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Varcarolis Canadian Psychiatric Mental Health Nursing
3rd Edition By Pollard All Chapter 1 - 35

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Chaptero01: MentaloHealth and Mental Illness

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Astaffnursecompletesorientationtoapsychiatricounit.Whichoofthefollowing wouldthenurse ex
pectoas an advanced practiceintervention?
a. Conductmentalhealthassessments
b. Prescribeopsychotropicmedication
c. Establishtherapeuticrelationships
d. Individualize nursing care plans
ANSWER:J B
Prescriptive privileges are granted to master’s-
preparednursepractitionersowho havetakenspecialcoursesoonoprescribing medication;thusitoisa n
advanced-
practiceintervention.Theonursepreparedoat thebasicolevelispermittedtoperformomental healthoaossessme
nts, establishrelationships, and provide individualized care planning.

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2. Whenoaonursingstudentexpressesconcernsabouthow mental healthnurseso“loseoalltheirnursi n

gJskills,” which of the following is thebestresponse by thementalhealthnurse?
a. “Psychiatriconurses practise in safer environmentsthanotherspecialties. Nurse
-to-
patient ratiosmust beobetter becauseooftheonatureooftheopatients’ prob
lems.” .
b. “Psychiatric nurses use complex communicationoskills asowell as critical thinking to sol
veomultidimensional problems. Ioam challenged byothosesituations.”
c. “That’samisconception. Psychiatricnursesfrequentlyusehigh-
technologymonitoringoequipment andmanageocomplexintravenoustherapies.”
d. “Psychiatriconurses do not haveotoJdeal with as muchopainoandosufferingJasmedioc
al–surgicalnurses do.Thatappealstome.”
ANSWER:J B
Theopracticeoof psychiatriconursing requiresa different set ofskills frommedical–
surgicalnursing, thoughothereoisosubstantial overlap. Twoodomainsorelatespecifically toopsychiatricon
ursing: behavioural, including communication,ocoping, andeducation; and safety, covering crisis an
driskomanagement. BasicpsychosocialnursingJconceptsareocentral to psychiatricnursingJpracti ce a
ndincrease yourocompetencyas apractitioner in allclinicalsettings.
WhateversettingJyouchoose to workoin, youwillhave theopportunity to improveothe livesofpeople w
ho areoexperiencingJmentalillness as an additionalchallenge tootheirohealth.
Yourexperienceoin theJmentalhealthonursing rotation canhelpoyougaininsightointooyourselfandgre atl
yoincreaseyouroinsightintoothe experiences of others. Thispart of nursingoeducationcanprovidegouidel
inesforoandotheopportunity toolearnonew skillsoforodealingJwithoavarietyofchallenging behavioours. Psy
chosocialpainandsufferingareoas real as physicalpainandsuffering.

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3. Whenoa new bill introduced in Parliament reduces fundingJfor careoofopeopleowith mental illness, agoro
up of people withmildomentalillnessowriteJlettersoto theirJelectedorepresentativesinoopposition toJ theol
egislationforallopeoplewithmentalillness. Whichoroledoesthisactionoportray?
a. Recovery
b. Self-care
c. Advocacy
d. Socialoaction
ANSWER:J C
Anadvocatedefends orJassertsanother’socause, particularlywhenotheotheropersonolackstheoabilityotoo
do that for himselforoherself. Onacommunityscale, advocacyoincludesopoliticalactivity, public speaki
ng, andpublication inotheinterest ofoimproving theohumanocondition. Sincefundingois necessoary to de
liver qualityoprogramming for peoplewithmentalillness, the letter-
writing campaign advocates for the cause for all people with mental illness.

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4. Which ofthe followingJhasobeenoidentified asoasignificant trendthatwillaffect thefutureoofpsychi atr

icmentalhealthnursingJin Canada?
a. Decreaseinthe agingJpopulation
b. Increaseinculturalodiversity
c. Role ofthe advanced-practiceonurse
d. Shortageofophysiciansoin ruralandourbanareas
ANSWER:J B
Fourosignificantotrendsoha vTe Eb eSeTn BidAe N
n tKi fiSe E
d Lt hLa tEwRil. l Ca fOf eMc t the futureoofopsychiatricomentalohealt
hnursingJinCanada; theseoincludeJan agingopopulation, anincreasein culturaldiversity, expanding te
chnology, andanincreasedawarenessoftheimpactofthedeterminantsofhealthonom entalillness.

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5. Which assessment findingJmost clearly indicates that a patient mayobe experiencingoa mentalillness
?
a. Theopatientoreports occasionalsleeplessnessand anxiety.
b. Theopatientoreports aconsistentlysad, discouraged, andhopelessomood.
c. Theopatient is ableoto describetheodifferenceJbetweeno“asif” and“forreal.”
d. Theopatientperceives difficultyomaking adecisionaboutwhether to changeojobs.
ANSWER:J B
Theocorrect response describesoaomoodalteration, which reflectsomental illness. Alterations incognit io
n, mood,oor behaviourothat arecoupled withsignificant distressoand impaired functioningJcharacterize
mental illness. The distracters describe behaviours thatoareomentallyohealthy orJwithinothe usualscope o
f human experience.

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6. Which finding best indicatesothat the goal “Demonstrates mentallyohealthy behaviour” wasachieved?
a. A patient seesoself as capable of achievingoideals and meeting demands.
b. A patientJbehaves withoutJconsideringJtheconsequences ofopersonal actions.
c. Apatient aggressivelymeetsownoneedsowithoutconsideringJtheorightsofothers.
d. Apatient seeksohelp fromotherswhenassuming responsibility for majoroareasofownl if
e.
ANSWER:J A
The correctoresponse describes an adaptive,ohealthy behaviour. The WHO definesomental health as “
a state ofwell-
beingJin which eachoindividual isJable toorealize hisoor heroownopotential, copeowith theonormal stresoses
of life, workJproductivelyand fruitfully, and makeoa contribution to theocommunity” (World He alth
Organization, 2010).The distractersdescribemaladaptivebehaviours.

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7. Anurseencounters anounfamiliarJpsychiatricodisorder on aonewpatient’s admissionoform. Whichres ou

rceshouldthenurseconsult todeterminecriteria used toestablish thisdiagnosis?
a. International Statistical Classification ofoDiseases and Related Health Problems (ICD-10)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. Abehaviouralohealthreferenceomanual
d. NurseOneoonline
ANSWER:J B
The DSM-
5ogivesotheocrite T
r iaEuSsT
e dBtAo Nd K
i a gS nEoLs eLeEa R
c h.mC eOnMt a l disorder. TheodistractersomayonotJcontainodiagnostioc
criteriafor apsychiatricillness.

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8. Anursewants to findaodescription of diagnosticocriteriaforoanxietydisorders. Whichresourcewouldoh

ave theomost complete information?
a. NursingoOutcomes Classification (NOC)
b. Diagnostic and Statistical Manual of Mental DisordersJ(DSM-5)
c. The ANA’s Psychiatric–Mental Health Nursing Scope andoStandards of Practice
d. International Statistical Classification of Diseases and Related Health Problems(ICD-10)
ANSWER:J B
The DSM-
5 details theodiagnostic criteria foropsychiatric clinical conditions andois theoofficialguideoforodiagnosi ng
psychiatricdisorders. Theotheroreferences areogood resourcesobut do notdefinethe diagnostic cri teria.

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9. Whichoindividual is demonstrating the highestJlevel of resilience?

a. Onewhoisableto repress stressors.
b. OnewhobecomesdepressedafterJtheodeath ofoaspouse.

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c. Onewhoolives inJaJshelterJforo2 yearsoafterJhisoorJher homeisdestroyed byofire.
d. Onewhoisableto connect withtheirosupportosystemsandosecurethe resourcestheyon
eed toobe well.
ANSWER:J D
Resilienceoisoclosely associated with the process of adapting and helpsopeople facing tragedies, loss, t raum
a, andoseverestress. ItJis aoprocessandoutcome of complexoculturalosystems rather thansimply anoindiv
idual’soability to overcomeoadversity. Repression and depressionoare unhealthy. Livingoinoa shelter for 2
yearsshows a failureotoomoveoforwardoafterJa tragedy. Seeorelatedoaudience responseoquestion.

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10. Completeothisoanalogy. NANDA: clinical judgement; NIC:

a. Patientooutcomes
b. NursingJactions
c. Diagnoses
d. Symptoms
ANSWER:J B
Analogiesoshowparallelrelationships.NANDA, theoNorth AmericanoNursing DiagnosisoAssociati o
n, identifies diagnostic statements regarding human responses to actual or potentialhealth probleoms
.These statements representclinical judgements.NIC (Nursing Interventions Classification) identifies acti
onsoprovidedbynursesthatenhancepatientoutcomes.Nursingocare activitiesmaybedirector i ndirec
t.

DIF: TOP: Nursing Process: Evaluation

Cognitive Level: AnaTl yE
z eS(A
TnBaAlyNsiK
s) SELLER.COM
MSC: Client Needs:Safe Effective CareoEnvironment

11. Acollegestudentosaid, “Mostofotheotime I’mohappyoandofeelgoodoaboutmyself. Ihave

learnedthat what Ioget outofsomethingisproportional to theoeffort Ioput intoit.” According to the Epp
classification, whichoquadrantoutcomeshouldtheJnurseselect?
a. Optimalmentalhealthowithmentalillness
b. Pooromentalohealthowithomentaloillness
c. Optimalmentalhealthwithoutomentalillness
d. Poor mentalhealthwithoutmentalillness
ANSWER:J C
Theostudentisohappyandhasoanoadequateself-concept. Thestudentois reality-
oriented,oworks effectively, and has control overohis or heroown behaviour. Mental health doesonot me an
thatapersonisalwayshappy.

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12. WhichdisorderJis aoculture-boundosyndrome?

a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depression

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ANSWER:J C
Culture-
boundsyndromesoccuroin specificosociocultural contextsJandareJeasilyorecognizedbypeople inot h
ose cultures. A syndrome recognized in parts of Southeast oAsia is runningoamok, in which aopersoono(us
uallyamale)orunsaroundengaging in furious, almostindiscriminateviolentobehaviour.

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13. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies which ofthe following?
a. Deviantbehaviours
b. Presentodisability orodistress
c. Peopleowithmentaldisorders
d. Mentaldisordersopeoplehave
ANSWER:J D
The DSM-
5 classifies disorderspeopleohaveratherothanopeopleothemselves. Theoterminology of thetool reflecotsot
hisdistinction by referringJto individuals witha disorder ratherothan as a “schizophrenic” or “alcoholi
c,” forJexample. Deviant behaviourois notogenerally considered amentalodisorder. Presentdisability o
rodistress is onlyoneaspect ofthediagnosis.

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14. Avisitoroat acommunityhealthfairoaskstheJnurse,“What is theJmost prevalentmentaldisord er

in Canada?” Select theonurse’sobest response.
a. Schizophrenia .
b. Bipolar disorder
c. Generalized anxiety disorder
d. MajorJdepression
ANSWER:J D
Theoprevalence of majorJdepressivedisorderoiso47%, andoapproximatelyo11.3%oofoadults willexperi enc
eomajordepressionoatosome timeintheir lives.Theprevalence ofschizophrenia is 1.3% per year
. Theoprevalence ofbipolarodisorderJis 1.5%.Theoprevalenceforogeneralizedanxietyodisorderois about 2
.6%oannually.

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15. Whichoof the following represents anooutcome domain of the NursingoOutcomes Classificoa
tion(NOS)?
a. Mental health
b. Perceivedhealth
c. Chronicillness
d. Mental illness
ANSWER:J B
Oneoof the seven outcome domains isoperceived health; the otherJsix are functional health,physiologic hea lth,
psychosocial health, health knowledge, familyohealth, and community health.

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DIF: Cognitive Level: Understand(Comprehension)
TOP: Nursing Process: Assessment MSC: ClientoNeeds:HealthPromotion andMaintenance

16. A patient’s relationships areointense and unstable. The patient initially idealizesotheosignificantother a nd t
hendevalues him orJher, resultingoin frequent feelingsoof emptiness. Thispatientowill benefit fro minte
rventionstoodevelopowhichaspectofmental health?
a. Effectiveness in work
b. Communicationskills
c. Productiveoactivities
d. Fulfilling relationships
ANSWER:J D
Theoinformationoprovidedcentres onrelationships withoothersthatoaredescribed as intenseand un stab
le. The relationships of mentally healthy individuals areostable,osatisfying, and socially integrate
d.Theyhaverichsocialrelationships.Dataarenotpresenttodescribeoworkeffectiveness,commun icationo
skills, or activities.

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17. Whichbeliefwillbestosupportanurse’sefforts toprovidepatient advocacyduringJamulti di

sciplinarypatientcareplanningosession?
a. All mental illnesses areoculturally determined.
b. Schizophrenia and bipolar disorder areocross-cultural disorders.
c. Symptomsoofomental disordersoareunchangedfromocultureotooculture.
d. Assessmentfindingsoinomentalodisorders reflectaperson’sculturalpatterns.
.
ANSWER:J D
A nurse whoounderstands thatoaopatient’s symptoms areoinfluencedoby cultureowill beoableotoadvocoateo
forthepatient to aogreaterodegreethananursewhoobelievesthatcultureoisoof little relevance. The dist
racters are untrue statements.

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18. Anurse is part of amultidisciplinary teamworkingJwithgroups of depressedpatients. Half thepati en

ts receivesupportiveinterventionsand antidepressantmedication. TheotherJhalfreceivesonly me
dication. Theteammeasuresoutcomesfor eachgroup. Whichtype of study is evident?
a. Incidence
b. Prevalence
c. Comorbidity
d. Clinical epidemiology
ANSWER:J D
Clinicaloepidemiologyois a broad field thatoaddresses studiesoofotheJnaturalohistory (or what happensoif the
reoisono treatment andotheproblem is leftoto runitscourse) of anoillness, studies of diagnosticoscreoeningJt
ests, andobservational andexperimentalstudies of interventions usedtotreat peoplewithotheillnessoors
ymptoms. PrevalenceJreferstonumbersofnewcases.
ComorbidityJrefers to havingomoreothan oneomental disorder at a time. IncidenceJrefers toothenumber o fn
ewcases ofmental disordersinahealthy populationowithinagivenperiod.

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19. Theospouseoof apatientdiagnosedwithschizophreniasays, “Idon’t understand how eventsfrom c hi

ldhoodhaveoanythingJto do withothisdisabling illness.” Whichoresponseobytheonursewill bestohelpothes
pouseounderstandthe causeofthisdisorder?
a. “Psychologicalstressisotheobasisofmost mentaldisorders.”
b. “Thisillnessresultsfromdevelopmentalfactorsorather thanstress.”
c. “Research suggests that this conditionomore likely has a biological basis.”
d. “ItomustobeofrustratingJforyouthat yourspouseoissicksomuch ofthe time.”
ANSWER:J C
Manyoof themost prevalent anddisabling mentaldisordershavestrong biological influences.Genet ics
isoonlyonepartofbiologicalfactors.Empathydoes notaddressoincreasingthespouse’slevel of knowl
edgeabout thecauseofthedisorder. Theotherodistractersare not established facts.

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20. Acategory5tornadooccurredoinoacommunityof400 people,oresulting inthedestructionoofmanyh o

mesand businesses. In the 2 yearsafter thisdisaster, 140 individualsowerediagnosedwith post-
traumatic stress disordero(PTSD). Whichtermbestapplies to theseJnewlydiagnosedcases?
a. Prevalence
b. Comorbidity
c. Incidence .
d. Clinicalepidemiology
ANSWER:J C
Incidence refers to the number of new cases of mental disorders in a healthy populationJwithina given peri
od of time. Prevalence describes the total number of cases, new and existing, inoa given population during a
specific period of time, regardless of when they became ill. Clinical epidemiologyJis a broad fieldothatoaddres
ses whatohappens afteropeople with illnesses areoseenoby clinical careoproviders. Comorbidityorefers tohavi
ngJmoreothanonementaldisorder at atime.

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21. Mostpsychiatricdisordersare theresult of which of theofollowing?

a. Childhoodtrauma
b. Adverseolife events
c. Multiple defective genes
d. Chronicmedicalconditions
ANSWER:J C

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Most psychiatricdisordersaretheoresult of multipleomutated or defectiveogenes, each of whichinoco mb
inationomaycontribute to thedisorder. Althoughdisordersomay be caused bychildhoodtrauma, advers
eoliveevents, andchronicmedicalconditions,otheyoarenot theocause of theomajority of psychiatricdisord
ers.

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22. Select theobestoresponse for theonurseJwho receives aquestionfrom anotherhealthoprofessi on

al seeking toounderstand the difference between aoDiagnostic and Statistical Manual of Mental Disor
ders(DSM-5)diagnosisoandaonursing diagnosis.
a. “There isonoofunctional differenceJbetweenothe two. Bothidentifyhumandiso
rders.”
b. “The DSM-
5 diagnosis disregards culture, whereas the nursing diagnosis takesculture into acco
unt.”
c. “The DSM-
5diagnosisdescribescausesofdisorders,whereasoa nursing diagnosisdoesnotexplore
etiology.”
d. “The DSM-
5diagnosisguidesmedicaltreatment,owhereasotheonursingdiagnosisoffersaframewor
koforoidentifying interventionsforJissuesapatient is experiencing.”
ANSWER: D
Theomedicaldiagnosis is concernedwiththepatient’sodiseasestate,ocauses, andcures,owhereasJthen
ursing diagnosisofocuses on theopatient’soresponse to stressoandpossiblecaring interventions. Botoh t
ools considerculture. The DSM-
5 is multiaxial. Nursing diagnoses alsoconsider potential problems.
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23. WhichonursinginterventionbelowispartoftheJscopeofanoadvanced-
practiceopsychiatricmentalhealthnurseoonly?
a. Coordinationoofocare
b. Healthteaching
c. Milieutherapy
d. Psychotherapy
ANSWER: D
Psychotherapyoispartofthescope ofpracticeofanoadvanced-
practicenurse. Thedistractersareowithinastaffnurse’sscopeoof practice.

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MULTIPLE RESPONSE

1. An experienced nurse says to a new graduate, “Whenoyou’ve practiced as long as I have, youinstantl yok
nowhow tootake careoof psychoticopatients.” Whatinformationoshouldtheonew graduateconsider whe
n analyzing this comment? (Select all that apply.)
a. Theoexperiencednursemayneed to be reminded of theoimportance of standardizedclass ifi
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cations.

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b. Neworesearchfindingsshould beointegrated continuously intooanurse’spractice to provid
e the most effectiveocare.
c. Experienceoprovidesmentalhealth nursesowiththeoessentialtoolsandskillsneededforJef f
ective professional practice.
d. Experiencedopsychiatricnursesohaveolearned thebestoways tocareforJmentallyillpatien ts
through trial and error.
e. An intuitive sense of patients’ needs guides effective psychiatric nurses.
ANSWER: A, B
Evidence-
informedpracticeoinvolvesousingresearch findings and standardsoof careoto providethe most effecti ve
nursing care. Evidence is continuously emerging, so nurses cannot orely solely on experience. The effectiv
enursealsomaintainsorespect for eachpatient asoan individual. Overgeneralizationocompromisesothat
perspective. Intuition andtrialand errorJareunsystematicapproaches tocare.

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P: Nursing Process: Diagnosis/Analysis
MSC: Client Needs: SafeoEffectiveoCareoEnvironment

2. Whichofindings are signs of a person who isomentally healthy? (Select all that apply.)
a. Says, “I have some weaknesses, but Iofeel I’m important to my family andofriends.”
b. Adheresostrictly to religious beliefs of parents and family of origin
c. Spends all holidays alone watching old movies on television
d. Considerspastexperienceswhenodecidingabout theofuture
e. Experiencesfeelings ofconflictJrelated to changingjobs
ANSWER: A, D, E
Mental healthois a state of T wEellS-
bTeBinAgNinKS
whEiL
chLeEaR
ch.iC
ndOiM
vidual is able to realizehis oroheroown potential, copewiththe normalstress es
of life, workproductively, andomakeacontributiontotheocommunity. Mentalhealthprovidesopeopl ewit
hothe capacityforrational thinking, communicationoskills, learning,Jemotional growth,oresilience, andsel
f-esteem.

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3. Apatient inotheemergency departmentsays,“VoicesosaysomeoneisostalkingJme. TheywantJto killom

eobecause Idevelopedacureforcancer. IhaveoaknifeJandwillostabanyonewhois athreat.” Whichasp
ectsoftheopatient’s mentalhealthhavethegreatest andmostimmediateconcernoto thenurse
? (Select all that apply.)
a. Happiness
b. Appraisaloof reality
c. Controloverbehaviour
d. Effectiveness in work
e. Healthy self-concept
ANSWER: B, C, E

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Theoaspects of mental health of greatest concernoaretheopatient’s appraisal of andcontroloverbehav iou
r. TheirJappraisal of reality isoinaccurate. There are auditory hallucinations, delusionsof persecutio n, ando
delusions of grandeur. Inoaddition, theopatient’s control overbehaviour is tenuous, asoevidencoed bythe
planto stabanyoneowhoseemsthreatening.Ahealthy
self-
concept is lacking, as evidenced by theodelusions of grandeur. Dataarenotopresentoto suggestJthaott
heoother aspects ofomental healtho(happinessoandoeffectiveness inowork) areoofimmediateoconceorn.

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Chapter 02: Historical Overview of Psychiatric MentaloHealth Nursing

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Whichoof the followingJhas largely been excluded from CanadianonursingJhistory?

a. Femaleonurses’ role in psychiatric nursing
b. Mental health field of study
c. Male attendants’ role in institutions
d. Generalist registered nurses’ role
ANSWER:J B
WhileothereJhasobeenomuchohistoricaloanalysis of psychiatric mentalhealthonursing inoEngland,Hollan d,o
andtheUnited States, Canadiannursing historyhaslargelyexcludedtheomentalhealthfield.

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2. Whichisotrueoofasylums?
a. Short-termostays
b. Cognitive-behavioural therapy experts
c. Place where people with mentaloillnessocould be cured
d. Middleoto uppersocioeconomicstatuspatientsowithomentaloillnessreceivedtreat
ment
ANSWE .
R: C
Asylums, designed toobe retreats from society,owereobuilt with the hopeothat with earlyointervention aondo
severalomonthsooforest, peopleowithmentaloillnesscouldobe cured. Generally,Jpeople inoasylums werep
atientsfromalowerosocioeconomicstatusandthosewithout family.Cognitive-
behaviouralotherapy did not occuroin asylums, and the stays were usually long term.

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3. Whichooftheofollowingorepresentedoaseventeenth-toJeighteenth-
centuryosocietal viewofpeoplewithmentalillness?
a. Restraintsowerenot to beousedonmentally illpatients.
b. ThoseowithmentalillnesswereoimmuneJto humandiscomforts.
c. Informedoconsent wasrequiredpriorotooadmissionto an asylum.
d. Patientoneglect rarely if ever occurred in asylums.
ANSWER:J B
Patients inthese settingswereooftenochainedoorocaged, andcrueltyoroneglectwas notuncommon. Thi
stypeoftreatmentreflectedthesocietalviewothatpeopleowith mentalillnesswereobestialoroless human
inonatureoand thereforerequiredodisciplineoandwereimmuneotoohumanodiscomfortssuchoas hunger or
cold. Informedconsentwas to bearequirement oftheJveryodistant future.

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4. Thenurse isocaring foroapatient in anoasylum inthemid-

1800s in Canada. What wouldthenurseoexpect to implement?
a. Assisting with eating and dressing
b. Groupotherapyinterventions
c. Electroconvulsive therapy(ECT)
d. Antipsychoticmedicationadministration
ANSWER:J A
Inomany asylums, a large population of peopleoreceived only minimal custodial care—
assistance in performingJthe basic daily necessities of life, suchoas dressing, eating, using a toilet, walk ing,
etc. There wereoveryfewomedicationsoused inothe 1800soandothereowerenooformal group therapiesoroEC
T treatments.

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5. Whowasinstrumental inolobbyingJfor theofirstmentalhealthohospitaloin the UnitedoStates andJfor ref or

min Britishand Canadianinstitutions?
a. Michel Foucault
b. Dorothea Dix
c. TheoGreyNuns
d. Philippe Pinel
ANSWER:J B
Duringoan encounteroat a Bostonjail, Dorothea Dixwasshocked to witnessthedegrading treatmeonto
ofawoman withmentalillnesswhoowasimprisonedthere.Passionateaboutsocialreform, sheob egan
advocatiTnE
gJS
foTrB
thAe Nim
KpSrE
ovLedLJE
trR
ea.tm
CeOnM
tJand public care of people withomental illness. Dix m etowith
manypoliticiansandeventhePopeto pushheroagendaoforward.Ultimately, shewasinfluentoial in lobb
ying for thefirstpublicmentalhospital in the United Statesandfor reform in Britishand Canadianin
stitutions.MichelFoucaultwasaFrenchphilosopher.PhilippePinelwasaFrenchophy sician. The Gr
ey Nunsowereoearly providers of careoforpeopleowithmentalillness.

DIF: CognitiveLevel: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

6. TheofirstasyluminCanadawasinwhichoftheofollowingJprovinces?
a. Alberta
b. Québec
c. Ontario
d. British Columbia
ANSWER:J B
Beauport,thefirstasylumin whatowouldosoonbecomeoCanada, wasopenedoin QuébecJin1845.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

7. ThefirstJpsychiatriconurseotrainingoprogramoinoCanada wasoin whichoof thefollowingJprovin

ces?

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a. Alberta
b. Québec
c. Ontario
d. British Columbia
ANSWER:J C
In1888,RockwoodAsyluminoKingston,Ontario,becameotheofirst psychiatricoinstitutioninCana d
atooopenatrainingoprogram for nurses.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

8. Theoexclusionofmalesfromattending psychiatric nurseotraining programshinderedwhichofthefo ll

owing?
a. Theoavailability of studentsoto enterJtheotraining program
b. Theoabilityoofinstitutionsto maintainenoughtrainednursingJstaff
c. Theorecognitionofthe importanceofnursingoknowledgeoandskills
d. Theostatus of femalenurses bylowering their status
ANSWER:J C
Consistentowithosocietal beliefs of the timeoaboutowomen’soinnateocaringcapacity, the trainingwasoof fer
ed only to females. Thisoexclusion of males fromtheoprogramhinderedtherecognition of the imoporta
nceoofonursing knowledge and skills,oasowell as loweringJthe status of male attendantsoatothe timoe.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity
.
9. TheoCanadianoNational AssociationoofoTrained Nurseswasestablished in whichoofthe
followingJyears?
a. 1898
b. 1908
c. 1918
d. 1928
ANSWER:J B
In theJearlypart of theotwentiethocentury,onurses’ lackoofocontrol overotheiroownoprofessionobeganoto shift
withchangesoto nursingJeducationomodelsandblossoming politicaloadvocacybynursinggroupsoacross
Canada, particularlywith the formation of the CanadianoNational AssociationoofoTrainedoNurs es in 19
08.

DIF:
Cognitive Level: Understand(Comprehension) TOP: Nu
rsing Process: Planning/Outcomes IdentificationMSC:
Client Needs: Psychosocial Integrity

10. Whichwasinstrumental in theoestablishment of apsychiatryrotation to thenursing curri cu

lumof Easternoand Atlantic Canada?
a. Dorothea Dix
b. Theo“WeiroReport”
c. TheoCanadianoNursesoAssociation
d. TheoCanadian Medical Association

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ANSWER:J B
Withthesupport ofnurseleaderslikeNettieoFiddler andthepublication oftheJ“Weir Report,”moreogenera
listhospitalprogramsbeganaddingapsychiatryrotationtothecurriculum.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingProcess: EvaluationMSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. Whicharehistoricalapproachesotoocaring for peopleowithmentalillnessfromoIndigenouspeopl

e’s perspective? (Select all that apply.)
a. Sweat lodges
b. Restraintoandoconfinement
c. Sundance
d. Potlatch
e. Abandonment
ANSWER: A, C, D
Canada’s Indigenousopeoplesohad a varietyofoapproaches toJcaring for peopleowithmentalJillness
. Mostowereoholistic—treating mind, body, andosoul—
andincludedsweatolodges,animistic charms, potlatch,oandSundance.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

2. Bytheoend of theJnineteenthocentury, the newfield ofpsychiatry wasobeingJchallenged tooprovideoa

medical cure forTmEenStT alBiA
llnNeK
ssS
.JE
WLhiLcE
hRexp. C
erOim
Mental treatments wereoused at that
time? (Select all that apply.)
a. Leeching
b. Hydrotherapy
c. Electroconvulsive therapy(ECT)
d. Insulinshocktreatment
e. Milieu management therapy
ANSWER: A, B, D
Sincethereowereofewomedicationsavailableother thanheavilyoalcohol-
based sedatives, doctorsusedmanyexperimental treatments—
for example, leeching (usingbloodsucking worms), spinning(tyingJthe patient tooa chairoandspinning
it forJhours),hydrotherapy(forcedbaths), and insulinshockJtreatment(injectionsooflargedosesof in
sulintooproducedailycomasoveroseveralweeks).ECTwas notintroduceduntilthemid-
twentiethcentury.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientNeeds:Psychosocial Integrity

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Chapter 03: Overview of Psychiatric MentaloHealthoNursingoCare WithinoVariousSettings

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Inpatienthospitalizationfor personswithmentalillness is generally reservedfor which oftheJfollow in

gopatients?
a. Patientswhopresentaocleardangerotoselforoothers
b. Patientswhooarenoncompliantwithomedicationoatohome
c. Patientswhoohaveolimitedosupport systems in theJcommunity
d. Patientswhoodevelopnew symptomsduring thecourse of an illness
ANSWER: A
Hospitalization is justifiedwhenthe patient is aodanger tooselfoorJothers or is unableoto meethis or h er
basicneeds, placingtheoindividual at imminentrisk of harmingJself. Thedistractersdonot necessarily
describepatientswhorequireinpatienttreatment.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs: SafeoEffectiveoCareoEnvironment

2. Apatientwashospitalizedfor24hoursafterareactiontoapsychotropic medication.Whileplanni n
gJdischarge,thenurselearnedothattheopatientreceived a noticeofeviction
immediatelyoprior tooadmission. Select thenurse’smost appropriateaction.
a. Postponeotheopatient’s discharge fromtheJhospital.
b. Contactotheolandlordow T
h oE eSvTi cBt eAd Nt hKe SpEa tLi eLn tEtRo .fuCrtOheMr discuss theosituation.
c. Arrangeatemporaryplaceofor theopatienttoostayuntilnew housing canobe
arranged.
d. Determineowhether theadverse medicationreactionwasgenuineobecausethepati e
nt had nowhere to live.
ANSWER:oC
Poverty, stigma, unemployment,andlackoofappropriatehousingJareidentifiedasomajorbarriers to r eco
very ofmentalhealth.TheonurseoneedstoconsiderJthesegapswhenoplanning dischargeoforpatien tsfro
macutecareosettingsasthe gapsocanodelaydischargeandincreasethelikelihoodofreadmission. Noneof
theother optionsisa viablealternative.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective CareoEnvironment

3. Apatientodiagnosedwithschizophreniaohadoan exacerbationorelated to medicationononcompliancoeoa

nd wasohospitalizedfor 5 days. TheJpatient’sthoughtsoarenowmoreoorganized, and dischargeoi s pla
nned. The patient’s family says, “It’s too soon for discharge.We will just goothrough all this ag ain.”Wh
ichofthe following shouldthenursedo?
a. Askthecase manageroto arrangeaotransferJtooalong-termcarefacility.
b. Notifyhospitalsecuritytoohandleotheodisturbance andescortothe familyoofftheounit.
c. Explainothatothepatientwillcontinuetoimproveoiftheomedicationois takenregul ar
ly.
d. Contacttheohealthcareprovider tomeetwiththefamilyoandexplainthedischargeratio n
ale.

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ANSWER:J C
Patients doonotostay in aohospital untileverysymptomdisappears. The nurseomust assumeoresponsiboilit
y to advocateforotheopatient’sorightJto the least restrictiveosetting asosoonoasothe symptomsoareund erJco
ntrol and forJtheorightoofocitizensoto controlhealthcareocosts. The health careproviderowill use the same
rationale. Shifting blame will not change the discharge.Security is unnecessary. The nurseoca n handle th
is matter.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

4. Anurseinspectsaninpatientopsychiatricunit andfindsthatoexitsarefreeofobstructions,nooneois sm
oking, andtheJjanitor’socloset is locked. These observationsrelateoto whichoof theofollowing?
a. CoordinatingJcareofpatients
b. Management of milieu safety
c. Managementoftheinterpersonalclimate
d. Use oftherapeuticointerventionstrategies
ANSWER:J B
NursingJstaffareoresponsibleofor all aspects of milieumanagement. Theoobservations mentioned in thi
squestiondirectlyrelateoto theosafetyoof theounit. Theotherooptions, althoughpart of theonurse’s cooncer
ns, areunrelatedto theobservationscited.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: EvaluationMSC: Client Needs: Safe EffectiveoCare Environment

5. The patients below were evTaE

luSatTeB
dJA
inNthKeSeEmLeL
rgE
enRc.y CdO
epMartment. The psychiatric unitohasoone be d
available. Which patient shouldbeoadmitted?
a. TheopatientwhoisofeelingJanxietyoandoaosadmoodafterJseparationfromaJspouseof10oy
ears.
b. Theopatientwhooself-
inflictedasuperficialcut on theforearmafterafamilyargument.
c. Theopatientexperiencingodry mouthandtremor relatedtotaking haloperidol(Hal d
ol).
d. Theopatientwhoisoanewparentandhearsvoicessaying, “Smother your baby.”
ANSWER:J D
Admission to theohospitalwould beojustifiedobyothe riskoof patientodangerJto selfooroothers. The otheropat
ients haveissuesthat can be handledwitholessrestrictiveoalternatives thanohospitalization.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs: SafeoEffectiveoCareoEnvironment

6. A nurse surveys medical records. Whichofinding signals a violation of patients’ rights?

a. Apatient wasnot allowedotoosendlettersotoJfamily.
b. A patient’s belongings wereJsearched at admission.
c. Apatient withsuicidalideationwasplaced oncontinuous observation.
d. Physical restraintowas usedoafter a patientowas assaultive toward a staff member.
ANSWER:J A

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Theopatient hasothe right toosend andreceiveocommunication andencouragingpatient autonomy a nd
communityconnectednesswillosupportpatient recovery. Inspectingpatients’belongings is a sa fety
measure. Patientsohave theorightoto a safeenvironment, includingJtheoright toobe protected against im
pulses to harm self.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: EvaluationMSC: Client Needs: Safe Effective Care Environment

7. Whichprinciplehastheohighestprioritywhenaddressing abehaviouralcrisisinaninpatientsetting
?
a. Suspend theJpatients’ rightsountil the crisis isoresolved.
b. Swift intervention is justified to maintain the integrity of a therapeuticJmilieu.
c. Rights of an individualpatientoareosuperseded bytheJrights ofthemajorityoofpatieont
s.
d. Patientsshouldhaveopportunitiesotoregain controlwithoutintervention if thesafe t
y of others is not compromised.
ANSWER:J A
Apatient’sorightsoaresuspended only inocircumstances whereprotectionoof the patientoor others is a p
riority. Plannedointerventions areonearlyJalways preferable. InterventionJmaybenecessaryJwhen the
patient threatens harm to self.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs: Safe Effective Care Environment

8. ClinicalpathwaysareusedbyotheomultidisciplinaryJteam,inmanagedcareosettings,toodowhich of
the following?
a. Stabilize aggressive paTtieEnStsTBANKSELLER.COM
b. Identifyobstacles tooeffective care
c. Relieveonurses of planningJresponsibilities
d. Streamlineothecareprocessandimproveoutcomes
ANSWER:J D
Clinicalpathways provideguidelines foroassessments, interventions, treatments, andoutcomes, as w el
l asoadesignatedtimelineoforoaccomplishment. Deviationsfromthe timelineomust beoreported and inve
stigated. Clinicalpathways streamlineothecareprocessoandoimprove outcomes. Carepathwaysodoonoti
dentifyobstaclesoorstabilizeoaggressiveopatients.StaffareJresponsiblefortheonecessaryinterv entions.
Careopathways donot relieveonursesoftheresponsibilityoofplanning;pathwaysmay,howe ver, maket
he task easier.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

9. Whichaspectoof directcareois anoexperienced, inpatientoregisterednurseomostlikely tooprovidefora pati

ent?
a. Hygiene assistance
b. Diversional activities
c. Assistance with job hunting
d. Building assertiveness skills
ANSWER:J D

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Buildingoassertivenessoskills is provided by thepsychoeducational skills of theonurse. Assistanceowit
hopersonalohygieneowouldousuallybeaccomplishedobya healthocareoaide.Diversionalactivities areusu
allytheoprovinceofrecreational therapists. Thepatientwouldprobablybeoassisted injob hunting by
a socialworker orooccupational therapist.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:HealthPromotionandMaintenance

10. Which ofthefollowingJscenarios bestdepictsa behavioural crisis?

a. A patient is waving fists, cursing, and shouting threats at a nurse.
b. Apatientois curled upin aocornerooftheobathroom, wrappedinatowel.
c. A patientois crying hysterically after receiving a phone call from aofamily member.
d. Apatient is performing push-
upsointhe middleoftheohall,forcingothersto walkaround.
ANSWER:J A
Thisbehaviourconstitutesabehaviouralcrisisbecauseothepatient is threateningJharmotooanotheroin
dividual. Interventionoisocalledforotoodefusethe situation.Theotherooptionsospeakofbehavioursothato
mayorequireointerventionoof alessurgent natureobecausethe patients inoquestion areonotothrea tening
harm tooself or others.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

11. A patientousually watches television alloday, seldom going out in the community or socializing with ot hers.
Theopatientosays,o“Iodon’toknowowhatoto do withomyofreeotime.” Which memberooftheomultidiscioplinary
treatmentteamwouldbemosthelpfultothispatient?
a. Psychologist .
b. Social worker
c. Recreational therapist
d. Occupationaltherapist
ANSWER:J C
Recreational therapistsohelp patientsouse leisure time toobenefit theiromental health. Occupationalt he
rapistsassistowithoabroadorange of skills, includingothoseforoemployment. Psychologistsoconducttest
ingoandprovideotheropatientservices. Social workers focusoonothe patient’ssupport system.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process:PlanningJMSC: ClientoNeeds: PsychosocialoIntegrity

12. Anurseperformedtheseoactionswhileocaringoforopatients in anoinpatient psychiatric setting.Whicoha

ctionoviolatedpatients’ rights?
a. Prohibitedapatient from usingJtheotelephone
b. In patient’spresence,oopenedaJpackageomailed toopatient
c. Remainedwithinarm’slengthofopatientowithohomicidalideation
d. Permittedoapatientowithpsychosisoto refuseoralpsychotropicmedication
ANSWER:J A

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Theopatienthasoarighttouseotheotelephoneoforcommunicationwith family membersor tosecur ec
ounsel. Thepatientshouldobe protectedagainstopossibleoharmtooself or others.
Patientshaveorights toosend andreceivemailand beopresent during packageinspection.Patients
have rights to refuse treatment.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: EvaluationMSC: Client Needs: Safe Effective Care Environment

13. Selecttheoresponsethatis an exampleofotertiaryprevention.

a. Helpingoapersondiagnosedwithaseriousomentaloillnessolearnoto managemoney
b. Restraining an agitated patient who has become aggressive and assaultive
c. Teaching school-agechildren aboutthe dangers of drugs and alcohol
d. Genetic counselling with a young couple expecting their first child
ANSWER:J A
Tertiary preventionoinvolves services that addressoresidual impairments,owithoa goal ofoimproved iond
ependentJfunctioning. Restraint is asecondaryoprevention. Genetic counsellingJand teaching scohoo
l-agechildrenaboutsubstanceabuse anddependenceoareexamplesoofprimaryprevention.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientoNeeds:HealthPromotionandoMaintenance

14. A suspicious, socially isolated patient lives alone, eats one meal aoday at aolocal shelter, andspends tohe re
maining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initia laction
.
a. Exploreways toohelptheopatientstopsmoking.
b. Reportothe situation toTthEe S
mTan
BaAgN
erKoS
fJE
thL
eL
shEeR
lte.r.COM
c. Assessotheopatient’soweight; determineofoodsandamountsoeaten.
d. Arrangeohospitalizationforothepatientinorderotooformulateoanewtreatmentplan.
ANSWER:J C
Assessment ofbiopsychosocialneedsandgeneralabilitytoliveinthecommunity iscalledforbefore an
yotherJactionoisotaken. Bothnutritionalstatusoandoincomeoadequacyareocriticalassessmentoparameoters.
Apatientmayobeoabletomaintain adequatenutritionwhileeating only onemeal a day.Theruleois to assess
before takingoaction. Hospitalization may not be necessary. Smoking cessation strategies can be pursuedolat
er.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

15. A nurseoreceiveso theofollowing three phoneocalls regarding a community patient.

 Thepsychiatristwants toocompleteoafollow-upoassessment.
 Aninternistwantstoscheduleoaophysicaloexamination.
 Thepatient’soattorney wantsanappointmentwiththepatient.
TheonurseoschedulesotheactivitiesforJthepatient. Whichrolehasthenurseofulfilled?
a. Advocate
b. CaseJmanager
c. Milieumanager
d. Providerofcare

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ANSWER:J B
Casemanagersdesignindividuallyotailoredtreatmentservicesfor patientsoandtrack outcomes of car
e. ThenewcaseomanagementincludesassessingJpatientneeds,odevelopingaoplanoforoservice,olinkingot heo
patientwithonecessaryoservices, monitoringtheeffectivenessofservices,andoadvocatingJforthe p atien
toasoneeded. Nursesroutinelycoordinateopatientoservices, servingas casemanagers as describedinthisosc
enario.Theroleoofadvocate wouldorequiretheonursetospeak outonthepatient’s behalf.The role of mil
ieuomanagerrefersoto maintainingoatherapeuticJenvironment. Provideroofcareorefers toJgioving direct
care to the patient.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingProcess: PlanningJMSC: ClientoNeeds: Safe Effective Care Environment

16. Whichocharacteristicwould beomoreapplicabletoacommunitymentalohealth nursethan toanurse w

orking in an operating room?
a. Kindness
b. Autonomy
c. Compassion
d. Professionalism
ANSWER:J B
Acommunity mentalhealthnurseoftenworksautonomously. Kindness,compassion,andprof essionalis
mapplyto bothnurses.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:Safe Effective Care Environment
17. ApatientJwithwhichofthefollowing diagnoseswouldbemostJappropriate toreferforassert iv
TeEntSJ (TABCATN)?KSELLER.COM
eocommunityotreatm
a. Aphobicfearoofcrowded places.
b. A single episode of major depression.
c. Acatastrophicreactiontoaotornadoinotheocommunity.
d. Schizophreniaoandfourhospitalizationsoin theopastyear.
ANSWER:J D
ACTprovidesintensiveocaseomanagementforopersonsowithseriouspersistentmental illness whoolivei
notheocommunity. Repeatedhospitalization is a frequentoreasonoforothis intervention.Thedistracteors id
entifymentalhealthoproblems ofa moreepisodicnature.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning MSC: Client Needs: SafeoEffectiveoCareoEnvironment

18. Select theresponseothat is an exampleoof primary prevention.

a. Assisting a personodiagnosedowith a serious mental illness to fill a pill-minder
b. Helpingoschool-ageochildrenidentifyandodescribeonormalemotions
c. Leadingapsychoeducationalgroupinacommunitycareohome
d. Medicating an acutely ill patient who assaulted a staff person
ANSWER:J B

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Primary preventionsaredirectedathealthypopulationswithagoalofopreventinghealthproblemsofr
om occurring. HelpingJschool-
ageochildrenodescribenormalemotionspeopleexperiencepromotescoping, a skillthatisneededt hr
oughoutolife. AssistingJa personowithoseriousoandpersistentmentalillnessoto filloaopill-
minderisoanoexampleoftertiaryprevention.MedicatingJanoacutelyillopatientowhooassaultedastaffp erso
nois secondary prevention.
Leadinga psychoeducationalogroupJinoaocommunitycarehomeoisoanoexampleooftertiarypreveontion.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientoNeeds:HealthPromotionandoMaintenance

19. Whichlevel ofpreventionoactivitiesowouldoaonurseJin an emergencydepartmentoemploymostoften?

a. Primary
b. Secondary
c. Tertiary
ANSWER:J B
AnoemergencyJdepartment nursewould generallyseeopatients inocrisisoor with acuteoillness, sosecond ar
ypreventionois used. Primaryopreventionoinvolvesopreventingoaohealthoproblemfrom developing,oaondt
ertiarypreventionoappliestorehabilitativeactivities.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: ClientoNeeds:HealthPromotionandoMaintenance

20. Theonurseoassigned tooassertiveocommunity treatmento(ACT)oshouldexplaintheJprogram’streat m

ent goal as whichofthe following?
a. Assisting patients toomT
aiE
ntSaiTnBaA
bsNtiK
neSnE
ceLfLroEmRal.cCoOhoMl and otherJsubstances of
abuse
b. ProvidingJstructureoandatherapeuticmilieuforomentallyillpatientswhosesym p
tomsrequire stabilization
c. MaintainingmedicationsandJstablepsychiatric statusforoincarceratedinmates whohavea
historyofmentalillness
d. ProvidingJservicesoforJmentallyoillindividualswhorequireointensivetreatmentto contin
ue to liveoin the community
ANSWER:J D
An ACT program providesointensivecommunityoservicesoto personswithserious,opersistentJmental ill
ness, wholiveoin theocommunity,obut requireoaggressive servicesoto preventrepeatedhospitalizatioons.

DIF: Cognitive Level: Understando(Comprehension)

TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment

21. The case manager plans to discuss the treatment plan with a patient’s family. Select the casemanag
er’s firstoaction.
a. DetermineJanoappropriate locationoforJthe conference.
b. SupportotheJdiscussionowithexamplesooftheopatient’sbehaviour.
c. Obtainthepatient’spermissionforotheexchangeofinformation.
d. Determineowhichofamilymembersshouldparticipatein theconference.
ANSWER:J C

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Theocaseomanagermustrespectthepatient’sright tooprivacy andconfidentiality, whichextends to di sc
ussions with family. Talking to family members is part of the case manager’s role, with theopatient’ scon
sent.Actionsidentifiedinthedistractersoccurafterthepatient hasgivenpermission.

DIF: Cognitive Level: Analyzeo(Analysis)

TOP: Nursing Process: Planning MSC: Client Needs: SafeoEffectiveoCareoEnvironment

22. Apatientdiagnosedwithschizophreniahas beenostableofor2months.Todaythepatient’sspouseca llso

thenurse to reportthe patienthas not takenprescribedomedicationandois having disorganized thoinkin
g. The patientforgototo refill theJprescription. Theonursearrangesoarefill.Selectothe bestoutco me to a
ddoto the planoof 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 theonurse weekly to discuss medication-related issues.
d. Theopatientowillreport tootheoclinicoforomedicationfollow-up everyweek.
ANSWER:J A
Theonursewill enhancetheJpatient’ssupportsystem toomeet patient needs wheneveropossible. Deliv er
y of medicationoby the nurseoshould beounnecessaryoforothe nurseotoodo ifothe patient orasignificantoothe
r can beoresponsible. Thepatient may not needmoreintensivefollow-
up as long as medication is taken as prescribed.

DIF: Cognitive Level: Apply(Application)

TOP: Nursing Process: Planning MSC: Client Needs: SafeoEffectiveoCareoEnvironment

23. Acommunitymentalhealthnursehasworkedoformonthstoestablishaorelationshipwithoadelusi ona

l,osuspiciousopatieTnEt.STTh B
eJ A
p aNt iKe nSt EreLceLnEtlR
y J.loCstOeMmployment and couldonoolonger
affordprescribedmedications. TheJpatient says, “Onlyaotraitor wouldmakemeogo toothe hospital.”Sel
ect the nurse’s best initial intervention.
a. Collaborateowiththeopatientto contactoresources tooprovidemedications withoutcharog
etemporarily.
b. Arrange a bedoin a local homeless shelter with nightly on-siteJsupervision.
c. HospitalizethepatientountilthesymptomsohaveJstabilized.
d. Askthepatient,“DooyoufeellikeIamatraitor?”
ANSWER:J A
Hospitalizationomayodamageotheonurse-
patient relationship, even if it provides an opportunity for rapidstabilization. Thetreatment outcom eo
is tostabilize andoimprovetheopatient’sleveloffunctioningJintheJcommunity. If medicationoisorest arte
d, thepatientmay possiblybestabilized in thehomesetting, evenif it takesa littlelonger.This wi ll aid in
theopatient’solongJtermrecoveryjourney. Programsareavailable to helppatientsowhoareounaobleotooaffo
rd their medications. Ahomelessshelteroisinappropriate andunnecessary. Hospitalizatio nmayobene
cessaryolater,butoalessrestrictivesolution shouldbetriedfirst, sincetheopatientoisnotoda ngerous.Ayes
/noquestionisnon-therapeutic communication.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning MSC: Client Needs: SafeoEffective Care Environment

24. Whichactivityoisappropriateforanurseoengagedexclusivelyincommunity-
basedprimaryprevention?

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a. Medication follow-up
b. TeachingJparenting skills
c. Substanceoabuseocounselling
d. Making a referral forofamily therapy
ANSWER:J B
Primarypreventionactivitiesoaredirectedto healthypopulationstoprovideoinformationforJdeveloop
ingJskillsothatopromotemental health. The distracters represent secondaryoorotertiarypreventio noact
ivities.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:HealthPromotionandMaintenance

25. Apsychiatristprescribeddepotinjectionseveryo3weeksoatthe clinicofor apatientwithoahistoryof me

dicationnoncompliance. Forothisplantobesuccessful,whichfactor will beof criticalimporta nce?
a. Theoattitudeofsignificant otherstowardthepatient
b. Nutritionservicesoin thepatient’sneighbourhood
c. Theoleveloftrustbetweenthe patientandnurse
d. Theoavailability of transportation toothe clinic
ANSWER:J D
Theoabilityoof theJpatient to get to theoclinic is of paramountimportanceoto theJsuccessoofothe plan. T he
depotmedicationrelievesthepatient of theonecessityoto takeomedicationodaily, but ifhe orJsheodoeos not
receivetheinjection at 3-
weekintervals,ononadherenceowillagainobe theissue. Attitudeotowardothepatient, trustingrelationships
, andnutrition are important but not fundamental tothisoparticular problem.
.
DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Assessment MSC: Client Needs: SafeoEffectiveoCareoEnvironment

26. Whichoassessmentfinding forapatientinthecommunitydeservespriorityointerventionbyothepsych ia

triconurse?
a. Theopatientoreceivesoprovincialodisabilityoincomeoplusoasmallchequeofromatrustfundoev
erymonth.
b. TheopatientwasabsentfromthreeofsixplannedAlcoholicsAnonymousomeetingsinothoeo
past 2 weeks.
c. Theopatientlivesoinoanoapartmentowithtwoopatientswhooattendopartialhos pi
talizationprograms.
d. The patient has aosibling who was recently diagnosed with a mental illness.
ANSWER:J B
Patientswhoouseoalcohol or illegal substancesoftenbecomemedicationnoncompliant. Medicatioon
noncompliance, along withtheodisorganizingoinfluenceoof substances onocellular brain function, pro
motesrelapse. Thedistractersdonotsuggestproblems.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Planning MSC: Client Needs: Health PromotionandMaintenance

27. Theonurseoshould referJwhich of theofollowingpatientsoto aJpartialhospitalizationoprogram?

a. Apatientowhoohasatherapeuticlithiumlevelandreportsregularlyoforobloodotestsandoc li
nicfollow-up.

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b. Apatient whooneedspsychoeducationfororelaxation therapyorelatedtoagoraphobiaand p
anicoepisodes.
c. Apatient whospent yesterday inoasupervised crisis careocentreoandocontinues tohaveoac
tiveosuicidal ideation.
d. Apatient whoostates,“I’monotosureoIocanavoidusing alcoholwhenmyspouseogoestowo rk
every morning.”
ANSWER:J D
ThispatientcouldprofitfromthestructureandsupervisionprovidedbyspendingJtheodayoat theparotia
lohospitalizationoprogram. During theoevening, at night,oand on weekends, thespousecouldoassume res
ponsibilityoforosupervision. Asuicidalpatient needsinpatienthospitalization.TheotheropatientsJ can be
servedoinothecommunity orJwithoindividualvisits.

DIF: Cognitive Level: Applyo(Application)

TOP: NursingProcess: PlanningJMSC: ClientoNeeds: SafeoEffectiveoCareoEnvironment

28. ACategoryVtornadohitsoa community,destroyingJmanyhomesandbusinesses. Which nursion

gJinterventionwould bestdemonstratecompassionandcaring?
a. Encouraging people toodescribeotheiromemories andfeelingsoaboutotheoevent
b. ArrangingJtransportation toothe local communityomental healthcentre
c. Referring a local resident to a community food bank
d. CoordinatingJpsychiatrichomecareoservices
ANSWER:J A
Disasterovictimsobenefit fromtellingtheir story. Nursesoshowocompassion by listeningJand offering ho
pe. Theodistracters identify otherJaspects of psychological first aidJandservicesontheomentalhealthc
ontinuum.
.
DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

29. Anursemakes anoinitialvisitotooahomeboundpatientdiagnosed withoaseriousmentalillness.Afamily

memberoffersthenurseacupofcoffee. Selectthenurse’s bestresponse.
a. “Thank you. IowouldJenjoyJhavingJaocupofocoffeewithoyou.”
b. “ThankJyou,butoIowould prefertoproceedwithotheassessment.”
c. “No,but thankoyou. Ineveracceptdrinksofrompatients orfamilies.”
d. “Ouroagencypolicyoprohibitsmefrom eatingJorodrinkingoin patients’ homes.”
ANSWER:J A
AcceptingrefreshmentsorJchattingoinformallywiththeopatientandfamilyrepresenttherapeuotic
useofselfandhelpoto establishrapport. Thedistractersfail tohelpoestablishrapport.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

MULTIPLE RESPONSE

1. Theohealthocareoteam atoanoinpatient psychiatricfacilitydraftstheseocriteriaoforoadmission. Whichcri teri

a should be included in theofinal version of the admissionopolicy? (Select all that apply.)

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a. Clear risk of danger to self orJothers
b. AdjustmentoneededoforJdoses ofpsychotropicomedication
c. Detoxificationfromolong-term heavyalcoholconsumptiononeeded
d. Respiteoforocaregivers ofpersons withseriousandpersistentmentalillness
e. Failureoofocommunity-based treatment, demonstratingJneed forintensiveotreatment
ANSWER: A,oC,oE
Medicationodoses canobe adjusted on anooutpatient basis. TheogoaloofocaregiverJrespite canobeaccom pl
ishedwithouthospitalizing thepatient. Theother optionsare acceptable,
evidence-informedcriteriaforoadmission of apatient tooan inpatientservice.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs: SafeoEffectiveoCareoEnvironment

2. ApsychiatriconurseJdiscussesrulesoofthetherapeuticJmilieuandpatients’rightsowithanewlyadmitte d
patient. Which rightsoshould be included? (Select all that apply.)
a. Theoright to receivedinformation
b. Theorightto confidentiality
c. Theorighttooretainolegalocounsel
d. Theorightto anoindependent panelreview, if certified
e. TheorighttoselecttheJnurseassignedtootheirocare
ANSWER: A, B, C, D
Patients’ rightsshould beodiscussed shortlyoafter admission. Patientsohaveorights related tooreceiving i
nformation, confidentiality,Jto retainolegal counsel and to an independent reviewoftheircertifications
tatus.Patients do nothavearighttoaprivateroomorselectingwhichonursewillprovideocare.
.
DIF: Cognitive Level: Understando(Comprehension)
TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

3. Anursecanbestoaddressfactorsoofcriticalimportance tosuccessfulocommunitytreatmentbyinclu di
ng makingoassessmentsorelative to which of the following: (Select all that apply.)
a. Sourceofincome
b. Familyandsupportsystems
c. HousingJadequacyandstability
d. Early psychosocial development
e. Substanceoabusehistoryoandcurrentouse
ANSWER: A, B, C, E
Earlyopsychosocialdevelopmentalhistoryoislessrelevant toosuccessfuloutcomes in thecommunit yot
hantheoassessmentsolistedinthe otheroptions. Ifapatientishomelessorfearshomelessness, fo cusin
gJonootherJtreatment issues is impossible. Sufficient incomeoforobasicneedsandJmedication is necessa
ry. Adequatesupport isoa requisite toocommunity placement.Substanceoabuseundermines medicatio
noeffectiveness andJinterfereswithcommunity adjustment.

DIF: Cognitive Level: Understando(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

4. Whichstatementsbypatientsdiagnosed withaseriousmental illnessbestdemonstratethat thecase m

anager hasoestablished anoeffective long-termorelationship? (Selectoall that apply.)

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a. “My case manager talks inJlanguage I can understand.”
b. “My case managerJhelps meokeep track of my medication.”
c. “My case managerJgives me little gifts fromotime to time.”
d. “My case manager looks atome as a whole person withomany needs.”
e. “Myocaseomanager letsmeodowhatever Ichooseowithoutinterfering.”
ANSWER: A, B, D
Eachcorrectanswer is an exampleofappropriatenursingJfoci:communicatingatoalevel understanoda
bletothepatient,providingJmedication supervision, andusingoholisticprinciplestooguideocare.T heodi
stractersviolate relationshipboundaries orJsuggest alaissezfaire attitude onotheopartoofothe nursoe.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: EvaluationMSC: ClientoNeeds: Psychosocial Integrity

5. Whichostatements most clearly reflectJthe stigma of mental illness? (Select all that apply.)
a. “Many mental illnesses are hereditary.”
b. “Mental illnessocanobe evidence of a brainodisorder.”
c. “People claim mental illness so they can get disability cheques.”
d. “Mentalillnessoresultsfromotheobreakdownoofnuclearofamilies.”
e. “IfpeopleowithomentalillnesswentJto church, theirosymptomswouldJvanish.”
ANSWER:J C, D, E
Stigmaisorepresentedbyojudgementalremarksothatdiscount therealityandvalidityofmentalillness. M
anymentaloillnessesaregeneticallyotransmitted. Neuroimaging can show changes associatedowitoh so
me mental illnesses.

DIF: Cognitive Level: AppT

lyE(S
ApTpB
licAaN
tioKn)SJo ELLER.COM
TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

6. Apersonointhecommunityoasks, “Peopleowithmentalillnesseswentoto isolatedhospitalsinearlieroti

mes. Why has that changed?” Select the nurse’s accurate responses. (Select all that apply.)
a. “Sciencehasmadeosignificantimprovements inodrugs formentalillness,soonowmany p
eoplemayliveintheir communities.”
b. “There’s nowabetterJselectionoofolessorestrictive treatmentJoptionsoavailableincom
munities toocare for peoplewithmentalillness.”
c. “Nationalorates ofmental illnessohaveodeclined significantly. Thereoactually isonot aneedfo
rostateoinstitutions anymore.”
d. “Mostpsychiatricoinstitutionswereoclosedbecauseoof seriousviolationsoof patie
nts’ rights and unsafeJconditions.”
e. “Federallegislationandpayment forJtreatmentofomental illnessohasshiftedJthefocu s
tocommunityratherthaninstitutionalsettings.”
ANSWER: A, B, E
Theocommunity is aoless restrictive alternativethanohospitalsforotreatment of peopleowithomentalillnoess
. Funding forotreatment of mentalillnessoremains largelyoinadequate, butnowofocuses on communityor
atherJthanoinstitutional care. Antipsychotic medicationsimproveomoresymptomsoof mentalillness; he
nce, management of psychiatricodisordersohasimproved. Rates of mentalillnessohaveoincrease d, not de
creased. HospitalsowereoclosedbecauseofundingJshiftedto theocommunity. Conditions in ins titutions h
ave improved.

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DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Implementation MSC: Client Needs:Safe Effective Care

7. Apatientdiagnosedwithschizophrenialivesinthecommunity. Onahomevisit,thecom m
unitypsychiatricJnurseocase managerolearnsotheofollowing:
 Thepatient wantsoto attendoanoactivityogroup atJthe mentalohealthoutreachocentre
 Thepatient isoworriedoabout being ableotoopayoforJthetherapy
 Thepatient does not know how to get fromhome to theoutreachocentre
 Thepatient has anoappointment tohaveobloodworkat theosameotime anactivity groupmeet s
 Thepatient wantsoto attend services at achurchothatoisoabout a kilometrefrom thepatie
nt’s home
Which tasks areopart of theorole of a communityomental health nurse? (Select all that apply.)
a. Rearranging conflicting care appointments
b. Negotiating thecost of therapyJforJtheopatient
c. Arranging transportation tootheooutreach centre
d. AccompanyingJtheopatient toochurch servicesoweekly
e. MonitoringJto ensurethepatient’sbasiconeedsaremet
ANSWER: A, C, E
Theocorrectoanswersoreflect theocoordinating roleoofothe communitypsychiatriconurseocasemanager. N
egotiating thecost of therapyandaccompanyingothepatient to churchservicesareinterventionstoheon
urseowouldonotobe expected tooundertake. Thepatient canowalk toothe churchoservices; thenursecan pr
ovide encouragement.

DIF: Cognitive Level: A p pT

l yE( SApTpBl i cAa N
t i oKn)SJ o ELLER.COM TOP: Nursing Process: Planning
MSC: Client Needs: SafeoEffectiveoCareEnvironment

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Chapter 04: Relevant Theories and Therapies for Nursing Practice

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. A parent says, “My 2-year-

oldchildrefusestoilettrainingJandshoutso“No!”whengivendirections.What doJyouthinkist h
echallengeforthechildinthissituation?”Select thenurse’sbestreply.
a. “Yourochildneedsfirmerocontrol. It isoimportant to set limitsnow.”
b. “Thisois normal foroyourochild’s age andodevelopmental stage. The child is striving for in
dependence.”
c. “ThereJmaybedevelopmental problems. MostochildrenareJtoilettrained byoage 2.”
d. “Someundesirableattitudesoareodeveloping. Achildpsychologistcanhelpyoudevel o
poa plan.”
ANSWER:J B
Thisbehaviouris typical ofachild aroundtheoageoof2 years, whoseodevelopmentaltask isotodeveloopa
utonomy.Thedistractersindicateothechild’sbehaviourois abnormal.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientoNeeds:HealthPromotionandMaintenance

2. A 26-month-
olddisplays negativebehaviour,refusestoiletotraining,andoftensays, “No!”Whichstageofpsy chosexuald
evelopmentisevident?
a. Oral
b. Anal
c. Phallic
.
d. Genital
ANSWER:J
B
The anal stage occurs from age 1 too3 years and has as its focus toiletotraining and learningotoodelay im medi
ategratification. Theoralstageoccursbetweenbirthand 1 year. Thephallicstageoccursbetwe en 3and
5 years, andthegenitalstageooccursbetweenage13and20 years.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandoMaintenance

3. A 26-month-
olddisplaysnegativebehaviour, refusestoiletJtraining, and oftenosays,“No!”Whichopsychosoci al
crisis is evident?
a. Trustversusomistrust
b. Initiativeoversusoguilt
c. Industryoversusinferiority
d. AutonomyoversusshameoandJdoubt
ANSWER:J D
Theocrisis of autonomyversusshameoanddoubtorelates toothe developmentalotask of gaining control ofs
elfandenvironment,oasoexemplifiedobyotoilet training. ThisopsychosocialcrisisooccursoduringJthepoeriodo
fearlychildhood.Trustversusmistrustoisthe crisisooftheJinfant. InitiativeJversusguiltoisthecroisis of the
preschoolandearlyschool-agedchild. Industryoversusinferiorityois thecrisis of the 6-
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to 12-year-old child.

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DIF: Cognitive Level: Understand(Comprehension)
TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandMaintenance

4. A 4-year-
old grabs toys from siblings andosays, “Iowantothat now!” Theosiblingsocry, and thechild’s parent beoco
mesupsetowithothebehaviour. AccordingJto Freudianotheory, this behaviour is aproduct of impoulses
originatinginowhichsystemofthepersonality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANSWER:J A
Theoidoperatesonthepleasureoprinciple, seekingoimmediateogratification of impulses.TheegoJac tso
as amediatorofbehaviour andweighstheoconsequences oftheaction, perhaps determining thatJta
kingthetoy is not worththemother’swrath. Thesuperegowouldopposethei mpulsivebehaviouroa
s“notnice.” Thepreconscious is alevelofawareness. ThisitemrelatesJtooanoaudienceoresponse que
stion.

DIF: Cognitive Level: Understando(Comprehension)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:Health PromotionandoMaintenance

5. Theoparentofa4-year-
old rewards and praises theochild for helpingoa younger sibling, beingJpolite,oand usinggood manners.
Thenurse supportsthisuse of praiseorelatedoto theseobehaviours. TheseJqualitiesareolikely to beointer
nalizedandbecomeopartofwhichsystemofthepersonality?
a. Id
b. Ego .
c. Superego
d. Preconscious
ANSWER:J C
Theosuperegoocontainsthe“shouldnots,” ormoral standardsointernalizedfrominteractionswith si gn
ificantothers.Praise fostersinternalizationofdesirableobehaviours.Theidoisthecentreoofbasici nstin
ctualdrives, andthe ego is theomediator. The egois theoproblem-solvingJandreality-
testing portionoofothe personalityothatJnegotiatessolutionswiththeoutsideworld.The preconsciou s
isalevelofawarenessofromwhichmaterialcan beretrievedeasilyowithconsciouseffort.Thisitemorelat
es to an audienceoresponse question.

DIF: Cognitive Level: Understando(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:HealthPromotionandMaintenance

6. Anursesupportsoa parent forJpraisingoa childobehavingoinoahelpful way. Whenothischildbehaves wi

thopoliteness andhelpfulnessoinadulthood,which feelingowillmostolikelyresult?
a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
ANSWER:J D

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Theoindividual will beoliving upoto the ego ideal, which will result in positive feelings about self rathe or tha
nofeelingsoofoinferiority. Theootherooptionsareoincorrectbecauseeachrepresentsaonegativeofeeli ng.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotionoand Maintenance

7. Anoadult says, “Ionever knowtheJanswers,” and“Myopinion doesn’t count.” Whichpsychoo

socialcrisiswasounsuccessfullyresolvedforothisoadult?
a. Initiativeoversusoguilt
b. Trustversusmistrust
c. AutonomyoversusshameJand doubt
d. Generativity versus self-absorption
ANSWER:J C
These statements showosevereself-
doubt, indicating that theocrisisoofogainingJcontrol overtheenvironment wasonotmetosuccessfully. Uns
uccessful resolution of the crisis of initiativeJversus guilt results in feelings of guilt. Unsuccessful r oesoluti
on of thecrisisoofotrustJversus mistrust results in poor interpersonal relationships andsuspici onofooth
ers. Unsuccessfulresolutionoftheocrisisofgenerativityversusself-
absorptionoresults inoself-absorptionothatJlimits theoabilitytoogrowoas aperson.

DIF: CognitiveLevel: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandMaintenance

8. Whichpatientstatementwouldleadthenursetoosuspect unsuccessfulcompletion ofthedeve lo

pmentaltask of infancy?
a. “I have very warmo andTcE loSseTfBriA
enNdKshSipEsL
.”LER.COM
b. “I’m afraid to allow anyoneoto really get tooknow me.”
c. “I’m always absolutely right, so don’t bother saying more.”
d. “I’mashamedthat Iodidn’t do thingsocorrectlyoin thefirstplace.”
ANSWER:J B
AccordingJtooErikson, thedevelopmentaltaskoofinfancyis theodevelopmentooftrust.Thecorrectroes
ponseoistheJonlystatementclearlyoshowinglackJofabilityto trustothers.Warm,closerelationsh ipss
uggestothe developmentaltaskofinfancyowassuccessfullycompleted; rigidityoandoself-
absorptionare reflectedinJtheobeliefoneois alwaysright;andshame for pastactionsosuggestsofailureot
ooresolvethecrisis of initiative versusguilt.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandMaintenance

9. Apatient is suspiciousandfrequentlyomanipulatesoothers. To whichopsychosexualstageodotheseotr

aitsrelate?
a. Oral
b. Anal
c. Phallic
d. Genital
ANSWER:J A

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Theobehaviours in the question developoasotheoresult of attitudes formedduring the oral stage,when an
infantofirst learnstorelatetoothe environment. Anal-
stage traitsoinclude stinginess,ostubbornness, orderliness, orotheir opposites. Phallic-
stage traits include flirtatiousness, pride, vanity, difficulty with authority figures,Jand difficulties with sex
ual identity. Genital-
stageotraits includeotheoability tooformosatisfying sexualoand emotional relationships with membersoofot
heoopposite sex, emancipationofromparents, astrongJsenseoof personalidentity, or theopposites ofth
ese traits.

DIF: CognitiveJLevel: Understando(Comprehension)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandMaintenance

10. Whichostageofpsychosexualdevelopmentismostrelevantotootheopatientthatexpressesadesire to
beocared forJbyothersandoftenobehavesinoahelplessfashion?
a. Latency
b. Phallic
c. Anal
d. Oral
ANSWER:J D
Fixation at theoralstageosometimes producesodependentinfantilebehaviours in adults. Latencyofixaoti
onsooftenoresult in difficulty identifying withothersanddeveloping socialskills,resultingJin aosenseoof i
nadequacyandinferiority. PhallicJfixationsoresultin havingodifficultyowithauthorityfiguresand poooros
exualidentity. Analfixationsometimesresults inoretentiveness, rigidity, messiness, destructiveoness, a
ndocruelty. Thisitemrelates tooanaudienceoresponse question.

DIF: CognitiveLevel:Understando(Comprehension)
TESTBANKSELLER.COM
TOP: NursingJProcess: Assessment MSC: Client Needs:HealthPromotionandMaintenance

11. Anurselistens tooa groupoof recentoretirees. OneJsays,o“I volunteer withoMeals on Wheels, coachtoee
nosports, andodoochurchovisitation.” Anotherolaughs andsays, “I’motoo busyotakingJcareoof myself to v
olunteer toohelp others.” Whichdevelopmentaltaskodothesestatementscontrast?
a. Trustandmistrust
b. Intimacyandoisolation
c. Industryandinferiority
d. Generativityandself-absorption
ANSWER:J D
Bothretireesareinmiddleadulthood,whentheJdevelopmentalcrisistoobeoresolvedisgener at
ivityversusself-absorption.Oneexemplifiesgenerativity;theotheroembodies
self-
absorption. Thisdevelopmentalcrisiswouldshowacontrastbetweenrelatingoto othersinatrustingofash
ionandbeing suspiciousandlackingJtrust. Failureoto negotiateothisodevelopmental crisiswouldroesultoino
aosenseoofinferiorityoorodifficultyolearning andworkingJas opposed to theoabilityotoowork competently. Be
havioursthat would be contrastedoareemotionaloisolationoandtheability to loveoandoco mmitoneself.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: ClientoNeeds:HealthPromotionandMaintenance

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12. Althoughoegoodefenceomechanismsandsecurityoperationsareomainly unconsciousoanddesigon
edoto relieve anxiety, theJmajorJdifference is which of thefollowing?
a. Defenceomechanismsareointrapsychicoandnotobservable.
b. Defenceomechanismscausearrestedpersonaldevelopment.
c. Securityoperationsoaremastermindedobytheoidoandosuperego.
d. Securityoperationsaddressointerpersonalrelationshipoactivities.
ANSWER:J D
Sullivan’stheoryexplainsthat securityoperationsareointerpersonal relationshipactivitiesdesignedotooo
relieveoanxiety. Becausetheyareinterpersonal, theyareobservable. Defenceomechanismsoareounconsci
ousoandoautomatic.Repressionisentirely intrapsychic, butothermechanismsresult inobservabl ebeh
aviours. Frequent,ocontinueduseofmanydefence mechanismsoftenresults in realitydistortio nand in
terferenceowith healthyadjustmentand emotional development. Occasional use of defence mechanis
ms is normalanddoesnotmarkedlyinterferewithodevelopment. Securityoperationsare egoo-
centred. Thisitemrelates toanaudienceresponsequestion.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process: AnalysisMSC: Client Needs: HealthoPromotionandMaintenance

13. Astudent nursesays,o“Iodon’t needoto interact with myopatients. Iolearn what Ioneed to know by obseorv
ation.” Anoinstructorocan bestinterpret theJnursingoimplications of Sullivan’s theorytoothisostuden tby
responding withwhich oftheofollowing?
a. “Interactionsare required inorderotoohelpoyoudeveloptherapeuticcommunicationskill
s.”
b. “Nursescannot beisolated. Weomust interact tooprovideopatients withopportunitiestop ra
ctice interpersonaTlJE
skSilTlsB.”ANKSELLER.COM
c. “Observingpatient interactionswillhelpoyouformulatepriorityonursing diagnoses
andappropriateinterventions.”
d. “Itoisimportanttopayattentiontopatients’behaviouralchangesobecausethesesigni f
yoadjustmentsinpersonality.”
ANSWER:J B
Theonurse’s role includes educatingpatients andassistingJthem in developing effective interperso na
lorelationships. Mutuality,orespectoforothe patient, unconditional acceptance, andempathyare coorners
tones of Sullivan’s theory. Thenurseowhodoesonot interact withthepatientcannot demonstroatethes
ecornerstones. Observationsprovideoonlyobjectivedata.
PrioritynursingJdiagnosesusuallyocannot beoaccurately establishedwithout subjectivedatafromth
epatient. Theotherodistracters relateoto Maslowandobehaviouraltheory. Thisitem relates tooan audi
ence response question.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientoNeeds:HealthPromotionandoMaintenance

14. Anurseconsistentlyencouragesa patient to do his or her ownactivities ofdailyolivingo(ADLs). Iofot

heopatient is unable toocompleteanoactivity, theonurseJhelpsuntilthepatientisonceagainindeopend
ent. Thisnurse’spracticeis mostinfluencedby whichtheorist?
a. Betty Neuman
b. PatriciaoBenner
c. Dorothea Orem
d. Joyce Travelbee

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ANSWER:J C
Orememphasizesotheroleofothenurse inpromotingJself-
careoactivities of the patient; this hasrelevance toothe seriously and persistently mentally ill patient.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess:PlanningJMSC: ClientoNeeds: Psychosocial Integrity

15. AnurseousesMaslow’shierarchy ofoneedsotooplancareforapatient withmentalillness.Whichpr

oblemowillreceivepriority?
a. Theopatientrefuses toeator bathe.
b. Theopatientoreports feelings of alienationofrom family.
c. Theopatientois reluctant tooparticipate inounit socialactivities.
d. Theopatientois unawareof medicationactionandadverseeffects.
ANSWER:J A
Theoneedfor foodandhygieneJarephysiologicalandthereforeotakeopriorityoverpsyc h
ological or meta-needsincareplanning.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Planning/Outcomes IdentificationM S
C: Client Needs: Safe Effective Care Environment

16. Operantconditioning is partofthe treatmentplantoencourageospeechinachildowhoisonearlymute. W

hich technique applies?
a. Encouragetheochild to observeotherstalking.
b. Includeothechildinosmall groupactivities.
c. Giveothe child aosmall tTr eEatSJ fTo B
r J sApN
eaKkiSnEg.LLER.COM
d. TeachotheJchildrelaxationotechniques.
ANSWER:J C
OperantconditioningJinvolvesgivingpositiveoreinforcementfor adesiredbehaviour.Treatsarere w
ardsoand reinforcespeechthroughpositivereinforcement.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientNeeds:Psychosocial Integrity

17. Theoparent of a childdiagnosedowithoschizophreniaotearfullyaskstheonurse, “What could Ihaved

oneodifferentlytopreventthisillness?”Selectthenurse’s bestresponse.
a. “Althoughschizophrenia resultsfromimpairedfamilyrelationships, tryonot to feelguilt
y. NoJonecan predicthowachildwillrespond toparental guidance.”
b. “Schizophreniaois aobiologicalillnessresultingJfromochangesoinohow the brainandnervou
ssystemfunction. Youarenot toblameforyourchild’sillness.”
c. “ThereJis still hope.Changingyouroparentingostylecanhelpoyour childlearntocope ef
fectivelywith theoenvironment.”
d. “Mostmentalillnessesresultofromogeneticoinheritance. YourJgenesaremoreoat faultotoh
an your parenting.”
ANSWER:J B

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Patientsand familiesoneed reassurance that theomajormentaldisordersoarebiological in originand ar eo
not the“fault” of parents. Theparent’socommentsuggests feelings of guiltJor inadequacy. Theonurose’so
responseoshouldaddressotheseofeelingsoasowelloasoprovide information. Oneodistracter places theburde
noofohaving faultygenes on theoshouldersoofothe parents. The otherJdistracters areneitherowhollyaccur
ateonor reassuring.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs: Psychosocial Integrity

18. AnurseoinfluencedbyPeplau’sinterpersonaltheoryworkswithananxious,withdrawnpatien
t. Interventionsshouldfocusoonowhich of thefollowing?
a. Rewarding desired behaviours
b. UseoofownJcapacities
c. Changing the patient’s self-concept
d. Administering medications to relieve anxiety
ANSWER:J B
Thenurse-
patient relationship is structured to providea modelfor adaptiveinterpersonalorelationshipsthatoca n
beogeneralized tooothers. The theoryocentres onohelping thepatient learntouse his oroherocapacities to li
veomoreoproductively. Theodistracters applyoto theories of cognitive, behavioural, andbiologicalthera
py.

DIF: CognitiveLevel: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs: Psychosocial Integrity

19. Apatient had psychotherapyweekly for 5 months. Theotherapistusedfreeassociation, dreamoanalysi s,

andofacilitatedtransference toohelptheopatientunderstandoconflicts andfosterochange.
SelectJtheterm thatoappliesTtE
o SthTisBmAeNthKoSd.ELLER.COM
a. Rational-emotive behaviour therapy
b. Psychodynamic therapy
c. Cognitive-behavioural therapy
d. Operant conditioning
ANSWER:J B
TheotechniquesareJaspects of psychodynamictherapy. Theodistractersuse othertechniques.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

20. Considerothis comment fromoatherapist: “Theopatient is homosexual buthaskept this preferenceos

ecret. Severe anxietyoandodepressionooccur whenothe patient anticipatesofamilyreactionsoto this sexu
alorientation.”Whichperspectiveisevidentinthespeaker?
a. Theoryof interpersonalrelationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviourism theory
ANSWER:J A
Theotheoryofinterpersonalrelationshipsrecognizestheoanxietyanddepressionoasthatwhicharisesofro
m social insecurityoorJthatJpreventsobiological needs fromobeing satisfied.
BehaviourismoandclassicalconditioningJtheories do not apply. Apsychosexualoformulationwould f
ocus on uncovering unconsciousmaterialthatrelatesoto the patient problem.
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DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

21. Apsychotherapistworkswithoanoanxious, dependentpatient.Whichstrategyismostconsi st

entwithpsychoanalyticopsychotherapy?
a. IdentifyingJtheopatient’sostrengths andassets
b. Praisingothepatientforodescribing feelings ofisolation
c. FocusingJonofeelings developed bytheopatientotowardotheotherapist
d. ProvidingJpsychoeducationoandoemphasizingomedication adherence
ANSWER:J C
Positive oronegativeofeelings of the patient toward the therapist indicate otransference. Transference is a psy
choanalyticoconceptothat can beoused to explorepreviouslyunresolved conflicts. Theodistracters relatet
oobiological therapyoandJsupportive psychotherapy. Use of psychoeducationalmaterials is acommon
“homework” assignmentousedoincognitivetherapy.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

22. A person says, “I was the only survivor in a small plane crash. Three business associates died.I got de press
ed and saw aocounsellorotwiceoa week for 4 weeks. We talkedoaboutomy feelings related to being a survivo
r,and I’mbetteronow.”Whichtypeoftherapyowasused?
a. Milieu therapy
b. Psychoanalysis
c. Behaviour modification
d. Interpersonal psychotherapy
.
ANSWER:J D
Interpersonalpsychotherapyreturnedthe patienttohisformer leveloffunctioning byhelping himc om
eto termswiththelossof friendsandJguiltooverJbeingoasurvivor. Milieutherapy refers to enviro nmental
therapy. PsychoanalysiswouldcallforalongJperiod ofexploration ofunconscious material. Behaviour
modificationowouldfocus onochanging aJbehaviourrather thanhelping thepatientunderostandwhatis
goingoninhislife.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

23. Whichtechniqueismostoapplicableto aversionotherapy?

a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement
ANSWER:J A
Aversionotherapyis akinoto punishment. Aversive techniquesoincludeopairing of aomaladaptivebehavi our wi
th anoxiousostimulus, punishment, andavoidancetraining.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess:PlanningJMSC: ClientoNeeds: PsychosocialoIntegrity

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24. Apatientsays toothe nurse, “Myofather hasbeendeadforover 10 years, but talkingJto you is almostoaso
comforting as theotalks he and IohadowhenoIowas a child.” Whichtermapplies toothepatient’s comoment
?
a. Superego
b. Transference
c. Reality testing
d. Counter-transference
ANSWER:J B
Transferencereferstofeelingsoapatienthasotowardothehealthcareworkerthatwereooriginallyheldoto w
ard significantothers inhis or herlife. Counter-
transference refers tounconscious feelingsthatthehealthocare workerhastowardothepatient.Thes upereg
oorepresents theomoral componentofpersonality; it seeksperfection.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: EvaluationMSC: Client Needs: PsychosocialoIntegrity

25. A collegestudent received an invitation tooattend theweddingoof a close friendwhoolivesacrossthe

country. Theostudentoisoafraid of flying. Which type of therapyowouldobe mosthelpful foroth ispati
ent?
a. Psychoanalysis
b. Milieu therapy
c. Systematic desensitization
d. Short-termodynamicotherapy
ANSWER:J C
Systematicodesensitizationois aotypeofotherapyoaimedatextinguishing aspecificbehaviour,suchoasth os
e associated wT
ithEaSfTeB
arAoN
fJK
flySiE
ngL.JL
PsEyR
ch.oCanOaMlysis and short-
termodynamictherapyoseekotoJuncoveroconflicts. Milieuotherapyoinvolves environmentalfactors.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process:Planning MSC: Client Needs: Psychosocial Integrity

26. Whichapproachwouldobeobestotooprovideotherapyinowhichopeersaswelloasstaffhaveavoice inodete rmi

ningopatients’privilegesand psychoeducationaltopics?
a. Milieu therapy
b. Cognitive therapy
c. Short-termdynamictherapy
d. Systematic desensitization
ANSWER:J A
Milieutherapy is based ontheoidea that allmembersoftheoenvironment contribute tootheplanningJ an
dofunctioning oftheosetting. Thedistractersoareindividualotherapiesthatdoonotofitthedescription
.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process:Planning MSC: Client Needs: Psychosocial Integrity

27. Apatientrepeatedlystated,“I’mstupid.”Whichstatementobythatpatientwouldshowprog re
ssresulting fromcognitivebehaviouraltherapy?
a. “Sometimes Iodostupidthings.”
b. “Things always go wrong for me.”

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c. “I always failowhen I try new things.”
d. “I’mdisappointedinmyolackoofability.”
ANSWER:J A
“I’mstupid”is acognitiveodistortion. Amoreorationalthought iso“SometimesoIdoostupid
things.”TheolatterothinkingJpromotesoemotionalself-
control.Thedistracters reflectoirrationalorodistortedothinking.ThisitemorelatestooanoaudienceJresp ons
equestion.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: EvaluationMSC: ClientoNeeds: PsychosocialoIntegrity

28. Apatientsays,“Allmyolife I’vebeensurroundedbyostupidity. EverythingoIobuyobreaks becauseotheoeonti

reoAmerican workforce is incompetent.” Whichoofothe followingJis thisopatientexperiencing?
a. A self-esteem deficit
b. A cognitive distortion
c. A deficit in motivation
d. A deficit in love and belonging
ANSWER:J B
Automaticothoughts,or cognitive distortions,areirrationalandleadtofalseassumptionsandmisinoterpreta
tions. Seerelatedaudienceresponseoquestion.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

29. Apatient isJfearful of ridingoonoelevators. Thetherapistfirstoridesoan escalator withthe

patient. The therapistJand pTaE
tieSnTt B
t hA
e nNsKt aSnEd LinLaEn Rel. e C
v aOt oMr o wit h o t he door openofor five minutes and l at
erwiththeelevator doorclosedfor fiveminutes.Whichtechniquehasthe therapist
used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rationalemotiveotherapy
d. Biofeedback
ANSWER:J B
Systematicodesensitization is aoform of behaviouromodificationtherapythat involvesothedevelopme
nt ofobehaviourtaskscustomized tothepatient’sspecificfears.Thesetasksare
presented to theopatientowhileousingJlearnedorelaxation techniques. Thepatient is incrementally exposoed
to the fear.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

30. Apatient says,“Ialways feelogoodwhenoIowear asize2petite.”Whichtypeoofcognitivedistorti on

is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization
ANSWER:J B

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Automaticothoughts, or cognitiveodistortions, areoirrational andlead to false assumptionsoand misinteorp
retations. Theoquestionooffers an exampleoofoovergeneralization. Seerelatedoaudienceresponse queostio
n.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs:Psychosocial Integrity

31. Whichcommentbestoindicatesoapatient isoself-actualized?

a. “Iohaveosucceededdespiteoaoworldfilledwithoevil.”
b. “I have a planofor my life. If I follow it, everything will be fine.”
c. “I’msuccessful becauseoIowork hard. NoJone hasever givenmeanything.”
d. “MyofavouriteJleisureois walkingonothe beach,hearing softsoundsofrolling waves
.”
ANSWER:J D
Theoself-actualizedpersonalityis associatedwithhighoproductivityoandenjoymentooflife.Self-
actualizedpersonsexperienceopleasureoin being aloneand an ability tooreflect on events.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs:Psychosocial Integrity

32. Anurseandpatientdiscussoaproblemothepatienthaskeptsecretoforomanyyears. Afterward,theopaotie

ntJsays,o“I feel so relieved thatoIfinallyotold somebody.” Whichotermbestdescribestheopatient’sfeeli
ng?
a. Catharsis
b. Superego
c. Cognitive distortion
d. Counter-transference .

ANSWER:J A
Freudinitially used talkJtherapy, knownoasotheocathartic method. Todaywe refer toocatharsisas “get tingJthin
gs offourJchests.” Thesuperegorepresentsthemoral component of personality.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process: EvaluationMSC: ClientoNeeds: PsychosocialoIntegrity

33. Whichpatientis thebestocandidateoforbriefpsychodynamictherapy?

a. An accountantwithaolovingfamilyoandsuccessfulcareerowhoowasoinvolved inashort ex
tramaritalaffair
b. An adultwithalongJhistoryoofmajorodepressionwhowaschargedwithdriving underoth
e influence (DUI)
c. Awomanwithahistoryoofborderlinepersonalityodisorderowhoorecentlyocutbothwrist s
d. An adult maleo recently diagnosed with anorexia nervosa
ANSWER:J A
Theobestocandidates foropsychodynamicotherapyarerelativelyhealthyandwell-
functioningJindividuals,sometimesreferredtooasthe“worriedwell,”whoohavea clearlyocircumscrib
ed
area of difficulty and are intelligent, psychologically minded, and well-
motivated for change.Patients withpsychosis, severe depression, borderline personalitydisorder, a ndo
severeocharacter disordersarenot appropriatecandidatesfor thistypeJof treatment.

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DIF: CognitiveLevel: Apply (Application)o
TOP: NursingJProcess: PlanningJM
SC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. A patient states, “I’m starting cognitive-

behaviouraltherapy.WhatcanoIoexpectofromthesessions?”Whichresponsesbythenurse wou ld b
e appropriate? (Select all that apply.)
a. “Theotherapist willobeactiveandquestioning.”
b. “Youwillobeogivensome homeworkassignments.”
c. “The therapist will ask you to describe your dreams.”
d. “TheJtherapist willohelpoyoulookoatJyourJideasoand beliefsaboutoyourself.”
e. “TheJgoal isoto increasesubjectivityaboutothoughtsthatgovernyourobehaviour.”
ANSWER: A, B, D
Cognitivetherapists areoactive rather thanpassiveduringJtherapysessionsobecausetheyohelppatients
reality-
test their thinking. Homeworkassignmentsaregivenandcompleted outsidethetherapyosessions. Ho
meworkois usuallydiscussedoat thenextotherapysession.Theogoalofcognitivetherapyis to assist thepati
ent in identifyingJinaccuratecognitionsand in
reality-
testingJand formulatingonew, accurate cognitions. Oneodistracteroapplies topsychoanal ysis.
Increasingsubjectivityoisonotdesirable.

DIF: CognitiveLevel: Applyo(Application)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. Whichcommentsobyoan elderlypersonbestindicatesuccessfulcompletion ofthedevel op

mentalotask?o(SelecTtEalSl JT
thBatAaNpK
plSy .E) J LLER.COM
a. “Ioamproudofomyochildren’ssuccessesinlife.”
b. “Ioshouldohaveogiven toocommunity charitiesomoreooften.”
c. “My relationshipowith my father made life more difficult for me.”
d. “Myoexperiencesinthewarohelpedmeoappreciateotheomeaning oflife.”
e. “Iooften wonderowhatwouldhavehappenedoif Ihadochosenadifferentocareer.”
ANSWER: A, D
Theodevelopmentalocrisis forJanJelderlyopersonorelates toointegrity versusodespair. Pride inoone’sooffsporin
goindicatesoaosenseoofofulfillment. Recognitionoof theowisdom gainedofromodifficultoexperienceso(such as
being in aowar) indicates a sense of integrity. Blaming and regretindicate despair and unsuccessf ul resolu
tion of theocrisis.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

3. Whichocomments by an adultobest indicate self-actualization? (Select all that apply.)

a. “Ioam content withagoodbook.”
b. “Iooften wonderif Iochosetheoright career.”
c. “Sometimes Iothinkabout how myoparents would haveohandledproblems.”
d. “It’soimportant foroourocountryoto providebasichealthcareoservicesforJeveryone.”
e. “When Iowaslostoatseaoforo2 days,oIogained anunderstandingJofowhatisimpo
rtant.”

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ANSWER: A, D, E

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Self-
actualizedopersonsenjoyoprivacy, haveoasense ofodemocracy,oandoshow positiveooutcomesassociaoted
withpeakexperiences. Self-doubt, defensiveness, andblamingJareonotconsistentowithself-
actualization.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

4. Which activities represent the art of nursing? (Select all that apply.)
a. Administeringmedications on timetoJa group of patients
b. ListeningJto a new widow grieve her husband’s death
c. Helpingapatientobtaingroceriesofromafoodobank
d. Teaching apatientabout a new medication
e. Holdingothe hand of a frightenedpatient
ANSWER: B, C, E
Peplauodescribedothe scienceandoart of professional nursingpractice. Theoart componentoofnursi ng
consists of thecare, compassion, andadvocacyonursesprovideoto enhancepatient comfort an dwe
ll-
being. Thesciencecomponent of nursing involvesothe application of knowledgeoto understandabr
oadrangeoofhuman problemsandopsychosocialphenomena,
intervening to relieveopatients’ sufferingJandpromotegrowth.Seerelatedaudienceoresponsequestion.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs: Psychosocial Integrity

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Chapter 05: UnderstandingoResponses to Stress

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Theoadultochildoof aopatient diagnosedwithmajorJdepressionoasks,“Do you think depressionandophy

sical illness are connected? Since my father’s death, my mother has had shingles and the flu, but s ohe’s us
uallyonot one whoogets sick.” WhichoanswerJbyothe nurse best reflects currentoknowledgeoab outpsych
oneuroimmunology?
a. “Itoisprobablyaocoincidence.Emotionsandphysicalresponsestravelondifferenttractos
of the nervous system.”
b. “Youmaybepaying moreoattentionto yourmothersinceyourfatherdiedandnotic in
gomorethingssuch asminoroillnesses.”
c. “Sofar, research on emotions orostressand becoming ill moreeasilyois unclear.Wedonotkn
ow for sureifthereisalink.”
d. “Negative emotionsand stressomayinterferewithothebody’s abilityto protectitselfandcoan
increasethelikelihoodofinfection.”
ANSWER:J D
Thisanswerobestoexplains theoresearch. Researchsupports a link betweennegative emotionsoand/oor p
rolonged stressoand impairedimmunesystem functioning. Activation of the immunesystem sen dsopr
oinflammatorycytokines toothe brain, andothe brain inoturn releasesitsoowncytokinesthatJsign althec
entralnervoussystem toinitiate myriadresponsestoostress.
Prolongedostress suppresses theJimmune systemoandolowersoresistanceoto infections. AlthoughtheJaod
ult childmayobe moreaware of issuesinvolvingothe mother,othe pattern of illnessesdescribedmay beoa
n increaTsE
eJfSroTm
BAthNe KmSoE erL’sEbRa.seC
thL liO
neM.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

2. Apatientdiagnosedwith emphysemaohassevereoshortnessoofobreathoand needsportableoxygenw he

noleavingJhome. Recently, theopatientJhas reducedactivitybecause of fearthatobreathingodifficult y wil
looccur. A nurse suggests usingoguided imagery. Which imageoshouldthe patientobeJencouragedo tovisual
ize?
a. Engaging in activity without using any supplemental oxygen
b. SleepingJcomfortablyoandsoundly, withoutrespiratorydistress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. HavingJayounger,Jhealthierbodyothatknows noexerciselimitations
ANSWER:oC
Theopatientohasdysfunctionalimages of dyspnea. Guidedimageryocan help replaceothedysfunctionali
mageowithapositivecopingJimage. AthleteshaveJfoundthatpicturingJsuccessful imagescanenhanceo
performance. EncouragingJtheopatientoto imagineoaJregularJbreathing depth andoratewill helpoimoprove
oxygen-
carbonodioxide exchange andhelpachievefurtherJrelaxation. Otherooptionsofocus on unrealistic goa lso
(beingyounger, notneedingosupplementaloxygen), ororestrict her qualityoof life.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Planning MSC: Client Needs: Psychosocial Integrity

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3. Anurseleadsapsychoeducationalgroupofordepressedpatients. Thenurseoplans to implementan ex er
cise regimeoforJeachpatient. Whichoofothe followingorationalesshouldthenurseousewhenopresentingJt
his plan to the treatment team?
a. Exerciseocanoleadtoprotection fromotheharmfuloeffects ofstress.
b. Exerciseopreventsdamageofromoverstimulationoofthe sympatheticnervoussystoe
m.
c. ExerciseodetoxifiestheobodyobyoremovingJmetabolicwastes andother toxins.
d. Exerciseoimprovesmoodstabilityofor patientswithbipolar disorders.
ANSWER:J A
Physicalexerciseocanolead tooprotection fromotheharmfuleffects of stressoonoboth physicalandmoent
al states. Regular physical activity was associated with a loweroincidence of all psychiatric diso rderse
xceptbipolardisorder. Theotherooptionsarenotoaccurate.

DIF: CognitiveLevel: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs: Physiological Integrity

4. Arecent immigrant from Hondurascomes toothe clinicwitha familyomember whohasbeenaCanad ia

noresident foro10 years. Theofamilymemberosays,o“The immigration tooCanada has beenverydifficoult.”
Considering culturalbackground, whichexpression of stress byothis patient would thenurse ex pect?
a. Motor restlessness
b. Somatic complaints
c. Memory deficiencies
d. Sensory perceptual alterations
ANSWER:J B
Honduraso is in Central AmTerEicSaT
.JB
MAanNyKpeSoEpLleLfE
roRm.A
CsOiaM,JAfrica and Central Americaoexpress distreo s
sinosomaticterms. Theotherooptionsareonot specifictothispatient’scultural
backgroundandarelesslikelyotoobeJobserved in people from Central America.
DIF: Cognitive Level: Understando(Comprehension)
TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

5. Apatient nervouslyJsays, “Financialoproblemsarestressing my marriage. I’veoheard rumoursabout c

utbacksoat work; Ioam afraid Iomight get laid off.” The patient’s pulseois 112 per minute; respirationsare
26 per minute; and bloodopressure is 166/88. Whichonursing interventionowillothe nurseoimplement?
a. Advise theopatient, “Gootoosleep 30 to 60ominutes earlieroeachonightto increaserest.”
b. Directthepatient inslow anddeep breathing viause of apositive, repeatedword.
c. SuggestotheJpatient considerJthat a new jobomightJbe betterJthan the presentoone.
d. Tell theopatient, “Relax by spendingJmore time playing with yourJpet.”
ANSWER:J B
Theopatientoisorespondingoto stresswithincreasedarousaloof thesympatheticnervousosystem,Jas evide
nced by elevatedovital signs. These will haveoa negative effectoon his healthoand increase his perce ption of
beingoanxiousandstressed. StimulatingJtheoparasympatheticnervousosystemowillcounterot heosympa
thetic nervoussystem’sarousal, normalizingthese vital-
signochanges and reducing the physiological demands stress is placingJon his body. Oth
erJoptionsodo not addresshisophysiological responsepatternoasodirectlyooroimmediately.

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DIF: Cognitive Level: Apply (Application)
TOP: NursingProcess: PlanningJMSC: ClientoNeeds: Physiological Integrity

6. AccordingJto the Recent Life Changes Questionnaire, whichsituationwouldmost necessitatea coo

mpleteoassessmentof aperson’sstressstatus andcoping abilities?
a. Apersonowhoohasbeenassignedmore responsibilityatowork
b. Aparentwhoseojoborequiredrelocationtoadifferentcity
c. Apersonoreturning tocollegeoafteranoemployer ceasedoperations
d. Amanwhorecentlyseparatedfromhisowifebecauseofmaritalproblems
ANSWER:J C
A person returningJto collegeoafterolosingoaojob is dealingJwithotwo significantostressors simultaneoou
sly. Together, thesestressorstotalomorelifeochangeunitsthan anyJof thesinglestressors citedoi n th
e otherooptions.

DIF: Cognitive Level: Analyze (Analysis)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

7. A patient newly diagnosed aso HIV-

positiveoseekstheonurse’s advice on how tooreduceothe riskofinfections. Thepatientsays,o“I usedoto go
toochurch and Iowas in my best healththen. Maybe Ioshould start going to churchagain.” Whichroespo
nseowill the nurseooffer?
a. “Religionodoes not usually affect health, but you were youngeroando strongerJthen.”
b. “Contactwithosupportivepeople at churchomightohelp, but religion itself isonotJespe ci
allyohelpful.”
c. “Studiesshowthat spiritual practicesocan enhanceoimmuneosystemfunctionandcopin
gJabilities.”
d. “Going to church woulT d EexSpToB
seAyNoK
u tSoEmLaLnE
yoR
po.teCnOtiM
al infections. Let’s think about
someootherooptions.”
ANSWER:J C
Studieshave shownaopositive correlationbetweenospiritualopracticesand enhanced immune systemofuoncti
onoand senseoof well-
being. Theotherooptionsowronglyosuggestthatspiritual practiceshaveJlittleJeffect on theJimmune systeom
ororejecttheopatient’spreferencesregardingJhealthomanagement.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

8. Whenaonurse asksanewlyoadmittedopatientotoodescribeosocial supports,othe patientosays, “Myparentosd

iedlast year, and Iohaveono family. Ioam newlydivorced, and myformerin-
lawsblameome. Idon’thavemanyfriendsbecauseomostpeopleomyagejustwanttoogooutdrinking.
”Which actionowilltheonurseapply?
a. AdviseJtheopatientthatbeing soparticularoaboutpotentialfriends reducesosocialcont a
ct.
b. SuggestousingJtheoInternet as a way toofind supportiveoothersowithJsimilarJvalues.
c. Encourageotheopatient to begin dating again, perhapsowithomembers of theochurch.
d. Discuss howodivorcesupportgroupscouldoincreasecopingoand socialsupport.
ANSWER:J D

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High-
quality socialosupport enhances mental and physicalohealth and acts asoa significantobuffer againstodis tress
. Low-
qualitysupportorelationshipsoaffect aperson’scopingonegatively. ResumingJdating soonoafterJaodivoroc
ecould placeoadditional stress on theopatient rather than helpoher cope with existingJstressors. Deveolopi
ngorelationships onothe Internetprobablyowouldnot substitute fullyoforodirect contactwithotherJ hum
ansand couldexposeher to predatorsmisrepresentingthemselves tootake advantage of vulnerablepe
ople.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

9. ApatientoexperiencingJsignificantostressoassociatedwithoadisturbing newmedicaldiagnosisasksoth eo
nurse, “Doyouothink sayingaJprayer wouldhelp?” SelecttheJnurse’sbestoanswer.
a. “It could beJthatJprayer isoyour only hope.”
b. “YouomayfindJprayerJgivescomfortandolowersyour stress.”
c. “IocanhelpoyouofeelocalmerobyteachingJyouomeditationexercises.”
d. “Weodoonot haveevidenceothatoprayerhelps,obutoitwouldn’t hurt.”
ANSWER:J B
Manyopatientsofind that spiritualomeasures, including prayer,oarehelpfulin mediatingostress.Studieos
haveshownthatspiritualpractices canoenhance thesenseoofwell-
being. Whena patient suggestsa viablemeans of reducing stress, itshould besupported byothenu rse.
Indicating that prayerJisthepatient’soonlyhopeisopessimisticandowould causeofurtherdistress.Sugoge
sting meditationorootheroalternativestoprayerimpliesothattheJnurseodoesnotthinkprayerwould beoeff
ective. Manyopatientsfindthatospiritual measures, includingJprayer,arehelpful inomediatingost ress.

DIF: Cognitive Level: Apply (Application)

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TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

10. Apatient is broughtoto theemergencyodepartment afterJaJmotorcycleoaccident. TheopatientJis alertaond

responsiveandisodiagnosedowitha brokenoleg.Thepatient’svitalsignsarepulse(P)72 andrespirationo(
R) 16.Afterobeing informedsurgery isorequiredoforothebroken leg, whichovitalsignreadingswo uld be e
xpected?
a. P 64, Ro14
b. P 68, R 12
c. P 72, Ro16
d. P 80, Ro20
ANSWER:J D
Theopatientowouldoexperiencestressoassociatedowithoanticipation of surgery. In timesoof stress,theosy m
patheticonervoussystemtakesovero(fight-or-
flight response)oandsendsosignalsoto the adrenalglands, therebyoreleasing norepinephrine. Theocircul at
ing norepinephrineoincreasesothe heart rate. Respirations increase, bringingomoreooxygenoto theJlun gs.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

11. Apatient tellsothenurse, “Ioknowthat Ioshould reducethestressoinmyolife,but Iohavenoideawheret o st

art.” Whatwould be the bestinitialnursing response?
a. “Physicalexerciseworkstoelevate moodandreduceoanxiety.”
b. “Readingoaboutstressandhow to manageitomightobeoa goodplacetostart.”

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c. “Whynot startbyolearningtomeditate?That techniquewillcoverJeverything.”
d. “Let’stalkaboutowhatoisgoingoonin yourlifeandothenlookJatopossibleooptions.”
ANSWER:J D
Inthis case,othenurselacksinformationaboutwhatstressorstheopatientisJcoping with,andwhatc op
ingJskillsothepatient alreadyopossesses. Furtheroassessment isoindicatedbeforepotential solutio ns ca
nobeoexplored. Suggestingoexplorationofthestress facingJthepatientisthe onlyoptionthatin volvesf
urther assessmentrather thansuggesting aparticularointervention.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

12. A patient tells theonurse,o“My doctor thinks my problemsowithostressorelate to the negativeowayIothinkoab

out thingsandosuggested Iolearnonew ways of thinking.” Whichoresponse by thenursewouldsupport th
e recommendation?
a. Encourageotheopatientoto imagineobeing inocalm circumstances.
b. Providethepatientwithoablankojournalandguidanceaboutojournaling.
c. Teachothe patient to recognize, reconsider, andreframeirrationalothoughts.
d. Teachthe patient toouse instrumentsothat giveJfeedback about bodilyofunctions.
ANSWER:J C
CognitiveJreframing focusesoon recognizing andocorrecting maladaptivepatternsoof thinkingothat creoat
estress orointerfere withcoping. Cognitive reframingoinvolvesorecognizingothe habitoof thinkingJab out
aosituation or issue inoa fixed,oirrational, andunquestioning manner. Helping thepatient toJrecognoize an
d reframeo(reword) suchthoughts so that theyoareorealistic and accurate promotesocopingJand roeducesostr
ess. ThinkingJabout beingJinocalmingJcircumstancesois a form of guidedim a g e r Ty .EI nS sTt r Bu m
A e NnKtsStE
haLtJL
giE
v eR .fe Ce dOb Ma c k aboutbodilyfunctionsareused in biofeedback. Journaling is effective forohoelping to incr
easeself-awareness. However, noneof
these lastthreeJinterventions is likely tooalter theopatient’somanneroofthinking.

DIF: Cognitive Level: Apply(Application)

TOP: NursingJProcess: Planning MSC: Client Needs: Psychosocial Integrity

13. ApatientwhohadbeenexperiencingJsignificantstressolearned to useprogressiveomuscleorelaxatio no

anddeepobreathing exercises. Whenthe patient returns tootheclinico2weeks later,whichfinding mo
st clearlyshowsthepatientois coping moreeffectivelywithostress?
a. Theopatient’sosystolicbloodopressureohaschangedofromthe 140s to the120smmHg.
b. Theopatientreports, “Iofeel better, and thingsareonot bothering me as much.”
c. Theopatientreports,o“Iospend moreotimenappingoorositting quietlyoat home.”
d. The patient’s weightJdecreased by 3 pounds.
ANSWER:J A
Objectiveomeasurestendtobethe mostreliablemeans ofogauging progress.Inothiscase,theopatient’s ele
vatedoblood pressure,anoindicationooftheobody’sphysiologicalresponseotoostress,hasdiminished. Thep
atient’soreport regarding activitylevel is subjective; sitting quietlycouldreflectdepressionoratheor thanim
provement.Appetite,omood, and energyolevels areoalsosubjective reportsthatdo not necess arilyreflecto
physiologicalchangesfromstressoandmayonotreflectimprovedcopingJwithstress. The patient’sweigh
t changecouldJbeoa positiveooronegativeindicator;theJblood pressureochangeoisthe beost answer.

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DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: EvaluationMSC: ClientoNeeds: Psychosocial Integrity

14. A patient tells theonurse, “Iowill never beohappy until I’m as successful as myoolder sister.” The nurse as
ksotheJpatient to reassessthis statementandreframeit. Which reframedstatementbyothepatientoisomos
t likely to promote coping?
a. “Peopleoshouldtreatomeasowellasotheytreatmyosister.”
b. “Ican findcontentmentinsucceeding atmyownjoblevel.”
c. “Iowon’tobeJhappyountilImakeJasmuchomoneyasomyosister.”
d. “Being asosmart or clever as my sisteroisn’t really important.”
ANSWER:J B
Finding contentment withinoone’s ownwork, evenwhen it doesnot involve successoas othersmightde
fine it, is likely toolead tooa reducedosenseoof distressoaboutoachievement level. It speaks toofinding s atisfacti
on andhappinessowithout measuringotheself against another person. Focusing on salaryois soimplyoa m
orespecificwayoof being as successfuloasothe sister,owhichwould notopromote coping. ExpoectingJothers
to treatoher as they do hersister is beyondher control. Dismissingtheosister’s clevernes s asounimportan
t indicatesthatthe patientocontinues to feelinferioroto theJsibling.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: EvaluationMSC: ClientoNeeds: Psychosocial Integrity

15. Apatient says,“OneoresultoofmychronicostressisthatIofeelsootired. Iusuallyosleepfrom11

p.m.too6:30 a.m. Iostarted settingomyalarmotoogivemeoanextra30ominutesoofsleepoeach
morning, but Iodon’t feel anyobetteroandoI’morushedoforJwork.” WhichonursingJresponse wouldbestoa dd
ressotheopatient’socTonEcSerTnB
s?ANKSELLER.COM
a. “YouomayneedotoJspeakotooyourodoctoroaboutotaking asedativetohelp youosleep.”
b. “Perhapsogoing toobedoa half-houroearlierowouldoworkobetterothanosleepingJlater.”
c. “Aglassoofwinein theoevening mighttakeotheJedgeooffandhelpoyou toorest.”
d. “Exercisingjust beforeretiringoforothenightmayhelpyou to sleepobetter.”
ANSWER:J B
Finding contentment withinoone’s ownowork, evenowhen it doesonot involve successoas othersmightode
fine it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding s atisfact
ion andohappinessowithout measuring the self against anotheroperson. FocusingJon salary isos implyJaJm
ore specific wayJof beingoas successful asothe sister, whichwould not promote coping. Expecting other
s tootreat heroas they dooherosisterois beyondherocontrol. Dismissingtheosister’soclevernes s as unimporta
nt indicatesthatthepatient continues to feelinferior totheosibling.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: EvaluationMSC: ClientoNeeds: Psychosocial Integrity

16. Apatientreports, “Ioamoverwhelmedbystress.”Whichquestionobyotheonurseowouldbemostimpoorta

nt toouse intheinitialassessmentofthispatient?
a. “Tellmeaboutyour familyohistory.Doyouhaveoanyrelativeswhohaveoproblemswiths
tress?”
b. “Tell me about your exercise. How much activity do you typically get in a day?”
c. “Tellmeoabout theokindsoofthingsoyoudootooreduceorJcopewithoyourstress.”

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d. “Stressocaninterfereowithosleep.How muchdidyousleeplastnight?”
ANSWER:J C
Theomost importantdatatoJcollectduringoaninitialassessmentisthatwhichreflectshowostressisaff ect
ingJtheopatientandhowhe is copingwithstress atopresent. Thisdataowouldindicatewhether oronootJhiso
distressisplacingJhimindanger (e.g.,oby elevatingJhisobloodpressureJdangerously, oroviamalad aptive r
esponses,suchoasdrinking),andwouldhelpthe nurseunderstandhowhecopesandhowwel lhiscopin
gJstrategiesandresourcesservehim. Of theochoicespresented, thehighest priority would beoto determ
inewhatheoisodoing to copeoat present, preferablyviaoan open-
endedinquiry. Family history, theextent of hisuseoof exercise,oandhowmuchsleep heoisogettingJare all
helpfuloinformationobutoprovidedatathatoisoless of apriority. Also, the manneroinowhich suchdataoisosou
ght here is likely tooprovideoonly brief responses(e.g.,Jhow muchsleepohe got onooneoparticular nightis
probablylessimportantthanhowmuch he is sleepingJingeneral).

DIF: Cognitive Level: Analyze(Analysis)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

17. Whichscenariobest demonstratesoan example ofoeustress?

a. An individual loses a belovedofamily pet.
b. Anindividualopreparestotakeaone-
weekJvacation tooa tropical island with a group of close friends.
c. An individualreceivesaobanknoticethattherewereinsufficientfunds in hisooroheraccou nt
forJarecent rent payment.
d. Anindividualreceives notificationthathisoorohercurrentemployeroisexperiencingJfinan ci
al problemsandosome workerswillbeoterminated.
ANSWE .
R: B
Eustressisobeneficialstress; itmotivatespeopleto developoskillsotheyoneedotosolve problemsandm ee
topersonalgoals.Positive lifeexperiencesproduceeustress. Goingoonoa tropicalvacationois anoexcoiting,
relaxing experienceandoisoanoexampleoofeustress. LosingJtheofamilypet, worryingoabout employment
security, andhaving financialproblemsoareexamples of distress, aonegativeexperienceothat drainsene
rgyandocanleadtosignificantoemotionalproblems.Seeorelatedaudienceresponseoquesti on.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

18. ApersonowithaofearJofoheights drivesoacrossaohighobridge.Whichostructurewillstimulateoarespon se

fromtheautonomicnervousosystem?
a. Thalamus
b. Parietalolobe
c. Hypothalamus
d. Pituitary gland
ANSWER:J C

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Theoindividualwillofindthis experiencestressful. Thehypothalamusfunctions asotheocommand-
and-
controlcentreowhenoreceivingJstressful signals.Thehypothalamusorespondstosignalsoofstressbye ng
agingotheautonomicnervoussystem. Theparietallobe is responsibleforJinterpretation ofotherJ sens
ations. Theothalamusoprocessesomessagesoassociatedwithpainandwakefulness. Thepituitarygolandm
ayobe involved inJotherJaspectsoof theperson’sresponsebut would notostimulate the autono mic nerv
ous system.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

19. Aperson withaofearJof heightsdrivesacrossaohighbridge. WhichJdivision ofthe autonomicnervo us

systemwill bestimulated inresponseJtothisexperience?
a. Limbic system
b. Peripheral nervoussystem
c. Sympathetic nervous system
d. Parasympatheticonervoussystem
ANSWER:J C
Theoautonomic nervoussystem is comprisedoof the sympathetico(fight-or-
flightresponse)oandparasympathetic(relaxation response)nervoussystem. Intimesofstress,thesyom
patheticonervousosystemoisostimulated. Apersonofearfuloof heightsowouldexperienceostressoassociaotedo
withdriving acrossoahighbridge.Theoperipheralnervoussystemresponds tomessages fromth esym
patheticnervousosystem.ThelimbicJsystemprocessesemotionalresponses butis notspecificoallypar
t of theautonomicnervoussystem.

DIF: Cognitive Level: Understand(Comprehension)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
.
MULTIPLE RESPONSE

1. Whichochanges reflect short-term physiological responses to stress? (Select all thatoapply.)

a. Muscular tension, blood pressure, and triglycerides increase.
b. Epinephrineis released, increasingJheartandrespiratory rates.
c. Corticosteroid releaseoincreasesstamina andoimpedesodigestion.
d. Cortisol is released,Jincreasing glucogenesis andoreducingofluid loss.
e. Immunesystem functioningJdecreases,Jand riskoof canceroincreases.
f. Riskofordepression,oautoimmuneodisorders, andheart diseaseoincreases.
ANSWER: A, B, C, D
These answers areoall short-
termophysiologicaloresponses toostress. Increasedriskoforimmunesystemodysfunction, cancer, cardiovascul
arJdisease,odepression, andautoimmuneodiseaseoareJallolong-termo(chronic) effectsoofostress.

DIF: Cognitive Level: Understando(Comprehension)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

2. Whichnursingocommentsarelikely toohelpJaJpatient to cope,obyoaddressingothemediators ofstress? (S

electoall thatoapply.)
a. “Adivorce, whileostressful, canobeJtheobeginning ofaonew,betterphase oflife.”
b. “You said you used to jog; getting back to aerobic exercise could be helpful.”
c. “Journalingooftenpromotesawareness of how experiencesohaveaffectedpeople.”

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d. “Slowingoyourobreathingobycountingtoothreeobetweenobreathswill calmoyou.”
e. “Wouldashort-termloanmakeyourfinancesolessstressful?”
f. “There isoa supportogroupoforonewlydivorcedopersons inoyouroneighbourhood.”
ANSWER:J A, C,JE, F
Stressmediatorsoarefactorsthatcanohelppeoplecopeby influencing how theyperceiveoandrespo n
dotostressors;theyincludeopersonality,socialsupport,perceptions,andculture.
Suggesting thatadivorcemayhavepositiveasowellasonegativeoaspectshelps theopatienttoalterperce ptions
ofthestressor. Journalingincreasesself-
awarenessoregarding howolifeoexperiences mayhaveoshaped how we perceive andrespond to stress (o r h
ow ouropersonalityaffectsohow we respondoto stressors). Aloanocouldohelpothepatient by reducingothe fi
nancialpressures. Participation in support groupsoisoan excellentway to expandone’ssupportn etworkr
elative to specific issues. However,oneitherJaerobic exercise norJbreathing-
control exercises, while helpful in other ways, affect stress mediators.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: ClientNeeds:Psychosocial Integrity

3. Theonursewishesotoouseoguided imageryto help apatientrelax. Whichcommentswouldbeappropri

ate to include in the guided imagery script? (Select all that apply.)
a. “Imagineothersotreatingoyoutheowaytheyoshould,otheowayyouwant toobeotreated
...”
b. “With each breath, you feel calmer, more relaxed, almost as if you are floatingo...”
c. “Youoareoaloneoonoabeach, thesunJis warm, andyouhearJonlytheosoundJof thesurf ..
.”
d. “Youhavetakencontrol; nothingocanohurtyounow.Everything isogoingJyour way
...” .
e. “YouohaveJgrownocalm; yourJmindoisstill; thereisnothingJtodisturboyourwell-
beingJ...”
f. “YouwillfeelobetteroasworkJcalmsdown, asoyourobossobecomesomore unde rs
tandingo...”
ANSWER: B, C, E
Theointent of guidedimagery to helpopatientsomanageostress is toolead the patient tooenvision imagesotha
t are calming andohealth-
enhancing. StatementsthatinvolveothepatientcalmingJprogressivelywithbreathing, feeling increasoin
gly relaxed,obeingoinoa calm and pleasant location, being away from stressors, and having a peaceful andoca
lmomind areotherapeutic andshould be includedoin theoscript. However, itemsothat raise stressf ul images
or memoriesoorothatoinvolve unrealisticoexpectations oroelementsobeyond theopatient’s control(e.g., tha
tootherswilltreat thepatient as he desires,othat everything isogoing theopatient’sway, that bossesoareound
erstanding)ointerfere with relaxation orodo notopromoteeffective coping(orJboth). T hus, theseareno
thealth-promotingandshouldnotbeincludedinthescript.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Planning MSC: Client Needs: Psychosocial Integrity

4. Anoindividualosays to theonurse, “Ifeelsoostressed out lately. Iothinkthestress isoaffectingmybody, al

so.” Which somatic complaints are most likely tooaccompany this feeling? (Select all that apply.)
a. Headache
b. Muscle flaccidity

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c. Ulcer
d. Arthritis
e. Myopia
ANSWER: A, C, D
Whenoindividuals feel “stressed-
out,” theyooftenohaveaccompanyingsomatic complaints, includingoheadache, ulcers,oandoarthritis
,tonameoaofew.Changesinvision,suchasomyopia,wouldnotbeexpected.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

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Chapter 06: The Nursing Process and Standards of Care for Psychiatric MentaloHealthNursi n
g
Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Whatoisthenurse’soprimarysourceofordatacollection?
a. Thepatient
b. Theopatientschart
c. Theoadmissionohistoryoandophysical
d. The patient’s family or significant other
ANSWER: A
The nurse’s primarysource of data is theopatient; however, thereomay beotimesowhen it is necessaryotoosu
pplementororelycompletely onoanotheroforotheoassessment information. Theseosecondarysourcescano
be invaluableo when caring for a patient experiencing psychosis, muteness, agitation, orocatatonia
. Such secondaryosources mayoincludeomembersoofothe family,friends,oneighbours, police, health careow
orkers, and medical records.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective CareoEnvironment

2. Anewlyadmittedopatient diagnosedowithomajorodepressionohas gained 10 kilogramsoverJa fewmontoh

sandhassuicidalideation. Theopatient hasotaken an antidepressantmedicationfor 1weekwithoutremi
ssionofsymptoms. Selectthe prioritynursing diagnosis.
a. Imbalanced nutrition; T mE
orSe TthBaA
nNboKdSy EreLqLuiEreRm.eC
ntOs M
b. Chronic low self-esteem
c. RiskforJsuicide
d. Hopelessness
ANSWER:oC
Risk for suicideoisotheopriority diagnosis when the patient has both suicidal ideation and aoplanto carry o ut t
he suicidal intent. Imbalancedonutrition, hopelessness, and chronicolow
self-
esteem may be applicable nursing diagnoses, but these problems do not affect patientsafety as ur gentlyo
as wouldasuicideattempt.

DIF: Cognitive Level: Analyze (Analysis)oTOP

: NursingoProcess: Diagnosis/AnalysisMSC:
Client Needs: Psychosocial Integrity

3. Apatientdiagnosedwithmajor depressionhaslost 9okilograms in onemonth, haschroniclowself-

esteem, andaoplanoforJsuicide. Theopatientohastakenoan antidepressantmedicationforJ1 week. Whichon
ursingJinterventionhasthehighestpriority?
a. Implementsuicide precautions.
b. Offer high-calorie snackso and fluids frequently.
c. Assisttheopatient tooidentify threepersonalstrengths.
d. Observepatientoforotherapeuticoeffects of antidepressant medication.
ANSWER: A

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ImplementingJsuicideprecautions isotheonly optionrelated topatientsafety. Theother options relat
ed tonutrition,self-esteem, andmedicationotherapyareimportant, but are notpriorities.

DIF: Cognitive Level: Analyze (Analysis)

TOP: NursingoProcess: PlanningJMSC: ClientoNeeds: Safe Effective Care Environment

4. Theodesiredoutcomeforapatientoexperiencing insomniais,“PatientwillsleepforJaominimumof5 h ou
rs nightlywithin 7 days.” At theend of7days,oreview ofsleepdatashows thepatientosleepsoanoaver ageof
4 hoursnightlyoandtakes a2-
hourafternoonnap. Theonurseowilldocumenttheoutcome as which ofothefollowing?
a. Consistently met
b. Oftenmet
c. Sometimesmet
d. Unmet
ANSWER:J D
Althoughtheopatientisosleeping 6hoursodaily, thetotalisnotooneouninterruptedosessionatnight. Therefore, t
heoutcomemust beevaluated as unmet.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: EvaluationMSC: ClientoNeeds: Physiological Integrity

5. Theodesiredoutcomeoforaopatient experiencingJinsomnia is, “Patientwill sleepfor aominimumof 5 hoou

rs nightly within 7 days.” At the end of 7 days, review of sleep data shows the patient sleepsoanoave rageoof
4ohoursnightlyandtakesa2-hour afternoonnap. What istheonurse’s next action?
a. Continue the current plT anESwTithBoA
utNcKhaSnEgL
esL.JER.COM
b. Removethisnursing diagnosisofromtheoplanoofcare.
c. Writeoanewnursingodiagnosisothatbetteroreflectstheproblem.
d. Examineinterventionsforopossible revisionofthe targetdate.
ANSWER:J D
SleepingJa total of 5 hoursoat night remainsaoreasonable outcome. Extendingtheoperiod for attaininog t
heooutcomeJmay beoappropriate. Examininginterventionsmight result inoplanning anoactivity duroing t
heJafternoon ratherothan havingJtime foraonap. ContinuingJthe currentplanwithoutochanges is i nappro
priate. Removingothisnursing diagnosisofromotheplan of care wouldobeocorrectowhen theoout come was
met, andtheoproblemoresolved. Writing anewnursingJdiagnosis is inappropriatebecausenoother nur
singJdiagnosisrelatestotheproblem.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: EvaluationMSC: ClientoNeeds: Physiological Integrity

6. Apatient beginsoanewprogramotoJassistwith buildingosocialskills. Inowhichopartoof theoplanofocare sh

ouldaonurseorecordtheoitem,“Encouragepatientotooattendone psychoeducationalgroupdaily”?
a. Assessment
b. Analysis
c. Implementation
d. Evaluation
ANSWER:J C

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InterventionsaretheonursingJprescriptions tooachieveothe outcomes. Interventionsshouldbespec if
ic.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

7. Beforeassessing anewpatient, anurseisotoldobyanotherohealthcareworker,“Ioknowothatpatien

t. No matter how hard we work, thereJisn’tmuchimprovement byothe timeoof discharge.” Theon
urse’s responsibility is to do which of the following?
a. Documenttheotheroworker’sassessmentofthe patient
b. Assessotheopatientobasedoonodata collectedfromallsources
c. Validate theo worker’so impression by contacting theo patient’s significant other
d. Discusstheworker’simpression withthepatientduringotheJassessmentinterview
ANSWER:J B
Assessmentoshouldincludeodataobtainedofromobothotheprimaryoandoreliablesecondarysources. Toog
ain an even clearer understandingJof your patient,oit isohelpful to look to outsidesources foroinformati
on.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs: SafeoEffectiveoCare Environment

8. Apatientpresents toothe emergencyodepartment withmixed psychiatric symptoms. Theadmission n ur

se suspectstheosymptomsmayobe theresultJof aomedical problem. LabresultsoshowelevatedoBUN (blo
odureanitrogen)andcreatinine.What isothenurse’s next best action?
a. Reportthefindings toothehealthcareprovider.
b. Assessothepatientoforoaohistoryof renaloproblems.
c. Assess the patient’s fam TEi lyShTisBtoArN
yJK
foSrJE
caLrdLiaEcRp.roCbO
leM
ms.
d. ArrangeforotheJpatient’shospitalization on thepsychiatricunit.
ANSWER:J B
Elevated BUN (bloodurea nitrogen) andcreatinineosuggest renalproblems. Renal dysfunctioncan ofte
noimitateopsychiatricodisorders. The nurseshouldfurtheroassessothepatient’sohistoryofororenaloproblems
andthensharethefindingswiththehealthcareprovider.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

9. A patient states,o“I’monot worthoanything. Iohaveonegative thoughtsoabout myself. Iofeel anxiousoaondo

shakyoall theotime. Sometimes Iofeel so sadthatoIwant toogooto sleepoandneverwakeup.” Which nursi
ngJintervention should haveothe highestopriority?
a. Self-esteem-building activities
b. Anxiety self-control measures
c. Sleepenhancementoactivities
d. Suicide precautions
ANSWER:J D

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Theonurseowouldplaceoapriority on monitoringoandreinforcing suicideself-

restraint because it relates directly and immediately to patient osafety. Patientosafety is always a priority con
cern.Theonurseneedsoto initiate suicideprecautions(e.g., ongoing observationsandmonitoringJ ofth
epatient, provision ofa protectiveoenvironment)forJthepersonowhoisoatserious riskoforosuicide
. Thenurseshouldmonitor andreinforceoall patient attempts to control anxiety,oimproveosleep patte rn
s, andodevelopoself-esteem, while givingJpriorityattention toosuicide
self-restraint.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Planning MSC: Client Needs: SafeoEffectiveoCareoEnvironment

10. Select theobestooutcome foroaopatientowith the nursingodiagnosisoImpaired social interaction related to so ci

oculturalodissonance as evidencedJbyostating, “Although I’d likeJto, Iodon’t joinin becauseoIdon’tJsope
ak theolanguageverywell.”
a. Patientwilloshowimproveduseoflanguage.
b. Patientwillodemonstrateoimprovedsocialskills.
c. Patientwillbecomemoreoindependentoinodecision making.
d. Patient will select and participate inoone group activity per day.
ANSWER:J D
Theooutcomedescribesosocialinvolvementoonothe part of thepatient. Neitherocooperationonorindeope
ndencehasobeen an issue. Thepatienthas alreadyexpressedadesireoto interact withothers. Outcomes
must be measurable. Two oftheodistracters are not measurable.

DIF:
Cognitive Level: Analyze (Analysis) TOP: Nursing Proce
ss: Outcomes Identification

11. Nursing behaviours associaTtE

edSw
TiBthAt N
heKiSmEplLe L
mEenRta.tiCo O
n oMp hase ofnursing processoareoco n
cernedwithwhichofthefollowing?
a. Participating in mutualidentificationoofpatient outcomes
b. Gathering accurateoand sufficient patient-centred data
c. Comparingpatient responses andexpectedoutcomes
d. Carrying outointerventions and coordinating care
ANSWER:J D
Thepsychiatricomental healthnursecoordinatestheimplementation oftheoplan andprovidesodocu mentat
ion.Some registeredonursesoandoregisteredopsychiatric nursesareeducationallyandJclinicallypreparedotooco
nductadvancedinterventionssuchoasofferingJpsychotherapytoindividuals, couples, goroups, andfamilies
andproviding consultation to other disciplinesusing evidence-
informedpsychotherapeuticframeworksoandonurse-patientotherapeuticrelationships.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

12. Whichstatementomadebyoa patientoduringJanoinitialoassessmentinterviewshouldoserveoastheJprioritoy f

ocus forothe planof care?
a. “I can always trust my family.”
b. “It seems like Ioalways haveobad luck.”
c. “Youonever knowwho willoturnagainstyou.”
d. “Iohearoevil voicesthatotellme to do badthings.”

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ANSWER:J D
Theostatementoregardingoevilovoicestellstheonurseothat theopatient is experiencingJauditoryhallucoin
ationsoandorepresents thepatient’s chiefcomplaint. TheootherJstatements areovagueand doonot clea
rlyoidentifythepatient’schiefsymptom.

DIF: CognitiveLevel:Analyze(Analysis)
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

13. Whoois theobestpersontooprovideinformation abouta4-year-

old’s behaviour, attitude, andperformance?
a. Thechild
b. Theparent(s)
c. Thefamily doctor
d. Thepsychologist
ANSWER:J B
WhenassessingJchildren, it is important to gatherodataofromoa variety of sources. Althoughthechildiost
heobest sourceofordeterminingemotions, theocaregiverso(parentsoor guardians)ooftenocan best desc ribeJt
heobehaviour, performance, and attitude of theochild. Caregivers alsoareohelpful inointerpreting the chi
ld’sowordsoand responses.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

14. Anurseassesses anoolderoadultopatientbroughtto theoemergencyodepartmentobyoafamilymember. Th

eopatientwasowanderingJoutsidesaying, “Iocan’t find my wayJhome.”Thepatientisconfusedandunab
le to aTnE
sw
SeTrJBquAeNstKioSnE
s.LSL
elE
ecRt.thCe O
nuMrse’s best action.
a. Recordthepatient’sanswerstoquestionsoonthenursing assessment form.
b. Ask anoadvanced-practicenurseoto performtheoassessmentointerview.
c. Callofor amentalhealthadvocateotoomaintain theJpatient’srights.
d. Obtainimportantinformationfromthefamilyomember.
ANSWER:J D
Whentheopatient (primarysource) is unable to provide information, secondarysourcesshouldbeous ed
, in this case,othe familymember. Later,omoredatamay be obtained fromother informationosourcoes fa
miliarowiththepatient. An advanced-
practicenurseoisonot neededfor this assessment; it is within theoscope of practiceoofothe staffonurse. Call
ing amentalhealthadvocateisunnecessary.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:SafeJEffective Care Environment

15. Anurseoasksoaopatient,“Ifyouhada feverandvomiting for 3days,whatwouldyoudo?”Which as

pect oftheomental statusexamination is theonurseassessing?
a. Behaviour
b. Cognition
c. Affectoandomood
d. Perceptual disturbances
ANSWER:J B

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Assessing cognitionoinvolvesodeterminingJaopatient’sojudgementanddecisionomaking. Inothiscase,t he
nursewouldoexpectaJresponseof“Callmyodoctor”iftheopatient’scognitionand
judgement areointact. If thepatient responds, “Iowould stopeating” or “Iowould justwaitandseewh at
happened,” thenursewouldconcludethatJjudgementoisoimpaired. Theotherooptionsrefer to otheroaspe
cts of theoexamination.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

16. An adolescentasksanurseoconductingJanassessment interview,“Whyoshould Iotell youanything?

You’lljustotellmyparentsowhateveroyouofindout.”Whichresponseobythenurseoisappropriate?
a. “Thatoisn’totrue.Whatyoutellous isoprivateoandheldoinostrict confidence.YourJparenots
have no right to know.”
b. “Yes,oyourparentsmayfindoutwhat yousay,butitisoimportantthatotheyknowabout yo
urJproblems.”
c. “Whatyousayaboutyourfeelingsisoprivate,obutsomeothings,likesuicidalthinki n
g, must beoreported to the treatment team.”
d. “ItsoundsJas thoughoyouareonotreallyreadyto workoon yourproblems andmakechan
ges.”
ANSWER:J C
Adolescents areoveryconcernedwithoconfidentiality. The patientJhasoaJrightJto knowthatmostinfor ma
tionwill be held in confidence but thatcertainmaterialmust be reported or sharedwiththetreat ment t
eam, suchoas threats of suicide, homicide, use of illegal drugs,Jor issues of abuse. Theoincorrectresponse
sarenottrue, willnotinspiretheconfidenceofthepatient,or
are confrontational. .
DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

17. Anursewantsotooassessoan adult patient’s recentmemory. Whichquestionwouldbest yieldthedesoir

ed information?
a. “Wheredidoyou gootooelementaryschool?”
b. “Whatodidyouhaveoforobreakfastothismorning?”
c. “Canoyounameothecurrentopresident oftheUnited States?”
d. “Afewminutesago,IotoldyouomyJname.Canoyouremember it?”
ANSWER:J B
Theopatient’s recall of aomealprovidesoevidenceooforecent memory. Two of theincorrectoresponsoes
areouseful to assessoimmediateand remote memory. Theotherodistracter assessesthepatient’sfund
of knowledge.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

18. Whenanurseassesses an olderJadult patient, answersseemovagueoorJunrelatedoto theJquestions. The pa

tient also leans forward andofrowns, listeningJintently to thenurse. Which ofJtheofollowing questions
wouldobeappropriate forJthenurseJtoask?
a. “Areoyou having difficulty hearing when I speak?”
b. “Howcan IomakethisJassessmentintervieweasieroforyou?”

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c. “Ionotice youarefrowning.Areoyouofeelingannoyedwithme?”
d. “You’re havingJtrouble focusingoon what I’m saying. What is distracting you?”
ANSWER:J A
Theopatient’s behaviours mayindicateodifficultyohearing. IdentifyingJanyophysicaloneed that the patie nt
mayohaveoat theonsetooftheinterview,andmakingaccommodations,are important consideration
s. By asking if the patient is annoyed, theonurse is jumpingJto conclusions.
AskingJhow toomake theointerviewoeasieroforotheopatient mayonotJelicit aoconcreteoanswer.AskingJ
aboutodistractions isoa way of askingoabout auditoryohallucinations, whichois not appropriateob ecau
sethenurseohas observedthat theopatient seems to beolisteningintently.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

19. At whatopointin anoassessment interviewwouldoanurse ask,“Howdoesyour faithohelpoyouinstressf ul

situations?”
a. Duringotheassessmentofchildhood growthanddevelopment
b. Duringotheoassessmentofsubstanceouseandabuse
c. DuringtheJassessment of educational background
d. DuringotheJassessmentofocopingJstrategies
ANSWER:J D
Whendiscussing coping strategies, theonursemight ask whatthepatient doeswhenoupset, what usuaolly
relievesstress,oandtoowhomthepatient goesototalk aboutproblems.ThequestionregardingJwhe ther th
epatient’sfaithhelpsdealwithostressfitswellhere. It wouldobeoutoofplaceoifintroducedJduri ng explora
tion of the other topics.

DIF: Cognitive Level: AppT

lyE(S
ApTpB
licAaN
tioKn)SJoELLER.COM
TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

20. Whenanewpatientishospitalized,anursetakesthepatientonatour,explainsrules oftheunit,oa nd

discussesothe dailyschedule. Thenurseis engaged in which ofthe following?
a. Counselling
b. Healthteaching
c. Milieu management
d. Psychobiological intervention
ANSWER:J C
Milieuomanagement providesatherapeuticoenvironment inowhichthepatient canfeel comfortableoa
nd safeowhileoengaging in activities that meet the patient’s physical and mentalhealth needs. Counse llingo
refers tooactivities designedotoopromote problemosolving andJenhancedocopingJandincludesintoerview
ing, crisis intervention, stressomanagement, andconflictresolution. Healthoteachingoinvolvesidentif
ying healthoeducationoneedsandgivingJinformationabout theseneeds.Psychobiologicali nterventi
ons involvemedicationoadministrationandmonitoring response to medications.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs: SafeoEffectiveoCare Environment

21. Afteroformulating theonursing diagnosesoforanewpatient,owhatisanurse’sonextaction?

a. Designingointerventionsoto includeoin theplan of care
b. DeterminingtheogoalsoandooutcomeJcriteria

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c. ImplementingJthenursingJplanoofcare
d. CompletingJthespiritualoassessment
ANSWER:J B
Theothirdstepoofothenursing process is outcomesidentification. Outcomescannot be deter mi
nedountilothenursingoassessment iscompleteoandonursingJdiagnoses havebeenformulate d.

DIF: Cognitive Level: Understando(Comprehension)

TOP: NursingJProcess: Implementation MSC: Client Needs:SafeJEffective Care Environment

22. Select themost appropriate labeloto completethisnursingodiagnosis:

relatedotofeelingsofoshynessandopoorlydevelopedsocialskillsasevidencedbyowatching television alone ato
homeeveryevening.
a. Deficientknowledge
b. Ineffectiveocoping
c. Social isolation
d. Powerlessness
ANSWER:J C
AnursingJdiagnosis isa clinicaljudgementoabout a patient’sresponse,oneeds, actualandpotentialpsychi
atricdisorders, mentalhealthproblems, andopotential co-morbidophysical illnesses.Awell-
chosenand well-
statednursingJdiagnosis is theobasisofor selectingotherapeutic outcomes andinterventions. In this inst an
ce, theo evidenceoshows social isolationothat is causedby shynessoand poorly developed social skills.

DIF: Cognitive Level: Apply (Application)

TOP:o NursingJProcess:oDiagTnE
osSisT
/ABnA
alN
ysKisSELLER.COM
MSC: Client Needs: Psychosocial Integrity

23. WhatdoesthenurseassesswhenocompletingJthe final“S”oftheoHEADSSSoPsychosocialInter vi

ewTechnique?
a. Suicide risk
b. Savagery
c. Sexuality
d. Social support
ANSWER:J B
TheofinalSintheJHEADSSSoPsychosocial Interview Techniqueistooassesssavagery, that is,violenc e
oroabuseinthe homeoenvironmentor neighbourhood.

DIF: Cognitive Level: Remember (Knowledge)

TOP: NursingoProcess: N/AMSC: ClientoNeeds: Safe Effective Care Environment

24. Anursedocuments, “Patient is muteJdespiteorepeatedefforts to elicit speech. Makes no eye contaoct.

Inattentiveoto staff. Gazesoffoto theJside orolooks upwardJratherJthan at speaker.” Whichnursing di
agnosisshouldbeoconsidered?
a. Defensiveocoping
b. Decisional conflict
c. Riskforother-directed violence
d. Impairedverbalcommunication

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ANSWER:J D
TheodefiningJcharacteristics aremorerelated to thenursing diagnosis of impairedverbalcommunica
tionthantotheothernursing diagnoses.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingJProcess: Diagnosis/Analysis MS C
: ClientoNeeds: Psychosocial Integrity

25. AnursepreparestoassessoaonewpatientwhomovedtoCanadafromoCentralAmericathreeyears ag
o. After introductions, what is thenurse’snextcomment?
a. “HowodidyougettoCanada?”
b. “Would you like forJa family memberJto help youotalk with me?”
c. “Anointerpreter is available. Would youolike foromeoto make aorequest forJtheseservic
es?”
d. “Areyoucomfortableoconversing inEnglish,orwouldyouprefertohaveoatrans la
tor present?”
ANSWER: D
TheonurseshoulddetermineowhetherJaotranslatorJisoneeded byJfirstassessingtheopatient forJlanguage ba
rriers. Accuracyofotheassessmentodepends on theoability to communicatein aolanguagethatisofami liarto
theopatient.FamilymembersoareonotJalwaysreliableotranslators. Aninterpreteromaychangeothe patient’s
responses; a translator is abetterresource.

DIF: Cognitive Level: Analyze (Analysis)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

26. The nurse records this entry in a patient’s progress notes: Patient escorted to unit byJER nurseJat 2130. Pati ent
’s clothing TwEaSs JTd iBr tAy .NI K
n J iSnEt eLr vLi eEwRr.o C
o mO, Mp a t i e n t sat withJhandsJoverJface,sobbingJsoftly.DidJnotJacknowledgeJnursoeJor
reply to questions. AfterJseveral minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, “Letom eJout of
here.” Verbal intervention unsuccessful. OrderJforJstat dose 2 mg haloperidol PO obtained; medication administered
at 2150. By 2215, patient stopped shouting and returned to sitwordlessly in chair. P atient placed on one-to-
one observation. How should this documentation be evaluated?
a. Usesunapprovedabbreviations
b. Containssubjectivematerial
c. Tooobriefto beofvalue
d. Excessively wordy
e. Meets standards
ANSWER: E
ThisnarrativenoteJdescribesopatientappearance, behaviour, andconversation. It mentionsthatJless-
restrictivemeasureswereattemptedbeforeoadministering medicationoandodocumentspatientoresponos
etoomedication.Thisonoteowouldoprobablyomeetstandards.A completenursingJassessment wouldb ei
norderoas soonasthepatientis abletooparticipate.Subjectivematerial is absentfromtheonote. Ab brevi
ations are acceptable.

DIF: Cognitive Level: Analyze (Analysis)

TOP: NursingJProcess: EvaluationMSC: Client Needs: Safe EffectiveoCare Environment

MULTIPLE RESPONSE

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1. Anurseassessedaopatientowho reluctantlyparticipated in activities, answeredoquestionsowithminim al

responses, and rarelyomade eye contact. Whatinformationshould beoincluded when documenting th
e assessment? (Select all that apply.)
a. Theopatientowasuncooperative
b. The patient’s subjective responses
c. Onlyodataoobtainedfromothepatient’soverbalresponses
d. Adescriptionoofothepatient’s behaviour during theointerview
e. Analysisofwhyothe patient wasunresponsiveduringJtheinterview
ANSWER:J B, D
Bothcontentandprocessoftheointerviewshould be documented.ProvidingJonlytheopatient’sverba l r
esponseswouldcreateoaskewedpictureoftheopatient. Writing thattheopatientwasuncooperative is su
bjectively worded.An objectiveodescriptionofpatientbehaviour wouldbepreferable.Analysisooftheo
reasonsforthepatient’sobehaviourwouldobespeculation,whichis inappropriate.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Safe Effective Care Environment

2. Anurseperforminganassessmentinterviewforapatientwithasubstanceuseodisorderdecid es
to use a standardized rating scale. Which scales are appropriate? (Select all thatapply.)
a. Addiction Severity Index (ASI)
b. Brief Drug Abuse Screen Test (B-DAST)
c. Abnormal Involuntary MovementoScaleo(AIMS)
d. Cognitive Capacity ScreeningJExaminationJ(CCSE)
TESTBANKSELLER.COM
e. RecoveryoAttitudeand Treatment Evaluatoro(RAATE)
ANSWER: A, B, E
Standardizedoscalesareousefulforobtaining dataaboutsubstanceousedisorders. TheoASI, B
-
DAST,oandRAATEarescalesorelatedto substanceoabuse. AIMSassessesinvoluntarymovementsasosociate
dowithantipsychotic medications. The CCSEassesses cognitiveofunction.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

3. What information is conveyed by nursing diagnoses? (Select all that apply.)

a. Medicaljudgementsoaboutthedisorder
b. Unmetpatientoneedscurrentlyopresent
c. Goalsoandoutcomesofor theplan of care
d. Supporting data that validateothe diagnoses
e. Probablecausesothatowill beotargets for nursing interventions
ANSWER: B, D,E
Nursing diagnosesofocus onphenomenaJofconcernto nursesratherJthanon medicaldiagon
oses.

DIF:
CognitiveLevel: Understando(Comprehension)T
OP: Nursing Process: Diagnosis/Analysis
MSC: Client Needs: SafeoEffective CareEnvironment

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4. Apatient is verysuspiciousoandstates,“The FBIohasome under surveillance.” Whichstrategiesshouldoa
nurse use whenogathering initial assessment data about thisopatient? (Select all that apply.)
a. Tell theopatientthatmedicationwillhelpthisotypeofthinking.
b. Askthepatient,“Tell me abouttheoproblem asoyouseeit.”
c. Seekinformationaboutowhentheproblembegan.
d. Tellothepatient,J“Youroideasarenotorealistic.”
e. Reassureotheopatient, “Youare safeohere.”
ANSWER: B, C, E
Duringtheoassessmentointerview, thenurseshouldlistenattentivelyandacceptothepatient’sstateom
ents in a non-
judgementalway. The psychosocialoassessment collects information, in the patient’s ownowords, ab
outowhatthepatient’sochiefcomplaintis thatday. Becauseothe
patient is suspicious andofearful, reassuring safety may be helpful, although trust is unlikely soearly in theor
elationship. SayingJthat medicationowill helpoor telling the patient that theoideas are not realistic w illunder
mineodevelopmentJof trustbetweenthenurseandpatient.

DIF: Cognitive Level: Apply (Application)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

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Chapter 07: Ethical Responsibilities and Legal Obligations forJPsychiatricoMental HealthN ursingJPr
actice
Varcarolis’s Canadian Psychiatric Mental Health Nursing, 3rd Edition

MULTIPLE CHOICE

1. Apsychiatricnurse best appliestheoethicalprinciple ofautonomy by doingwhich ofthefollow in

g?
a. Exploring alternativeosolutions withaopatient, whoothenomakesaochoice.
b. Suggesting that twopatientsowhoowerefightingobeorestricted to theunit.
c. Intervening whenoaoself-mutilatingopatientoattemptsoto harmoself.
d. Staying with a patient demonstrating a high level of anxiety.
ANSWER:J A
Autonomyistheright toself-
determination, that is,oto makeJone’s ownodecisions. By exploring alternativeswith theopatient, t he
patient isobetteroequipped toomake an informed,autonomousodecision. Theodistracters demonstrat
e beneficence, fidelity, andjustice.

DIF:
Cognitive Level: Apply (Application)T
OP: Nursing Process: Evaluation
MSC: Client Needs: Safe Effective Care Environment

2. Anursefinds apsychiatricoadvance directive in themedicalrecord of apatientexperiencingpsychosi

s. The directiveowas executed duringJaperiodwhenothepatientwasstableoand competent. Thenurse
shoulddowhichofthefollowing?
a. Reviewotheodirective TwEithSTthBe ApN
atK
ienStEtoL eLnEsuRr.e C
itJO
isMcurrent.
b. Ensurethatthedirectiveisorespectedinotreatment planning.
c. Consider the directive only if there is aJcardiac or respiratoryo arrest.
d. Encouragetheopatienttoreviseotheodirectiveinlightofothecurrenthealthoproblem.
ANSWER:J B
Theonurse hasoan obligation to honourotherightotoself-
determination. Anoadvanceopsychiatricodirectiveosupports thatgoal. Sinceothepatient is currentlyop sychot
ic, thetermsoftheJdirectivenowapply.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: Client Needs: SafeoEffective Care Environment

3. Twohospitalized patients fight wheneverJtheyoaretogether. DuringJaoteamJmeeting,oaonurseassert s

that safety is of paramount importance, so treatmentoplans should call forbothpatientsoto beoseoclud
edtokeepthem frominjuringJeach other.Thisassertionodoeswhichofthefollowing?
a. Reinforcesotheautonomyoofthetwoopatients
b. Violatestheocivilrights ofbothopatients
c. Representstheintentionaltortoofbattery
d. CorrectlyoplacesemphasisonsafetyJAo
NSWER:J B
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Patientshaveoaright tootreatment in theoleast restrictive setting. Safety isoimportant,obut lessrestric tiv
eJmeasures should beotriedofirst. UnnecessaryseclusionomayoresultJin a chargeoofofalseJimprison ment
. Seclusionviolatesothepatient’sautonomy. Theoprinciple by whichthenurseois motivated is benefi
cence, not justice. Theotortorepresented is falseimprisonment.

DIF:
CognitiveoLevel: Apply (Application)T
OP: Nursing Process: Planning
MSC: Client Needs: Safe Effective Care Environment

4. InateammeetingJa nursesays,“I’mconcerned aboutwhetheroweoareobehaving ethicallyoby usingroes

traint to prevent oneopatient fromself-mutilation, whileothecareplanoforoanotherself-
mutilating patient requiresone-on-
one supervision.” Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
ANSWER:J D
Theonurse isoconcernedaboutjustice,othatis,fair distributionoofcare,whichincludestreatmentwi th t
heoleastJrestrictive methodsoforJbothopatients. BeneficenceJmeans promotingtheogood of others. Auto
nomy isotheoright to make one’soown decisions. Fidelity is the observance of loyalty and commit ment to
the patient.

DIF:
CognitiveoLevel: Understand(Comprehension)T
OP: NursingoProcess: Planning
MSC: Client Needs: SafTeEEfSfT
ecBtiAveNC
KaSrE LnLvEirRon.mCeOnM
eJE t

5. Select theresponsethat is anoexampleoof aotort.

a. Theoplanofcareforoapatient isonot completedwithin 24hoursofthepatient’sadmi ss
ion.
b. AnursegivesoaPRNdoseofanantipsychotic drugotoanagitatedpatientbecausetheu ni
t is short-staffed.
c. Anoadvanced-
practicenurserecommendshospitalizationoforapatientowhoisdangeroustoselfoand
others.
d. Apatient’sadmissionstatuschangeofrominvoluntaryto voluntaryoafterthepatie
nt’s hallucinations subside.
ANSWER:J B
A tortoisoaocivil wrongJagainst aopersonothat violates his orJherJrights. GivingJunnecessaryomedicatioonf
orotheoconvenience of staff, controlsbehaviouroin amannerosimilaroto secludingaopatient; thus, falsei
mprisonment is apossiblecharge. Theotheroptionsdo notexemplifytorts.

DIF:
Cognitive Level: Understand (Comprehension)T
OP: NursingoProcess: Evaluation
MSC: ClientoNeeds: Safe EffectiveoCareJEnvironment

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6. Whatistheolegalsignificanceofanurse’sactionwhenapatientverballyorefusesomedicationandtheJ nu
rsegivesthemedicationovertheopatient’sobjection?

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a. Theonursehasbeennegligent.
b. Theonursehascommittedmalpractice.
c. Theonurseohas fulfilledothestandardoofcare.
d. Theonurseocanobeocharged withbattery.
ANSWER:J D
Batteryois anointentional tortoin whichooneoindividual violatesotheorightsoof another throughtouchoin
gowithoutoconsent. Forcingoaopatient tootake medication afterothe medicationowasrefusedconstitut
es battery. Theocharge of batteryocan be broughtoagainstothe nurse. Theomedicationomay notonecess
arilyharmthepatient; harm is acomponentJofmalpractice.

DIF:
Cognitive Level: Understand (Comprehension)T
OP: NursingoProcess: Evaluation
MSC: ClientoNeeds: Safe Effective Care Environment

7. Whichnursingointervention demonstratesofalseoimprisonment?
a. Aconfusedoandocombativepatientosays,“I’m gettingJoutofhere, andno oneocanstop m
e.”Thenurserestrainsthispatient without ahealthocareprovider’sorder andthenp rom
ptly obtains an order.
b. Apatienthasobeenoirritatingandattention-
seekingmuchofotheoday. Anurseescortsotheopatientdownthe hallosaying,“Stayinoy our room, o
royou’llbeoput inseclusion.”
c. Anoinvoluntarilyhospitalized patientowithsuicidal ideationrunsoutoof theopsychiatroico
unit.Thenurserushesafterothepatient andoconvincesthepatientotoreturn to the unit.
d. Anoinvoluntarily hospitalized patient with homicidal ideation attempts tooleaveothefacilioty.
Ao nurseo c a l l sTtE
heSsTe B
c uAriNtyKteSaEmLaLnEd Ru .seCs J O
e sMta bl i s he d protocolso too prevento theo patienot fr
om leaving.
ANSWER:J D
Falseoimprisonmentinvolves holdingJa competentopersonoagainst his or her will. Actualoforceoison otoa
requirement offalseimprisonment.Theindividualoneedsonlyto beplacedoinfearJofimpriso nment
bysomeonewhoohastheabilityto carry outthethreat. Ifapatientis not competent (conf used), then
thenurseoshould act withbeneficence. Patients admittedinvoluntarilyshouldonotobe allowed toolea
ve without permission of thetreatmentteam.

DIF:
CognitiveoLevel: Apply (Application)T
OP: NursingoProcess: Evaluation
MSC: Client Needs: Safe Effective Care Environment

8. Which of the followingJpatientsomeets criteriaoforJinvoluntaryhospitalizationoforopsychiatrictreat

ment?
a. Theopatientwhois noncompliantwiththetreatmentoregimen
b. Theopatientwhofraudulentlyofilesfor bankruptcy
c. Theopatientowhosoldoanddistributedillegaldrugs
d. ThepatientwhothreatenstoharmselfandothersJA
NSWER:J D

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Involuntaryhospitalization protects patientsowhoaredangerous toJthemselves or othersoand cann ot
careoforJtheir ownobasiconeeds. Involuntarycommitment alsooprotects otheroindividuals inosoci ety.
Theobehaviours described inothe otheroptions areonot sufficient toorequire involuntaryhospitoalizati
on.

DIF:
CognitiveoLevel: Understand (Comprehension)T
OP: Nursing Process: Assessment
MSC: Client Needs: Safe Effective Care Environment

9. Anurseprepares to administeroa scheduledoinjection of haloperidoldecanoate (Haldol) tooan outpa ti

entowithoschizophrenia. As theonurseoswabs thesite, theopatient shouts,“Stop! Idon’towant tootak etha
t medicineanymore. IohatetheJsideeffects.”Selectthenurse’sbestaction.
a. Assembleootherstaffforashowofforceoandproceedwithotheinjection,ousing restr ai
ntif necessary.
b. Stopthemedicationadministrationprocedureandsaytothepatient,“Tellmemore abou t t
hesideeffectsyou’vebeenhaving.”
c. Proceedwiththe injectionbutexplaintoothepatientthatthereJareomedications thatwill h
elpreduceJtheounpleasantsideeffects.
d. SayJtootheJpatient,o“SinceI’vealreadyodrawnthemedicationintheosyringe, I’mrequiredt
oogiveit,butlet’stalk tothedoctorabout delaying nextmonth’sdose.”
ANSWER:J B
Patientswithmentaloillness retaintheiroright toorefuse treatmentunlessthere is clear, cogent,and coonv
incingJevidenceoof harming themselves oroharmingJothers. Thepatient in this situationpresents no e
vidence of harm. Thenurse, as anoadvocateoandoeducator, shouldoseekJmoreinformation aboutthepat
ient’s decisionandnotforcethemedication.
.
DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

10. A nurse is concerned thatJanoagency’s policies areoinadequate. Whichounderstandingabout the reloat

ionshipbetweenosubstandardinstitutionalopolicies andindividualnursingJpractice shouldguiden
ursingJpractice?
a. Agencyopoliciesodoonotexempt anindividual nurseofresponsibilityotoopracticeaccorodi
ngoto professionalstandardsofnursingocare.
b. Agencyopoliciesoareotheolegalstandardbywhichaprofessionalonurseomustactandtheref or
e override other standards of care.
c. Facedwith substandardpolicies,oanursehasaJresponsibilitytoinformothesupe r
visor and discontinuepatient careimmediately.
d. Interpretation of policies by thejudicialsystem is rendered on anoindividual basisandot he
refore cannot beopredicted.
ANSWER:J A

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Theoweaknessoof individualinstitutionssettingJsuchcriteriais thataparticular hospital’spolicym ay
beosubstandard.Substandardinstitutional policies,however, do not absolveotheindividualnuroseoof
responsibility to practise on theobasis of professional standards of nursingocare. Nurses are professi
onallybound to uphold standardsoof practiceregardlessoflesserostandards establishedboya healtho
careoagency or aprovince/territory. Conversely, if theoagencystandards areohigherthanstandards of
practice,otheagencystandardsmustobeupheld. Thecourtsmayoseekoto establish theostandard of car
ethroughotheuseofexpert witnesseswhentheoissueisclouded.

DIF:
CognitiveoLevel: Understand (Comprehension)T
OP: NursingoProcess: Planning
MSC: Client Needs: Safe Effective Care Environment

11. Anewlyadmittedoacutelypsychotic patientoisoa privateopatientooftheomedicalodirectoroandhas pri va

te medicalinsurance. ToJwhom doesthepsychiatric nurseassigned to theopatientoweothedut yoof
care?
a. Medical director
b. Hospital
c. Profession
d. Patient
ANSWER:J D
Althoughtheonurse isoaccountableotothehealthcareoprovider,theoagency, the patient,andthe proofession,
thedutyofcareisowedtotheopatient.

DIF:
CognitiveoLevel: Understand(Comprehension) T
OP:
NursingoProcess:TImEpSlT
emBeAnNtaKtiSno ELLER.CO
M MSC: Client Needs: Safe Effective Care Environment

12. Whichaction byoa nurseoconstitutesabreach ofapatient’s right tooprivacy?

a. DocumentingJtheopatient’sodailybehaviouroduringJhospitalization
b. ReleasingJinformationoto thepatient’semployerowithoutoconsent
c. Discussingotheopatient’sohistorywithotherstaffoduringJcareoplanning
d. AskingJfamilytoshareinformationoaboutoaopatient’sopre-hospitalizationobehaviour
ANSWER:J B
Releaseoof informationowithoutpatientauthorizationviolatestheopatient’soright to privacy. The
otherooptionsareacceptablenursing practiceoand doonot constituteoabreach of thepatie nt’srigh
ttoprivacyofinformation (confidentiality).

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Evaluation
MSC: ClientoNeeds: Safe Effective Care Environment

13. An adolescent hospitalizedafter aviolentphysicaloutbursttellsthenurse,“I’mgoing to killmy fat h

er, but youocan’ttellanyone.”Selectthenurse’sbestresponse.
a. “Youareright.Federallawrequiresmetokeepoclinicalinformationprivate.”
b. “Ioam obligatedtoshareothat informationowithothetreatmentteam.”
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c. “Thoseokindsoofothoughts willomakeyourJhospitalizationolonger.”
d. “Youshouldsharethisthought withyour psychiatrist.”

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ANSWER:J B
Breachofonurse-
patient confidentialityodoes not poseoa legaldilemmaoforonurses in thesecircumstancesobecausea teoa
mapproach to delivery of psychiatricocarepresumesocommunication of patient informationto ot hero
staffmembers to developtreatment plansand outcomeocriteria. TheoCNA’scode of ethicsclari fies th
atothe person’sright tooprivacy is notoabsolute. Inosome situations,odisclosure mayobe mandatoed to pro
tect thepatient, other persons, or publicohealth. Thepatient should alsoknowothatthetea mhasadut
ytowarnthefatheroftheriskfor harm.

DIF:
Cognitive Level: Apply (Application)T
OP: Nursing Process: Implementation
MSC: Client Needs: SafeoEffective Care Environment

14. Avoluntarilyhospitalizedopatient tellstheonurse,“Get me theformsofor discharge. Iowant toleave

now.” Selectothe nurse’s bestoresponse.
a. “Iowill gettheoformsforJyourightnowandobring themoto youroroom.”
b. “Since you signed your consent forJtreatment, you may leave if you desire.”
c. “I will get themoforoyouobutolet’s talkJaboutoyourodecisionoto leave treatment.”
d. “Iocannot giveoyouthoseformswithout your healthcareprovider’sopermission.”
ANSWER:J C
Avoluntarily admittedpatienthasotheright toodecideoto leavethehospital. However, asoa patient adv oc
ate, theonurse is responsible forJweighingJfactors related to the patient’sowishesandobestointerests. Byoas
king for information, thenurseomay be ableoto helpothepatient reconsidertheodecision. Facilitat ingodischa
rgewithoutoconsentois notoinotheopatient’sobestointerestsobeforeoe x plori n gT tEh eS T
r e Ba sAo Nn Kf oSr Et hL e Lr eEq R
u e.s C
t.J
OM
DIF:
CognitiveoLevel: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

15. AregisterednurseorequeststhatotheunlicensedhealthocareoworkergiveJaJpatient hisoorhermedicat io

noat1000 hours as thenurseowillobeat coffeebreak. Thisorepresentsoanexample ofwhichooftheof ollo
wing?
a. Malpractice
b. Intentional tort
c. Vicariousoliability
d. Defamation of character
ANSWER:J C
Vicariousoliability,alsooknownoassupervisoryliability,isdemonstratedintheexample,astheRNi si
nappropriatelyodelegatingomedicationadministration to an unlicensed healthcare worker.

DIF:
Cognitive Level: Understand (Comprehension)T
OP: NursingoProcess: Implementation
MSC: Client Needs: Safe Effective Care Environment

16. Whichoindividual with mental illness may needoemergency oroinvoluntary admission?

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a. An individual who resumes using heroin while still taking naltrexone (ReVia).
b. An individual who reports hearing angels playingJharps during thunderstorms.
c. Anindividualwhodoes notJkeep anooutpatient appointmentowiththeomentalhealthnurs e.
d. An individualowhothrowsaheavyplate atoawaiter atothedirection ofcommandhalluc in
ations.
ANSWER:J D
ThrowingJaoheavyplateislikely tooharmotheowaiter andoisevidenceooftheopossibilityofharmin g othe
rs. Thisobehaviour meetsthe criteria for emergency or involuntaryhospitalizationofor mental ill
ness. Theobehavioursointheother optionsevidencementalillnessbutonotimminent dangerofor har
ming self or others.

DIF:
CognitiveoLevel: Analyzeo(Analysis)TO
P: NursingoProcess: Implementation
MSC: Client Needs: Safe Effective Care Environment

17. Apatient inalcoholorehabilitation reveals tootheonurse, “Ifeel terribleoguiltoforosexuallyabusingom

y6-year-oldbeforeoIowasadmitted.”Selectthenurse’s mostimportantaction.
a. Reportotheoabuseotothelocal childwelfareoagency.
b. Reply, “I’m glad you feel comfortableotalking toJme about it.”
c. File a writtenoreport withothe agency’s ethics committee.
d. RespectJnurse-patientorelationshipoconfidentiality.
ANSWER:J A
Itois yourolegalandethicalresponsibilityoto make aoreportoof suspectedabuse to youroprovince’s oroteroritori
es cThEildST
wBelA
faN
reKaSgE
enLcyL.EM
Ro.sC
t sOt aMt u t e s include the consequences of
failureto report.Manyprovincesandterritoriesospecificallyorequirenurses to reportcases of
suspectedabuse.

DIF:
CognitiveoLevel: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: Client Needs: SafeoEffective Care Environment

18. Afamilyomemberoof aJpatientwithdelusionsoofpersecution asksthenurse,“Arethereanycircuom

stancesunderowhichthetreatmentteam is justified inoviolatingJa patient’soright to confidentialioty?”
Theonurseshouldoreplythatoconfidentialityomaybebreachedinwhichofthefollowingcircu mstan
ces, if any?
a. UnderJno circumstances
b. Attheodiscretion ofthepsychiatrist
c. Whenoquestions are asked by law enforcement
d. Iftheopatient threatenstheolife of anotherperson
ANSWER:J D
Theoduty toowarn aopersonowhoselifeohasbeenothreatened by aopsychiatricopatient overridesthe pa tie
nt’s rightJto confidentiality. Theorightoto confidentialityois not suspendedoat theodiscretion of thoether
apistorforlegalinvestigations.

DIF:
CognitiveoLevel: Understand (Comprehension)T
OP: NursingoProcess: Implementation
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MSC: Client Needs: SafeoEffective Care Environment

19. Anewoantidepressant isprescribedforoanelderly patientwithmajor depression,butthedoseismor et

hanothe usual geriatricdose. Whatshouldothenursedo?
a. Consult a reliable drugJreference.
b. Teachothe patientoaboutpossible sideeffectsoandoadverseoeffects.
c. WithholdothemedicationandconferJwithothehealthocare provider.
d. Encouragetheopatient tooincrease oralfluids tooreduce drugoconcentration.
ANSWER:J C
Theodose of antidepressants for elderlypatients is often lessothan theousual adult dose. Thenurseosh
ould withholdtheomedicationoandconsultothe healthcare providerwhowrote theoorder. The nurs
e’sduty is toopractise accordingJto professionalostandards as well as interveneoandprotectoth epatie
nt.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: Client Needs: Safe Effective Care Environment

20. Apatientdiagnosedwithschizophreniabelievesoalocalministerostirred evilspirits. Thepatient th

reatensoto bomboaolocalchurch. Theopsychiatristonotifies theominister. SelecttheanswerJwithotoheoc
orrect rationale.
a. Theopsychiatristoreleased informationowithout properoauthorization.
b. Theopsychiatrist demonstratedthedutyoto warn andprotect.
c. The psychiatrist violated the patient’s confidentiality.
d. Theopsychiatristavoidedcharges ofmalpractice.
.
ANSWE
R: B
Itois thehealthcareoprovider’sodutyoto warnooronotify an intendedvictimoafteroaothreatoofoharmohas bee
nomade. Informing a potentialovictim of aothreat is aolegal responsibility of thehealthocareprovider. It
isnotaoviolation ofconfidentiality.

DIF:
Cognitive Level: Understand (Comprehension)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

21. Apatient withpsychosisbecameaggressive, struckanother patient, andrequiredseclusion.Select t

he best documentation.
a. Patientstruck another patientwhoattempted tooleaveJday room to go toJbathroom.Secl
usion necessary ato1415. Plan: Maintain seclusion foro8 hours and keeptheseotwoopatienots
awayfrom each other for 24 hours.
b. Seclusion ordered by physicianoato1415 afterocommand hallucinations told thepatie nt
toohit anotheropatient. Careful monitoringoof patientJmaintainedoduring period of secl
usion.
c. Seclusionoordered by physician foroaggressive behaviour. Begun ato1415. Maintained foorJ2 h
ourswithoutincident. Outcome: Patientcalmer and apologizedfor outburst.
d. Patientopacing, shouting. Haloperidol 5 mg givenoPO ato1300. No effect by 1315.At 14 15
patient yelled,“I’ll punchanyoneowhogetsonear me,” andstruckanother patient withfis
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t.Physicallyoplaced inoseclusionoat 1420.SeclusionoorderJobtained

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fromphysicianoat 1430.
ANSWER:J D
Documentationmust beospecificoand detail theokeyaspects of care. It shoulddemonstrateoimplem ent
ation of theoleast restrictive alternative. JustificationoforJwhya patientJwas secluded should be reocorde
d, alongowithinterventionsattemptedoin an effort tooavoidoseclusion. Documentationoshould includeoa
descriptionoof behaviourJandoverbalizations, interventionstriedandotheirJoutcomes, andJ thename o
f thehealthocareoproviderordering theuseoof seclusion.

DIF:
CognitiveoLevel: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: Client Needs: Safe Effective Care Environment

22. Aperson inthecommunityoasks,o“Whyoaren’tpeoplewithmentalillnesskept ininstitutionsanym

ore?” Selectothe nurse’s bestoresponse.
a. “Less restrictive settings are available now to care for individuals with mentalillness
.”
b. “There arefeweropeopleowithmentalillness,osofewerohospitalobedsoareoneeded.”
c. “Most peopleowith mental illness are still in psychiatric institutions.”
d. “Psychiatric institutions violated patients’ rights.”
ANSWER:J A
Theocommunity is aoless restrictiveoalternativeothanohospitals forotreatment of peoplewithment al
illness. Changesoin theoprovincial/territorial actsovertheyearsoreflectaoshift in emphasisfroomin
stitutionalcare ofpeople withmentalillness toocommunity-
basedcaredeliverymodels. TheodisT trE
acSteTrsBaAreNiK
ncSoErrL
ecLtE
anRd.pCarOtJM
of the stigma of mental illne ss
.
DIF:
CognitiveoLevel: Apply (Application)T
OP: Nursing Process: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

23. A patient experiencingJpsychosisoasks a psychiatric technician, “What’s the matter withme?”

Theotechnicianreplies,“NothingJiswrong withoyou.Youjust needtouseosome s
elf-
control.”Thenurseowhooverheardtheoexchangeshouldtakeoaction basedonwhich ofthefollo wi
ng?
a. The technician’s unauthorized disclosure of confidential clinical information.
b. Violationoofthepatient’s rightJtoobeotreated withdignityandrespect.
c. Theonurse’sobligationotooreportocaregiveronegligence.
d. Theopatient’s right to social interaction.
ANSWER:J B
Patientshavetheright tobetreatedwithdignityandrespect.Thetechnician’socomment disregard st
heoseriousness ofthepatient’s illness.TheCode ofEthics foroNursesrequiresintervention.Pati ent e
motionalabusehasbeenodemonstrated, not negligence. Anointeractionwith thetechnician is notan
aspectofsocialinteraction.Thetechniciandidonotodiscloseclinicalinformation.

DIF: Cognitive Level: Understand (Comprehension)

TOP: NursingoProcess: Evaluation MSC: Client Needs: Psychosocial Integrity
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24. Whichdocumentation of apatient’s behaviourJbest demonstratesaonurse’soobservations?

a. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
b. Calmer;morecooperative. Participatedoactivelyinogroup. Nooevidenceoofpsyc h
oticothinking.
c. Appeared to hallucinate. Frequentlyincreasedvolume on television, causingconfli
ct with others.
d. Worefour layersoof clothing. States, “Ioneed protectionfrom evil bacteriatryingtopierce
my skin.”
ANSWER:J D
Theodocumentationostates specificobservations of theopatient’s appearanceoandtheexactstatem
entsmade. Theootherooptionsoarevague orosubjectiveostatements andcan be interpreted in di ffere
ntways.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

25. Afterleaving work,oanurserealizesodocumentationoofadministrationoofaPRNmedicationwaso m

itted. This off-
dutynurseophonesthenurseoonJdutyand says,“Pleaseodocument administration of themedicati onof
orome. Myopassword isalpha1.” TheonursereceivingJthecallshould dowhichofothe following
?
a. Fulfillothe request promptly.
b. Documentotheocaller’spassword.
c. RefertheJmatter totheochargeonurseotooresolve.
d. Reporto the request toTthEeSpT
atB
ieAnN
t’sKhSeE
alL
thLcEarRe.pC
roO
vMider.
ANSWER:J C
Fraudulentodocumentationomaybegroundsfordisciplineobyprovincial/territorialonursingoassociat io
ns orJcolleges. ReferringtheomatterJtoothecharge nursewilloallow observance of hospitalopolicywhil
eensuringothatdocumentationoccurs. Notifying theohealth careoprovider would be unnecessar ywhe
nothechargenurseocanresolvetheproblem. Nursesshouldnotprovideopasswords tooothers.

DIF:
CognitiveoLevel: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

26. Whichoindividual diagnosed with a mental illness may need involuntary hospitalization?
a. Anindividualowho hasapanicattackafter herJchildgetslostoinoashoppingomall
b. Anindividualwithvisionsof demonsoemerging fromcemetery plotsthroughoutthecoo
mmunity
c. AnindividualwhoJtakes38acetaminophentabletsafterohisor her stockportfoliobeco
mesworthless
d. An individualdiagnosedowithmajorJdepressionowhostopsotakingoprescribedanti d
epressantmedication
ANSWER:J C

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Involuntaryhospitalization protects patientsowhoaredangerous toJthemselves or othersoand cann ot
careoforJtheir ownobasiconeeds. Involuntaryhospitalization alsoprotectsootheroindividuals in soociety.
Anooverdose of acetaminophenoindicates dangerousness toJself. Theobehaviours describedinothe ot
her optionsare not sufficientoto requireinvoluntaryohospitalization.

DIF:
CognitiveoLevel: Apply (Application)T
OP: Nursing Process: Assessment
MSC: Client Needs: Safe Effective Care Environment

27. Anounlicensedhealthcareoworker inoa psychiatrichospitalsaystootheonurse,“Wedon’thaveJtimeoevoer

ydaytohelpeachpatientocompleteamenuselection. Let’stelldietaryotoopreparepopular choice s and
send them to our unit.” Select the nurse’s best response.
a. “Thanksforothesuggestion,butthatoideaomaynotworkbecausesomanyopatientstake
MAOIo(monoamine oxidaseinhibitor)antidepressants.”
b. “Thanksfor theoidea, butoit’simportanttotreatopatients asindividuals.Givingchoi c
es is onewaywe canrespectpatients’ individuality.”
c. “Thankyoufor thesuggestion, buttheopatients’ bill of rights requiresous tooallowpatie nt
s to selectotheir own diet.”
d. “Thank you. That is a verygoodidea. It will makeomealpreparationeasier for thedietar yo
department.”
ANSWER:J B
Theonurse’sresponse to theworkershouldrecognizepatients’ rights toobe treatedowithodignitya ndre
spectaswellaspromoteautonomy.ThisresponseoalsoshowsrespectforotheworkerJandoful fillsothen
urse’sobligation to providesupervision ofunlicensed personnel. Theincorrectresponoses hTaEveSJfTlaBw
AeNd KraStiEonLaLleEoRr J.d oCnOoMt J respect o patients as individuals.
DIF:
CognitiveoLevel: Analyze (Analysis)TO
P: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

28. In order tooreleaseoinformation tooanother healthcarefacilityor thirdpartyregardingJa patieont

diagnosedowithaomentaloillness,thenursemustobtain whichoof thefollowing?
a. Asignedconsent by thepatientfororeleaseoof informationstatingspecificJinforo
mation to be released.
b. Averbalconsent for informationreleasefrom thepatientandthepatient’sguarod
ian or next of kin.
c. Permissionfromomembers oftheohealthcareteamowho participateintreatmentplanoni
ng.
d. ApprovalofromotheattendingJpsychiatristoto authorizeothe releaseoofoinformation.
ANSWER:J A
Nurseshaveanobligationto protectopatients’privacyoandoconfidentiality. Clinical
informationshouldnotbereleasedwithoutthepatient’sosignedconsentfor theoreleaseunlessothe re i
sevidenceofharmtoselfor others.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Planning
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MSC: ClientoNeeds: Safe Effective Care Environment

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MULTIPLE RESPONSE

1. Inowhich situations would a nurseohave theoduty to interveneoand report? (Select all thatapply.)
a. A peerohas difficulty writing measurableooutcomes.
b. Ahealthocareoprovider givesa telephoneoorder for medication.
c. Apeerotriesotooprovideopatientocareoinoanoalcohol-impaired state.
d. Ateamomemberoviolatesrelationshipboundarieswithoa patient.
e. Apatient refusesmedicationoprescribedbyaolicensed healthocareoprovider.
ANSWER:J C, D
Bothkeyedanswersoareeventsthatojeopardizepatientosafety. Theodistractersdescribesituatoionst
hatmaybeoresolvedowithoeducation orothatareacceptable practices.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Evaluation
MSC: ClientoNeeds: Safe Effective Care Environment

2. Whichoactions violate the civil rights of aopsychiatric patient? (Select all that apply.)
a. Theonurse performsomouthochecksafter overhearing aopatientsay,“I’vebeenspittoi
ngoout my medication.”
b. Theonursebeginssuicideoprecautionsbefore apatientisoassessed bytheJhealth care provid
er.
c. Theonurseoopensandreadsaletterapatientleftatthe nurse’sstationto bemailed.
d. The nurse places a patient’s JexpensiveJwatch inJthe hospital business office safe.
TESTBANKSELLER.CO
e. TheonurseorestrainsapatientwhoousesprofanityowhenspeakingJto theJnurse.
ANSWER:J C, E
Theopatienthasotherighttoosendandreceivemailwithoutinterference.Restraintis notindicated be
causeaopatient usesprofanity; thereareJotherJless restrictiveoways to dealwiththisobehaviour. The
otherooptionsoareexamples of goodnursing judgementanddoonot violate thepatient’scivil rights.

DIF:
Cognitive Level: Apply (Application)T
OP: NursingoProcess: Implementation
MSC: ClientoNeeds: Safe Effective Care Environment

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Chapter 08: CulturalJConsiderationsofor PsychiatricoMental Health Nursing

Varcarolis’soCanadian Psychiatric Mental Health Nursing,o3rd Edition

MULTIPLE CHOICE

1. Whichotermreferstotheosharingoofcommontraits, customs,andrace?
a. World view
b. Ethnicity
c. Ethnocentrism
d. Culture
ANSWER:J B
Ethnicityorefers to the sharing of common traits, customs, and race. World view is a major paradigmouse d to
explain theworldanditsmysteries, inclusive of beliefs about health, illness,and theohereafter. Etohnoce
ntrism is the perception that one’s own values, beliefs, and behaviours are superior. Culture comp risesothe
sharedbeliefs, values,oandpracticesthat guidea group’smembersoin patternedwaysoof think ingoandact
ing, andincludesfactorssuch as religion, geography, socioeconomicstatus, occupation, ability orodisa
bility, andsexual orientation.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingProcess: PlanningJMSC: ClientoNeeds: Psychosocial Integrity

2. Apatient whoospeakslimitedEnglishhasgottenupsetwiththeonursewhenshegesturedwithher fo ot t
owardstheowashroom as herohandswere full andwantedoto helpthe patientfindthewashroom.
Whatshouldthenurseodo?
a. Contact atranslator. TESTBANKSELLER.COM
b. Apologizeforoupsettingothepatientandaskwhat happenedthatupset thepatient.
c. ExplainJtoothepatientthatoyouwerepointing tothewashroomwithoyourofoot.
d. Researchthepatients’culturalbackgroundtoassessowhatoitwasthatomayohave beenom
isinterpreted.
ANSWER:J B
Nurses can becomeawareoof signs of cultural paino(e.g., a patient’sofeelingoof alienation, emotional up
set) andrecoverotrustand rapport byoaskingJwhat hascaused theoffence, apologizingoforoinsens itivit
y, andexpressingowillingness to provideoculturallysensitivecare.

DIF: Cognitive Level: Apply(Application)

TOP: NursingProcess: EvaluationMSC: Client Needs: Psychosocial Integrity

3. Tooprovideculturallycompetentcare,theonurseoshoulddowhichoofthefollowing?
a. Accuratelyointerpretothethinking ofindividual patients
b. Predict how a patient may perceiveo treatment interventions
c. FormulateinterventionstooreduceotheJpatient’s ethnocentrism
d. Identifystrategiesthatfitwithintheculturalcontextofothepatient
ANSWER: D

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Culturalcompetence is theoability of nurses to applyknowledgeandskillappropriately in cross-
culturalosituations. Having culturalosensitivity orJawareness is an essentialcomponentoofculturalocomp
etence.Culturallycompetentcare goesobeyondculturally sensitivecareobyadapting careotomeetthoeop
atient’s cultural needsandJpreferences. Interpreting theothinkingJofindividualpatients doesnot eonsur
eculturally competentocare. ReducingJapatient’sethnocentrismomaynot beoa desiredoutcome.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning/Outcomes Identification M S
C: Client Needs: Psychosocial Integrity

4. Apatient of Asiandescentohasadiagnosis of depression. A colleague tells thenurse,“ThispatientJof te

nolooksodownoand isoreluctantoto shareofeelings. However, I’veobservedotheJpatientspontaneouslyoi nter
actingwithotheroblack patients.”SelectJthenurse’s best response.
a. “Blackpatientsodependontheochurch forsupport. Haveyouconsultedtheopatient’spast or
?”
b. “Encouragethepatienttotalkinagroupsetting. ItwillbeolessintimidatingJthanone-
to-oneinteraction.”
c. “Don’t take itopersonally. Blackopatientsoftenohaveoaresentful attitudethat takesa long toi
me to overcome.”
d. “TheopatientmayhaveodifficultyocommunicatingJinEnglish.HaveyouconsideredJusing a
cultural broker?”
ANSWER:J D
Asianimmigrantsounderutilizedohealthocareservicesodueoto language barriersoandocultural beliefsoaboout
healthand treatmentoptions. Theouseoof translators is one strategyforJovercomingJcommunicati on b
arriers. SocietyexpectsaJculturallyJdiverseJpatientotoJaccommodateoandouseoEnglish. Feelings aroe abst
ract, which requiresoa greateroT
coEmSm
TaBnA
dNofKtS
heElaLnL
guEaR
ge..C
TO
hiM
s mayJbeoespecially difficult duringepisode
sofhighostress orJmentalillness.
Culturalbrokerscan be helpful withlanguageandhelptheonurseoto understandJtheoAsianworldvi
ew and cultural nuances.
DIF: Cognitive Level: Apply (Application)
TOP: NursingJProcess: Implementation MSC: Client Needs:Psychosocial Integrity

5. Apatientdiagnosedwithodepressionotellsthenurse, “There’sonothing you canodo. This is apunisoh

ment. The only thing I can do is see a healer.” A religious world view perspective would indicat e wh
ichofthe following?
a. Theopatienthasdelusionsofpersecution.
b. The patient has likely been misdiagnosed with depression.
c. Theopatientmaybelievethedistressisotheresult ofaocurseoorJspell.
d. Theopatientofeels hopelessoandJhelplessrelated tooanJunidentified cause.
ANSWER:J C
Individuals of African, Haitian, andother culturesomayholdfatalistic attitudes about illness, believ eot
hey arebeingJpunishedfor wrongdoingJoroare victims of witchcraft or voodoo. Theymayobe reticoent t
ooshareinformationaboutocurseswiththerapists. No dataoarepresent inothe scenario to suppor tdelus
ions. Misdiagnosismoreoftenlabels apatientwithdepression as having schizophrenia.

DIF: Cognitive Level: Apply(Application)

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TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

6. A group activityoon an inpatient psychiatric unit is scheduled toobegin at 1000ohours. A patient,owh o

was recently dischargedofromothe Canadian Navy, arrives at 0945 hours. Whichanalysis bestoexpl ains t
his behaviour?
a. Theopatientwants toleadtheogroupoandgivedirectionsotooothers.
b. Theopatientwants toosecureoa chairthatowillobeoclosetootheogroupoleader.
c. Theomilitaryoculturevaluestimeliness.Thepatientdoes notwant to belate.
d. Theobehaviouroindicatesofeelingsoofself-
importanceothatthepatientowantsothersoto appreciate.
ANSWER:J C
World views shapeoperceptions about time, asowell as health and illness,orights and obligationsin soci ety,a
ndoacceptableways ofbehaving inorelationotooothers andnature.Cultureismore
thanethnicityandsocialnorms. Inothisoinstance,othe patient’smilitaryoexperiencerepresentsanaspe cto
of theopatient’sobehaviour. Theomilitaryculturevalues timeliness. Thedistracters representomisin terp
retationoofthe patient’s behaviouroandhave nobearingonthesituation.

DIF: Cognitive Level: Analyze(Analysis)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

7. Theonurseowouldincreaseotheodistanceofpersonalspaceowheninteractingwithoapatientwhoisof w
hichofthefollowing origins?
a. Middle Eastern
b. Asian
c. Southern European
d. LatinoAmerican
.
ANSWER:J B
WhenoworkingJwithpatientsofAsian descent,it isimportant forJtheonurseto knowthatJpersonalosp ace
is significantly further away than traditionally used in Western culture. Peopleof Middle Eastern
, Southern European, andJLatinJAmericanodescentgenerallyhaveoa closerJpersonal space. Within thoes
ecultures, standingJcloseindicatesacceptanceooftheother.

DIF: Cognitive Level: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

8. ThesiblingJof an Asian Canadianpatienttellstheonurse,“Mysisteroneedsohelpofor pain. Sheocries fro mt

heohurt.” Whichunderstanding by theonurseJwill contributeoto culturally competentcareforthis poatien
t?
a. PeopleoofAsian descent oftenexpressoemotionaldistresswithphysicalsymptoms.
b. PeopleofoAsianodescentJwillprobablyorespond best toatherapistowhooisimpeor
sonal.
c. PeopleoofoAsianodescent will requireoprolongedJtreatment toostabilize thesesym p
toms.
d. PeopleofoAsianodescentshouldbegivendirectinformationaboutotheodiagnosisand pr
ognosis.
ANSWER:J A

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Among several cultures, body-mind-

spirit is seen as a single entity. For example, such ideas predominate in Eastern world views, prevalen t ino
many AsianoCanadians, andoarebased onotheancient beliefs of Chineseoand Indianophilosophersaond the
spiritual traditions of Confucianism, Buddhism, and Taoism. Thereforetheonurseomayobserve Asian
Canadians expressingJsomatic complaints whenothereoisoaopsychological or spiritual problem. Treatment
will likelyobe short. Thepatientwillprobablyorespondobestoto aotherapist whoois perceivedoas giving.Asi
anoCanadians usuallyhaveostrongofamily tiesandvaluehopemoreothanotruth.

DIF: CognitiveLevel: Understand(Comprehension)

TOP: NursingJProcess: Assessment MSC: Client Needs:Psychosocial Integrity

9. WhichocommunicationotechniqueswouldbemostJeffectiveforoaonurseoto useduringanassesos
mentointerviewwith anadult Indigenouspatient?
a. Openandofriendly;ask directquestions;touchthepatient’sarmorhandoccaosi
onally for reassurance.
b. Frequentnonverbalbehaviours, such as gestures andsmiles; makeoan unemotionalfaceto
express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
ANSWER:J C
IndigenousculturestresseslivingJinoharmonyowithonature.Cooperative,osharingostyles rather thanoc o
mpetitiveor intrusiveapproachesarepreferred;thus, themoreopassiveostyledescribedwouldbebe st r
eceived. Theotheroptionsowould beomoreoeffectiveoto usewithpatients of a Westernorientatioon.

DIF: CognitiveLevel: ApplyJ(Application)

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TOP: NursingJProcess: Implementation MSC: Client Needs: Psychosocial Integrity

10. AnIndigenouspatientsadlydescribesadifficult childhood.Thepatientabusedalcoholasa teenage

rJbutstopped10 yearsago. Thepatientonow says,o“Iofeelstupidandgoodfor nothing. Idon’t helpmyp
eople.” Howoshouldthetreatment teamfocusplanningforothispatient?
a. Psychopharmacologicalandsomatictherapiesshould be centraltechniques.
b. Applyapsychoanalyticoapproach, focusedon childhoodtrauma.
c. Depressionoandoalcoholabuseshould betreatedoconcurrently.
d. Use aoholistic approach, includingJmind, body, and spirit.
ANSWER:J D
Indigenous peoples, because of theirobeliefs inothe interrelatedness of partsoand about beingJinharmoon
ywithnature, respondobestoto aholisticoapproach. Noodata areopresent to support aconcurrent di sorder
becausethepatienthasresolvedthe problemof excessivealcoholuse.
Psychopharmacological andosomatictherapiesomay beopart of theotreatment,Jbut the focusshouldbe
moreholistic.Psychoanalysis isa long-
term, expensive therapy; cognitive therapymight be a better choice.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning/Outcomes Identification M S
C: Client Needs: Psychosocial Integrity

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11. AFirst NationspatientdescribesadifficultchildhoodanddroppingJout of highschool. Theopatient us
edomanyrecreationalosubstances as aoteenageroto escapefeelings ofoisolationobutostopped 13 yearsaogo.T
heopatient now says,“Ifeel stupid.I’venever hada goodjob.Thereisnothing that Iam gooden oughoat
doingoto beableotowork.”Whichnursingdiagnosis applies?
a. Riskofor other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation
ANSWER:J B
LivingJin poverty subjectspeople toobias anddiscrimination that diminishesself-esteemandself-
efficacy, contributingoto exclusion andomarginalization. Relative poverty refers to inequities in material resour
ces acrosssegments of thepopulation—that is, between“thehaves” and“thehave-
nots.” InoCanada,thisgapiswidening,whichisocauseforconcern.Oneofthemostimpoverished grooup
sisIndigenouspeoples.Thepatient hasgivenseveralindications ofchroniclowself-
esteem. Formingoapositiveself-
imageoisooften difficult foroIndigenousindividualsbecauseotheseindigenouspeoplemustblendotogethe
rodifferentoworld views. Noodefining characteristicsoare presentfortheother nursingodiagnoses.

DIF:
Cognitive Level: Apply (Application)T
OP: Nursing Process: Diagnosis/Analysis MS
C: Client Needs: Psychosocial Integrity

12. Theonurse knowsthatotheJblueprintfor guidingactionsthatimpactocare,health,andwell-

being isowhichofothefollowing?
a. Worldoview
b. Ethnicity
c. Ethnocentrism
.
d. Culture
ANSWER:J D
Cultureoisotheoblueprint foroguiding actionsthatimpact care, health,oandwell-being.

DIF:
Cognitive Level: Understand(Comprehension) TOP: N
ursingJProcess: Planning/Outcomes IdentificationJMSC:
Client Needs: Psychosocial Integrity

13. Whichointerventionobestdemonstratesthatanurseocorrectlyunderstandstheculturalneedsofahosopit
alized AsianoCanadianopatientodiagnosedowithoamental illness?
a. Encouraging thefamilytoattendcommunitysupportgroups
b. Involving the patient’s familyoto assist with activities of daily living
c. ProvidingJeducationalpamphletsoto explainothepatient’s mentaloillness
d. Restricting homemadeoherbaloremediestheofamilybrings totheohospital
ANSWER:J B
TheoAsiancommunityovaluestheJfamilyoinocaringoforeachother.Theyviewthefamilyoascentralotoooone’
sidentity,andfamilyinterdependenceoandgroupodecisionmakingarethenorm.TheoAsiancomm unity
usestraditionalmedicinesandohealers,oincluding herbsfor mentalosymptoms. TheoAsianocommounityde
scribesillnessinsomaticoterms.TheoAsiancommunityoattachesastigmatomentalillness, soointerfacin
gJwithotheocommunitywould not beJappealing.

DIF: Cognitive Level: Apply (Application)

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