NR Mental Health Exam Test Bank Questions with Correct Answers, Exams of Nursing

Download NR Mental Health Exam Test Bank Questions with Correct Answers and more Exams Nursing in PDF only on Docsity! NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ Chapter 01: Mental Health and Mental Illness MULTIPLE CHOICE 1. A staff nurse completes orientation to a psychiatric unit. Which of the following would the nurse expect as an advanced practice intervention? a. Conduct mental health assessments b. Prescribe psychotropic medication c. Establish therapeutic relationships d. Individualize nursing care plans ANS: B Prescriptive privileges are granted to master’s-prepared nurse practitioners who have taken special courses on prescribing medication; thus it is an advanced-practice intervention. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 2. When a nursing student expresses concerns about how mental health nurses “lose all their nursing skills,” which of the following is the best response by the mental health nurse? a. “Psychiatric nurses practise in safer environments than other specialties. Nurse- to- patient ratios must be better because of the nature of the patients’ problems.” b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.” c. “That’s a misconception. Psychiatric nurses frequently use high- technology monitoring equipment and manage complex intravenous NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ therapies.” NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for himself or herself. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for people with mental illness, the letter-writing campaign advocates for the cause for all people with mental illness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 4. Which of the following has been identified as a significant trend that will affect the future of psychiatric mental health nursing in Canada? a. Decrease in the aging population b. Increase in cultural diversity c. Role of the advanced-practice nurse d. Shortage of physicians in rural and urban areas ANS: B Four significant trends have been identified that will affect the future of psychiatric mental health nursing in Canada; these include an aging population, an increase in cultural diversity, expanding technology, and an increased awareness of the impact of the determinants of health on mental illness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe Effective Care Environment 5. Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? a. The patient reports occasional sleeplessness and anxiety. b. The patient reports a consistently sad, discouraged, and hopeless mood. c. The patient is able to describe the difference between “as if” and “for real.” d. The patient perceives difficulty making a decision about whether to change jobs. ANS: B NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ The correct response describes a mood alteration, which reflects mental illness. Alterations in cognition, mood, or behaviour that are coupled with significant distress and impaired functioning characterize mental illness. The distracters describe behaviours that are mentally healthy or within the usual scope of human experience. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 6. Which finding best indicates that the goal “Demonstrates mentally healthy behaviour” was achieved? a. A patient sees self as capable of achieving ideals and meeting demands. b. A patient behaves without considering the consequences of personal actions. c. A patient aggressively meets own needs without considering the rights of others. d. A patient seeks help from others when assuming responsibility for major areas of own life. ANS: A The correct response describes an adaptive, healthy behaviour. The WHO defines mental health as “a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community” (World Health Organization, 2010). The distracters describe maladaptive behaviours. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. A behavioural health reference manual NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ d. NurseOne online NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ happy. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which disorder is a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depression ANS: C Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behaviour. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies which of the following? a. Deviant behaviours b. Present disability or distress c. People with mental disorders d. Mental disorders people have ANS: D The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example. Deviant behaviour is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ 14. A visitor at a community health fair asks the nurse, “What is the most prevalent mental NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ disorder in Canada?” Select the nurse’s best response. a. Schizophrenia b. Bipolar disorder c. Generalized anxiety disorder d. Major depression ANS: D The prevalence of major depressive disorder is 47%, and approximately 11.3% of adults will experience major depression at some time in their lives. The prevalence of schizophrenia is 1.3% per year. The prevalence of bipolar disorder is 1.5%. The prevalence for generalized anxiety disorder is about 2.6% annually. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 15. Which of the following represents an outcome domain of the Nursing Outcomes Classification (NOS)? a. Mental health b. Perceived health c. Chronic illness d. Mental illness ANS: B One of the seven outcome domains is perceived health; the other six are functional health, physiologic health, psychosocial health, health knowledge, family health, and community health. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 16. A patient’s relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ receives only medication. The team measures outcomes for each group. Which type of study is NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ evident? a. Incidence b. Prevalence c. Comorbidity d. Clinical epidemiology ANS: D Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe Effective Care Environment 19. The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how events from childhood have anything to do with this disabling illness.” Which response by the nurse will best help the spouse understand the cause of this disorder? a. “Psychological stress is the basis of most mental disorders.” b. “This illness results from developmental factors rather than stress.” c. “Research suggests that this condition more likely has a biological basis.” d. “It must be frustrating for you that your spouse is sick so much of the time.” ANS: C Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics is only one part of biological factors. Empathy does not address increasing the spouse’s level of knowledge about the cause of the disorder. The other distracters are not established facts. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ 20. A category 5 tornado occurred in a community of 400 people, resulting in the destruction of many homes and businesses. In the 2 years after this disaster, 140 individuals were diagnosed with post-traumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence b. Comorbidity c. Incidence d. Clinical epidemiology ANS: C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill. Clinical epidemiology is a broad field that addresses what happens after people with illnesses are seen by clinical care providers. Comorbidity refers to having more than one mental disorder at a time. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Safe Effective Care Environment 21. Most psychiatric disorders are the result of which of the following? a. Childhood trauma b. Adverse life events c. Multiple defective genes d. Chronic medical conditions ANS: C Most psychiatric disorders are the result of multiple mutated or defective genes, each of which in combination may contribute to the disorder. Although disorders may be caused by childhood trauma, adverse live events, and chronic medical conditions, they are not the cause of the majority of psychiatric disorders. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ staff nurse’s scope of practice. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment MULTIPLE RESPONSE 1. An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you instantly know how to take care of psychotic patients.” What information should the new graduate consider when analyzing this comment? (Select all that apply.) a. The experienced nurse may need to be reminded of the importance of standardized classifications. b. New research findings should be integrated continuously into a nurse’s practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients’ needs guides effective psychiatric nurses. ANS: A, B Evidence-informed practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Safe Effective Care Environment 2. Which findings are signs of a person who is mentally healthy? (Select all that apply.) NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. Says, “I have some weaknesses, but I feel I’m important to my family and friends.” b. Adheres strictly to religious beliefs of parents and family of origin NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ c. Spends all holidays alone watching old movies on television d. Considers past experiences when deciding about the future e. Experiences feelings of conflict related to changing jobs ANS: A, D, E Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. A patient in the emergency department says, “Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat.” Which aspects of the patient’s mental health have the greatest and most immediate concern to the nurse? (Select all that apply.) a. Happiness b. Appraisal of reality c. Control over behaviour d. Effectiveness in work e. Healthy self-concept ANS: B, C, E The aspects of mental health of greatest concern are the patient’s appraisal of and control over behaviour. Their appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patient’s control over behaviour is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusions of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ recovery of mental health. The nurse needs to consider these gaps when planning discharge for patients NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ from acute care settings as the gaps can delay discharge and increase the likelihood of readmission. None of the other options is a viable alternative. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 3. A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient’s thoughts are now more organized, and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” Which of the following should the nurse do? a. Ask the case manager to arrange a transfer to a long-term care facility. b. Notify hospital security to handle the disturbance and escort the family off the unit. c. Explain that the patient will continue to improve if the medication is taken regularly. d. Contact the health care provider to meet with the family and explain the discharge rationale. ANS: C Patients do not stay in a hospital until every 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. Security is unnecessary. The nurse can handle this matter. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 4. A nurse inspects an inpatient psychiatric unit and finds that exits are free of NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. Stabilize aggressive patients NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. Identify obstacles to effective care c. Relieve nurses of planning responsibilities d. Streamline the care process and improve outcomes ANS: D Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes, as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and improve outcomes. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 9. Which aspect of direct care is an experienced, inpatient registered nurse most likely to provide for a patient? a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills ANS: D Building assertiveness skills is provided by the psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a health care aide. Diversional activities are usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social worker or occupational therapist. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. Which of the following scenarios best depicts a behavioural crisis? NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. A patient is waving fists, cursing, and shouting threats at a nurse. b. A patient is curled up in a corner of the bathroom, wrapped in a towel. c. A patient is crying hysterically after receiving a phone call from a family member. d. A patient is performing push-ups in the middle of the hall, forcing others to walk around. ANS: A This behaviour constitutes a behavioural crisis because the patient is threatening harm to another individual. Intervention is called for to defuse the situation. The other options speak of behaviours that may require intervention of a less urgent nature because the patients in question are not threatening harm to self or others. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, “I don’t know what to do with my free time.” Which member of the multidisciplinary treatment team would be most helpful to this patient? a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist ANS: C Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other patient services. Social workers focus on the patient’s support system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 12. A nurse performed these actions while caring for patients in an inpatient NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. Report the situation to the manager of the shelter. c. Assess the patient’s weight; determine foods and amounts eaten. d. Arrange hospitalization for the patient in order to formulate a new treatment plan. ANS: C Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 15. A nurse receives the following three phone calls regarding a community patient. · The psychiatrist wants to complete a follow-up assessment. · An internist wants to schedule a physical examination. · The patient’s attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a. Advocate b. Case manager c. Milieu manager d. Provider of care ANS: B Case managers design individually tailored treatment services for patients and track outcomes of care. The new case management includes assessing patient needs, developing a plan for service, linking the patient with necessary services, monitoring the effectiveness of services, and advocating for the patient as needed. Nurses routinely coordinate patient services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the patient’s behalf. The role of NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the patient. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment 16. Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a. Kindness b. Autonomy c. Compassion d. Professionalism ANS: B A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 17. A patient with which of the following diagnoses would be most appropriate to refer for assertive community treatment (ACT)? a. A phobic fear of crowded places. b. A single episode of major depression. c. A catastrophic reaction to a tornado in the community. d. Schizophrenia and four hospitalizations in the past year. ANS: D ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distracters identify mental health problems of a more episodic nature. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment 18. Select the response that is an example of primary prevention. a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill patient who assaulted a staff person ANS: B Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill patient who assaulted a staff person is secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 19. Which level of prevention activities would a nurse in an emergency department employ most often? a. Primary b. Secondary c. Tertiary ANS: B An emergency department nurse would generally see patients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ MSC: Client Needs: Safe Effective Care Environment NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ 22. A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient’s spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care. a. The patient’s spouse will mark dates for prescription refills on the family calendar. b. The nurse will obtain prescription refills every 90 days and deliver to the patient. c. The patient will call the nurse weekly to discuss medication-related issues. d. The patient will report to the clinic for medication follow-up every week. ANS: A The nurse will enhance the patient’s support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as medication is taken as prescribed. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment 23. A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, “Only a traitor would make me go to the hospital.” Select the nurse’s best initial intervention. a. Collaborate with the patient to contact resources to provide medications without charge temporarily. b. Arrange a bed in a local homeless shelter with nightly on-site supervision. c. Hospitalize the patient until the symptoms have stabilized. d. Ask the patient, “Do you feel like I am a traitor?” ANS: A Hospitalization may damage the nurse-patient relationship, even if it provides an opportunity for rapid stabilization. The treatment outcome is to stabilize and improve the patient’s level of functioning in the NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ community. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. This will aid in the patient’s long term recovery journey. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment 24. Which activity is appropriate for a nurse engaged exclusively in community- based primary prevention? a. Medication follow-up b. Teaching parenting skills c. Substance abuse counselling d. Making a referral for family therapy ANS: B Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. The distracters represent secondary or tertiary prevention activities. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 25. A psychiatrist prescribed depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. For this plan to be successful, which factor will be of critical importance? a. The attitude of significant others toward the patient b. Nutrition services in the patient’s neighbourhood c. The level of trust between the patient and nurse d. The availability of transportation to the clinic ANS: D NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ response. a. “Thank you. I would enjoy having a cup of coffee with you.” NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. “Thank you, but I would prefer to proceed with the assessment.” c. “No, but thank you. I never accept drinks from patients or families.” d. “Our agency policy prohibits me from eating or drinking in patients’ homes.” ANS: A Accepting refreshments or chatting informally with the patient and family represent therapeutic use of self and help to establish rapport. The distracters fail to help establish rapport. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy? (Select all that apply.) a. Clear risk of danger to self or others b. Adjustment needed for doses of psychotropic medication c. Detoxification from long-term heavy alcohol consumption needed d. Respite for caregivers of persons with serious and persistent mental illness e. Failure of community-based treatment, demonstrating need for intensive treatment ANS: A, C, E Medication doses can be adjusted on an outpatient basis. The goal of caregiver respite can be accomplished without hospitalizing the patient. The other options are acceptable, evidence-informed criteria for admission of a patient to an inpatient service. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 2. A psychiatric nurse discusses rules of the therapeutic milieu and patients’ rights with a newly admitted patient. Which rights should be included? (Select all that apply.) a. The right to received information NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. The right to confidentiality c. The right to retain legal counsel d. The right to an independent panel review, if certified e. The right to select the nurse assigned to their care ANS: A, B, C, D Patients’ rights should be discussed shortly after admission. Patients have rights related to receiving information, confidentiality, to retain legal counsel and to an independent review of their certification status. Patients do not have a right to a private room or selecting which nurse will provide care. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment 3. A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to which of the following: (Select all that apply.) a. Source of income b. Family and support systems c. Housing adequacy and stability d. Early psychosocial development e. Substance abuse history and current use ANS: A, B, C, E Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 4. Which statements by patients diagnosed with a serious mental illness best demonstrate NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. “Science has made significant improvements in drugs for mental illness, so now many people may live in their communities.” b. “There’s now a better selection of less restrictive treatment options available in communities to care for people with mental illness.” c. “National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore.” d. “Most psychiatric institutions were closed because of serious violations of patients’ rights and unsafe conditions.” e. “Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.” ANS: A, B, E The community is a less restrictive alternative than hospitals for treatment of people with mental illness. Funding for treatment of mental illness remains largely inadequate, but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care 7. A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns the following: · The patient wants to attend an activity group at the mental health outreach centre · The patient is worried about being able to pay for the therapy · The patient does not know how to get from home to the outreach centre · The patient has an appointment to have blood work at the same time an activity group meets · The patient wants to attend services at a church that is about a kilometre from the patient’s home Which tasks are part of the role of a community mental health nurse? (Select all that apply.) NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. Rearranging conflicting care appointments b. Negotiating the cost of therapy for the patient c. Arranging transportation to the outreach centre d. Accompanying the patient to church services weekly e. Monitoring to ensure the patient’s basic needs are met ANS: A, C, E The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment Chapter 04: Relevant Theories and Therapies for Nursing Practice Halter: Varcarolis’s Canadian Psychiatric Mental Health Nursing, 2nd Edition MULTIPLE CHOICE 1. A parent says, “My 2-year-old child refuses toilet training and shouts “No!” when given directions. What do you think is the challenge for the child in this situation?” Select the nurse’s best reply. a. “Your child needs firmer control. It is important to set limits now.” b. “This is normal for your child’s age and developmental stage. The child is striving for independence.” c. “There may be developmental problems. Most children are toilet trained by age 2.” d. “Some undesirable attitudes are developing. A child psychologist can help you develop a plan.” ANS: B This behaviour is typical of a child around the age of 2 years, whose developmental task is to develop NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ autonomy. The distracters indicate the child’s behaviour is abnormal. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ ANS: C NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ The superego contains the “should nots,” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviours. The id is the centre 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 retrieved easily with conscious effort. This item relates to an audience response question. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 6. A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Humility d. Self-esteem ANS: D The individual will be living up to the ego ideal, which will result in positive feelings about self rather than feelings of inferiority. The other options are incorrect because each represents a negative feeling. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 7. An adult says, “I never know the answers,” and “My opinion doesn’t count.” Which psychosocial crisis was unsuccessfully resolved for this adult? a. Initiative versus guilt b. Trust versus mistrust c. Autonomy versus shame and doubt d. Generativity versus self-absorption NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ ANS: C NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ Wheels, coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ taking care of myself to volunteer to help others.” Which developmental task do these statements contrast? a. Trust and mistrust b. Intimacy and isolation c. Industry and inferiority d. Generativity and self- absorption ANS: D Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviours that would be contrasted are emotional isolation and the ability to love and commit oneself. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. Although ego defence mechanisms and security operations are mainly unconscious and designed to relieve anxiety, the major difference is which of the following? a. Defence mechanisms are intrapsychic and not observable. b. Defence mechanisms cause arrested personal development. c. Security operations are masterminded by the id and superego. d. Security operations address interpersonal relationship activities. ANS: D Sullivan’s theory explains that security operations are interpersonal relationship activities designed to relieve anxiety. Because they are interpersonal, they are observable. Defence mechanisms are unconscious and automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviours. Frequent, continued use of many defence mechanisms often results in reality distortion and NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ interference with healthy adjustment and emotional development. Occasional use of defence mechanisms is normal and does not markedly interfere with development. Security operations are ego-centred. This item relates to an audience response question. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Analysis MSC: Client Needs: Health Promotion and Maintenance 13. A student nurse says, “I don’t need to interact with my patients. I learn what I need to know by observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to this student by responding with which of the following? a. “Interactions are required in order to help you develop therapeutic communication skills.” b. “Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills.” c. “Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions.” d. “It is important to pay attention to patients’ behavioural changes because these signify adjustments in personality.” ANS: B The nurse’s role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan’s theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The other distracters relate to Maslow and behavioural theory. This item relates to an audience response question. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. Encourage the child to observe others talking. b. Include the child in small group activities. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques. ANS: C Operant conditioning involves giving positive reinforcement for a desired behaviour. Treats are rewards and reinforce speech through positive reinforcement. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 17. The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I have done differently to prevent this illness?” Select the nurse’s best response. a. “Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance.” b. “Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child’s illness.” c. “There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment.” d. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.” ANS: B Patients and families need reassurance that the major mental disorders are biological in origin and are not the “fault” of parents. The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response should address these feelings as well as provide information. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ DIF: Cognitive Level: Apply (Application) NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on which of the following? a. Rewarding desired behaviours b. Use of own capacities c. Changing the patient’s self-concept d. Administering medications to relieve anxiety ANS: B The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. The theory centres on helping the patient learn to use his or her capacities to live more productively. The distracters apply to theories of cognitive, behavioural, and biological therapy. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 19. A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behaviour therapy b. Psychodynamic therapy c. Cognitive-behavioural therapy d. Operant conditioning ANS: B The techniques are aspects of psychodynamic therapy. The distracters use other techniques. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. Consider this comment from a therapist: “The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker? NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. Psychoanalysis c. Behaviour modification d. Interpersonal psychotherapy ANS: D Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis would call for a long period of exploration of unconscious material. Behaviour modification would focus on changing a behaviour rather than helping the patient understand what is going on in his life. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 23. Which technique is most applicable to aversion therapy? a. Punishment b. Desensitization c. Role modeling d. Positive reinforcement ANS: A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behaviour with a noxious stimulus, punishment, and avoidance training. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 24. A patient says to the nurse, “My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child.” Which term applies to the patient’s comment? a. Superego b. Transference c. Reality testing NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ d. Counter-transference NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ ANS: B Transference refers to feelings a patient has toward the health care worker that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 25. A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient? a. Psychoanalysis b. Milieu therapy c. Systematic desensitization d. Short-term dynamic therapy ANS: C Systematic desensitization is a type of therapy aimed at extinguishing a specific behaviour, such as those associated with a fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental factors. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 26. Which approach would be best to provide therapy in which peers as well as staff have a voice in determining patients’ privileges and psychoeducational topics? a. Milieu therapy b. Cognitive therapy c. Short-term dynamic therapy d. Systematic desensitization ANS: A NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. “I have a plan for my life. If I follow it, everything will be fine.” NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ c. “I’m successful because I work hard. No one has ever given me anything.” d. “My favourite leisure is walking on the beach, hearing soft sounds of rolling waves.” ANS: D The self-actualized personality is associated with high productivity and enjoyment of life. Self-actualized persons experience pleasure in being alone and an ability to reflect on events. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 32. A nurse and patient discuss a problem the patient has kept secret for many years. Afterward, the patient says, “I feel so relieved that I finally told somebody.” Which term best describes the patient’s feeling? a. Catharsis b. Superego c. Cognitive distortion d. Counter-transference ANS: A Freud initially used talk therapy, known as the cathartic method. Today we refer to catharsis as “getting things off our chests.” The superego represents the moral component of personality. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 33. Which patient is the best candidate for brief psychodynamic therapy? a. An accountant with a loving family and successful career who was involved in a short extramarital affair b. An adult with a long history of major depression who was charged with driving under the influence (DUI) c. A woman with a history of borderline personality disorder who recently cut both wrists NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ d. An adult male recently diagnosed with anorexia nervosa NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ ANS: B, C, E Peplau described the science and art of professional nursing practice. The art component of nursing consists of the care, compassion, and advocacy nurses provide to enhance patient comfort and well- being. The science component of nursing involves the application of knowledge to understand a broad range of human problems and psychosocial phenomena, intervening to relieve patients’ suffering and promote growth. See related audience response question. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity Chapter 05: Understanding Responses to Stress Halter: Varcarolis’s Canadian Psychiatric Mental Health Nursing, 2nd Edition MULTIPLE CHOICE 1. The adult child of a patient diagnosed with major depression asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge about psychoneuroimmunology? a. “It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.” b. “You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.” c. “So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.” d. “Negative emotions and stress may interfere with the body’s ability to protect itself and can increase the likelihood of infection.” ANS: D This answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to infections. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother’s baseline. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 2. A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently, the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize? a. Engaging in activity without using any supplemental oxygen b. Sleeping comfortably and soundly, without respiratory distress c. Feeling relaxed and taking regular deep breaths when leaving home d. Having a younger, healthier body that knows no exercise limitations ANS: C The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen), or restrict her quality of life. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 3. A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. Which of the following rationales should the nurse use when presenting this plan to the treatment team? a. Exercise can lead to protection from the harmful effects of stress. b. Exercise prevents damage from overstimulation of the sympathetic nervous system. c. Exercise detoxifies the body by removing metabolic wastes and other toxins. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ d. Exercise improves mood stability for patients with bipolar disorders. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ d. Tell the patient, “Relax by spending more time playing with your pet.” ANS: B The patient is responding to stress with increased arousal of the sympathetic nervous system, as evidenced by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system’s arousal, normalizing these vital-sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 6. According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person’s stress status and coping abilities? a. A person who has been assigned more responsibility at work b. A parent whose job required relocation to a different city c. A person returning to college after an employer ceased operations d. A man who recently separated from his wife because of marital problems ANS: C A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. A patient newly diagnosed as HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient says, “I used to go to church and I was in my best health then. Maybe I should start going to church again.” Which response will the nurse offer? NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ a. “Religion does not usually affect health, but you were younger and stronger then.” NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ b. “Contact with supportive people at church might help, but religion itself is not especially helpful.” c. “Studies show that spiritual practices can enhance immune system function and coping abilities.” d. “Going to church would expose you to many potential infections. Let’s think about some other options.” ANS: C Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient’s preferences regarding health management. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 8. When a nurse asks a newly admitted patient to describe social supports, the patient says, “My parents died last year, and I have no family. I am newly divorced, and my former in-laws blame me. I don’t have many friends because most people my age just want to go out drinking.” Which action will the nurse apply? a. Advise the patient that being so particular about potential friends reduces social contact. b. Suggest using the Internet as a way to find supportive others with similar values. c. Encourage the patient to begin dating again, perhaps with members of the church. d. Discuss how divorce support groups could increase coping and social support. ANS: D High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person’s coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than help her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable people. NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight-or-flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 11. A patient tells the nurse, “I know that I should reduce the stress in my life, but I have no idea where to start.” What would be the best initial nursing response? a. “Physical exercise works to elevate mood and reduce anxiety.” b. “Reading about stress and how to manage it might be a good place to start.” c. “Why not start by learning to meditate? That technique will cover everything.” d. “Let’s talk about what is going on in your life and then look at possible options.” ANS: D In this case, the nurse lacks information about what stressors the patient is coping with, and what coping skills the patient already possesses. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. A patient tells the nurse, “My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking.” Which response by the nurse would support the recommendation? a. Encourage the patient to imagine being in calm circumstances. b. Provide the patient with a blank journal and guidance about journaling. c. Teach the patient to recognize, reconsider, and reframe irrational thoughts. d. Teach the patient to use instruments that give feedback about bodily functions. ANS: C Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient’s manner of thinking. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 13. A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress? a. The patient’s systolic blood pressure has changed from the 140s to the 120s mm Hg. b. The patient reports, “I feel better, and things are not bothering me as much.” c. The patient reports, “I spend more time napping or sitting quietly at home.” d. The patient’s weight decreased by 3 pounds. ANS: A Objective measures tend to be the most reliable means of gauging progress. In this case, the patient’s elevated blood pressure, an indication of the body’s physiological response to stress, has diminished. The patient’s report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient’s weight change could be a positive or negative indicator; the blood pressure change is the best answer. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Evaluation NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister’s cleverness as unimportant indicates that the patient continues to feel inferior to the sibling. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 16. A patient reports, “I am overwhelmed by stress.” Which question by the nurse would be most important to use in the initial assessment of this patient? a. “Tell me about your family history. Do you have any relatives who have problems with stress?” b. “Tell me about your exercise. How much activity do you typically get in a day?” c. “Tell me about the kinds of things you do to reduce or cope with your stress.” d. “Stress can interfere with sleep. How much did you sleep last night?” ANS: C The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously, or via maladaptive responses, such as drinking), and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful information but provide data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general). NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 17. Which scenario best demonstrates an example of eustress? a. An individual loses a beloved family pet. b. An individual prepares to take a one-week vacation to a tropical island with a group of close friends. c. An individual receives a bank notice that there were insufficient funds in his or her account for a recent rent payment. d. An individual receives notification that his or her current employer is experiencing financial problems and some workers will be terminated. ANS: B Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and is an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems. See related audience response question. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 18. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system? a. Thalamus b. Parietal lobe c. Hypothalamus d. Pituitary gland ANS: C The individual will find this experience stressful. The hypothalamus functions as the command-and- control centre when receiving stressful signals. The hypothalamus responds to signals of stress by NR MENTAL HEALTH EXAM| 2023/2024 TEST BANK QUESTIONS WITH CORRECT ANSWERS A+ engaging the autonomic nervous system. The parietal lobe is responsible for interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person’s response but would not stimulate the autonomic nervous system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 19. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience? a. Limbic system b. Peripheral nervous system c. Sympathetic nervous system d. Parasympathetic nervous system ANS: C The autonomic nervous system is comprised of the sympathetic (fight-or-flight response) and parasympathetic (relaxation response) nervous system. In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity MULTIPLE RESPONSE 1. Which changes reflect short-term physiological responses to stress? (Select all that apply.) a. Muscular tension, blood pressure, and triglycerides increase. b. Epinephrine is released, increasing heart and respiratory rates.