MENTAL HEALTH EXAM 1 QUESTIONS WITH ANSWERS 2024 UPDATES, Exams of Nursing

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MENTAL HEALTH EXAM 1 QUESTIONS WITH ANSWERS 2024

UPDATES

Question 1 2 out of 2 points A nurse says, “I am the only one who truly understands this patient. Other staff members are too critical.” The nurse’s statement indicates: Answers: a. advocacy. b. boundary blurring. c. positive regard. d. sexual harassment. Response Feedback: When the role of the nurse and the role of the patient shift, boundary blurring may arise. In this situation, the nurse is becoming overinvolved with the patient as a probable result of unrecognized countertransference. When boundary issues occur, the need for supervision exists. The situation does not describe sexual harassment. Data are not present to suggest positive regard or advocacy. Question 2 2 out of 2 points A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web site’s address most alerts the nurse that the site may have biased and prejudiced information? Answers: a. Address ends in “.com” b. Address ends in “.gov” c. Address ends in “.net” d. Address ends in “.org” Response Feedback: Financial influences on a site are a clue that the information may be biased. “.com” at the end of the address indicates that the site is a commercial one. “.gov” indicates that the site is maintained by a

government entity. “.org” indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. “.net” can have multiple meanings. Question 3 2 out of 2 points A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? Answers: a. Attending b. Recovery c. Advocacy d. Evidence-based practice Response Feedback: An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for him or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. Question 4 0 out of 2 points A patient begins therapy with a first generation antipsychotic medication. What teaching should a nurse provide related to the drug’s strong dopaminergic effect? Answers: a. Chew sugarless gum. b. Report muscle stiffness. c. Arise slowly from bed. d. Increase dietary fiber. Response Feedback: First generation antipsychotic medications block dopamine receptors in both the limbic system and basal ganglia. Dystonia is likely to occur early in the course of treatment and is often heralded by sensations of muscle stiffness. Early intervention with an antiparkinsonian medication can increase the patient’s comfort and prevent dystonic reactions. The incorrect responses apply to potential anticholinergic effects of first generation antipsychotic medications. Question 5 2 out of 2 points

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? Answers: a. “Tell me everything from the beginning.” b. “Am I correct in understanding that…?” c. “What are the common elements here?” d. “Tell me again about your experiences.” Response Feedback: Asking, “Am I correct in understanding that…?” permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening. Question 6 2 out of 2 points At what point in the nurse-patient relationship should a nurse plan to first address termination? Answers: a. In the termination phase b. In the orientation phase c. During the working phase d. When the patient initially brings up the topic Response Feedback: The patient has a right to know the conditions of the nurse-patient relationship. If the relationship is to be time limited, then the patient should be informed of the number of sessions. If it is open ended, then the termination date will not be known at the outset and the patient will know that the issue will be negotiated at a later date. The nurse is responsible for bringing up the topic of termination early in the relationship, usually during the orientation phase. Question 7 2 out of 2 points An individual is experiencing problems associated with memory. Which cerebral structures are most likely to be involved in this deficit? (Select all that apply.) Answers: a. Basal ganglia b. Occipital lobe

c. Parietal lobe d. Temporal lobe e. Prefrontal cortex Response Feedback: The prefrontal cortex, parietal, and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The occipital lobe is predominantly involved with vision. The basal ganglia influence the integration of physical movement, as well as some thoughts and emotions. Question 8 2 out of 2 points A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse’s most caring comment. Answers: a. “How did you get so depressed that hospitalization was necessary?” b. “I understand why you’re so depressed. When I got divorced, I was devastated too.” c. “You should forget about your marriage and move on with your life.” d. “Let’s discuss some means of coping other than suicide when you have these feelings.” Response Feedback: The nurse’s communication should evidence caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions. Question 9 2 out of 2 points A nurse should assess a patient taking a medication with anticholinergic properties for inhibited function of the: Answers: a. medulla oblongata. b. reticular activating system. c. parasympathetic nervous system. d. sympathetic nervous system. Response Feedback: Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When acetylcholine action is inhibited by anticholinergic drugs, parasympathetic symptoms such as blurred vision, dry mouth, constipation, and urinary retention appear. The functions of the

sympathetic nervous system, the reticular activating system, and the medulla oblongata are not affected by anticholinergic medications. Question 10 2 out of 2 points While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed? Answers: a. A message filter b. Social skills c. A cultural barrier d. Nonverbal communication Response Feedback: Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patient’s social skills or whether a cultural barrier exists. Question 11 2 out of 2 points A patient says, “Please don’t share information about me with the other people.” How should the nurse respond? Answers: a. “I won’t share information with others without your permission, but I will share information about you with other staff members.” b. “A therapeutic relationship is just between the nurse and the patient. It’s up to you to tell others what you want them to know.” c. “I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.” d. “It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others.” Response Feedback: A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff members need to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse- patient contract is established, and suggest mutual problem solving. The relationship must be patient centered. Question 12 2 out of 2 points

Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan? Answers: a. Teach the child relaxation techniques, then coax speech. b. Have the child observe others talking. c. Ignore the child for using silence. d. Give the child a small treat for speaking. Response Feedback: Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards to reinforce speech. Ignoring the child will not change the behavior. Having the child observe others describes modeling. Teaching relaxation techniques and then coaxing speech is an example of systematic desensitization. Question 13 2 out of 2 points A school-age child tells the school nurse, “Other kids call me mean names and will not sit with me at lunch. Nobody likes me.” Select the nurse’s most therapeutic response. Answers: a. “Call them names if they do that to you.” b. “You should make friends with other children.” c. “Just ignore them and they will leave you alone.” d. “Tell me more about how you feel.” Response Feedback: The correct response uses exploring, a therapeutic technique. The distracters give advice, a non- therapeutic technique. Question 14 2 out of 2 points A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? Answers: a. Endocrine-stimulating effects b. Anticholinergic effects

c. Dopamine-blocking effects d. Ability to stimulate spinal nerves Response Feedback: Medications that block dopamine often produce disturbances of movement such as akathisia because dopamine affects neurons involved in both the thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation. Question 15 2 out of 2 points An example of a breach of a patient’s right to privacy occurs when a nurse: Answers: a. asks a family to share information about a patient’s prehospitalization behavior. b. discusses the patient’s history with other staff members during care planning. c. documents the patient’s daily behaviors during hospitalization. d. releases information to the patient’s employer without consent. Response Feedback: The release of information without patient authorization violates the patient’s right to privacy. The other options are acceptable nursing practices. Question 16 2 out of 2 points Which action by a psychiatric nurse best supports a patient’s right to be treated with dignity and respect? Answers: a. Consistently addressing a patient by title and surname. b. Discussing a patient’s condition with another health care provider in the elevator. c. Informing a treatment team that a patient is too drowsy to participate in care planning. d. Strongly encouraging a patient to participate in the unit milieu. Response Feedback: A simple way of showing respect is to address the patient by title and surname rather than assuming that the patient would wish to be called by his or her first name. Discussing a patient’s condition with a health care provider in the elevator violates confidentiality. Informing a treatment team that the patient is too drowsy to participate in care planning violates patient autonomy. Encouraging a patient to participate in the unit milieu exemplifies beneficence and fidelity. Question 17 2 out of 2 points

A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item “Encourage patient to attend one psychoeducational group daily”? Answers: a. Implementation b. Evaluation c. Assessment d. Analysis e. Planning Response Feedback: Interventions (implementation) are the nursing prescriptions to achieve the outcomes. Interventions should be specific. Question 18 2 out of 2 points Which basic intervention should a psychiatric mental health nurse plan to provide for a patient diagnosed with a mood disorder? Answers: a. Using appropriate diagnostic tests to monitor patient condition b. Sharing clinical expertise to enhance patient treatment c. Conducting stress management and health maintenance classes d. Performing individual or group psychotherapy for the patient Response Feedback: Conducting stress management and health maintenance classes is the basic intervention that should be performed by a psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management classes are examples of health maintenance classes. Consulting nurses from other disciplines to share clinical expertise and enhance patient treatment is an advanced practice psychiatric mental health nursing intervention. Performing individual and group psychotherapy and performing diagnostic tests like blood pressure, etc., are also advanced practice psychiatric mental health nursing interventions. Question 19 2 out of 2 points

As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? Answers: a. The invitation facilitates dependency on the nurse. b. The invitation is therapeutic for the patient’s diversional activity deficit. c. The nurse’s action blurs the boundaries of the therapeutic relationship. d. The nurse’s action assists the patient’s integration into community living. Response Feedback: The invitation creates a social relationship rather than a therapeutic relationship. Question 20 2 out of 2 points A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. A new nurse who begins work with this patient will: Answers: a. enter into a social relationship. b. resume the working relationship. c. begin at the orientation phase. d. return to the emotional catharsis phase. Response Feedback: After the termination of a long-term relationship, the patient and new nurse usually have to begin at ground zero, the orientation phase, to build a new relationship. If termination is successfully completed, then the orientation phase sometimes progresses quickly to the working phase. Other times, even after successful termination, the orientation phase may be prolonged. Question 21 2 out of 2 points An advanced practice nurse determines that a group of patients would benefit from opportunities to practice appropriate social behaviors and learn about basic living skills. The nurse would arrange for: Answers: a. cognitive therapy. b. systematic desensitization. c. short-term dynamic therapy. d. milieu therapy. Response Feedback:

Milieu therapy provides an opportunity for all members of the environment to contribute to the planning and functioning of the setting, practice social behaviors in a safe setting, and gain knowledge in basic living skills. The other therapies are all individual therapies that do not fit the description. Question 22 2 out of 2 points Which patient would a nurse refer to partial hospitalization? An individual who: Answers: a. states, “I’m not sure I can avoid using alcohol when my spouse goes to work every morning.” b. because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy. c. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. d. spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal. Response Feedback: This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume supervision responsibilities. The patient who is actively suicidal needs inpatient hospitalization. The patient in need of psychoeducation can be referred to home care. The patient who reports regularly for blood tests and clinical follow-up can continue on the same plan. Question 23 2 out of 2 points Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient: Answers: a. has a sibling who is interested and active in care planning. b. receives Social Security disability income plus a small check from a trust fund. c. lives in an apartment with two patients who attend day hospital programs. d. purchases and uses marijuana on a frequent basis. Response Feedback: Patients who regularly buy illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of illegal drugs on cellular brain function, promotes relapse. The remaining options do not suggest problems. Question 24 2 out of 2 points

The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient’s thoughts are now more organized. The patient’s family members are upset and say, “It’s too soon for discharge. Hospitalization is needed for at least a month.” The nurse should: Answers: a. explain that health insurance will not pay for a longer stay for the patient. b. call the psychiatrist to come explain the discharge rationale. c. call security to handle the disturbance and escort the family off the unit. d. explain that the patient will continue to improve if medication is taken regularly. Response Feedback: Patients no longer stay in a hospital until all evidence of a symptom disappears. The nurse must assume responsibility to advocate for the patient’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handle this matter. Question 25 2 out of 2 points Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: Answers: a. are noncompliant with medications at home. b. have no support systems in the community. c. present a clear danger to self or others. d. develop new symptoms during the course of an illness. Response Feedback: Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The incorrect options do not necessarily describe patients for whom less restrictive treatment is indicated. Question 26 2 out of 2 points A single parent is experiencing feelings of inadequacy related to work and family since one teenaged child ran away several weeks ago. The parent seeks the help of a therapist specializing in cognitive therapy. The psychotherapist who uses cognitive therapy will treat the patient by: Answers: a. focusing on unconscious mental processes.

b. negatively reinforcing an undesirable behavior. c. discussing ego states. d. helping the patient identify and change faulty thinking. Response Feedback: Cognitive therapy emphasizes the importance of changing erroneous ways people think about themselves. Once faulty thinking changes, the individual’s behavior changes. Focusing on unconscious mental processes is a psychoanalytic approach. Negatively reinforcing undesirable behaviors is behavior modification, and discussing ego states relates to transactional analysis. Question 27 2 out of 2 points A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to: Answers: a. arrange a temporary place for the patient to stay until new housing can be arranged. b. document that the adverse medication reaction was feigned because the patient had nowhere to live. c. cancel the patient’s discharge from the hospital. d. contact the landlord who evicted the patient to discuss the situation. Response Feedback: The case manager should intervene by arranging temporary shelter for the patient until suitable housing can be found. This is part of the coordination and delivery of services that falls under the case manager role. The other options are not viable alternatives. Question 28 2 out of 2 points A nurse works with a patient to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patient’s best interest. What is the nurse’s best action? Answers: a. Formulate a more appropriate outcome without the patient’s input. b. Remain silent. c. Explore with the patient possible consequences of the outcome. d. Educate the patient that the outcome is not realistic. Response Feedback:

The nurse should not impose outcomes on the patient; however, the nurse has a responsibility to help the patient evaluate what is in his or her best interest. Exploring possible consequences is an acceptable approach. Question 29 2 out of 2 points A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, “No!” when given directions. Using Freud’s stages of psychosexual development, a nurse would assess the child’s behavior is based on which stage? Answers: a. Anal b. Oral c. Phallic d. Genital Response Feedback: In Freud’s stages of psychosexual development, the anal stage occurs from age 1 to 3 years and has, as its focus, toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between 13 and 20 years. Question 30 2 out of 2 points A patient should be considered for involuntary commitment for psychiatric care when he or she: Answers: a. sells and distributes illegal drugs. b. fraudulently files for bankruptcy. c. is noncompliant with the treatment regimen. d. threatens to harm self and others. Response Feedback: Involuntary commitment protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization. Question 31 0 out of 2 points Which scenario is an example of a tort?

Answers: a. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized. b. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed. c. The primary nurse does not complete the plan of care for a patient within 24 hours of the patient’s admission. d. A patient’s admission status is changed from involuntary to voluntary after the patient’s hallucinations subside. Response Feedback: A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff members controls behavior in a manner similar to secluding a patient; thus false imprisonment is a possible charge. The other options do not exemplify torts. Question 32 2 out of 2 points Which documentation of a patient’s behavior best demonstrates a nurse’s observations? Answers: a. Wears four layers of clothing. States, “I need protection from dangerous bacteria trying to penetrate my skin.” b. Calmer and more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Isolates self from others. Frequently fell asleep during group. Vital signs stable. d. Appeared to hallucinate. Patient frequently increased volume on television, causing conflict with others Response Feedback: The documentation states specific observations of the patient’s appearance and the exact statements made. The other options are vague or subjective statements and can be interpreted in different ways. Question 33 2 out of 2 points Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will: Answers: a. attend clinic appointments on time. b. take medications as prescribed. c. deny suicidal ideation.

d. report a sense of well- being. Response Feedback: Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery. Question 34 0 out of 2 points A participant at a community education conference asks, “What is the most prevalent type of mental disorder in the United States?” Select the nurse’s best response. Answers: a. “Affective disorders” b. “Why do you ask?” c. “Schizophrenia” d. “Anxiety disorders” Response Feedback: The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%. Question 35 2 out of 2 points A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification? Answers: a. “Can you give me an example of what you mean by ‘stoned’?” b. “So, all in all, you feel as though you had a rather poor night’s sleep?” c. “It sounds as though you were uncomfortable with the content of your dream.” d. “I understand what you’re saying. Bad dreams leave me feeling tired, too.” Response Feedback: The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient’s statement. Asking for a definition of “stoned” directly asks for clarification. Restating that the patient is uncomfortable with the dream’s content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient’s comment. Question 36 2 out of 2 points

A patient’s history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient’s needs are not met. Which aspect of mental health is a problem? Answers: a. Productive activities b. Communication skills c. Fulfilling relationships d. Effectiveness in work Response Feedback: The information provided centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities. Question 37 2 out of 2 points When a nurse assesses an older adult patient, the patient’s answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: Answers: a. “I notice you are frowning. Are you feeling annoyed with me?” b. “Are you having difficulty hearing when I speak?” c. “You’re having trouble focusing on what I’m saying. What is distracting you?” d. “How can I make this assessment interview easier for you?” Response Feedback: The patient’s behaviors may indicate difficulty hearing. Identifying any physical need the patient may have at the onset of the interview and making accommodations are important considerations. By asking if the patient is annoyed, the nurse is jumping to conclusions. Asking how to make the interview easier for the patient may not elicit a concrete answer. Asking about distractions is a way of asking about auditory hallucinations, which is not appropriate because the nurse has observed that the patient seems to be listening intently. Question 38 2 out of 2 points A 4-year-old child grabs toys from siblings, saying, “I want that toy now!” The siblings cry, and the child’s parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the child’s behavior as a product of impulses originating in the:

Answers: a. preconscious. b. id. c. superego. d. ego. Response Feedback: The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the parent’s wrath. The superego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness. Question 39 2 out of 2 points After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, “Please document the administration of the medication I forgot to do. My password is alpha1.” The nurse should: Answers: a. fulfill the request. b. access the record and document the information. c. refer the matter to the charge nurse to resolve. d. report the request to the patient’s health care provider. Response Feedback: At most hospitals, termination is a possible penalty for unauthorized entry into a patient record. Referring the matter to the charge nurse will allow the observance of hospital policy while ensuring that documentation occurs. Making an exception and fulfilling the request places the on-duty staff nurse in jeopardy. Reporting the request to the patient’s health care provider would be unnecessary. Accessing the record and documenting the information would be unnecessary when the charge nurse can resolve the problem. Question 40 2 out of 2 points An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freud’s stages of psychosexual development? Answers: a. Oral b. Phallic

c. Anal d. Latency Response Feedback: According to Freud, fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in a difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. Question 41 2 out of 2 points In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? Answers: a. Person who is usually pessimistic but strives to meet personal goals b. Person who attends a charismatic church and describes hearing God’s voice c. Wealthy person who gives $20 bills to needy individuals in the community d. Person with an optimistic viewpoint about getting his or her own needs met Response Feedback: Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill. Question 42 2 out of 2 points In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? Answers: a. “Our patients need our help to learn behaviors that will help them get along in society.” b. “Your comments are inconsiderate and inappropriate. Keep the report objective.” c. “Let’s all show acceptance of this patient by wearing lots of makeup too.” d. “This is a psychiatric hospital, so we expect our patients to behave bizarrely.” Response Feedback: Accepting patients’ needs for self-expression and seeking to teach skills that will contribute to their well- being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the

privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other. Question 43 2 out of 2 points The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized and become part of the child’s: Answers: a. superego. b. preconscious. c. ego. d. id. Response Feedback: In the Freudian theory, the superego contains the “thou shalts” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality- testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be easily retrieved with conscious effort. Question 44 2 out of 2 points A voluntarily hospitalized patient tells the nurse, “Get me the forms for discharge against medical advice so I can leave now.” What is the nurse’s best initial response? Answers: a. “I can’t give you those forms without your health care provider’s knowledge.” b. “I will get them for you, but let’s talk about your decision to leave treatment.” c. “Since you signed your consent for treatment, you may leave if you desire.” d. “I’ll get the forms for you right now and bring them to your room.” Response Feedback: A patient who has been voluntarily admitted as a psychiatric inpatient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient’s wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. The statement that discharge forms cannot be given without the health care provider’s knowledge is not true. Facilitating discharge without consent is not in the patient’s best interest before exploring the reason for the request. Question 45 2 out of 2 points

A new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? Answers: a. Prescribe psychotropic medication. b. Establish therapeutic relationships. c. Individualize nursing care plans. d. Perform mental health assessment interviews. Response Feedback: Prescriptive privileges are granted to Master’s-prepared nurse practitioners who have taken special courses on prescribing medications. The nurse prepared at the basic level performs mental health assessments, establishes relationships, and provides individualized care planning. Question 46 2 out of 2 points Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion: Answers: a. reveals that the nurse values the principle of justice. b. represents the intentional tort of battery. c. violates the civil rights of the two patients. d. reinforces the autonomy of the two patients. Response Feedback: Patients have a right to treatment in the least restrictive setting. Less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion removes the patient’s autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment, not battery. Question 47 2 out of 2 points A new psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls embarrassing events concerning the parent’s behavior in the community. Select the best ways for this nurse to cope with these feelings. (Select all that apply.) Answers: a. Recognize that the feelings may add sensitivity to the nurse’s practice, but supervision is important.

b. Recognize that psychiatric nursing is not an appropriate career choice, and explore other nursing specialties. c. Begin new patient relationships by saying, “My own parent had mental illness, so I accept it without stigma.” d. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. e. Recognize that these feelings are unhealthy, and try to suppress them when working with patients. Response Feedback: The nurse needs to explore these feelings. An experienced psychiatric nurse is a resource who may be helpful. The knowledge and experience gained from the nurse’s relationship with a parent who is mentally ill may contribute sensitivity to a compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories. Question 48 2 out of 2 points A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?” What is the nurse’s best response? Answers: a. “Do you think you can’t speak to a doctor?” b. “I will be glad to address it when I see your doctor later today.” c. “That’s a good topic for you to take up with your doctor.” d. “Why are you asking me when you’re able to speak for yourself?” Response Feedback: Nurses should encourage patients to work at their optimal level of functioning. A nurse does not act for the patient unless it is necessary. Acting for a patient increases feelings of helplessness and dependency. Question 49 2 out of 2 points A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurse’s best response. Answers: a. “The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.” b. “The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.”

c. “The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience.” d. “No functional difference exists between the two diagnoses. Both serve to identify a human deviance.” Response Feedback: The medical diagnosis, defined according to the DSM-5, is concerned with the patient’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient’s response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems. Question 50 2 out of 2 points A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting? Answers: a. The health care provider will order neuroimaging studies. b. A treatment plan will be formulated. c. The team will request a court-appointed advocate for the patient. d. Assessment of the patient’s need for placement outside the home will be undertaken. Response Feedback: Treatment plans are formulated early in the course of treatment to streamline the treatment process and reduce costs. It is too early to determine the need for alternative post-discharge living arrangements. Neuroimaging is not indicated for this scenario. Monday, June 17, 2019 10:54:13 AM CDT OK