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Test Bank For Psychiatric Mental Health Nursing, 9th Edition by Sheila L. Videbeck All Chapters 1-24 LATEST written by TestBanksGuru The Marketplace to Buy and Sell your Study Materia...

Test Bank For Psychiatric Mental Health Nursing, 9th Edition by Sheila L. Videbeck All Chapters 1-24 LATEST written by TestBanksGuru The Marketplace to Buy and Sell your Study Material At Stuvia, you will find the best notes, summaries, flashcards & other study material. Search for your school or uni and find the study material you need. www.stuvia.com Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material TEST BANK Psychiatric-Mental Health Nursing By SHEILA L. VIDEBECK 9th Edition Page 1 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Table of contents UNIT 1 Current Theories and Practice  1. Foundations of Psychiatric–Mental Health Nursing  2. Neurobiologic Theories and Psychopharmacology  3. Psychosocial Theories and Therapy  4. Treatment Settings and Therapeutic Programs UNIT 2 Building the Nurse–CLIENT Relationship  5. Therapeutic Relationships  6. Therapeutic Communication  7. Client’s Response to Illness  8. Assessment UNIT 3 Current Social and Emotional Concerns  9. Legal and Ethical Issues  10. Grief and Loss  11. Anger, Hostility, and Aggression  12. Abuse and Violence UNIT 4 NURSING Practice for Psychiatric Disorders  13. Trauma and Stressor-Related Disorders  14. Anxiety and Anxiety Disorders  15. Obsessive–Compulsive and Related Disorders  16. Schizophrenia  17. Mood Disorders and Suicide  18. Personality Disorders  19. Addiction  20. Eating Disorders  21. Somatic Symptom Illnesses  22. Neurodevelopmental Disorders  23 Disruptive Behavior Disorders  24 Cognitive Disorders Page 2 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Psychiatric-Mental Health Nursing 9th edition by Videbeck Test Bank Chapter 1 Foundations of Psychiatric–Mental Health Nursing 1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the Nurse identify as having a positive impact onthe individual's mental health? A) Not needing others for companionship B) The ability to effectively manage stress C) A family history of mental illness D) Striving for total self-reliance ANSWER: B RATIONALE: Individual factors influencing mental health include biologic makeup, autonomy, independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness are both needed for good mental health, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologic makeup of an individual, which may have a negative impact on an individual's mental health, as well as a negative impact on an individual's interpersonal and social cultural factors of health. Total self-reliance is not possible, and a positive social/cultural factor is access to adequate resources. 2. Which of the following statements about mental illness are true? Select all that apply. A) Mental illness can cause significant distress, impaired functioning, or both. B) Mental illness is only due to social/cultural factors. C) Social/cultural factors that relate to mental illness include excessive dependency on or withdrawal from relationships. D) Individuals suffering from mental illness are usually able to cope effectively with daily life. E) Individuals suffering from mental illness may experience dissatisfaction with relationships and self. ANSWER: A, D, E RATIONALE: Mental illness can cause significant distress, impaired functioning, or both. Mental illness may be related to individual, interpersonal, or social/cultural factors. Excessive dependency on or withdrawal from relationships are interpersonal factors that relate to mental illness. Individuals suffering from mental illness can feel overwhelmed with daily life. Individuals suffering from mental illness may experience dissatisfaction with relationships and self. Page 1 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 3. Which of the following are true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill. ANSWER: C RATIONALE: What one society may view as acceptable and appropriate behavior, another society may see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness. 4. A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be, A) You may have a temporary mental illness because you are experiencing so much pain. B) You are not mentally ill. This is an expected reaction to the loss you have experienced. C) Were you generally dissatisfied with your relationship before your husband's death?î D) Try not to worry about that right now. You never know what the future brings ANSWER: B RATIONALE: Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally the behavior must not be culturally expected. Acute grief reactions are expected and therefore not considered mental illness. False reassurance or over analysis does not accurately address the client'sconcerns. Page 2 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 5. The NURSE consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment ANSWER: D RATIONALE: The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. Diagnosis of mental illness is not within the generalist RN's scope of practice, so documenting the code in the medical record would be inappropriate. 6. Which would be a reason for a student NURSE to use the DSM? A) Identifying the medical diagnosis B) Treat clients C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses. ANSWER: D RATIONALE: Although student NURSES do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis, treating, and evaluating treatments are not a part of the nursing process. 7. The legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care ANSWER: A RATIONALE: The Community Mental Health Centers Construction Act of 1963 accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care. Page 3 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 8. WHICH one of the following is a result of federal legislation? A) Making it easier to commit people for mental health treatment against their will. B) Making it more difficult to commit people for mental health treatment against their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons. ANSWER: B RATIONALE: Commitment laws changed in the early 1970s, making it more difficult to commit people for mental health treatment against their will. Deinstitutionalization accomplished the release of individuals from long-term stays in state institutions. Deinstitutionalization also had negative effects in that some mentally ill persons are subjected to the revolving door effect, WHICH may limit care for mentally ill persons. 9. The goal of the 1963 Community Mental Health Centers Act was to A) ensure patients' rights for the mentally ill. B) deinstitutionalize state hospitals. C) provide funds to build hospitals with psychiatric units. D) treat people with mental illness in a humane fashion. ANSWER: B RATIONALE: The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of CLIENTS with mental illness from large state institutions to care based in the community. Answer choices A, C, and D were not purposes of the 1963Community Mental Health Centers Act. 10. The creation of asylums during the 1800s was meant to A) improve treatment of mental disorders. B) provide food and shelter for the mentally ill. C) punish people with mental illness who were believed to be possessed. D) remove dangerous people with mental illness from the community. ANSWER: B RATIONALE: The asylum was meant to be a safe haven with food, shelter, and humane treatment for the mentally ill. Asylums were not used to improve treatment of mental disorders or to punish mentally ill people who were believed to be possessed. The asylum was not created to remove the dangerously mentally ill from the community. Page 4 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 11. The major problems with large state institutions are: Select all that apply. A) attendants were accused of abusing the residents. B) stigma associated with residence in an insane asylum. C) CLIENTS were geographically isolated from family and community. D) increasing financial costs to individual residents. ANSWER: A, C RATIONALE: CLIENTS were often far removed from the local community, family, and friends becausestate institutions were usually in rural or remote settings. Choices B and D were not major problems associated with large state instructions. 12. A significant change in the treatment of people with mental illness occurred in the 1950s when A) community support services were established. B) legislation dramatically changed civil commitment procedures. C) the Patient's Bill of Rights was enacted. D) psychotropic drugs became available for use. ANSWER: D RATIONALE: The development of psychotropic drugs, or drugs used to treat mental illness, began in the 1950s. Answer choices A, B, and C did not occur in the 1950s. 13. Before the period of the enlightenment, treatment of the mentally ill included A) creating large institutions to provide custodial care. B) focusing on religious education to improve their souls. C) placing the mentally ill on display for the public's amusement. D) providing a safe refuge or haven offering protection. ANSWER: C RATIONALE: In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and ridiculing the mentally ill, who were seen as animals, less than human. Custodial care was not often provided as persons who were considered harmless were allowed to wander in the countryside or live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed as evil or possessed. Priests performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted with offenders burned at the stake. It was not until the period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions. Page 5 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 14. The first training of NURSES to work with persons with mental illness was in 1882 inWHICH state? A) California B) Illinois C) Massachusetts D) New York ANSWER: C RATIONALE: The first training for NURSES to work with persons with mental illness was in 1882 atMcLean Hospital in Belmont, Massachusetts. 15. What is meant by the term ìrevolving door effectî in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings ANSWER: B RATIONALE: The revolving door effect refers to shorter, but more frequent, hospital stays. CLIENTS arequickly discharged into the community where services are not adequate; without adequate community services, CLIENTS become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriately could result in stabilization and less need for emergency department visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness. Page 6 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 16. WHICH of the following statements is true of treatment of people with mental illness inthe United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only 25% of people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining. ANSWER: C RATIONALE: Only one in four (25%) adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%. 17. WHICH of the following is the priority of the Healthy People 2020 objectives for mentalhealth? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness ANSWER: D RATIONALE: The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Answer choices A, B, and C are not priorities of Healthy People 2020. Page 7 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 18. WHICH is a positive aspect of treating CLIENTS with mental illness in a community- basedcare? A) ìYou will not be allowed to go out with your friends while in the program.î B) ìYou will have to have supervision when you want to go anywhere else in the community.î C) ìYou will be able to live in your own home while you still see a therapist regularly.î D) ìYou will have someone in your home at all times to ask questions if you have any concerns.î ANSWER: C RATIONALE: CLIENTS can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is notincluded in community-based programs. 19. One of the unforeseen effects of the movement toward community mental health services is A) fewer CLIENTS suffering from persistent mental illnesses. B) an increased number of hospital beds available for CLIENTS seeking treatment. C) an increased number of admissions to available hospital services. D) Longer hospital stays for people needing mental health services. ANSWER: C RATIONALE: Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The number of individuals with mental illness did not change. 20. WHICH is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness ANSWER: B RATIONALE: One of the Healthy People 2020 objectives is to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community. Page 8 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 21. A CLIENT diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes A) medical management of symptoms. B) daily psychotherapy. C) constant staff supervision. D) psychological stabilization. ANSWER: A RATIONALE: Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting. 22. WHICH of the following is defined as an advanced-level function in the practice area ofpsychiatric mental health nursing? A) Case management B) Counseling C) Evaluation D) Health teaching ANSWER: C RATIONALE: Advanced-level functions are psychotherapy, prescriptive authority, consultation and liaison, evaluation, and program development and management. Case management, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing. 23. Psychiatric nursing became a requirement in nursing education in WHICH year?A) 1930 B) 1940 C) 1950 D) 1960 ANSWER: C RATIONALE: It was not until 1950 that the National League for Nursing, WHICH accredits nursingprograms, required schools to include an experience in psychiatric nursing. Page 9 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 24. A new graduate NURSE has accepted a staff position at an inpatient mental health facility.The graduate NURSE can expect to be responsible for basic-level functions, including A) providing clinical supervision. B) using effective communication skills. C) adjusting CLIENT medications. D) directing program development. ANSWER: B RATIONALE: Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision. 25. WHICH one of the following is one of the American NURSES Association standards ofpractice for psychiatricñmental health nursing? A) Prescriptive authority is granted to psychiatricñmental health registered NURSES. B) All aspects of Standard 5: Implementation may be carried out by psychiatricñmental health registered NURSES. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatricñmental health advanced practice NURSES. D) Psychiatricñmental health advanced practice NURSES are the only ones who mayprovide milieu therapy. ANSWER: C RATIONALE: Prescriptive authority is used by psychiatricñmental health advanced practice registered NURSES in accordance with state and federal laws and regulations. Standards 5DñG are advanced practice interventions and may be performed only by the psychiatricñmental health advanced practice registered NURSE. Psychiatricñmental health registered NURSES may provide milieu therapy according to Standard 5C. This is not restricted to psychiatricñmental health advanced practice NURSES. Page 10 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 26. WHICH of the following is a standard of professional performance? A) Assessment B) Education C) Planning D) Implementation ANSWER: B RATIONALE: Education is a standard of professional performance. Other standards of professional performance include the quality of practice, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Assessment, planning, and implementation are components of the nursing process, not standards of professional performance. 27. WHICH of the following is a standard of practice? A) Quality of care B) Outcome identification C) Collegiality D) Performance appraisal ANSWER: B RATIONALE: Standards of practice include assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion, and milieu therapy. The standards of professional performance include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Page 11 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 28. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes WHICH of the following actions? Select all that apply. A) Tells the CLIENT about personal events and interests B) Discusses the anxious feelings with the instructor C) Assumes that the CLIENT's unwillingness to talk to a student NURSE is a personalinsult or failure D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises F) Gravitates to CLIENTS that the student may know personallyANSWER: B, D, E RATIONALE: Listening carefully, showing genuine interest, and caring about the CLIENT are extremely important rather than speaking about oneself. The student must deal with his or her own anxiety about approaching a stranger to talk about very sensitive and personal issues. Student NURSES should not see the CLIENT's unwillingness to talk to a student NURSE as a personal insult or behavior. Being available and willing to listen are often all it takes tobegin a significant interaction with someone. Questions involving personal matters should not be the first thing a student says to the CLIENT. These issues usually arise aftersome trust and rapport have been established. The nursing instructor and staff are always available to assist if the CLIENT is shocking or distressing to the student. If the student recognizes someone he or she knows, it is usually best for the student to talk with the CLIENT and reassure him or her about confidentiality. The CLIENT should be reassured that the student will not read the CLIENT's record and will not be assigned to work with the CLIENT. 29. The appropriate action for a student NURSE who says the wrong thing is to A) pretend that the student NURSE did not say it. B) restate it by saying, ìThat didn't come out right. What I meant was...î C) state that it was a joke. D) ignore the error, since no one is perfect. ANSWER: B RATIONALE: No one magic phrase can solve a CLIENT's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the CLIENT are extremely important. A NURSE who possesses these elements but sayssomething that sounds out of place can simply restate it by saying, ìThat didn't come outright. What I meant wasÖî Pretending that the student NURSE did not say it, stating that itwas a joke, and ignoring the error are not likely to help the student NURSE build and maintain credibility with the CLIENT. Page 12 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 1. Chapter 2.The NURSE is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The NURSE suspects WHICH part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala ANSWER: A RATIONALE: The frontal lobes of the cerebrum control the organization of thought, body movement, memories, emotions, and moral behavior. The cerebellum is located below the cerebrum and is the center for coordination of movements and postural adjustments. The medulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory. 2. An abnormality of WHICH of the following structures of the cerebrum would beassociated with schizophrenia? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes ANSWER: B RATIONALE: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assists in coordinating language generation and visual interpretation, such as depth perception. Page 1 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 3. A patient with bipolar disorder asks the NURSE, ìWhy did I get this illness? I don't want tobe sick.î The NURSE would best respond with, A) ìPeople who develop mental illnesses often had very traumatic childhood experiences.î B) ìThere is some evidence that contracting a virus during childhood can lead to mental disorders.î C) ìSometimes people with mental illness have an overactive immune system.î D) ìWe don't fully understand the cause, but mental illnesses do seem to run in families.î ANSWER: D RATIONALE: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness. 4. WHICH of the following statements about the neurobiologic causes of mental illness ismost accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors. ANSWER: D RATIONALE: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common. Page 2 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 5. WHICH of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine ANSWER: B RATIONALE: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters. 6. WHICH of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA ANSWER: A RATIONA LE: Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory neurotransmitters. GABA is an inhibitory neurotransmitter. 7. A NURSE is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications.The best response is, A) ìWhen studies are published they can be trusted to be accurate.î B) ìWe need to look at the research very closely to see how reliable the studies are.î C) ìYour prescribed medication is the best for your condition, so you should not read those studies.î D) ìSwitching medications will alter the course of your illness. It is not advised.î ANSWER: B RATIONALE: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for CLIENTS and their families to understand. The NURSE must ensure that CLIENTS and families are well informed about progress in these areas and mustalso help them to distinguish between facts and hypotheses. The NURSE can explain if or how new research may affect a CLIENT's treatment or prognosis. The NURSE is a good resource for providing information and answering questions. Page 3 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 8. The NURSE is preparing a patient for an MRI scan of the head. The NURSE should ask thepatient, A) ìHave you ever had an allergic reaction to radioactive dye?î B) ìHave you had anything to eat in the last 24 hours?î C) ìDoes your insurance cover the cost of this scan?î D) ìAre you anxious about being in tight spaces?î ANSWER: D RATIONALE: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, WHICH takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the NURSE. 9. How should the NURSE respond to a family member who asks how Alzheimer's disease isdiagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living CLIENTS. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease. ANSWER: B RATIONALE: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living CLIENTS. These conditions previously could be diagnosedonly through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests. Page 4 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 10. A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. WHICH of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac) ANSWER: A RATIONALE: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the CLIENT's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms. 11. WHICH one of the following types of antipsychotic medications is most likely to produceextrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers ANSWER: B RATIONALE: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, WHICH may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications. Page 5 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the NURSE how this medicine works. The NURSE explains that the mechanism by WHICH the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain. ANSWER: D RATIONALE: The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine. 13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. WHICH of the following side effects would the NURSE expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose ANSWER: B RATIONALE: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil. Page 6 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 14. WHICH one of the following drugs should the NURSE expect the patient to require serumlevel monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac ANSWER: C RATIONA LE: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For CLIENTS taking lithium and the anticonvulsants, monitoring blood levels periodicallyis important. 15. WHICH of the following disorders are extrapyramidal symptoms that may be caused byantipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women ANSWER: A, B, D RATIONALE: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom. 16. WHICH of the following antidepressant drugs is a preferred drug for CLIENTS at high riskof suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil) ANSWER: B RATIONALE: SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound. Page 7 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 17. The NURSE knows that the CLIENT understands the rationale for dietary restrictions whentaking MAOI when the CLIENT makes WHICH of the following statements? A) ìI am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate.î B) ìCertain foods will cause me to have sexual dysfunction when I take this medication.î C) ìFoods that are high in tyramine will reduce the medication's effectiveness.î D) ìI should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels.î ANSWER: D RATIONALE: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness. 18. A CLIENT who is taking paroxetine (Paxil) reports to the NURSE that he has been nauseatedsince beginning the medication. WHICH of the following actions is indicated initially? A) Instruct the CLIENT to stop the medication for a few days to see if the nausea goesaway. B) Reassure the CLIENT that this is an expected side effect that will improve with time. C) Suggest that the CLIENT take the medication with food. D) Tell the CLIENT to contact the physician for a change in medication.ANSWER: C RATIONALE: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The CLIENT should not stop taking the drug. It would be appropriate to reassure the CLIENT that this is an expected side effect that will improve with time, but that would not be done initially. A change inmedication may be indicated if the nausea is intolerable or persistent, but that would notbe done initially. Page 8 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 19. In planning for a CLIENT's discharge, the NURSE must know that the most serious risk forthe CLIENT taking a tricyclic antidepressant is WHICH of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose ANSWER: D RATIONALE: Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia. CLIENTS may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that CLIENTS discontinue drug therapy. The risk of seizures is increased by bupropion, WHICH is a different type of antidepressant. 20. A CLIENT with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The NURSE observes that the CLIENT's behavior includes repetitivemovements of the mouth and tongue, facial grimacing, and rocking back and forth. The NURSE recognizes these behaviors as indicative of A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia ANSWER: D RATIONALE: The CLIENT's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long- term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The CLIENT's behavior is not a loss of voluntary control or posturing. Page 9 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 21. A CLIENT is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as WHICH of the following? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia ANSWER: D RATIONALE : Akathisia is reported by the CLIENT as an intense need to move about. The CLIENT appearsrestless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. 22. WHICH of the following is a term used to describe the occurrence of the eye rolling backin a locked position, WHICH occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism ANSWER: B RATIONALE: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, WHICH occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects. Page 10 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 23. WHICH of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone (Geodon) B) Chlorpromazine (Thorazine) C) Haloperidol (Haldol) D) Fluphenazine (Prolixin) ANSWER: A RATIONALE: First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs. 24. WHICH of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) Dehydration D) Vegetarian diet ANSWER: C RATIONALE: Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS. 25. WHICH of the following was the first nonstimulant medication specifically designed andtested for ADHD? A) Methylphenidate (Ritalin) B) Amphetamine (Adderall) C) Atomoxetine (Strattera) D) Pemoline (Cylert) ANSWER: C RATIONALE: Strattera was the first nonstimulant medication specifically designed and tested for ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert). Page 11 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 26. WHICH of the following is the primary consideration with CLIENTS taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep ANSWER: C RATIONALE: Suicide is always a primary consideration when treating CLIENTS with depression. 27. WHICH of the following would not be included as a symptom of drug- inducedparkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia ANSWER: D RATIONALE: Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest. 28. WHICH drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics ANSWER: D RATIONALE: Antipsychotic drugs are the primary medical treatment for CLIENTS diagnosed withschizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis. Page 12 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 29. A CLIENT on the unit suddenly cries out in fear. The NURSE notices that the CLIENT's head istwisted to one side, his back is arched, and his eyes have rolled back in their sockets. The CLIENT has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the NURSE would be to A) get a stat. order for a serum drug level. B) hold the CLIENT's medication until the symptoms subside. C) place an urgent call to the CLIENT's physician. D) give a PRN dose of benztropine (Cogentin) IM. ANSWER: D RATIONALE: The CLIENT is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in CLIENTS younger than 40 years, in males, and in those receiving high-potency drugs such as Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief. 30. One week after beginning therapy with thiothixene (Navane), the CLIENT demonstratesmuscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinaselevel, stupor, and incontinence. The NURSE should notify the physician because these symptoms are indicative of A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia. ANSWER: C RATIONALE: The CLIENT demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing. Page 13 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 31. A CLIENT with bipolar disorder has been taking lithium, and today his serum blood levelis 2.0 mEq/L. What effects would the NURSE expect to see? A) Constipation and postural hypotension B) Fever, muscle rigidity, and disorientation C) Nausea, diarrhea, and confusion D) None; the serum level is in therapeutic range ANSWER: C RATIONALE: Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The CLIENT would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination. 32. For a CLIENT taking clozapine (Clozaril), WHICH of the following symptoms should the NURSE report to the physician immediately as it may be indicative of a potentially fatalside effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and malaise ANSWER: D RATIONALE: Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects. 33. A patient with bipolar disorder takes lithium 300 mg three times daily. The NURSEevaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-worth. ANSWER: C RATIONALE: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the CLIENT's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, WHICH should diminish with effective treatment. Page 14 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 34. When the CLIENT experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the NURSE is aware that thisis due to WHICH of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication. ANSWER: B RATIONALE: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication. 35. When the CLIENT asks the NURSE how long it will take before the SSRI antidepressantmedication will be effective, WHICH of the following replies is most accurate and therapeutic? A) ìThis is a good medication! It will be effective within 20 minutes of the first dose.î B) ìYou will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.î C) ìIt will probably take months for the medication to work. In the meantime, you should work on improving your attitude.î D) ìIf you believe it will work, then it will. You have to have faith!î ANSWER: B RATIONALE: SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when neurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months for the medication. Attitude and faith will improve with the medication's effectiveness. Page 15 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 36. A CLIENT has a lithium level of 1.2 mEq/L. WHICH of the following interventions by theNURSE is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time. ANSWER: D RATIONALE: The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level. 37. A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The NURSE should assess for WHICH of the following common contributors to nonadherence? A) The patient is symptom-free and therefore does not need to adhere to the medication regimen. B) The patient cannot clearly see the instructions written on the prescription bottle. C) The patient dislikes the weight gain associated with antipsychotic therapy. D) The patient sells the antipsychotics to addicts in the neighborhood. ANSWER: C RATIONALE: Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychotics should be taken regularly and not omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do they have addictive potential. 38. WHICH of the following side effects of lithium are frequent causes of noncompliance?Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy ANSWER: B, E RATIONALE : Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance. Page 16 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 39. The NURSE is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. WHICH of the following should be included in the plan? Select allthat apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time. ANSWER: B, C, E RATIONALE: Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The CLIENT should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the CLIENT should avoid laxatives. The use ofsunscreen is recommended because photosensitivity can cause the CLIENT to sunburn easily. If the CLIENT forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or thenext dose is due, the CLIENT can omit the forgotten dose. 40. The NURSE has completed health teaching about dietary restrictions for a CLIENT taking a monoamine oxidase inhibitor. The NURSE will know that teaching has been effective by WHICH of the following CLIENT statements? A) ìI'm glad I can eat pizza since it's my favorite food.î B) ìI must follow this diet or I will have severe vomiting.î C) ìIt will be difficult for me to avoid pepperoni.î D) ìNone of the foods that are restricted are part of a regular daily diet.î ANSWER: C RATIONALE: Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular concern to this CLIENT is the potential life-threatening hypertensive crisis if the CLIENTingests food that contains tyramine. Answer choices A, B, and D are inappropriate statements toward effective teaching for the CLIENT receiving a monoamine oxidase inhibitor. Page 17 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 41. When teaching a CLIENT about restrictions for tranylcypromine (Parnate), the NURSE willtell the CLIENT to avoid WHICH of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods ANSWER: A RATIONALE: Parnate is a monoamine oxidase inhibitor; CLIENTS must avoid tyramine, and broad beanscontain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine- containing foods. Page 18 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 1. Chapter 3 The NURSE understands that crises are self-limiting. This implies that uponevaluation of crisis intervention, the NURSE should assess for WHICH outcome? A) The patient will identify possible causes for the crisis. B) The patient will discover a new sense of self-sufficiency in coping. C) The patient will resume the precrisis level of functioning. D) The patient will express anger regarding the crisis event. ANSWER: C RATIONALE: Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in one of three ways. In the first two, the person either returns to his or her precrisis level of functioning or begins to function at a higher level; both are positive outcomes for the individual. The third resolution is that the person's functioning stabilizes at a level lower than precrisis functioning, WHICH is a negative outcome for the individual. Assisting the person to use existing supports or helping the individual find new sources of support candecrease the feelings of being alone or overwhelmed. The patient may develop guilt if heor she examines possible causes for the crisis. Expression of anger at 4 to 6 weeks indicates a less than favorable outcome of crisis intervention. 2. A patient who has been working on controlling impulsive behavior shows a strengthening ego through WHICH of the following behaviors? A) Going to therapy only when there is nothing more desirable to do B) Weighing the advantages and disadvantages before making a decision C) Telling others in the group the right way to act D) Reporting having fun at a recent social event ANSWER: B RATIONALE: The id is the part of one's nature that reflects basic or innate desires such as pleasure- seeking behavior, aggression, and sexual impulses. The id seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social convention. The superego is the part of a person's nature that reflects moral and ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id. The third component, the ego, is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world. Page 1 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 3. A patient has just been told she has cervical cancer. When asked about how this is impacting her, she states, ìIt's just an infection; it will clear up.î The statement indicates that this patient A) needs education on cervical cancer. B) is unable to express her true emotions. C) should be immediately referred to a cancer support group. D) is using denial to protect herself from an emotionally painful thought. ANSWER: D RATIONALE: Ego defense mechanisms are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at the unconscious level of awareness, so people are not aware of what they are doing and often need help to see the reality. Education and referrals are premature at this point in the patient's ability to cope. 4. A teenage patient defies the NURSE's repeated requests to turn off the video game and go to sleep. The teen says angrily, ìYou sound just like my mother at home!î and continues to play the video game. The NURSE understands that this statement likely indicates A) the need of stricter discipline at home. B) early signs of oppositional defiant disorder. C) viewing the NURSE as her mother. D) expression of developing autonomy. ANSWER: C RATIONALE: Transference occurs when the CLIENT displaces onto the therapist attitudes and feelingsthat the CLIENT originally experienced in other relationships. Transference patterns are automatic and unconscious in the therapeutic relationship. The occurrence of transference does not indicate ineffective parenting or disciplinary practices, nor is it indicative of a disorder. Autonomy is developed much earlier in the toddler years. 5. A patient reports a pattern of being suspicious and mistrusting of others, causing difficulty in sustaining lasting relationships. WHICH stage according to Erikson's psychosocial development was not successfully completed? A) Trust B) Autonomy C) Initiative D) Industry ANSWER: A RATIONAL E: The formation of trust is essential: mistrust, the negative outcome of this stage, will impair the person's development throughout his or her life. Page 2 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 6. The NURSE has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the NURSE. The relationship has entered WHICHphase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution ANSWER: B RATIONALE: The orientation phase is directed by the NURSE and involves engaging the CLIENT in treatment, providing explanations and information, and answering questions. The identification phase begins when the CLIENT works interdependently with the NURSE, expresses feelings, and begins to feel stronger. In the exploitation phase, the CLIENT makes full use of the services offered. In the resolution phase, the CLIENT no longer needsprofessional services and gives up dependent behavior and the relationship ends. 7. A NURSE is meeting with a crisis support group. In efforts to help patients identify withone another, the NURSE explains WHICH of the following about the crisis experience? A) ìEven happy events can cause a crisis if the stress is overwhelming.î B) ìOnly people who have unfortunate life events will experience a crisis.î C) ìA person has no control over how a crisis will affect him or her.î D) ìPeople can prevent all crises if they develop good coping skills early.î ANSWER: A RATIONALE: Not all events that result in crisis are ìnegativeî in nature. Events like marriage, retirement, and childbirth are often desirable for the individual but may still present overwhelming challenges. All individuals can experience a crisis when they confront some life circumstance or stressor that they cannot effectively manage through use of their customary coping skills. A number of factors can influence how a person experiences a crisis. Page 3 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 8. WHICH of the following theories could be classified as humanistic theories? Select allthat apply. A) Cognitive therapy B) Maslow's hierarchy of needs C) Gestalt therapy D) Rogers' CLIENT-centered therapy E) Rational emotive therapy F) Piaget's cognitive stages of development ANSWER: B, D RATIONALE: Humanism represents a significant shift away from the psychoanalytic view of the individual as a neurotic, impulse-driven person with repressed psychic problems and away from the focus on and examination of the CLIENT's past experiences. Humanistictheories include Maslow's hierarchy of needs and Rogers' CLIENT- centered therapy. Cognitive therapy is an existential therapy that focuses on immediate thought processingóhow a person perceives or interprets his or her experience and determines how he or she feels and behaves. Gestalt therapy is an existential therapy that emphasizes the person's feelings and thoughts in the here and now. Rational emotive therapy is an existential theory that looks at irrational beliefs and automatic thoughts that make people unhappy. Piaget's cognitive stages of development is a developmental theory. 9. WHICH of the following are examples of adventitious crises? Select all that apply. A) Death of a loved one B) Natural disasters C) Violent crimes D) War E) Leaving home for the first time ANSWER: B, C, D RATIONALE: Adventitious crises include natural disasters like floods, earthquakes, or hurricanes; war, terrorist attacks; riots; and violent crimes such as rape or murder. Maturational or developmental crises are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. Situational crises are unanticipated or sudden events that threaten the individual's integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member. Page 4 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 10. A nursing supervisor reprimands an employee for being chronically late for work. If the employee handles the reprimand using the defense mechanism of displacement, he would most likely do WHICH of the following? A) Argue with the supervisor that he is usually on time B) Make a special effort to be on time tomorrow C) Tell fellow employees that the supervisor is picking on him D) Tell the unit housekeeper that his work is sloppy ANSWER: D RATIONALE: Displacement involves venting feelings toward another, less threatening person. Arguing is denial. Making a special effort is compensation. Telling fellow employees that the supervisor is picking on him is projection. 11. The NURSE is assessing a CLIENT who is talking about her son's recent death but who shows no emotion of any kind. The NURSE recognizes this behavior as WHICH of the following defense mechanisms? A) Dissociation B) Displacement C) Intellectualization D) Suppression ANSWER: C RATIONALE: The CLIENT is aware of the facts of the situation but does not show the emotions associated with the situation. Dissociation involves dealing with emotional conflict by a temporary alteration in consciousness or identity. Displacement is the ventilation of intense feelings toward a person less threatening than the one who aroused those feelings. Suppression is replacing the desired gratification with one that is more readily available. Page 5 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 12. A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, ìI have to work too much and don't have time to study. It wouldn't matter anyway because the teacher is so unreasonable.î The defense mechanisms the student is using are A) denial and displacement B) rationalization and projection C) reaction formation and resistance D) regression and compensation ANSWER: B RATIONALE: When stating that it wouldn't matter if the student studied, the student is using rationalization, WHICH is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect. When stating that the teacher is unreasonable, the student is using projection or the unconscious blaming of unacceptable inclinations or thoughts as an external object. Denial is the failure to acknowledge an unbearable condition. Displacement is the ventilation of intense feelings toward persons less threatening than the one who aroused those feelings. Reaction formation is acting the opposite of what one thinks or feels. Resistance is overt or covert antagonism toward remembering or processing anxiety-producing information. Regression is moving back to a previous developmental stage to feel safe or have needs met. Compensation is overachievement in one area to offset real or perceived deficiencies in another area. 13. A CLIENT is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the NURSES. He also yells that they are lazy and incompetent. The CLIENT's behavior is an example of WHICH of the following defensemechanisms? A) Introjection B) Projection C) Rationalization D) Reaction formation ANSWER: B RATIONALE: Projection is blaming unacceptable thoughts on others; the CLIENT cannot accept the fact that he may be lazy or incompetent to care for himself. Introjection is accepting anotherperson's attitudes, beliefs, and values as one's own. Rationalization is excusing one's own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self- concept. Reaction formation is acting the opposite of what one thinks or feels. Page 6 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 14. A CLIENT begins to take stock of his life and look into the future. The NURSE assesses thatthis CLIENT is in WHICH of Erikson's developmental stages? A) Identity versus role confusion B) Industry versus inferiority C) Integrity versus despair D) Generativity versus stagnation ANSWER: C RATIONALE: Erikson's stage of integrity versus despair is when an adult begins to reflect on his or her life. Identity versus role confusion occurs in adolescence when the person is forming a sense of self and belonging. Integrity versus despair occurs in maturity; accepting responsibility for oneself and life is the corresponding task. Generativity versus stagnation occurs in middle adulthood, WHICH includes the tasks of being creative and productive and establishing the next generation. 15. A basic assumption of Freud's psychoanalytic theory is that A) all human behavior can be caused and can be explained. B) human behavior is entirely unconscious. C) free association is the key to understanding. D) sexuality does not relate to behavior. ANSWER: A RATIONALE: Freud believed that everything we do has meaning, whether it is conscious or unconscious. Freud believed that human behavior can be motivated by subconscious thoughts and feelings but could also be in the preconscious or unconscious. Freud based his theory of childhood development on the belief that sexual energy, termed libido, was the driving force of human behavior. 16. WHICH of the following is a major developmental task of middle adulthood? A) Developing intimacy B) Learning to manage conflict C) Reexamining life goals D) Resolving the past ANSWER: C RATIONALE: An important task for middle-aged adults is to examine life goals, ideally with some satisfaction. Developing intimacy occurs in young adulthood. Learning to manage conflict occurs in preschool. Resolving the past and accepting responsibility for oneself and life occur in maturity. Page 7 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 17. WHICH cognitive mode, according to Harry Stack Sullivan, begins in early childhood asthe child begins to connect experiences in sequence? A) Prototaxic mode B) Parataxic mode C) Bitaxic mode D) Syntaxic mode ANSWER: B RATIONALE: The parataxic mode begins in early childhood as the child begins to connect experiences in sequence. The child may not make logical sense of the experiences, although he or she may not understand what he or she is doing. The prototaxic mode involves brief, unconnected experiences that have no relationship to one another. In the syntaxic mode, the person begins to perceive himself or herself and the world within the context of the environment and can analyze experiences in a variety of settings. There is not a bitaxic mode. 18. Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The NURSE leader recognizes that the group is in WHICH stage of group development? A) Planning B) Initial C) Working D) Termination ANSWER: C RATIONALE: The working stage of group development begins as members begin to focus their attention on the purpose or task the group is trying to accomplish. The beginning stage of group development, or the initial stage, commences as soon as the group begins to meet. Members introduce themselves, a leader can be selected, the group purpose is discussed, and rules and expectations for group participation are reviewed. The final stage, or termination, of the group occurs before the group disbands. The work of the group is reviewed, with the focus on group accomplishments or growth of group members. Page 8 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 19. The family members of a patient with bipolar disorder express frustration with the unpredictable behaviors of their loved one. WHICH group should the NURSE suggest asmost helpful to this family? A) Family therapy group B) Family education group C) Psychotherapy group D) Self-help support group ANSWER: B RATIONALE: Family education discusses the clinical treatment of mental illnesses and teaches the knowledge and skills that family members need to cope more effectively. The goals of family therapy groups include understanding how family dynamics contribute to the CLIENT's psychopathology, mobilizing the family's inherent strengths and functional resources, restructuring maladaptive family behavioral styles, and strengthening family problem-solving behaviors. The goal of a psychotherapy group is for members to learn about their behavior and to make positive changes in their behavior by interacting and communicating with others. In a self-help group, members share a common experience, but the group is not a formal or structured therapy group. 20. A student NURSE attends a self-help group as part of a class assignment. While there thestudent recognizes a family friend. Upon returning home, the student talks about the experience with the family. The student's actions can be described as A) appropriate; persons familiar with group members are allowed self-help group membership. B) appropriate; self-help groups are not professional and therefore are open to public knowledge. C) inappropriate; most self-help groups have a rule of confidentiality. D) inappropriate; the student should not have been allowed to attend the group. ANSWER: C RATIONALE: Most self-help groups have a rule of confidentiality: whoever is seen and whatever is said at the meetings cannot be divulged to others or discussed outside the group. In many 12-step programs, such as Alcoholics Anonymous and Gamblers Anonymous, people use only their first names, so their identities are not divulged (although in some settings, group members do know one another's names). Page 9 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 21. The NURSE would recommend individual therapy for the patient who expresses a desireto A) bring about personal changes. B) gain a sense of belonging. C) develop leadership skills. D) learn more about treatment. ANSWER: A RATIONALE: People generally seek individual psychotherapy based on their desire to understand themselves and their behavior, to make personal changes, to improve interpersonal relationships, or to get relief from emotional pain or unhappiness. Groups are recommended for persons to accomplish tasks that require cooperation, collaboration, or working together. 22. WHICH one of the following statements is most accurate regarding the cohesiveness of agroup in group therapy? A) It is commonly present in the first meeting of the group. B) It is necessary for the group to have maximum cohesiveness, the more the better. C) Group cohesiveness is the degree to WHICH members think alike and many thingsare left unspoken. D) Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. ANSWER: D RATIONALE: Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. It is not common for the group to be cohesive during the first meeting of the group. During the first meeting, or the initial stage, members introduce themselves and the parameters of the group are established. Group members begin to ìcheck outî one another and the leaders as they determine their levels of comfort in the group setting. Cohesiveness is associated with the working stage of a group that may take two or three sessions in a therapy group because members must develop some level of trust before sharing personal feelings or difficult situations. If a group is ìoverly cohesive,î in that uniformity and agreement become the group's implicit goals, there may be a negative effect on the group outcome as members may not offer needed feedback and this may thwart critical thinking and creative problem solving. Group cohesiveness is the degree to WHICH members work together cooperatively to accomplish the purpose. Page 10 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 23. WHICH one of the following is an important characteristic of an effective therapistñCLIENTrelationship in individual psychotherapy? A) Homogeneity between the CLIENT and the therapist. B) Mutual benefit for the CLIENT and the therapist. C) The CLIENT must adapt to the therapist's style of therapy and theoretical beliefs. D) Match between the theoretical beliefs and style of therapy and the CLIENT's needsand expectations of therapy. ANSWER: B RATIONALE: Compatibility between the therapist and the CLIENT is required for therapy to be effective.The CLIENT must select a therapist whose theoretical beliefs and style of therapy are congruent with the CLIENT's needs and expectations of therapy. It is not required that the CLIENT and therapist be the same. The CLIENT's benefit is the most important consideration.The CLIENT also may have to try different therapists to find a good match. 24. WHICH of the following is most essential when planning care for a CLIENT who isexperiencing a crisis? A) Explore previous coping strategies B) Explore underlying personality dynamics C) Focus on emotional deficits D) Offer a referral to a self-help group ANSWER: A RATIONALE: Crisis intervention focuses on using the person's strengths, such as previous coping skills, and providing support to deal with the current situation. Exploring underlying personality dynamics and focusing on emotional deficits would not help the CLIENT in thecrisis situation. When the CLIENT is in a crisis situation, offering a self-help group would not be appropriate. 25. During the initial interview with a CLIENT in crisis, the initial priority is to A) assess the adequacy of the support system. B) assess for substance use. C) determine the precrisis level of functioning. D) evaluate the potential for self-harm. ANSWER: D RATIONALE: Safety is always the priority; CLIENTS in crisis may be suicidal. Assessing the adequacy ofthe support system, assessing for substance use, and determining the precrisis level of functioning would be important assessments but not as high priority as evaluating the potential for self-harm. Page 11 Downloaded by: esther7749 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material 26. Patients on an inpatient psychiatric unit can earn off-unit privileges for daily use of socially appropriate behavior. This is an example of employing WHICH concept of behavior modification? A) Systematic desensitization B) Negative reinforcement C) Classical conditioning D) Operant conditioning ANSWER: D RATIONALE: The theory of operant conditioning says people learn their behavior from their history or past experiences, particularly those experiences that were repeatedly reinforced. Behavior that is rewarded with reinforcers tends to recur. Positive reinforcers that follow a behavior increase the likelihood that the behavior will recur. In classical conditioning, behavior can be changed through conditioning with external or environmental conditions or stimuli. Negative reinforcement involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again. In systematic desensitization, the CLIENT learns and practices relaxation techniquesto decrease and manage anxiety. He or she is then exposed to the least anxiety provoking situation and uses the relaxation techniques to manage the resulting anxiety. 27. A patient states, ìI hate spending time with my family. They're always on my back about something! I won't do anything they ask me to do.î WHICH response by the NURSE reflects a behavioral perspective? A) ìLet's play like I'm your parent, and we'll practice some better ways to communicate that won't result in an argument.î B) ìSome medicines really help with anger. Are you interested in talking to your physician about starting you on something?î C) ìThat's probably your way of getting back at them f