parents, blaming them for not supporting
him after he was fired from various jobs.
e. He would like to further his education but realizes that he must first work for a
while to pay off student loans.
ANS: A, B, C, D
Early signs of an abusive personality include a push for quick involvement, as seen in the rush
to get married. Demonstrating jealous and controlling behaviors in not allowing his partner to
go out with friends, blaming his family for his own problems, and attempting to isolate his
partner from her family are also signs of an abusive personality. Working to pay off loans
before furthering education is a realistic expectation and not indicative of an abusive
personality.

OBJ: 9 TOP: Early Signs of Abusive Personality
m
er as
co
eH w
COMPLETION
o.
1. __________ refers to a sudden occurrence of physical force that causes harm or injury to
another person. rs e
ou urc
ANS: NURSINGTB.COM
Violence
o
aC s
Violence is a type of physical activity that is socially unacceptable.

vi y re

ed d
ar stu
2. The theory that implies that aggressive and violent behaviors are learned through role
modeling of other people is known as the:
ANS:
is
Social learning theory

Th
Social learning theory suggests that people learn behavior from others in their environment
based on the values, attitudes, and actions of role models.
sh

3. __________ refers to abuse or battering of a family member by another family member.
ANS:

Domestic violence
Domestic violence can be psychological or physical.

m
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 27: Inward-Focused Emotions: Suicide

MULTIPLE CHOICE
1. Self-protective responses are seen in behaviors that meet basic:

a. Goals
b. Needs
c. Wants
d. Demands
ANS: B
People behave in many ways to secure basic safety and security needs.

OBJ: 1 TOP: Continuum of Behavioral Responses
m
2. Bob drives fast everywhere he goes, especially when he is drinking. Last night, he was
er as
arrested for gambling and loud behavior. Bob is engaging in ____ behavior.
co
a. Adaptive
eH w
b. Suicidal
o.
c. Direct self-destructive
rs e
d. Indirect self-destructive
ou urc
ANS: D
NURSare
Indirect self-destructive behaviors INbehaviors
GTB.Cthat O Mmay result in harm or death to the
individual who has no intention of ending his or her life. Suicide and direct self-destructive
o
behavior are behaviors that convey an active wish to die. The behavior in this situation is
aC s
maladaptive, not adaptive.

vi y re

ed d
ar stu
3. Suicide in the United States is:

a. Not a problem
b. The tenth leading cause of death
c. Most prevalent among the middle-aged
is
d. Controlled by the use of antidepressants

Th
ANS: B
Suicide is the tenth leading cause of death in the United States.
sh

OBJ: 2 TOP: Impact of Suicide on Society
4. The theory that suicide rates are affected by group support, social changes, regulations,
religion, legal sanctions or limitations, and philosophical beliefs is known as the ____ theory.
a. Biological

b. Sociological
c. Interpersonal
d. Psychoanalytical
ANS: B
Sociological theory considers the relationship between the number of suicides and the social
conditions in an area. Biological theory refers to anxiety and depression caused by
irregularities in neurotransmitters, leading to suicide; interpersonal theory views suicide as the
result of an inability to resolve interpersonal conflicts; and psychoanalytical theory considers
suicide as anger turned inward.

OBJ: 6 TOP: Theories About Suicide
5. Children are at greater risk for committing suicide if they have ____ problems.
a. Family
b. Social
c. Mental health
m
d. Acute physical
er as
co
ANS: C
eH w
Children with existing mental health problems are at greater risk for committing suicide than
are other children because they often do not have effective coping skills.
o.
PTS: 1 rs e
ou urc
OBJ: 7 TOP: Suicide and Children
U S N T O
o
6. Suicide is attempted three times more frequently by ____ but is more often successfully
aC s
completed by ____.
vi y re
a. Adult men, women

b. Adult women, men
c. Adult fathers, mothers
d. Adolescent mothers, fathers
ed d
ANS: B
ar stu
Women attempt suicide three times more frequently than men, but men are more often
successful at completing the act.
is

OBJ: 2 | 7 TOP: Suicide and Adults
Th
7. The caregiver works with suicidal clients to establish therapeutic rapport. The focused
communications and concerned actions encourage suicidal persons to:
sh
a. Feel in control
b. Feel self-worth
c. Talk about themselves
d. Feel foolish for thinking about suicide
ANS: B

The focused communications and concerned actions of caregivers help suicidal individuals to
feel self-worth, which directly affects the treatment goals of the individual.

OBJ: 9 TOP: Therapeutic Interventions for Suicidal Clients
8. Suicide attempts by ____ are more successful because one out of every two attempts results in
death.
a. Adolescents
b. Older adults
c. Young adults
d. Middle-aged adults
ANS: B
The incidence of successful suicides increases with age because of the fact that older adults
are less likely than persons of all other age groups to communicate their intentions to others.
m
OBJ: 7 TOP: Suicide and Older Adults
er as
co
eH w
9. When the environment lacks security or presents dangers, the perception that life will be short
or will end in violence is most compelling for:
o.
a. Children
b. Adolescents rs e
ou urc
c. Young adults
d. Middle-aged adults NURSINGTB.COM
o
ANS: B
aC s
This age group tends to feel this way more than other age groups do, and if this is the feeling
vi y re
of an adolescent, he or she sees no promise for the future.

OBJ: 7 TOP: Suicide and Adolescents
ed d
ar stu
10. All people who commit suicide are depressed or psychotic. This statement is a(n):
a. Fact
b. Myth
is
c. Opinion
d. Attitude
Th
ANS: B
Many false ideas about suicide still exist. It is important for the nurse to become familiar with
these myths if he is to be skilled in educating others about suicide.
sh

OBJ: 2 TOP: Myths About Suicide

11. The nurse is caring for a male client with a major depressive disorder who has not responded
well to various treatments in the past. The latest treatment method has resulted in slight
improvement in the client’s symptoms. On this particular day, the client has a very positive
affect and says he feels “amazingly better.” The nurse should:
a. Congratulate him on his recovery
b. Document the client’s improvement
c. Ask him what he feels has helped him feel better so suddenly
d. Assess the client for signs and symptoms of suicidal thoughts
ANS: D
This behavior is frequently seen when a depressed individual has made the decision to commit
suicide. The other options ignore this important sign.

12. An adult female whose fiancé recently called off the wedding attempts suicide by taking an
overdose of sleeping medication. Immediately after taking the medication, she calls friends
m
and family to tell them what she has done. Her friends and family activate the emergency
er as
response system, and she is taken to the emergency department and is admitted to a mental
co
health facility for monitoring. She is exhibiting signs and symptoms most evident of which
eH w
suicidal motivational category?
o.
a. Cry for help
b. Relieving distress
rs e
ou urc
c. Preoccupation with suicide
d. Refusal to accept a diminished style of life
NURSINGTB.COM
ANS: A
o
This behavior is characteristic of a cry for help. Calling others after her attempt shows that she
aC s
was not intent on committing suicide. Relieving distress refers to individuals who face
vi y re
situations that threaten their own intactness as a person, such as terminal illness;
preoccupation with suicide indicates the only form of control for one’s own life; and refusal to
accept a diminished style of life refers to considering all options and then rationally deciding
that suicide is the best option.
ed d
ar stu

OBJ: 4 TOP: Categories of Motivation
is
13. A terminally ill female client chooses the time and place of her own death. This is an example
Th
of:
a. Suicide
b. Self-injury
c. Rational suicide
sh
d. Planned suicide
ANS: C
In this situation, the person knows that she is going to die, so the decision of where to die is
made freely and with sound mind. Suicide and planned suicide simply refer to intentionally
taking one’s own life. Self-injury is an active attempt to injure oneself.


OBJ: 3 TOP: Social Factors
14. An elderly male client’s wife of 50 years recently died from cancer. He suffers from a chronic
debilitating illness and has been refusing to eat, drink, or take his medications. This client is
displaying behavior characteristic of:
a. Suicidal threats
b. Suicidal attempts
c. Suicidal ideation
d. Passive suicide
ANS: D
Passive suicide is seen most frequently in older adults as a result of depression and loneliness.
Suicidal threats refer to written or verbal threats of suicide; suicidal attempts are self-directed
actions to harm oneself; and suicidal ideation is a preoccupation with the idea of suicide.
m
OBJ: 7 TOP: Suicide and Older Adults
er as
co
eH w
15. In the __________ dimension, an individual who is considering suicide experiences distorted
thinking and self-defeating thoughts.
o.
a. Emotional
b. Social rs e
ou urc
c. Intellectual
d. Spiritual NURSINGTB.COM
o
ANS: C
aC s
This dimension is characterized by self-defeating thoughts rather than attempts to

vi y re
problem-solve. The emotional dimension refers to feelings such as ambivalence, anger, guilt,
and hopelessness; the social dimension refers to feelings of inferiority; and the spiritual
dimension encompasses an individual’s ethics, religion, and societal beliefs.
ed d

ar stu
OBJ: 4 TOP: Characteristics of Suicide

16. Methods of suicide differ by gender. What is a preferred method of female suicide victims?
is
a. Firearm use
b. Hanging
Th
c. Overdose
d. Drowning
ANS: C
sh
Women who commit suicide use a method such as overdose or inhalation of carbon
monoxide. Men generally utilize more violent methods such as firearm use, hanging, or
drowning.

OBJ: 2 TOP: Characteristics of Suicide

17. Biological studies of suicide victims show an imbalance of which neurotransmitter system?
a. Serotonin
b. Epinephrine
c. Norepinephrine
d. Dopamine
ANS: A
Researchers have demonstrated that when certain chemicals in the brain (neurotransmitters)
are not in balance, people have difficulty regulating their moods. Irregularities in a certain
neurotransmitter pattern, called the serotonin system, have been found in depressed and
suicidal persons.

OBJ: 6 TOP: Theories About Suicide: Biological Evidence
18. In assessing a client for suicide, which finding presents the greatest risk for the client?
a. “If I had AIDS or cancer and died, then my family would be sorry.”
m
er as
b. “I just don’t see any other way out of this situation.”
co
c. “I tried to kill myself 6 months ago, but my friend stopped me. The next time, no
eH w
one will know.”
d. “I have thought about planning it, but I haven’t done it.”
o.
ANS: C rs e
ou urc
In assessing a client for risk of suicide, all of these factors (suicide ideation, present suicide
plan, and level of despair) indicate
NURSaIrisk. However,
B.COMa client with previous attempts presents
the highest risk. NGT
o
aC s

vi y re
OBJ: 8 TOP: Suicide Assessment

19. After establishing a no-harm contract with the client, the nurse should:
ed d
a. Begin to assess client risk factors

ar stu
b. Continue to maintain close observation

c. Decrease observation activity to allow client autonomy
d. Begin treatment with antidepressants
is
ANS: B
After the client agrees to a no-harm contract, the health care provider must still maintain close
Th
observation while continuing to work on underlying issues of self-worth and despair. The
assessment process should have been started prior to this. Antidepressants are prescribed
based on physician order. Decreasing observation may increase client risk at this time.
sh

MULTIPLE RESPONSE

1. Which of the following are included in the continuum of self-protective responses? (Select all
that apply.)
a. Suicide
b. Self-injury
c. Depression
d. Goal setting
e. Self-enhancement
f. Growth-promoting risk taking
g. Supportive communications
ANS: A, B, E, F
Suicide, self-injury, positive risk taking, and self-enhancement are behaviors in the continuum
of self-protective responses.

2. Which are facts about suicide? (Select all that apply.)
m
a. Suicide occurs most often in lower socioeconomic classes.
er as
b. Depression is a high risk factor for attempting suicide.
co
c. Giving away important possessions is a sign of suicidal thoughts.
eH w
d. It is harmful to discuss the subject of suicide with clients.
o.
e. Suicidal threats are serious only if the client conveys the planned method.
ANS: B, C rs e
ou urc
These are only two of the facts about suicide. The other options are myths regarding suicide.
NU
It is important for the nurse to beRfamiliar
SINGTwith
B.C OMthe facts and the myths regarding suicide.
both
o

aC s

vi y re
3. Which social factors impact the incidence of suicide? (Select all that apply.)
a. Social isolation
ed d
b. Legal status of gun ownership

ar stu
c. Poverty and homelessness

d. Veterans of combat
e. Availability of Internet resources
is
ANS: A, B, C, D
Social isolation increases as people are more mobile and separated from family and support
Th
systems. The legal availability of firearms increases the suicide rate. Circumstances where
people cannot care for their basic needs through homelessness and poverty increase the
incidence of suicide. Persons who have suffered some type of PTSD, such as survivors of
sh
natural disasters or veterans of combat, have higher suicide rates. Access to Internet resources
does not impact the incidence of suicide.

OBJ: 3 TOP: Social Factors

COMPLETION
1. Standard interventions implemented in a mental health facility to prevent a client from

attempting suicide are called __________.
ANS:
Suicide precautions
Clients with strong suicidal intent require these precautions, which are standard in all mental
health facilities.

2. __________ is a term that is used to describe a form of active suicidal behavior, such as
gestures, threats, or attempts to end one’s own life.
m
er as
ANS:
Direct self-destructive behavior
co
eH w
These behaviors convey an active wish to die, even though the individual may be indecisive
o.
about wanting to live and wanting to die.
rs e
ou urc
OBJ: 1 TOP: Continuum of Behavioral
NURSINGTB.COM Responses
o
aC s
3. __________ is when a client thinks or fantasizes about death with no definite intent to commit
vi y re
suicide.
ANS:
Suicidal ideation
ed d
ar stu
This is a risk factor for attempting suicide and should be investigated further.

OBJ: 8 TOP: Assessment of Suicidal Potential
is
Th
sh


Chapter 28: Substance-Related Disorders

MULTIPLE CHOICE
1. Abused substances are those chemicals that alter the person’s perception by affecting the:
a. Central nervous system
b. Autonomic nervous system
c. Cardiorespiratory system
d. Peripheral nervous system
ANS: A
Abused substances are chemicals that affect the central nervous system (CNS). They often
enhance or depress moods or emotions.

OBJ: 1 TOP: Definition of Terms
m
er as
2. Children who are smaller at birth, have small heads (microcephaly), and fail to develop
co
normally have characteristics of:
eH w
a. Parents who smoke
b. Fetal alcohol syndrome
o.
rs e
c. Fetal alcohol intoxication
ou urc
d. Fetal accumulation syndrome
ANS: B
These are some of the effects of fetal alcohol syndrome, which occurs with excessive alcohol
o
use during pregnancy.

aC s
vi y re

OBJ: 2 TOP: Drugs in Pregnancy
ed d
3. With children younger than 12 years of age, drug abuse:

ar stu
a. Does not exist

b. Is never a problem
c. Occurs infrequently
d. Occurs more often than is suspected
is
ANS: D
Th
The number of admissions of children younger than 12 to substance treatment units is

increasing.

sh
OBJ: 2 TOP: Substance Use and Age

4. The drug most often abused by adolescents is:

a. Alcohol
b. Cocaine
https://www.coursehero.com/file/28033191/mental-health-28doc/

c. Tobacco
d. Marijuana
ANS: A
Alcohol is the most frequently abused drug among adolescents.

5. The client has frequent drug reactions to, and side effects from, his medications. He is 72
years old and lives alone. What should he be assessed for?
a. Clarity of mind
b. Suicidal wishes
c. Concurrent substance use
d. Using someone else’s medications
ANS: C
More than 40% of all drug reactions occur in persons older than 65, which suggests the
possibility of substance abuse.
m
er as
co
eH w
o.
rs e
6. The main active ingredient in coffee, black teas, most cola drinks, and many other bottled
ou urc
beverages that stimulates the nervous system, relieves fatigue, increases alertness, and
increases the body’s metabolic rate is:
a. Alcohol
o
b. Cocaine
c. Caffeine
aC s
vi y re
d. Amphetamines
ANS: C
Caffeine is the main active ingredient in coffee, black teas, most cola drinks, and many other
bottled beverages.
ed d
ar stu

OBJ: 4 TOP: Chemicals of Abuse
is
7. One begins to prefer being high to other activities during which stage of addiction?
Th
a. The early stage

b. The middle stage
c. The late stage
d. The chronic stage
sh
ANS: A
These behaviors are typically seen in the early stage of addiction. Tolerance to the substance
develops in the middle stage. The late stage is also known as the chronic stage, in which the
need for the substance causes loss of control over one’s behavior.


OBJ: 6 TOP: Stages of Addiction
8. Significant complications such as sudden death due to cardiac dysrhythmia or respiratory

depression are associated with the use of:
a. Alcohol
b. Cocaine
c. Inhalants
d. Hallucinogens
ANS: C
Significant complications of inhalant use include sudden death caused by cardiac dysrhythmia
and respiratory depression. Inhalant use is most prevalent in adolescents and young adults.

OBJ: 5 TOP: Inhalants KEY: Nursing Process Step: Assessment
9. For a substance-related disorder to be diagnosed, the pattern of substance use must lead to:
m
er as
a. Significant costs involved with the habit
b. Significant disturbances in social functioning
co
eH w
c. Significantly impaired functioning and distress
d. Significant physical changes related to the abused substance
o.
ANS: C
rs e
ou urc
The pattern of substance use must be disabling and must lead to significantly impaired
functioning and distress. The person must demonstrate signs of tolerance, withdrawal, and
dependence.
o

aC s
OBJ: 7 TOP: Criteria for Diagnosis

vi y re
10. Before treatment of an addiction can actually begin, many persons first must go through the
ed d
process of removing the substance from their bodies under medical supervision. This is known
as:
ar stu
a. Abstinence
b. Withdrawal
c. Detoxification
is
d. Intoxication
Th
ANS: C
Before treatment actually can begin, many persons first must go through detoxification, the
process of withdrawing from a substance under medical supervision. Abstinence refers to not
engaging in an activity; withdrawal refers to the signs and symptoms experienced when an
sh
individual stops taking a substance that he or she is dependent on; and intoxication is a state of
behavioral or psychological change that results from exposure to a chemical.


11. A drug that is taken daily to help reduce the desire for alcohol is:
a. Hydroxyzine (Atarax)
b. Disulfiram (Antabuse)
c. Methadone (Dolophine)
d. Meclizine (Antivert)
ANS: B
Disulfiram (Antabuse) is a medication that is taken daily by recovering alcoholics because it
causes a very unpleasant physical reaction when combined with alcohol.

12. Typical central nervous system responses when an individual has drunk five or more alcoholic
beverages or has a blood alcohol content of 0.20% within a 4-hour period include:
a. Thought, restraint, reaction time, and judgment are slowed, and the individual
usually is more at ease socially
m
b. The entire motor area of the brain is depressed; the individual is staggering, easily
er as
angered, and emotional and feels fatigued
co
c. Comatose; the medullary area of the brain is severely depressed, and respiratory
eH w
failure can result in death
d. Confused, unresponsive to most external stimuli; loss of ability to control
o.
rs e
involuntary responses and decreased vital signs
ou urc
ANS: B
These responses can vary somewhat among individuals. Slowed reaction time usually is seen
with one or two drinks or with a blood alcohol content of 0.05%; a comatose state occurs with
o
seven or more drinks or 0.40% to 0.50% alcohol blood content; and confusion and
aC s
unresponsiveness to most external stimuli occur with six to seven drinks or a blood alcohol
vi y re
content of 0.30%.

ed d
ar stu
13. __________ is a processed stimulant that reaches the brain immediately and produces an
intense but short-lived high.
a. Heroin
is
b. Opioids
Th
c. Cocaine
d. Crack
ANS: D
Crack is processed cocaine that is extremely addicting because of the immediate high.
sh
Cocaine is a natural stimulant. Heroin is an opioid, which is a central nervous system

depressant.


14. A male client takes ibuprofen twice a day, every day, for his arthritis. He becomes very
anxious when he does not take his normal doses. This client is experiencing:
a. Physical tolerance
b. Substance dependency
c. Psychological tolerance
d. Early-stage addiction
ANS: C
Because ibuprofen is not a chemical that causes physical dependency, this client is
experiencing psychological tolerance. Physical tolerance occurs when an individual’s body
has adjusted to living and functioning with the substance in the system; substance dependency
refers to the need to take a substance to prevent withdrawal symptoms; and early-stage
addiction is characterized by an individual who is enjoying the effects of the substance.

OBJ: 6 TOP: Stages of Addiction
m
15. The nurse assessing a newborn shortly after delivery notes that the infant is very jittery,
er as
irritable, and has a high-pitched cry. The nurse suspects that the mother took which substance
co
during pregnancy?
eH w
a. Alcohol
b. Heroin
o.
c. Cocaine
rs e
ou urc
d. Analgesics
ANS: C
Infants who were exposed to cocaine in utero have sleeping and eating problems, unusual
o
levels of irritability, and high-pitched cries.

aC s
vi y re

ed d
16. The school nurse reports that a student who was brought to her appears to be tense and angry,
ar stu
and her speech is rapid. She denies use of illegal substances. What does the nurse suspect the
student has ingested?
a. Ibuprofen
b. Penicillin
is
c. Ritalin
Th
d. Valium
ANS: C
A recent study has shown that 1 in 5 adolescents have abused prescription drugs. Tension,
anger, and rapid speech are common to use of stimulants such as diet pills, amphetamines, and
sh
Ritalin.


17. Which of the following persons is said to have a dual diagnosis?

a. The anorexic adolescent suffering from depression
b. The school-age child suffering from a learning disorder and asthma
c. The older adult suffering from hypertension and diabetes
d. The young adult suffering from psychosis who smokes marijuana regularly
ANS: D
People with serious mental illness who also are addicted to or use chemicals are said to have a
dual diagnosis. It is estimated that as many as 75% of the mentally ill population have a dual
diagnosis.

OBJ: 1 TOP: Scope of the Problem Today
18. The family of a 35-year-old alcoholic who refuses to seek treatment reaches out to the
community health center for assistance. Which organization should the nurse refer them to for
counseling?
a. Al-Anon
m
b. Alcoholics Anonymous
er as
c. Families Anonymous
co
d. Narcotics Anonymous
eH w
ANS: A
o.
It is important to provide support for the family and refer them to group counseling. Al-Anon
rs e
is a self-help group for families of alcoholics. Alcoholics Anonymous is a self-help group for
ou urc
alcoholics. Families Anonymous is a self-help group for parents, relatives, and friends of drug
addicts, and Narcotics Anonymous is a self-help group for individuals recovering from drug
abuse.
o
aC s

vi y re
OBJ: 9 TOP: Self-Help Groups for Recovering Abusers

MULTIPLE RESPONSE
ed d
ar stu
1. The breathing in of volatile substances has become popular with adolescents and young adults
because such inhalants are (Select all that apply):
a. Legal
is
b. Illegal
c. Harmless
Th
d. Expensive
e. Inexpensive
f. Easily obtained
g. Undetectable in the body
sh
ANS: A, E, F
Reasons that adolescents and young adults abuse inhalants include the legality of the
substances, their inexpensiveness, and how easily they can be obtained.

OBJ: 5 TOP: Inhalants KEY: Nursing Process Step: Assessment

2. Which are signs and symptoms most commonly associated with heroin use? (Select all that
apply.)
a. Watery eyes
b. Constricted pupils
c. Clammy skin
d. Drowsiness
e. Euphoria
f. Sweating
ANS: B, D, E
These are common signs and symptoms of heroin use. Watery eyes and sweating are
characteristic of heroin withdrawal, and clammy skin is seen most commonly with heroin
overdose.

OBJ: 4 TOP: Categories of Abused Substances
m
er as
co
3. It is important for the nurse to ensure that the client understands the physical reactions
eH w
associated with drinking alcohol while taking disulfiram (Antabuse). Which of the following
are reactions that may result from ingesting alcohol while taking Antabuse? (Select all that
o.
apply.)
a. High blood pressurers e
ou urc
b. Headache
c. Blurred vision
d. Nausea
o
e. Double vision
aC s
f. Vomiting
vi y re
g. Chills
ANS: B, C, D, F
Headache, blurred vision, nausea, and vomiting occur with concomitant use of alcohol and
ed d
Antabuse. Additional reactions include flushing and low blood pressure.

ar stu

is
4. Which of the following are interventions included in the plan of care for an individual with
Th
substance abuse? (Select all that apply)

a. Ignore physical symptoms of dependence and withdrawal to ensure the individual
will rehabilitate
sh
b. Focus on client’s weaknesses to encourage client to change

c. Teach client about the negative effects of the disease
d. Monitor the effects of therapies prescribed to control substance use
e. Meet physical needs during detoxification
f. Encourage client to focus on present and future, not only the past
ANS: C, D, E, F

The most important intervention for clients with substance-related problems is to act as a
therapeutic agent. Other interventions are designed to meet physical needs, especially during
detoxification. Monitor effects of therapies; teach about the disease and its progression; help
clients problem-solve; and encourage the client’s family and significant others to become
involved. Focusing on the client’s weaknesses does not give the client a sense of hope.

COMPLETION
1. __________ is the drug of choice in the treatment of heroin addiction to ease the effects of
withdrawal from the drug.
ANS:
Methadone
It is important to monitor clients who are taking methadone because it can become addicting
m
er as
itself.
co
eH w
o.
rs e
ou urc
2. When the body physically needs or is dependent on a substance, the individual is said to be
__________ to the substance.
o
ANS:
aC s
Addicted
vi y re
This is the definition of addiction.

ed d
OBJ: 1 TOP: Vocabulary of Terms

ar stu
is
Th
sh

Chapter 29: Sexual Disorders

Test Bank
MULTIPLE CHOICE
1. The end of the continuum that is marked by sexual actions harmful to self or others in some
manner is known as:
a.Adaptive
b.Homosexual
c.Maladaptive
d.Functional
ANS: C
As the continuum moves toward maladaptive, sexual behaviors become impaired or
dysfunctional. The adaptive end of the continuum consists of satisfying sexual behaviors that
respect the rights and wishes of others. The other options do not relate to the continuum.
m
TOP: Continuum of Sexual Responses KEY: Nursing Process Step: Assessment
er as
co
eH w
2. A strong influence on discussion of sexual issues with clients is the nurse’s or caregiver’s:
a. Self-awareness
o.
b. Self-confidence
rs e
ou urc
c. Sexual knowledge
d. Assessment abilities
ANS: A
o
The caregiver must be aware of his or her values regarding sexuality. Values are easily
aC s
conveyed, often through nonverbal messages, if the caregiver is not fully aware of his or her
vi y re
beliefs.

TOP: Self-Awareness and Sexuality KEY: Nursing Process Step: Intervention
ed d

ar stu
3. The caregiver has been assigned to care for Mr. X, a pedophile who is being treated for AIDS.
The thought of caring for him disgusts her. The caregiver’s therapeutic interactions and
interventions are most likely to be:
is
a. Effective
Th
b. Ineffective
c. Well received
d. Effective if she can conceal her true feelings
sh
ANS: B
Caregivers’ values often are communicated to clients. Disapproval dampens the effectiveness
of the therapeutic relationship.

TOP: Self-Awareness and Sexuality KEY: Nursing Process Step: Intervention

4. Children learn to label themselves according to their sex around the age of ____ year(s).
a. 1
b. 6
c. 2
d. 4
ANS: C
Around the age of 2 years, children learn to label themselves according to their sex. Most
respond to being called “good girls” or “brave boys” by adults.

TOP: Sexuality in Childhood KEY: Nursing Process Step: Assessment
5. By the time they enter school, it is thought that most children identify with:
a. Same-sex peers
b. Opposite-sex peers
c. The same-sex parent
m
d. The opposite-sex parent
er as
ANS: C
co
By school age, most children identify with the same-sex parent.
eH w
o.
rs e
TOP: Sexuality in Childhood KEY: Nursing Process Step: N/A
ou urc
6. An image of the older adult as an asexual, unintelligent person who is not interested in sex
o
represents:
a. A myth
aC s
b. An ideal
vi y re
c. The truth
d. An attitude
ANS: A
ed d
The picture of the older adult as asexual and not interested in sex is a myth. The emphasis of
ar stu
the older adult’s sexual expression is on companionship and intimate communication, rather
than procreation as it was in adulthood.
is

TOP: Sexuality in Older Adulthood KEY: Nursing Process Step: N/A
Th
7. The client was injured in a work accident. He now has a fused spine and moves with
difficulty. He wonders if he will ever be able to be intimate with his wife. What is the nurse’s
sh
most accurate response?

a. “You will not be able to engage in sexual activity.”
b. “You can enjoy a satisfying sex life with some adaptation.”
c. “You eventually will return to the preinjury level of functioning.”
d. “You will become more sexually active after you recover from the injuries.”

ANS: B
Many permanently disabled persons are able to enjoy rich and satisfying sex lives with some
adaptation. The other options provide inaccurate information.

TOP: Sexuality and Disability KEY: Nursing Process Step: Assessment
8. People who express their sexuality with members of the opposite sex are:
a. Asexual
b. Bisexual
c. Homosexual
d. Heterosexual
ANS: D
Persons who express their sexuality with members of the opposite sex are heterosexual.
Asexual refers to a group of individuals who fall into the category of homosexual, who
engage in little to no sexual activity; bisexual refers to individuals who are sexually attracted
to members of both genders; and homosexual refers to individuals who prefer expression of
m
their sexual identity with members of the same gender.
er as
co
eH w
TOP: Heterosexuality KEY: Nursing Process Step: N/A
o.
rs e
9. Experiencing sexual excitement from wearing the clothing of the opposite sex is defined as:
ou urc
a. Cross-acting
b. Transvestism
c. Transsexuality
o
d. Sexual dysfunction
aC s
vi y re
ANS: B
Transvestism is defined as sexual excitement derived from wearing the clothing of the
opposite sex.
ed d

TOP: Transvestism KEY: Nursing Process Step: Assessment
ar stu
10. The client confides in the nurse that intercourse has been painful since she became
is
menopausal. What is the nurse’s most therapeutic response?

a. “Don’t worry; it will pass.”
Th
b. “Are you still sexually active?”

c. “Perhaps we can discuss this with your doctor.”
d. “I understand how difficult it is to discuss sex.”
sh
ANS: C
Many sexual dysfunctions are treatable, so clients should be referred to their physicians.
Saying that the pain will pass is a nontherapeutic response that disregards the feelings of the
client; asking the client if she is still sexually active makes the client feel that she is not
normal; and empathizing with the client is helpful but does not address the problem.


TOP: Sexual Dysfunctions KEY: Nursing Process Step: Intervention
11. Between the ages of __________ years, the greatest amount of sexual activity with multiple
partners and serial relationships occurs.
a. 13 and 17
b. 18 and 24
c. 25 and 34
d. 35 and 44
ANS: B
Because of the decreased age of first intercourse and the increased age of marriage, more
unmarried adults are engaging in this type of sexual activity in today’s society.

TOP: Sexuality in Adulthood KEY: Nursing Process Step: Assessment
12. An individual is bisexual. The belief that this individual’s sexual variation is related to genetic
m
er as
influences is the belief held by _____ theorists.
a. Biological
co
eH w
b. Behavioral
c. Psychosocial
o.
d. Psychoanalytical
rs e
ou urc
ANS: A
Biological theorists believe that an individual’s sexual variation is related to genetic
influences. Behavioral theorists believe that modes of sexual expression are learned responses,
o
and psychoanalytical theorists view modes of sexual expression other than heterosexual
aC s
expression to be neurotic or psychopathic in nature and due to the Oedipus/Electra complex of

vi y re
childhood. Psychosocial theory is not cited as a theory on sexual orientation.

TOP: Theories Relating to Psychosexual Variations
ed d
ar stu
13. A female client is suffering from vaginismus. The nurse is aware that this is a type of:
a. Paraphilia
b. Sexual dysfunction
is
c. Psychosexual disorder
d. Gender identity disorder
Th
ANS: B
Vaginismus refers to the persistent involuntary contractions of muscles around the vagina
when penetration is attempted; it is classified as a sexual dysfunction. Sexual dysfunction
sh
refers to any disturbance in the four stages of the sexual response cycle and/or any discomfort
or pain that occurs during sexual intercourse. Paraphilia refers to a group of sexual variations
that depart from society’s traditional and acceptable modes of seeking sexual gratification; a
psychosexual disorder is a broad reference to problems that cause distress or impaired
functioning in an individual’s sexual functioning; and gender identity disorder is inconsistency
between an individual’s biological gender and the gender with which he or she identifies.


TOP: Sexual Dysfunctions KEY: Nursing Process Step: Assessment
14. A male client is transsexual and decides to become a female through major surgery and
hormonal therapy. The nurse informs the client that this process may be delayed for as long as
_____ years.
a. 2
b. 5
c. 8
d. 10
ANS: A
The process of changing one’s identity is purposely delayed for up to 2 years because this
transformation is irreversible. In addition to the surgery and the hormonal therapy, intense
psychological counseling is part of the process.

TOP: Gender Identity Disorder KEY: Nursing Process Step: Intervention
m
er as
co
eH w
15. A homosexual couple lives together, but both partners continue to have sexual experiences
with others. This is an example of a(n) _____ relationship.
o.
a. Functional
b. Dysfunctional rs e
ou urc
c. Close-coupled
d. Open-coupled
o
ANS: D
These couples are not firmly committed to their primary relationship. A functional relationship
aC s
vi y re
refers to homosexuals who have several sexual partners with no one specific partner; a
dysfunctional relationship refers to homosexual individuals who regret their sexual
orientation; and a close-coupled relationship refers to a homosexual couple that is analogous
to a traditional married couple in a monogamous relationship.
ed d
ar stu

TOP: Homosexuality KEY: Nursing Process Step: Assessment
is
16. The rate of pregnancy and transmission of HIV is higher in the adolescent population than the
general population of sexually active adults due to the fact that because adolescents:
Th
a. Have more sexual partners

b. Utilize ineffective contraception
c. Have not been educated regarding sexuality
sh
d. Seek behaviors that reflect their need to be independent

ANS: B
Most adolescent girls use ineffective or no contraception at all and most adolescent boys do
not use condoms. Because of this practice, the sexually transmitted disease (including human
immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS]) and pregnancy
rates are higher for adolescents than the general population of sexually active adults.


TOP: Sexuality in Adolescence KEY: Nursing Process Step: Assessment
17. An individual’s orientation, whether heterosexual, homosexual, or bisexual, is established by

the time of:
a. Adolescence
b. Early adulthood
c. Late childhood
d. Early childhood
ANS: C
One’s sexual orientation is established by late childhood. It continues to develop through
adulthood. Gender is understood in early childhood.

m
er as
18. While performing a search of an adult male’s home based on suspicion of criminal activity,
the police find pictures of him with young children between the ages of 5 and 10. The
co
eH w
pictures are sexual in nature. The man is suspected of:
a. Voyeurism
o.
b. Sexual sadism
c. Pedophilia rs e
ou urc
d. Necrophilia
ANS: C
o
Pedophilia is fondling and/or other types of sexual activities with a prepubescent child
(usually under age 13 years and having not yet developed secondary sex characteristics).
aC s
vi y re
Sexual sadism is sexual arousal achieved by inflicting pain or humiliation on someone else,
voyeurism is sexual arousal achieved by observing unsuspecting persons in the act of
disrobing or engaging in sexual activity. Necrophilia deals with sexual activity with a corpse.
ed d

TOP: Description of Paraphilias KEY: Nursing Process Step: Assessment
ar stu
19. A 68-year-old man is being treated for an enlarged prostate. While discussing health history
is
with the nurse, he states that he seems to be having erectile difficulties and is not sure if it is
from his medical condition or the medication he is taking. Which nursing diagnosis is most
Th
appropriate?
a. Sexual dysfunction
b. Injury, risk for
sh
c. Coping, ineffective
d. Family processes, dysfunction
ANS: A

Sexual dysfunction is a disturbance anywhere that occurs at any time during these four stages
of the sexual response cycle. The causes are often related to psychological distresses,
medication or illicit drug use, and many physical conditions. Arthritis, diabetes, and chronic
illness can result in various sexual dysfunctions or alterations in sexual desire. The other
nursing diagnoses do not apply in this situation.

MULTIPLE RESPONSE
20. Which are signs of sexual addiction? (Select all that apply.)
a. Inability to stop
b. Bragging to others about exploits
c. Refusing to stop enjoying the act
d. Out-of-control sexual behaviors
e. Enjoying cross-dressing
m
f. Persisting in behaviors despite severe consequences
er as
g. Spending excessive time pursuing sexual experiences
co
eH w
ANS: A, D, F, G
Inability to stop, out-of-control sexual behaviors, persisting in behaviors despite severe
o.
consequences, and spending excessive time pursuing sexual experiences are characteristics of
sexual addicts. rs e
ou urc
TOP: Sexual Addiction KEY: Nursing Process Step: Assessment
o

aC s
21. The criteria for healthy or adaptive sexual response include: (Select all that apply.)
vi y re
a. Sexual acts between two consenting adults

b. Sexual acts that fulfill the desire of only oneself
c. Sexual acts that are not forced or coerced
ed d
d. Sexual acts that are conducted in privacy

ar stu
e. Sexual acts that fulfill the desire between two people

ANS: A, C, D, E
These are conditions of sexuality that are considered adaptive. Sexual acts that fulfill only the
is
desire of oneself are maladaptive because they do not consider others.

Th

TOP: Continuum of Sexual Responses KEY: Nursing Process Step: Assessment
sh
22. What are the types of relationships that put individuals at greatest risk for sexually transmitted
diseases, including HIV/AIDS? (Select all that apply.)
a. Bisexual
b. Asexual
c. Functional homosexual
d. Dysfunctional homosexual

e. Open-coupled homosexual
f. Close-coupled homosexual
ANS: A, C, D, E
These relationships pose the greatest risk because of lack of monogamy. Asexual homosexual
individuals have little desire or a low level of sexual activity, and close-coupled relationships
are similar to traditional monogamous heterosexual marriages.

23. Which of the following are indicative of sexual dysfunction? (Select all that apply.)
a. Sexual aversion disorder
b. Sadism
c. Erectile disorder
d. Dyspareunia
e. Exhibitionism
ANS: A, C, D
m
er as
Sexual aversion disorder, erectile disorder, and dyspareunia are examples of sexual
dysfunctions that are disturbances in any phase of the sexual response cycle. They are usually
co
eH w
related to psychological distress, medication, and physical illness. Sadism and exhibitionism
are examples of paraphilias—sexual variations that depart from society’s traditional and
o.
acceptable modes of seeking sexual gratification.
rs e
ou urc
o
aC s
COMPLETION
vi y re
24. The primary nursing diagnoses for a client who is experiencing problems with sexuality are
sexual dysfunction and __________.
ed d
ANS:
ar stu
ineffective sexuality pattern

These are the two most common nursing diagnoses seen in clients who are experiencing
sexual problems. Other nursing diagnoses may apply to individual situations.
is

Th
TOP: Nursing Process KEY: Nursing Process Step: Nursing Diagnosis

25. According to the DSM-IV-TR, sexual arousal that is attained by an individual while he is
sh
observing an unaware person who is naked, disrobing, or engaging in sexual activity is known
as __________.
ANS:
voyeurism

This sexual disorder is a type of paraphilia. These individuals sometimes are referred to as
“peeping Toms.”

TOP: Paraphilias KEY: Nursing Process Step: Assessment
m
er as
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
is
Th
sh

Chapter 30: Personality Disorders

MULTIPLE CHOICE
1. Infants who experience nurturing environments develop the ability to:

a. Test others
b. Trust others
c. Manipulate others
d. Model others’ behaviors
ANS: B
When the infant’s needs are consistently met, a sense of trust and self-worth develops.

OBJ: 2 TOP: Personality in Childhood
m
2. Behavioral theorists see personality disorders as the result of:
er as
a. Social stressors
co
b. Conditioned responses
eH w
c. Neurophysical problems
o.
d. An imbalance among the three forces of the personality
ANS: B rs e
ou urc
Behavioralists see personality disorders as the result of conditioned responses caused by
NURrefer
previous events. Social stressors
S INtoGsociocultural
T B.COM theories; neurophysical refers to
biological theories; and imbalance among the three forces of the personality describes
o
psychoanalytical theories.
aC s
vi y re

OBJ: 3 TOP: Behavioral Theories KEY: Nursing Process Step: N/A
ed d
3. Paranoid personality disorders are diagnosed more often in:

ar stu
a. Men
b. Women
c. Children
d. Adolescents
is
ANS: A
Th
Paranoid personality disorders are diagnosed in up to 2.5% of the population, more often in
men than in women.
sh

OBJ: 5 TOP: Eccentric Cluster
4. Studies of families, twins, and relatives with personality disorders have demonstrated that the
developing personality is influenced by:
a. Genetics

b. Order of birth
c. Financial factors
d. Number of siblings
ANS: A
Studies of families, twins, and relatives of individuals with personality disorders have
demonstrated that behavior and personality have a strong genetic influence.

OBJ: 3 TOP: Biological Theories
5. The group of personality disorders characterized by odd or strange behaviors is known as the
____ cluster.
a. Erratic
b. Fearful
c. Eccentric
d. Obsessive-compulsive
ANS: C
m
er as
The eccentric cluster is characterized by odd or strange behaviors. Individuals in this cluster
find it difficult to be comfortable in social settings and do not relate well to others.
co
eH w
o.
rs e
ou urc
6. The central feature of one of our most pressing mental health problems today is a pervasive
U S NN R I G B.C M
pattern of disregard for, and violation T rightsO of others. This personality disorder is
of, the
o
called:
aC s
a. Avoidant
vi y re
b. Paranoid
c. Dependent
d. Antisocial
ed d
ANS: D
One of our most pressing mental health problems today is antisocial personality disorder,
ar stu
manifested as a pervasive pattern of disregard for and violation of the rights of others.
Avoidant personality disorder refers to individuals who avoid situations for fear of rejection
and humiliation; paranoid personality refers to individuals who assume that everyone is out to
is
harm, deceive, or exploit them; and dependent personality refers to individuals who express
the need to be cared for so they can avoid turning people away.
Th

OBJ: 4 TOP: Erratic Cluster
sh
7. The client relies on deceit and manipulation to get his own way. He seems to have a complete
lack of conscience. His goal is always self-gratification at the other person’s expense. He is
referred to as:
a. A nerd
b. A psychotic

c. A psychopath
d. Narcissistic
ANS: C
The hallmark of psychopaths (sociopaths) is a lack of conscience. Psychopaths use charm,
manipulation, intimidation, and violence to control others and satisfy their own selfish needs.

8. The childhood trait that increases the risk for developing an antisocial personality disorder is:
a. Poor impulse control
b. Frequent reading in solitude
c. Poor preschool learning practices
d. Difficulty controlling others in the environment
ANS: A
Some children have trouble controlling their impulses, so they become disruptive and develop
antisocial ways of coping.
m
er as
co
eH w
OBJ: 2 | 6 TOP: Erratic Cluster
o.
rs e
9. The client is a 38-year-old woman with a diagnosis of narcissistic personality disorder.
ou urc
Behaviors associated with this diagnosis are:
a. Avoidant
b. Odd or eccentric
NURSINGTB.COM
o
c. Attention seeking
aC s
d. Reflective of lack of trust in others

vi y re
ANS: C
A narcissistic personality disorder is characterized by grandiosity and the need to be admired.

ed d

ar stu
10. The client is unable to make a decision by herself. She clings to her husband and quickly
moves to fill his requests. Although she sometimes appears angry, her emotions are not
is
expressed. The client’s diagnosis is:

Th
a. Neuroticism
b. Paranoid personality disorder
c. Dependent personality disorder
d. Narcissistic personality disorder
sh
ANS: C

The anxiety of dependent personality disorder is associated with separation and abandonment.
Neuroticism refers to an individual who experiences a mental imbalance that causes distress
and anxiety without affecting rational thought; paranoid personality disorder is displayed by
assumptions that everyone is out to harm, deceive, or exploit; and narcissistic personality
disorder involves grandiose feelings of self-importance.

OBJ: 6 TOP: Fearful Cluster
11. The nurse is planning goals for a male client with the diagnosis of personality disorder. What
is the main goal of the client’s therapy?
a. To adjust to his medications
b. To learn to get along with others
c. To learn to control his environment
d. To become aware of how his behavior affects his life
ANS: D
Although all are goals of care for clients with personality disorder, the most important goal is
m
to help clients identify and then become responsible for their own behavior. This is necessary
er as
for all other treatment to be effective.
co
eH w
o.
rs e
ou urc
12. In treating clients with personality disorders, compliance with prescribed medications must be
NURSImust
monitored frequently and safeguards NGTbeB.C inMplace to prevent or reduce the risk for:
put O
a. Deceit
o
b. Suicide
aC s
c. Homicide
vi y re
d. Manipulation
ANS: B
Clients may hoard their medications until they have enough to make up a lethal dose.
ed d
ar stu

KEY: Nursing Process Step: Assessment | Nursing Process Step: Intervention
is
13. A male client has a schizotypal personality disorder. A female client compliments him on his
Th
style of dressing, and he interprets this as her caring deeply for him and desiring to date him.
What is the client experiencing?
a. Paranoia
sh
b. Ideas of reference
c. Inappropriate affect
d. Delusions of grandeur
ANS: B

Ideas of reference are incorrect perceptions of casual events as having great or significant
meaning and are frequently seen in clients with schizotypal personality disorder. Paranoia
refers to individuals who assume that everyone is out to harm, deceive, or exploit them;
inappropriate affect refers to inappropriate emotional expressions; and delusions of grandeur
are irrational grandiose thoughts, but they differ from ideas of reference in that an interaction
is not necessary to cause the delusions of grandeur.

14. A wife is discussing her co-worker with her husband. The wife states, “I am so tired of her.
She is always dressing in flamboyant clothing and pretends to have an accent. She doesn’t
relate well to any of our co-workers because she is so superficial.” Which personality disorder
is being described?
a. Paranoid
b. Impulsive
c. Histrionic
d. Narcissistic
m
er as
ANS: C
co
An individual with this type of personality disorder displays a pattern of excessive emotional
eH w
expression and attention-seeking behaviors. Paranoid personality refers to individuals who
o.
assume that everyone is out to harm, deceive, or exploit them; impulsive personality refers to
rs e
disorders that include behaviors such as gambling, use of drugs, and spending money
ou urc
irresponsibly; and narcissistic personality refers to grandiose feelings of self-importance.
PTS: 1 NURSILevel:
DIF: Cognitive NGTApplication
B.COM REF: p. 357
o
OBJ: 6 TOP: Erratic Cluster Personality Disorders

aC s
vi y re
15. Medications are used with extreme caution in clients with personality disorders because of
their questionable effectiveness. If a client is receiving an antipsychotic medication, it is
especially important for the nurse to monitor the client for side effects of:
a. Increased thirst and urination, nausea, and anorexia
ed d
b. Dry mouth, altered taste, sexual dysfunction, and dizziness

ar stu
c. Bone marrow depression, gastrointestinal symptoms, and confusion

d. Extrapyramidal movements, dry mouth, blurred vision, and photophobia
ANS: D
is
These side effects are characteristic of antipsychotic medications and should be assessed
Th
because they sometimes become irreversible. Increased thirst, urination, nausea, and anorexia
are side effects most commonly seen with lithium; dry mouth, altered taste, sexual
dysfunction, and dizziness are commonly seen with antidepressants; and bone marrow
depression, gastrointestinal symptoms, and confusion are seen most frequently with
sh
anticonvulsants.


16. The daughter of an elderly man notices that her father has stopped seeing his friends for their
daily walk and acts in an aggressive manner when anyone comes to his house. She states that
he normally looks forward to interacting with his friends on a daily basis and his general
demeanor is friendly and caring. What does the nurse advise?
a. This is a normal part of aging and there should be no reason for concern.
b. The change in personality and behavior should be ignored as it is manipulative.
c. The change in personality and behavior should be evaluated.
d. The change in personality and behavior indicates it is time for nursing home
placement.
ANS: C
A sudden change in personality is not a normal sign of aging. By older adulthood, the
personality is deeply entrenched. Patterns of thinking and behaving remain intact until death.
Do not assume that a personality change in an older adult is normal. Changes in emotional
control, responses, and levels of interest must be investigated. Many physical and biochemical
problems first appear as subtle changes in personality.

OBJ: 2 TOP: Personality in Older Adulthood
m
er as
co
17. A 40-year-old who works at the same entry level job for many years without seeking
eH w
advancement and politely declines when friends ask her to try new vacation spots or hobbies
o.
may be suffering from which personality disorder?
a. Histrionic
rs e
ou urc
b. Paranoid
c. Schizoid
d. Avoidant NURSINGTB.COM
o
ANS: D
aC s
In avoidant personality disorder, anxiety is related to a fear of rejection and humiliation. To

vi y re
prevent possible rejection, individuals narrow their interests to a small range of activities. It is
part of the fearful cluster of disorders. Histrionic is part of the erratic cluster and is
characterized by excessive emotional expression. Paranoid and schizoid are included in the
eccentric cluster, and the main characteristics are suspicion and the inability to maintain
ed d
relationships.
ar stu

OBJ: 6 TOP: Fearful Cluster
is
Th
18. Two nurses are discussing a new patient during report. They discover that she has the staff
divided on their opinion of her. One group has had very positive interactions with her and find
her to be very cooperative. The other group has had a difficult time in gaining her compliance
in treatment interventions. What action would be most appropriate in dealing with this
sh
situation?
a. Provide consistent limit setting with the client
b. Assign the staff with the positive interactions to the client’s care
c. Work with the group experiencing the negative interactions to maintain an
accepting attitude
d. Take away privileges from the client until she changes her behavior

ANS: A
Clients use a technique called splitting, emotionally dividing the staff by complimenting one
group and degrading another. Consistent limit setting and reinforcement help clients to define
their limits, but care providers must keep in mind their own therapeutic boundaries and
communicate with each other frequently.

19. Clients suffering from a personality disorder usually do not seek treatment because they:
a. Do not have identifiable impairments
b. Cannot be treated
c. Are unable to recognize their problems
d. Often do not have health insurance
ANS: C
People with personality disorders often have serious impairments but do not seek treatment
because they are unable to recognize their own problems. Their distorted self-perception and
m
er as
view of reality often place them in the position of seeing themselves as the victim. Most
individuals with personality disorders are considered treatable to varying degrees. Health
co
eH w
insurance is not the reason the individual does not seek treatment.
o.
OBJ: 7
rs e
TOP: Treatment and Therapies
ou urc
NURSINGTB.COM
MULTIPLE RESPONSE
o
aC s
1. Which are characteristics of a personality disorder? (Select all that apply.)

vi y re
a. Delusions
b. Depression
c. Hallucinations
d. Inappropriate sexual behaviors
ed d
e. Inflexible and maladaptive behaviors

ar stu
f. Difficulties with interpersonal relations

g. Behaviors that cause significant functional impairment
ANS: A, B, D, E, F, G
is
Delusions, depression, inappropriate sexual behaviors, inflexible and maladaptive behaviors,

Th
difficulties with interpersonal relations, and behaviors that cause significant functional
impairment are all characteristics of personality disorders. Hallucinations refer to other types
of mental health disorders.
sh

2. Personality disorders that are considered to be in the erratic cluster include

(Select all that apply):

a. Antisocial
b. Borderline
c. Paranoid
d. Histrionic
e. Avoidant
f. Obsessive-compulsive
g. Narcissistic
ANS: A, B, D, G
The main characteristic of the erratic cluster of personality disorders is dramatic behavior.
Paranoid personality disorder belongs to the eccentric cluster of personality disorders, and
avoidant personality disorder and obsessive-compulsive personality disorder belong to the
fearful cluster.

3. Characteristics of borderline personality disorder include which of the following? (Select all
m
that apply.)
er as
a. Fear of being abandoned
co
b. Splitting
eH w
c. Gambling
o.
d. Engaging in unsafe sex
rs e
e. Isolation of self from others
ou urc
ANS: A, B, C, D
NUisRcharacterized
Borderline personality disorder SINGTB.CbyOM fear of abandonment. Therefore, clients
with this disorder avoid being alone. Because of instability, behaviors demonstrated to staff
o
may be called splitting, which includes complimenting one group while degrading another.
aC s
Because of the impulsivity, borderline personality disorder clients often engage in risk-taking
vi y re
activities including gambling and engaging in unsafe sex.
PTS: 1 DIF: Cognitive Level: Application REF: p. 359 | p. 362

ed d
ar stu
COMPLETION
is
1. A characteristic trait of individuals with __________ disorder is that they may be extremely
orderly and so overly preoccupied with details that they accomplish very little.
Th
ANS:
Obsessive-compulsive personality
sh
Persons with obsessive-compulsive personality disorder focus their anxiety on uncertainty of

future events. They are extremely orderly and so preoccupied with details that they
accomplish very little.

OBJ: 4 TOP: Fearful Cluster Personality Disorders

2. An individual with an __________ personality disorder relies on deceit and manipulation to

get his or her way.
ANS:
Antisocial
An individual with an antisocial personality disorder has a disregard for and repeatedly
violates the rights of others through manipulation and deceit.

OBJ: 4 TOP: Erratic Cluster Personality Disorders
m
er as
co
eH w
o.
rs e
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 31: Schizophrenia and Other Psychoses

MULTIPLE CHOICE
1. The client lives so completely in a world of his or her own that he or she is unable to
recognize reality, relate to others, or cope with life’s demands. This client is considered:
a. Exotic
b. Anorectic
c. Neurotic
d. Psychotic
ANS: D
Psychosis often prevents individuals from being able to perform activities of daily living. The
other options do not cause loss of touch with reality.

OBJ: 3 TOP: Psychosis in Adolescence
m
er as
co
2. Schizophrenia in children as young as 5 years:
eH w
a. Is a myth
o.
b. Can occur
c. Never occurs
rs e
ou urc
d. Cannot occur
Psychotic disorders can occur in children as young as 5 years of age, with causes including
o
genetics, complications during the pregnancy or birth, and biochemical imbalances.

aC s
vi y re

OBJ: 3 TOP: Psychosis in Adolescence KEY: Nursing Process Step: N/A
ed d
3. When people successfully adapt to their environment by using logical thought and socially
ar stu
appropriate ways, they are said to be functioning at the adaptive end of the ____ continuum.
a. Emotional
b. Self-protective
c. Neurobiological
is
d. Psychobiological
Th
ANS: C
The neurobiological continuum, which is a term used in psychiatry to describe interactions
based on the ability to function, change, and adapt in society, is influenced by certain physical
sh
brain functions.

OBJ: 1 TOP: Continuum of Neurobiological Responses
4. Schizophrenia affects approximately __________% of the world’s population.

a. 1
b. 5
c. 9
d. 13
ANS: A
This estimate means that 2.5 million people in the United States are affected, with 10% to
15% of the homeless population in the United States being schizophrenic.

OBJ: 4 TOP: Schizophrenia
5. Theories based on study of the brain and its activities are called:
a. Social
b. Biological
c. Psychological
d. Psychobiological
ANS: B
m
er as
Biological theories view schizophrenia as a brain disorder. Social theories view schizophrenia
to be caused by the effects of the environment; psychological theories view the cause of the
co
eH w
disease to be a character flaw combined with poor family relationships; and psychobiological
theories do not exist.
o.
PTS: 1 rs e
ou urc
OBJ: 4 TOP: Biological Theories KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial
N Integrity
R I G B.C M
U S N T O
o
6. The client has become unable to recognize formerly familiar objects and people in his
aC s
environment. The client is experiencing:

vi y re
a. Affect
b. Agnosia
c. Apraxia
d. Anhedonia
ed d
ANS: B
ar stu
Agnosia is an inability to recognize familiar objects or people; affect is an individual’s

expression of emotion; apraxia refers to the loss of an individual’s ability to carry out
purposeful movements, even when having the desire and physical ability to do so; and
is
anhedonia is the inability or decreased ability to experience pleasure in life.

Th

OBJ: 6 TOP: Signs, Symptoms, and Behaviors
sh
7. The client is describing her trip to town. She tells the nurse, “I cold town yellow water girl
outside below ground.” This speech disturbance is called:
a. Neologism
b. Word salad
c. Flight of ideas
d. Verbigeration

ANS: B
Word salad is verbal communication in which a series of unrelated words with no connection
is used. Neologism is words or expressions invented by the individual. Flight of ideas refers to
rapid flow of speech along with a rapid change of topics; and verbigeration is purposeless
repeating of phrases.

8. The signs and symptoms of schizophrenia must be present for at least ____ months before a
diagnostic label is assigned.
a. 3
b. 6
c. 12
d. 18
ANS: C
The signs and symptoms of schizophrenia must be present for at least 1 year before a
m
er as
diagnostic label is assigned.
co
eH w
OBJ: 6 TOP: Phases of Becoming Disorganized
o.
rs e
ou urc
9. The client in whom schizophrenia has been diagnosed usually is medicated with what class of
drugs?
a. Antianxiety NURSINGTB.COM
o
b. Antipsychotic
aC s
c. Antidepressant
vi y re
d. Antihypertensive
ANS: B
Medications used to treat psychoses are called antipsychotic or neuroleptic drugs.
ed d

ar stu
OBJ: 7 TOP: Pharmacological Therapy

10. The client interprets the proverb “A rolling stone gathers no moss” as “As long as the rock
is
keeps moving, it won’t turn green.” This is an example of:

Th
a. Mutism
b. Flight of ideas
c. Concrete thinking
d. Loose association
sh
ANS: C
Concrete thinking is the inability to identify or describe feelings, experiences, and behaviors
abstractly. Mutism is a refusal to speak; flight of ideas is a rapid flow of speech along with a
rapid change of topics; and loose association refers to thinking that is characterized by speech
that moves from one unrelated idea to another.


OBJ: 6 TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: N/A
11. The nurse notes that a male client, who is taking an antipsychotic medication, is constantly
moving from chair to chair during a group activity, and he complains that he feels “nervous
and jittery inside.” The nurse is aware that this client most likely is experiencing:
a. Akinesia
b. Dystonia
c. Dyskinesia
d. Akathisia
ANS: D
Akathisia is one of the extrapyramidal side effects of antipsychotic medications that the nurse
must monitor for and report to the physician. Akinesia refers to the absence of mental or
physical movement; dystonia refers to rigidity of muscles; and dyskinesia is involuntary
abnormal skeletal muscle movement.
m
er as
OBJ: 9 TOP: Special Considerations
co
eH w
12. To cope with the devastating effects of schizophrenia and other serious mental illnesses,
o.
family members or significant others and clients will benefit most from:
rs e
a. Regular psychoanalysis
ou urc
b. Intensive short-term therapy
NURSINGTB.COM
c. Ongoing treatment and support
d. Continued medication adjustments
o
aC s
ANS: C
vi y re
Continued treatment and support are needed for family members or significant others and
clients alike if they are to cope with the devastating effects of psychotic mental illnesses
because all aspects of life are affected.
ed d

ar stu

13. The onset of schizophrenia most commonly occurs during the decade of age in the:
is
a. Teens
b. 20s
Th
c. 30s
d. 40s
ANS: B
sh
This is the usual age of onset, although oftentimes it is not noticed by others, or the condition
may not be diagnosed until signs and symptoms become much more prominent.

OBJ: 3 TOP: Psychosis in Adulthood

14. A female client with a psychotic disorder is experiencing olfactory hallucinations. Most
likely, she would be complaining of:
a. A vision that is disturbing to her
b. A sound that is disturbing to her
c. A smell that is disturbing to her
d. A sense of touch that is disturbing to her
ANS: C
Hallucinations are false sensory inputs with no external stimuli that can occur with any of the
senses. Olfactory refers to the sense of smell.

15. The police bring a man to the emergency department because he is wandering the streets
yelling to people. He attempted to attack the police officer because he accused him of “being a
part of that plot to kill the president and me.” Which category of schizophrenia is he
m
exhibiting?
er as
a. Paranoid
co
b. Catatonic
eH w
c. Disorganized
o.
d. Residual
ANS: A rs e
ou urc
People with paranoid schizophrenia believe someone or thing is out to get them. They have
complex delusions of grandeurNU(belief
RSINthatGTthey
B.Care
O Mspecial or better than others). Because they
feel they are being persecuted, they are withdrawn, suspicious, guarded, and hostile and may
o
exhibit violent behavior. Catatonic schizophrenia is manifested by motor immobility.

aC s
Disorganized schizophrenia is manifested by being unable to think, speak, or act in an

vi y re
organized manner. Residual schizophrenics are free of psychosis.

OBJ: 5 TOP: Subtypes of Schizophrenia
ed d
ar stu
16. The family of a client diagnosed with schizophrenia describes her behavior over the last few
days as being very docile and non-confrontational. When asked to go and change her shoes to
go shopping, she goes to change them, but a when a family member checks on her several
is
minutes later, she appears to be lost in thought. This phase of schizophrenia is the
Th
_______________phase.
a. Residual
b. Prodromal
c. Prepsychotic
sh
d. Acute
ANS: C

In the prepsychotic phase, individuals are usually quiet, passive, and obedient, and they prefer
to be alone. Family members may report that they can sense the individual “slipping away” in
front of their eyes. The prodromal phase and residual phases begin with withdrawal, a lack of
energy, and little motivation. Individuals may appear confused and in a world of their own.
They may complain about multiple physical problems or show a new, excessive interest in
religion or philosophy. Ideas and beliefs become odd or unusual. Some individuals become
agitated or angry. Speech becomes difficult to follow. In the acute phase individuals lose
contact with reality and become unable to function even in the most basic ways.

OBJ: 6 TOP: Phases of Becoming Disorganized
17. The mother of a 20-year-old diagnosed with paranoid schizophrenia is upset by the fact that
her child tried to attack her during her daily visit. What is the most appropriate support the
nurse can give her after this incident?
a. “Your child is working through relationship issues with you and does not know
how to express them.”
b. “You should stop coming for a while, as your visits upset your child.”
m
er as
c. “Your child’s illness is due to a loss of contact with reality, and not directed to you
as his mother.”
co
eH w
d. “You must make him realize that his behavior toward you is inappropriate.”
o.
ANS: C
rs e
People with paranoid schizophrenia believe someone or thing is out to get them. Violent
ou urc
behaviors are common. In addition a primary characteristic of any psychotic disorder is an
inability to recognize reality. Due to this disconnect with reality, working through relationship
N not
issues, correcting behavior are U
RSappropriate
INGTB.C at O
M
this early point in treatment. Parents suffer
o
the grief of losing a normal child and then must cope with the stigma of having a child who is
“mentally ill.”
aC s
vi y re

OBJ: 9 TOP: Psychosis in Adulthood
ed d
18. A woman who delivered a healthy infant three weeks ago is experiencing auditory
ar stu
hallucinations and has not changed her clothes or taken a shower in a week and expresses no
interest in her infant. After a short inpatient stay, her symptoms improve and she is back to
caring her herself and her infant. What disorder is this indicative of?
is
a. Paranoid schizophrenia
b. Dual diagnosis
Th
c. Schizotypal
d. Brief psychotic disorder
ANS: D
sh
A brief psychotic disorder is a psychotic disturbance that lasts for more than 1 day but less
than 1 month. The individual has delusions, hallucinations, impaired functioning and speech,
and disorganized behavior. They eventually return to their normal state. The episode may
have been triggered by stressors or having given birth recently (1 to 4 weeks).

OBJ: 8 TOP: Other Psychoses

MULTIPLE RESPONSE
1. The client who is taking a low-potency antipsychotic medication should be informed by the
nurse that the most common side effects are (Select all that apply):
a. Dystonia
b. Akathisia
c. Dry mouth
d. Bradykinesia
e. Blurred vision
f. Urinary retention
ANS: C, E, F
Anticholinergic side effects are most common with low-potency antipsychotic medications.
The other options are extrapyramidal side effects that are seen most typically with
higher-potency and long-term use of antipsychotic medications. However, all clients on
antipsychotic medications should be monitored for both categories of side effects.
m
er as
co
eH w
o.
rs e
2. Positive symptoms of schizophrenia include (Select all that apply):
ou urc
a. Flat affect
b. Hallucinations
c. Poor grooming
NURSINGTB.COM
o
d. Speech problems
aC s
e. Bizarre behaviors
vi y re
f. Withdrawal from others

ANS: B, D, E
Symptoms of schizophrenia fall into two categories: positive symptoms, which relate to
ed d
maladaptive thoughts and behaviors; and negative symptoms, which relate to lack of adaptive
ability. The incorrect answers are examples of the negative symptoms.
ar stu

is
Th
3. Neuroleptic malignant syndrome is a potentially fatal side effect of antipsychotic medications.

Which of the following symptoms are indicative of NMS? (Select all that apply.)
a. Hypothermia
b. Hyperthermia
sh
c. Rigid posturing
d. Agitation
e. Tachycardia
f. Diaphoresis
g. Slow, shallow respirations

ANS: B, C, D, E, F
Symptoms of NMS begin with a sudden change in the client’s level of consciousness and a
rapid onset of rigid muscles. Often there is an associated respiratory difficulty, tremors, and an
inability to speak; however, the cardinal sign of NMS is a high body temperature.
Temperatures can reach as high as 108° F but usually range between 101° and 103°.
Hypothermia and slow, shallow respirations are not indicative of NMS.

OBJ: 7 TOP: Neuroleptic Malignant Syndrome
COMPLETION
1. __________ are central nervous system alterations that are characterized by abnormal,
involuntary movement disorders caused by antipsychotic medications and leading to an
imbalance between two major neurotransmitters (dopamine and acetylcholine) in portions of
the brain.
m
ANS:
er as
Extrapyramidal side effects
co
eH w
The client should be monitored continually for these potentially debilitating and/or
life-threatening side effects.
o.
PTS: 1 rs e
ou urc
M Needs: Physiological Integrity
U S N T O
o
2. Schizophrenia is a complex syndrome of maladaptive thoughts and behaviors that affects

aC s
human functioning in the emotional, spiritual, intellectual, and __________ areas of an

vi y re
individual’s life.
ANS:
Social
ed d
ar stu
This disorder affects all aspects of a person’s life.

is
Th
sh


Chapter 32: Chronic Mental Health Disorders

MULTIPLE CHOICE
1. Persons with chronic mental health problems have much higher rates of:
a. Apathy
b. Suicide
c. Homicide
d. Physical illness
ANS: B
Individuals with chronic mental health problems have much higher rates of suicide because
they often cannot see a bright future for themselves and find it difficult to meet basic needs.

OBJ: 1 TOP: Scope of Mental Illness
m
er as
2. The process of emptying state mental hospitals and placing mentally ill persons in the
co
community is known as:
eH w
a. Recidivism
o.
b. Exacerbation
c. Deinstitutionalism
rs e
ou urc
d. Deinstitutionalization
ANS: D NURSINGTB.COM
State psychiatric hospitals discharge long-term patients into the community through a practice
o
called deinstitutionalization. Recidivism refers to a pattern of short hospital admissions and

aC s
discharges; and exacerbation is a period of dysfunction accompanied by an increase in the

vi y re
signs, symptoms, and seriousness of a problem.

OBJ: 2 TOP: Effects of Deinstitutionalization
ed d
ar stu
3. The experience and suffering of living with mental illness:

a. Decreases as one grows older
b. Is unique to each person
is
c. Follows a predictable course

Th
d. Is common to all mentally ill persons

ANS: B
Each client is a unique individual; therefore, even if clients share the same diagnosis, the
sh
experiences are unique.

OBJ: 2 TOP: Characteristics of Chronic Mental Illness

4. The client finds fault in every success she has. She is afraid to try anything new because she
“just knows” that she will fail because she is mentally ill. Her behaviors demonstrate:
a. Low self-esteem
b. Suicidal ideation
c. Low abstraction abilities
d. Altered thought processes
ANS: A
Mentally troubled people often see themselves as helpless, ineffective, and incapable of
change, which leads to chronic low self-esteem. Suicidal ideation refers to persistent thoughts
of suicide; low abstraction abilities refer to the inability to think conceptually; and altered
thought processes refer to a disruption in the ability to think clearly.

OBJ: 3 TOP: Psychological Characteristics
5. The child has not developed the ability to respond to others. He cannot communicate his
needs. He may remain dependent upon others throughout his life. He is most accurately
m
described as having:
er as
a. Autism
co
b. Anxiety
eH w
c. Mental retardation
o.
d. Attention-deficit disorder
ANS: A rs e
ou urc
Children with autism do not develop the ability to respond to and communicate their needs,
and they remain dependent on NU RSIN
others, GTB.CO
sometimes M
throughout their lives. These children do not
respond well to reality. The other options do not accurately match the description in the
o
situation.
aC s
vi y re

OBJ: 4 TOP: Children and Adolescents With Chronic Mental Illness
ed d
6. Approximately __________% of individuals with chronic mental illness use or abuse drugs.
ar stu
a. 25
b. 50
c. 75
d. 100
is
ANS: C
Th
This statistic poses a significant problem in the treatment of mental illness.

sh
OBJ: N/A TOP: Persons with Multiple Disorders

7. The client has been diagnosed with depression for a long time. He recently started using
cocaine to help relieve his depression. The most accurate description of these behaviors is
a(n):
a. Addiction

b. Dual diagnosis
c. Fear of failure
d. Poor prognosis
ANS: B
Although all of the options might apply, this answer most accurately describes the behavior.
Individuals with a dual diagnosis are suffering from two mental health disorders, one of which
usually is substance related.

OBJ: 6 TOP: Persons with Multiple Disorders
8. The criterion that necessitates the need to hospitalize an individual with chronic mental health
problems occurs when his or her:
a. Behaviors pose a threat
b. Caregivers need a respite
c. Subsistence benefits expire
d. Medications need readjustment
m
er as
ANS: A
Persons with chronic mental health problems are hospitalized only when their behaviors pose
co
eH w
a threat to themselves or others. Other options that are less disruptive than hospitalization can
be found for the other situations.
o.
PTS: 1 rs e
ou urc
OBJ: 7 TOP: Inpatient Environment
U S N T O
o
9. The client has schizophrenia. He has moved frequently between the community and mental
health facilities for the past 7 years. The client’s behavior is an example of:
aC s
vi y re
a. Relapse
b. Recidivism
c. Remission
d. Exacerbation
ed d
ANS: B
ar stu
Recidivism remains a problem for both health care professionals and their clients.
Coordinating care between the community and the institution helps to reduce the number of
admissions to facilities. Relapse refers to the return to maladaptive behavior; remission is a
is
period of partial or complete disappearance of symptoms; and exacerbation refers to the

reoccurrence of symptoms.
Th

OBJ: 8 TOP: Access to Health Care
sh
10. A male client is experiencing hallucinations. The intervention that would be most helpful in
controlling the hallucinations is:
a. Actively listening to his concerns
b. Establishing a trusting relationship
c. Encouraging appropriate behaviors

d. Teaching him to use distraction techniques when experiencing hallucinations

ANS: D
Distraction techniques, such as whistling or telling the hallucination to go away, will be
helpful in controlling the hallucinations. Actively listening to his concerns and establishing a
trusting relationship are interventions that will help in improving communication skills, and
encouraging appropriate behaviors will help the client build social skills.

11. Neuroleptic drugs are prescribed to treat:

a. Anxiety disorders
b. Personality disorders
c. Psychotic disorders
d. Somatoform disorders
ANS: C
Neuroleptic drugs are also known as antipsychotic drugs and are used to treat psychosis.
m
er as
co
eH w
o.
rs e
12. Individuals with mental illness live an average of __________ years less than the general
ou urc
population.
a. 2 to 4
b. 5 to 8
NURSINGTB.COM
o
c. 10 to 15
aC s
d. 18 to 25
vi y re
ANS: C
Fifty percent of clients with mental health disorders also suffer from physical disorders, and,
frequently, they are not capable of managing either disorder.
ed d

ar stu

13. Individuals with schizophrenia tend to use the chemical __________ most often.
is
a. Alcohol
Th
b. Cocaine
c. Heroin
d. Hypnotics
sh
ANS: A
Alcohol is used most commonly by individuals with schizophrenia, whereas cocaine is used
most often by individuals with mood disorders, and heroin is used most frequently by those
with conduct disorders. Hypnotics are not referenced as being used predominantly by any
specific group.


14. A female client with a chronic mental health disorder tells the nurse that she has great
difficulty every morning getting ready for work because she cannot decide what to wear to
work or what to eat for breakfast. This client is experiencing:
a. Auditory hallucinations
b. Altered thought processes
c. Delusions of grandeur
d. Chronic low self-esteem
ANS: B
Commonly experienced with chronic mental illness is an altered thought process, which
disrupts the individual’s ability to think clearly, problem-solve, or make plans. Auditory
hallucinations refer to hearing false sounds; delusions of grandeur refer to a false fixed belief
of elevated self-worth; and chronic low self-esteem often is experienced by these individuals
because they feel helpless and hopeless but this option does not lend itself to the situation.
m
er as
co
eH w
15. A client in an inpatient mental health setting is scheduled to be discharged with follow-up at a
o.
rs e
community mental health center. His family is concerned that his inpatient stay was not long
enough, and he will be re-admitted in the near future. The nurse knows that the average length
ou urc
of inpatient stay is:
a. 5 days NURSINGTB.COM
b. 10 days
o
c. 25 days
aC s
d. 1 month
vi y re
ANS: B
The average length of stay for a mental illness is 10 days. The short inpatient stay, combined
with a short community care involvement often leads to recidivism, as the immediate goal in
ed d
the inpatient setting is to help the client control his or her behavior.
ar stu

OBJ: 1 TOP: Inpatient Settings
is
16. The nurse is completing an admission interview with an older adult on a busy medical unit.
Th
What action is most appropriate for the nurse to take?

a. Complete the admission interview with the client’s son.
b. Shout at the client so he or she can hear.
sh
c. Provide pen and paper and let the client write his answers
d. Allow the client time to respond to the questions regarding health history.
ANS: D
Information processing speed decreases with age, and it may take longer for the client to
retrieve the information and respond.


OBJ: 2 TOP: Psychiatric Rehabilitation
17. A woman with a history of chronic mental illness was dating someone for about a month
before they ended the relationship. What is the probable action the woman will take?
a. Endure a brief period of grieving and seek to begin dating again.
b. Speak to friends and other support persons and consider the positive aspects of the
relationship.
c. Withdraw and refuse to seek out or enter into another relationship.
d. Take up an activity with friends to avoid staying home and thinking about the
failed relationship.
ANS: C
When individuals with chronic mental health problems basic needs for love and belonging go
unmet, and they respond by becoming more emotionally paralyzed. The experience of a small
success in a short-term relationship will often prevent them from making any further attempts
because they “just know” that they will eventually fail. When self-concept is low, it is difficult
to convince someone that a brighter future can exist. The other responses demonstrate positive
m
coping strategies.
er as
co
eH w
o.
rs e
18. Which of the following clients in the community with chronic mental illness is most likely to
ou urc
be compliant in taking their prescribed medications on a consistent basis?
NURSINGofTB.C
a. The client who has an understanding M disease and medication’s effect
his orOher
in controlling symptoms
o
b. The client who has insurance that covers the cost of all prescribed medications
aC s
c. The client who has very little insight of his or her illness and is living with a family
vi y re
member
d. The client who is trying to live independently in a homeless shelter
ANS: A
ed d
The side effects of many medications are uncomfortable, and clients often stop taking them as
ar stu
soon as the acute symptoms subside. One of the most powerful predictors of medication
refusal is one’s insight into the illness, and most chronically or severely mentally ill
individuals have little insight. Nurses must carefully monitor clients routinely for compliance
with medications.
is
Th
PTS: 1 DIF: Cognitive Level: Application REF: p. 362 | p. 365

sh
MULTIPLE RESPONSE
1. In the United States today, the effects of deinstitutionalization include (Select all that apply):
a. A comprehensive mental health care system
b. A decrease in the need for medical treatment
c. An increase in the jail and prison populations

d. An increase in the homeless population

e. People who cannot obtain adequate food or shelter
f. Well-adjusted people with CMI
g. Unlimited access to mental health care
ANS: C, D, E
Deinstitutionalization refers to the widespread discharge of clients from psychiatric hospitals
into the community, largely caused by the introduction of psychotherapeutic drugs in the
1950s.

OBJ: 1 TOP: Deinstitutionalization
2. Psychiatric rehabilitation focuses on (Select all that apply):

a. Helping clients control their behaviors
b. Assisting clients to cope effectively with their life situations
c. Helping clients identify their feelings
d. Preventing the client from harming himself or herself
m
e. Assisting the client with problem-solving techniques
er as
f. Assisting with occupational and vocational training
co
eH w
ANS: B, C, E, F
Goals of psychiatric rehabilitation include identification and processing of feelings, learning
o.
and applying problem-solving and coping skills, and preparing for re-entry into the
rs e
community with rehabilitative training to improve socialization, confidence, organizational
ou urc
abilities, income, and quality of life.
NURSINGTB.COM
o
OBJ: 7 TOP: Psychiatric Rehabilitation

aC s
vi y re
3. Persons with which of the following diagnoses respond well to therapeutic interventions and
may have no further problems? (Select all that apply.)
a. Psychosis
ed d
b. Depression
ar stu
c. Anxiety disorders
d. Schizophrenia
e. Phobias
f. Erratic behavioral disorder
is
ANS: B, C, E
Th
Persons with phobias, anxiety disorders, or depression often respond well to therapeutic
interventions and have no further problems. However, for a certain group of individuals,
mental illness becomes a way of life.
sh

COMPLETION

1. The nurse on a mental health unit administers a medication to a female client for the purpose
of reducing her psychotic symptoms and quieting her behavior. This medication is considered
a __________.
ANS:
Chemical restraint
Chemical restraints should be used as a last resort measure with clients. Chemical restraints
require a physician’s order and must adhere to specific guidelines.

OBJ: 1 TOP: Effects of Deinstitutionalization
2. Adolescents in whom diabetes is diagnosed have high rates of depression and __________.
ANS:
Suicide
m
er as
Diabetes is a chronic and life-changing illness that differentiates adolescents from others their
co
age, leading to depression and possibly suicide.
eH w
o.
OBJ: 4
rs e
TOP: Children and Adolescents With Chronic Mental Illness
ou urc
NURSINGTB.COM
o
aC s
vi y re
ed d
ar stu
is
Th
sh


Chapter 33: Challenges for the Future

MULTIPLE CHOICE
1. The need for mental health applies to:

a. All persons
b. People with illnesses
c. All married persons
d. People with mental problems
ANS: A
The need for mental health applies to all people. Every person experiences periods of
emotional turmoil and crises, and, at some time, most individuals need some assistance with
coping strategies.

m
er as
co
2. An aging population, an overburdened welfare system, and a cost conscious U.S. Congress
eH w
exerting its influence on the health care system are all examples of ____ changes.
o.
a. Social
b. Cultural
rs e
ou urc
c. Environmental
d. Technological
NURSINGTB.COM
ANS: A
o
These are all examples of social changes that affect today’s health care system. Cultural
aC s
changes are exhibited in the population served in the health care setting; the environment
vi y re
refers to the health care setting; and technological advances guide the level of care and the
way care is delivered.

ed d
OBJ: 6 TOP: Changes in Mental Health Care

ar stu
3. Families without a home now make up __________% of the homeless population in the
United States.
is
a. 14
Th
b. 28
c. 38
d. 44
sh
ANS: C
Nearly half of this population work, but they do not earn enough to pay for housing.


4. To implement the concept of the least restrictive treatment environment, health care team
members:
a. Monitor the medications schedule
b. Assess the client’s ability to live alone
c. Assess available financial resources
d. Assess available community resources
ANS: D
The main function of the mental health care team is to coordinate care as the client moves
from inpatient to community settings because this is the least restrictive treatment
environment. The other options involve actions of care team members, but they are not
directly related to the surroundings.

OBJ: 4 TOP: The Mental Health Care Team
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention
5. A treatment team member works with a client who is living in a residential treatment facility
m
with a diagnosis of severe paranoid schizophrenia. The team member who collaborates with
er as
the physician to coordinate the client’s therapy and medications and necessary referrals is the:
co
a. Nurse case manager
eH w
b. Psychiatric technician
o.
c. Certified nursing assistant
rs e
d. Home health care provider
ou urc
ANS: A
NURcertified
While the psychiatric technician,
SINGTnursing
B.COassistance,
M and home health care provider
are important care team members in the collaboration effort, they do function as
o
independently as the nurse case manager in coordination of the client’s care.

aC s
vi y re

OBJ: 7 TOP: Expanded Role for Nurses
ed d
6. Routine health screenings, regular educational discussions, and support groups are nursing
ar stu
responsibilities that are:

a. Curative
b. Educational
c. Restorative
is
d. Preventive
Th
ANS: D
All of the options are responsibilities of the nurse, but preventive best represents the criteria
listed in the question. Preventive health care is an important responsibility of the nurse.
sh
Prevention reduces the incidence of illness and the difficulty associated with treatment.


7. A way of helping people with mental health problems to readjust and adapt to life in the
community that is based on a nonmedical model of treatment is:
a. Client advocacy
b. Psychosocial treatment
c. Compliance with medications
d. Psychosocial rehabilitation
ANS: D
The psychosocial (psychiatric) rehabilitation model of treatment focuses on wellness,
wholeness, and the abilities of the client, and it encourages freedom of choice and
self-direction.

8. As many as 75% of people with chronic mental health disorders

a. Live alone
b. Refuse to take their medications
m
c. Use or abuse drugs
er as
d. Use or abuse their prescribed medications
co
eH w
ANS: C
Individuals with a dual diagnosis experience two or more disorders, one of which is
o.
commonly drug abuse.
rs e
ou urc
OBJ: 1 TOP: Dual Diagnoses
NURSINGTB.COM
o
aC s
9. The deliberate effort to make things different within a system is called:

vi y re
a. Planned change
b. Unplanned change
c. Unexpected change
d. Workplace dynamics
ed d
ANS: A
ar stu
Planned change is the deliberate effort to make things different within a system. Unplanned or
unexpected change often is not desired change. With both types of change, workplace
dynamics is affected and change often is met with strong reactions.
is

Th
OBJ: 8 TOP: The Change Process

10. Each complaint of people with HIV/AIDS must be investigated carefully because CNS
sh
problems can be mistaken for:

a. Anxiety
b. Delusions
c. Compulsions
d. Psychiatric problems

ANS: D
Individuals with HIV can have signs of CNS damage that may present as a psychiatric illness
before HIV or AIDS is detected.

OBJ: 9 TOP: Persons With AIDS
11. In the United States, 1 in __________ individuals has a diagnosable mental health disorder.
a. 4
b. 8
c. 12
d. 16
ANS: A
This figure equates to 58 million individuals in the United States.

OBJ: 1 TOP: Changes in Mental Health Care
m
er as
12. Historically, the homeless population has primarily consisted of:
co
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a. Families
b. African American men over 40 years of age
o.
c. White male adults with an average age of 50 years
rs e
d. Individuals in their 30s with mental and physical disabilities
ou urc
ANS: C
This group constituted the majority
N R I G B.C M
U SofNtheThomeless
O population in the past, but the face of the
o
homeless population has changed over time.

aC s
vi y re

ed d
13. Adults with chronic mental illness account for approximately __________ of the homeless
population.
ar stu
a. Forty percent
b. One-third
c. One-half
is
d. Fifty percent
Th
ANS: A
Decreased community mental health services and lack of ability for the individual to function
in daily life have led to the growing number of homeless persons with chronic mental illness.
sh


14. A male client was discharged to home from an inpatient setting with the diagnosis of
obsessive-compulsive disorder. Upon discharge, he was able to reason, understand, and make
informed choices regarding his care. Now, he is unable to leave his house, is engaging in
compulsive behaviors, and is not taking his medication. The best description of this situation
is that the client is lacking in:
a. Competency
b. Client rights
c. Self-direction
d. Self-determination
ANS: A
Competency incorporates the four criteria of being able to make a choice, understand
important information, apply reasoning, and understand one’s own situation. This client is
demonstrating inability in all of these areas.

OBJ: 5 TOP: Competency KEY: Nursing Process Step: Assessment
m
15. A nurse is overheard by a family member of a client discussing the condition of the client.
er as
This nurse is in violation of the:
co
a. Client’s informed consent
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b. Right to competent care
o.
c. Americans with Disabilities Act
rs e
d. Health Insurance Portability and Accountability Act
ou urc
ANS: D
NURand
The Health Insurance Portability SIAccountability
NGTB.COMAct (HIPAA) of 1996 was the first
national standard instituted for the protection of the privacy of an individual’s health
o
information. Informed consent refers to appropriate information given to the client in order for
aC s
the client to make informed decisions regarding his care. The right to competent care refers to
vi y re
the right of the client to receive care from an individual who is knowledgeable and skilled in
providing care; and the Americans with Disabilities Act refers to the rights of individuals with
disabilities.
ed d

ar stu
OBJ: 6 TOP: Obligations of Care Providers

16. A woman whose culture believes her depression is the result of being possessed by the spirit
is
of a deceased relative is considered to have a(an):

Th
a. Impaired coping mechanism

b. Culture-bound disorder
c. Medically diagnosed disorder
d. Projection based disorder
sh
ANS: B
Some mental health problems may be specifically limited to the members of a certain group.
These types of problems are called culture-bound disorders because they appear to be related
to specific cultures. For example, the Hispanic disorder susto is an emotional anxiety that
results from “soul loss.”


OBJ: 1 TOP: Cultural Influences
17. The nurse who advocates for a health-oriented approach to clients is likely to encourage the
development of which outcome?
a. The client will maintain compliance in medication administration
b. The client will adjust to the limitations of chronic illness
c. The client will keep in mind his limitations as a barrier to achievement of goals
d. The client will focus on continued progress and improvements in planning goals
ANS: D
A health-oriented approach focuses on the possibilities and positive achievements that are
within the client’s grasp. The other options focus on the limitations and negative view of the
client’s illness.

OBJ: 8 TOP: A Look to the Future
m
er as
co
18. A nurse at the mental health clinic is leaving his job and relocating to another part of the
eH w
country in six months. What is the best way for him to deal with his clients?
a. Begin to prepare clients for his departure by assisting to transition them to another
o.
nurse.
rs e
b. Increase dosage of medications for each client in anticipation of the effect his
ou urc
leaving will have on their progress.
NUafter
c. Do not inform clients until RSI NG
the TB.C
nurse OMto avoid additional anxiety.
leaves
d. Wait until the nurse’s last day to inform clients to allow them to say goodbye, but
o
avoid additional anxiety.

aC s
vi y re
ANS: A
Planning changes for clients slowly and incrementally allow for minimal resistance. Although
there may be a sense of anxiety and loss, it is diminished if done in steps. Increasing
medication dosages, and not informing clients until the nurse is gone or on his last day do not
ed d
provide for the open communication and preparation.

ar stu

OBJ: 8 TOP: The Change Process
is
19. A person suffering from paranoid schizophrenia is discharged from an inpatient facility before
Th
community mental health services can be established for him. Which statement most
appropriately describes this action?
a. The client has a right to be discharged to the least restrictive environment.
sh
b. The client is not competent to be discharged without community mental health

resources for his transition to a less restrictive environment.
c. The client has a responsibility to ask to remain in the inpatient setting.
d. The client will demonstrate improved compliance with treatment once in a less
restrictive environment.
ANS: B

The concept of least restrictive environment begins to break down when the client is unable to
care for himself. Competence must be demonstrated. It is not the responsibility of a client who
is not competent to request a longer length of stay. Without proper support and resources
compliance with treatment will most likely not improve.

OBJ: 5 TOP: Competency KEY: Nursing Process Step: Assessment
MULTIPLE RESPONSE
1. In the United States today, the seriously mentally ill constitute (Select all that apply):
a. The neglected, the abused, and the confined
b. A large segment of jail and prison populations
c. More than half of all homeless persons
d. More than one third of the homeless population
e. The main pool of workers covered under the ADA
f. Most persons receiving medical treatment
m
g. Unmarried, intermittently employed, white adult males
er as
ANS: B, D
co
eH w
These are characteristics of homeless persons in the United States.
o.
OBJ: 2
rs e
TOP: Homelessness
ou urc
U with
2. What should the client do to cope
N R I G B.C M
S Ninformation
T O overload? (Select all that apply.)
o
a. Learn to think critically

aC s
b. Ignore any information

vi y re
c. Be open to new information

d. Promise yourself that you will look at it later
e. Learn to find relationships in new information
f. Learn at least one new piece of information a day
ed d
g. Ignore new information unless it relates directly to the job

ar stu
ANS: A, C, E, F
Information overload is a state of mind in which many facts have been absorbed and all
become an unrelated clutter of stored information. This is a common phenomenon in today’s
is
society with the ease of obtaining new information from so many sources, such as the Internet.
Th

OBJ: 10 TOP: Information Overload
sh
3. In order to be actively involved in a plan of care the client must demonstrate which of the
following responsibilities? (Select all that apply.)
a. Truthfulness
b. Education
c. Acceptance
d. Responsibility

e. Cooperation
ANS: A, D, E
In order to be involved in a plan of care that is effective for them, clients must demonstrate
truthfulness in sharing information with the health care provider, responsibility in actions and
behaviors and cooperation with the treatment plan. Provision of education and acceptance are
obligations of the health care provider.

OBJ: 6 TOP: Obligations of Clients
COMPLETION
1. A person is considered __________ according to the Americans with Disabilities Act (ADA)
if he has a mental or physical impairment that significantly limits one or more major life
activities.
ANS:
m
Disabled
er as
co
An employer must make reasonable adjustments for disabled employees.
eH w
o.
OBJ: 3
rs e
TOP: Americans with Disabilities Act
ou urc
2. Because of the active role of N URconsumer

the SINGTinB.C OM society, the term __________ is used
today’s
o
frequently to describe the consumer of health care.

aC s
ANS:
vi y re
Client
The term patient has a passive connotation and frequently has been replaced by the term
ed d
client.
ar stu

OBJ: 5 TOP: Empowerment of Clients
is
3. The __________ is the member of the mental health treatment team who has advanced
Th
certified nursing assistant training and provides care in both inpatient and community settings.
ANS:
Patient care technician (PCT)
sh
Patient care technician

PCT
These individuals work with the nurse in providing care to the mental health client.

OBJ: 4 TOP: Providers of Care

m
er as
co
eH w
o.
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NURSINGTB.COM
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aC s
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sh



Test Bank For Foundations of Mental Health Care 6th Edition by Morrison-Valfre

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FoundationsStuvia.

Chapter 01: The History of Mental Health Care

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 5

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5. As a direct result of Clifford N

a. Early detection of symptoms of mental illness

c. Current treatment options

they a priority for the Committee for Mental Hygiene.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6

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behaviors. Which description of this procedure is accurate?

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6

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c. Treatment for veterans suffering from mental health disorders

d. Educating the public about mental illness

public occurred later.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6

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c. Lithium carbonate therapy

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7

b. State mental health care systems

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addressed in the OBRA of 1987.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8

companies __________ coverage for psychiatric care.

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PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 6

problems exist in any one of these areas.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 2

MSC: Client Needs: Psychosocial Integrity

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8

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1. The humoral theory of disease embraced by Hippocrates required a balance of which

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 2

Recommendations focused on increased funding, availability of care, access to care, and

greater involvement of consumers and their families.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 8

c. Activities of daily living

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 7

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PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 3

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Chapter 02: Current Mental Health Care Systems

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 11

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 11

OBJ: 1 TOP: Mental Health Care in Britain

a. Community support systems

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d. Seven to eight times per week

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 15

KEY: Nursing Process Step: Intervention

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PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 17

OBJ: 7 TOP: Impact of Mental Illness