(Test Bank) Psychiatric Mental Health Nursing Concepts Of Care In Evidence Based Practice

Townsend, 8

Nursing

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8th Edition

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Author(s): Townsend

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Test Bank for Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice 8e Mary Townsend Chapter 1 . The Concept of Stress Adaptation Multiple Choice 1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6 -month score of 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data? A. The c lient is experiencing severe distress and is at risk for physical and psychological illness. B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress -related illness. C. Susceptibility to stress -related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D. The client may view these losses as challenges and perceive them as opportunities. ANS: C The Recent Life Changes Questionnaire is an expanded version of the Sched ule of Recent Experiences and the Rahe -Holmes Social Readjustment Rating Scale . A 6-month score of 300 or more, or a year -score total of 500 or mor e, indicates high stress in a client’s life. However, positive coping mechanisms and strong social support can limit susceptibility to stress -related illnesses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 2. A physically and e motionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client ’s appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 3. Which client statement should alert a nurse that a client may be responding maladaptively to stress? A. “I’ve found that avoiding contact with others helps me cope.” B. “I really enjoy journaling; it’s my private time.” C. “I signed up for a yoga class this week.” D. “I made an appointment to meet with a therapist.” ANS: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learn ing appropriate coping skills and can prevent access to needed support systems. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need : Psychosocial Integrity 4. A nursing student finds that she comes down w ith a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight -or-flight stage ANS: C At the stage of exhaustion , the student’s exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychos ocial Integrity 5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client ’s mother states, “That’ s not something to be stressed about!” Which is the most appropriate nursing response? A. “Teenagers! They don’t know a thing about real stress.” B. “Stress occurs only when there is a loss.” C. “When you are in poor physical condition, you can ’t experien ce psychological well -being.” D. “Stress can be psychological. A threat to self -esteem may result in high stress levels.” ANS: D Stress can be physical or psychological in nature. A perceived threat to self -esteem can be as stressful as a physiological ch ange. KEY: Cognitive Level: Application | Integrated Processes : Nursing Process: Implementation | Client Need: Psychosocial Integrity 6. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time? A. Meditation B. Problem -solving training C. Relaxation D. Journaling ANS: B The student must assess his or her situation and determine the best course of action. Problem - solving training, by providing structure and objectivity, can assist in decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Proces s: Implementation | Client Need: Psychosocial Integrity 7. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem -solving. During a routine physical examination , the graduate confides in the clinic nurse. Which is the most a ppropriate nursing intervention? A. Encourage the student to use the alternative coping mechanism of relaxation exercises. B. Complete the problem -solving process for the client. C. Work through the problem -solving process with the client. D. Encourage the client to keep a journal. ANS: C During times of high anxiety and stress, clients will need more assistance in problem -solving and decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 8. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’s reaction to her perceived probl em? A. The problem is endangering her well -being. B. The problem is personally relevant to her. C. The problem is based on immaturity. D. The problem is exceeding her capacity to cope. ANS: B Psychological stressors to self -esteem and self -image are related to how the individual perceives the situation or event. Self -image is of particular importance to adolescents , who feel entitled to have all the advantages that other adolescents experience. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 9. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into one’s feelings C. A demonstration of appropriate role behaviors D. An enhanced ability to problem -solve ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluatio n | Client Need: Psychosocial Integrity 10. A distraught, single, first -time mother cries and asks a nurse, “How can I go to work if I can ’t afford childcare ?” What is the nurse’ s initial action in assisting the client with the problem - solving process? A. Determine the risks and benefits for each alternative. B. Formulate goals for resolution of the problem. C. Evaluate the outcome of the implemented alternative. D. Assess the fac ts of the situation. ANS: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 11. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. Which student response indicates that learning has occurred? A. “When an individual has limited experience dealing with stress” B. “When an individual inherits maladaptive genes” C. “When an individual experiences existing conditions that exacerbate stress” D. “When an individual’s physiological and psychological resour ces have become depleted” ANS: D During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is the time when diseas es of adaptation may occur. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance 12. When an individual’ s stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response ANS: A In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur. A decreased immune response is seen at this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity 13. Which symptom should a nurse identify as typical of the “fight -or-flight” response? A. Pupil constriction B. Increased heart rate C. Increased salivation D. Increased peristalsis ANS: B During the “fight -or-flight” response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows unessential functions. OK KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity 14. A nurse is evaluating a client’ s response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event? A. When the individual judges the event to be benign B. When the individual judges the event to be irrelevant C. When the individual judges the resources and skills needed to deal with the event D. When the individual judges the event to be pleasurable ANS: C When the individual judges the resources and skills needed to deal with the event, the individual is conducting a sec ondary appraisal. There are three types of primary appraisals: irrelevant, benign -positive, and stressful. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 15. Research undertak en by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool? A. Sp ecific illnesses are not identified. B. The numerical values associated with specific life events are randomly assigned C. Stress is viewed as only a physiological response. D. Personal perception of the event is excluded. ANS: D Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration . KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance 16. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response? A. “Genetics have nothing to do with your temperament.” B. “How you reacted to past experiences influences how you feel now.” C. “If you’re in good physical health , your stress level will be low.” D. “Stress can always be avoided if appropriate coping mechanisms are employed.” ANS : B Past experiences are occurrences that result i n learned patterns that can influence an individual’s current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors. KEY: Cognitive Level : Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity Multiple Response 17. A nurse is interviewing a distressed client , who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the client ’s appraisal of the situation? Select all that apply. A. “What resources have you used previously in stressful situations?” B. “Have you ever experienced a similar stressful situation?” C. “Who do you think is to blame for this situation?” D. “Why do you think you were fired from your job?” E. “What skills do you possess that might lead to gainful employment?” ANS: A, B, E These questions specifically address the client’s coping resources and encourage the client to apply learning from past experiences. These questions also encourage the client to consider altern ative methods for dealing with stress. Asking who is to blame does not assess coping abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a nontherapeutic block to communication. KEY: Cognitive Level: Application | Integrat ed Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 18. A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? Select all that apply. A. “Enjoy a pet.” B. “Spend time with a loved one.” C. “Listen to music.” D. “Focus on the stressors.” E. “Journal your feelings.” ANS: A, B, C, E Focusing on the stressors is more likely to increase stress in the c lient’s life. However, pets, music, journaling feelings, and healthy relationships have all been shown to decrease amounts of stress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Int egrity 19. A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress C. Re laxation exercises D. Identifying support systems ANS: B Although all of the above answers may be useful in the comprehensive management of stress, the initial step is awareness that stress is being experienced and awareness of factors that create stress. KEY: Cognitive L evel: Analysis | Integrated Processes: Teaching/ Learning | Client Need: Psychosoc ial Integrity 20. A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physica l injury , but she appears very hyperactiv e and talkative . Which of these symptoms manifested by the patient are common initial biological responses to stress ? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations ANS: B, D, E Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress. Since dilated pupils rather than constricted pupils are related to “Fight or Flight” syndrome, this symptom should be assessed for other potential causes. Unusual food c ravings have not been identified as a typical biologic al response to stress . KEY: Cogniti ve Level: Analysis | Integrated Processes : Nursing Process: Assessment | Client Need: Physiological Integrity Chapter 2. Mental Health/Mental Illness: Historical and Theoretical Concepts Multiple Choice 1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. T he client’s appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client’s behaviors? A. The client’s behaviors demonstrate mental illness in the form of depression. B. The client’ s behaviors are extensive, which indicates the presence of mental illness. C. The client’s behaviors are not congruent with cultural norms. D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness. ANS: D The nurse sho uld assess that the client’s daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the client’s distress does not indicate a menta l illness. KEY: Cognitive Level: Analysis | Integrated Process es: Nursing Process: Assessment | Client Need: Psychosocial Integrity 2. At what point should the nurse determine that a client is at risk for developing a mental disorder ? A. When thoughts , feelings, and behaviors are not reflective of the DSM -5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates significant distress D. When the client uses defense mechanisms as ego protection ANS: B The nurse should determine that the client is at risk for mental disorder when responses to stress are maladaptive and interfere with daily functioning. The DSM -5 indicates that in order to be diagno sed with a mental disorder , there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usua lly associated with significant distress or disability in social, occupational , or other important activities. The client’s ability to communicate distress would be considered a positive attribute. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Assessment | Client Need: Psychosocial Integrity 3. A nurse is assessing 15 -year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents? A. Reactions to stress are relative rather than absolute; individual responses to stress vary. B. It is abnormal for identical twins to react differently to similar stressors. C. Identical twins should share the same temperament and respond similarly to stress. D. Environmental influences weigh more heavily than genetic influences on reactions to stress . ANS: A Responses to stress are variable among individuals and may be influ enced by perception, past experience, and environmental factors in addition to genetic factors. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Implementation | Client Need: Psychosocial Integrity 4. A client has a history of excessive drinking , which has led to multiple arrests for driving under the influence (DUI) . The client states, “I work hard to provide for my family. I don’t see why I can’t drink to relax.” The nurse recognizes the use of which defense mechanism? A. Pro jection B. Rationalization C. Regression D. Sublimation ANS: B The nurse should recognize that the client is using rationalization, a common defense mechanism. The client is attempting to make excuses and create logical reasons to justify unacceptable feelings or behaviors. KEY: Cognitive Level: Application | Integr ated Process es: Nursing Process: Assessment | Client Need: Psychosocial Integrity 5. Which client should the nurse anticipate to be most receptive to psychiatric treatment? A. A Jewish, female journalist B. A Baptist, homeless male C. A Catholic, black male D. A Protestant, Swedish business executive ANS: A The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important as physical health. Women are also more likely than men to seek treatment for mental health problems . KEY: Cognitive Level: Comprehension | Integrated Process es: Nursing Process: Planning | Client Need: Psychosocial Integrity 6. A new psychiatric nurse states, “This client’s use of defense mechanisms should be eliminated.” Which is a correct evaluation of th is nurse’s statement? A. Defense mechanisms can be self-protective responses to stress and need not be eliminated. B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. D. Defense mechanisms cause disinteg ration of the ego and should be fostered and encouraged. ANS: A The nurse should know that defense mechanisms serve the purpose of reducing anxiety during times of stress. A client with no defense mechanisms may have a lower tolerance for stress, predispo sing him or her to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Implementation | Client Need: Psyc hosocial Integrity 7. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s best response? A. “It’s just a routine part o f our assessment. All clients are asked these same questions.” B. “Why are you concerned about these types of questions?” C. “Psychological factors, like excessive stress, have been found to affect medical conditions.” D. “We can skip these questions, if y ou like. It isn’t imperative that we complete this section.” ANS: C The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip either physiological or psychosocial questions, as this would lead to an inaccurate assessment. KEY: Cognitive Level: Analysis | Integrated Process es: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance 8. Which statement reflects a student nurse’ s accurate understanding of the concepts of mental health and mental illness? A. “The concepts are rigid and religiously based.” B. “The concepts are multidimensional and culturally defined.” C. “The concepts are universal and unchanging.” D. “The concept s are unidimensional and fixed.” ANS: B The student nurse should understand that mental health and mental illness are multidimensional and culturally defined. It is important for nurses to be aware of cultural norms when evaluating a client’s mental state . KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Evaluation | Client Need: Safe and Effective Care Environment 9. A mental health technician asks the nurse , “How do psychiatrists determine which diagnosis to give a patient ?” Which of these responses by the nurse would be most accurate? A. Psychiatrists use pre -established criteria from the APA’s Diagnostic and Statistical Manual of Mental Disorders ( DSM -5). B. Hospital policy dictates how psychiatrists diagnose mental disorders. C. Psychiatrists assess the patient and identify diagnoses based on the patient’s unhealthy responses and contributing factors. D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from. ANS: A The DSM -5 is an organized manual describing mental disorders and the criteria that determine whether a given diagnosis is appropriate. It is published by the American Psychiatric Association (APA) . It intends to facilitate accurate and reliable medical diagnosis an d treatment. Item C describes nursing rather than medical diagnosis. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 10. The nurse is preparing to provide medication instruction for a patient. Which of the following understandings about anxiety will be essential to effective instruction? A. Learning is best when anxiety is moderate to severe. B. Learning is enhanced when anxiety is mild. C. Panic level anxiety helps the nurse tea ch better. D. Severe anxiety is characterized by intense concentration and enhances the attention span. ANS: B Mild anxiety sharpens the senses, increases the perceptual field, and results in heightened awareness of the environment. Learning is enhanced. As anxiety increases, attention span decreases and learning becomes more difficult. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Health Promotion and Maintenance 11. Which of the following are ide ntified as psychoneurotic responses to severe anxiety as they appear in the DSM -5? A. Somatic symptom disorders B. Grief responses C. Psychosis D. Bipolar disorder ANS: A Somatic symptom disorder is characterized by preoccupation with physical symptoms for which there is no demonstrable organic pathology. One of the diagnostic criteria is a high level of anxiety about health concerns or illness. KEY: Cognitive Level: Compr ehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 12. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this empl oyee? A. The employee assertively confronts the boss B. The employee leaves the staff meeting to work out in the gym C. The employee criticizes a coworker D. The employee takes the boss out to lunch ANS: C The client using the defense mechanism of displa cement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less -threatening target. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Assessment | Client Need: Psychosocial Integrity 13. A teenage boy is attracted to a female teacher. Without objective evidence, a school nurse overhears the boy state, “I know she wants me.” This statement reflects which defense mechan ism? A. Displacement B. Projection C. Rationalization D. Sublimation ANS: B The nurse should determine that the client’ s statement reflects the defense mechanism of projection. Projection refers to the attribution of one’s unacceptable feelings or impulses to another person. When the client “passes the blame” of the undesirable feelings, anxiety is reduced. Displacement re fers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Assessment | Client Need: Psychosocial Integrity 14. A fourth -grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defe nse mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation ANS: C The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from bein g expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Projection refers to the attribution of unacceptable feelings o r behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities. KEY: Cognitive Level: Application | Integrated Process es: Nursing Process: Assessment | Client Need: Psychosoci al Integrity 15. Which nursing statement about the concept of neuroses is most accurate? A. “An individual experiencing neurosis is unaware that he or she is experiencing distress.” B. “An individual experiencing neurosis feels helpless to change his or her situation.” C. “An individual experiencing neurosis is aware of psychological causes of his or her behavior.” D. “An individual experiencing neurosis has a loss of contact with reality.” ANS: B The nurse should understand that the concept of neuroses includes the followi ng characteristics . The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of