(Test Bank) Varcarolis : Essentials Of Psychiatric Mental Health Approach To Evidence-Based Care

Varcarolis, 4

Nursing

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4th Edition

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Chapter 01: Science and the Therapeutic Use of Self in Psychiatric Mental Health Nursing Varcarolis: Essentials of Psychiatric Mental Health Nurasbinirbg.c:omA/teCst ommunication Approach to Evidence -Based Care, 4th Edition MULTIPLE CHOICE abirb.com/test 1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the commu nity and diagno sed with serious and paebrisrbis.ctoemn/ttemst ental illness? Within 3 months, the patient will demonstrate what behavior? a. Denying suicidal ideation b. Reporting a sense of well-being c. Taking medications as prescribed d. Attending clinic appointments on time ANS: B abirb.com/test abirb.com/test Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellne ss. The inco rrect options focus on the classic medabicirba.lcommo/tedset l rather than recovery. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Outcomes Identification MSC: NCLEX: Health Promotion and Maintenance abirb.com/test 2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse’s most caring comment. abirb.com/test a. “Let’s discuss healthy means of coping when you have suicidal feelings.” b. “I understand why you’re so depressed. When I got divorced, I was devastated too.” c. “You should forget about your ma rriage and move on awbiirtbh.coymo/uterstlife.” d. “How did you get so depressed that hospitalization was necessary?” ANS: A The nurse’s commu nication should evidence caring and a acboirmb.cmomit/tmeset nt to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful for therapeutic interventions. DIF: Cognitive Level: Application (Applying) abirb.com/test TOP: Nursing Process: Implementation MSC: NCLEX: Psychosoci al Integrity 3. In the s hift-change rep ort, an off -going nurse c riticizes a paabtiirbe.ncotmw/tehsot wears extr emely heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. “This is a psychiatric hospital, so we expect our patients to behave bizarrely.” b. “Let’s all show accepta nce of t his patient by wearing laobtisrbo.cfomm/teaskt eup too .” c. “Your comments are inconsiderate and inappropriate. Keep the report objective.” d. “Our patients need our help to learn behaviors that will help them get along in society.” ANS: D WWW.THENURSINGMASTERY.COM WWW.N URSYLA B.COM abirb.com/test abirb.com/test abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM Accepting patients’ needs for self -expression and seeking to teach skills that will contribute to their well -being demonstrate respect and are important parts of advocacy. The on -coming nurse needs to take action to ensure that oth ers are not pr ejaubidrbi.cceomd/taegstainst the pat ient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off -going nurse in a critical way will create conflict. Nurses must show compassion for each other. DIF: Cognitive Level: Application (Applying) abirb.com/test TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment abirb.com/test 4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of “attending”? a. “We all have stress in life. Being in a psychiatric hospital is not the end of the world.” abirb.com/test b. “Tell me why you felt you had to be hospitalized to receive treatment for your depression.” c. “You will feel be tter after we get s ome an tidepressant ambirebd.ciocma/ttieostn started for you .” d. “I’d like to sit with you for a while, so you may feel more comfortable talking with me.” ANS: D abirb.com/test Attending is a technique that demonstrates the nurse’s commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are nontherapeutic. abirb.com/test DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. A patient shows the nur se an a rticle from t he Internet abo uatbiarb.hcoemal/ttehstproblem. Wh ich characteristic of the website’s address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in “.org.” b. Address ends in “.com.” c. Address ends in “.gov.” d. Address ends in “.net.” ANS: B abirb.com/test abirb.com/test Financial influences on a site are a clue that the information may be biased. “.com” at the end of the address indicates that the site is a commercial one. “.gov” indicates that the site is maintained by a gover nment e ntity. “.org” in dicates that thaebirsbi.cteomis/tenstonproprietary; the site may or may not have reliable information, but it does not profit from its activities. “.net” can have multiple meanings. abirb.com/test DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 6. A nurse sa ys, “When I was in sc hool, I learned to call u pseatbirpba.ctoimen/tetsst by name to g et their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name.” Which statement is the best appraisal of this nurse’s comment? abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM a. One descriptive research study rarely provides enough evidence to change practice. WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New resear ch findings should be in corpora ted into clinaibcirabl.caomlg/toesrtithms b efore using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change. ANS: A abirb.com/test Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hi erarchy of evide nce. Clinical algorit hms u se flowchaarbtisrbt.coomm/taesntage probl ems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change. abirb.com/test DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. Two nursing students discuss ca reer plans a fter gradua tiona.bOirbn.ceoms/tteusdt ent wants to enter psychiatric nursing. The other student asks, “Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.” Select the best response by the student interested in psychiatric nursing. abirb.com/test a. “Psychiatric nurses’ practice in safer environments than other specialties and nurse -to-patient ratios are better because of the nature of patients’ problems.” b. “Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional pro blems. I’m c hallenged b yabtirhbo.csoem/steisttuations .” c. “I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.” d. “Psychiatric nurses do not have to deal with as much paabiirnb . caonmd/ t essutf f eri n g as medical -surgical nurses. That appeals to me.” ANS: B The prac tice of psychi atric nur sing requires a different setaobfirbs.ckoimll/stestht an medical-surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse –patient ratios and workloads in psychiatric settings have increased, similar to o ther spe cialties. Psychi atric nur sing involves claibniribc.acolmp/treasct tice, not sim ply documentation. Psychosocial pain is real and can cause as much suffering as physical pain. DIF: Cognitive Level: Application (Applying) abirb.com/test TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 8. Which research evidence would most influence a group of nurses to change their practice? a. Expert c ommittee report of r ecommendatio ns for practaibcireb.com/test b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway ANS: B abirb.com/test abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is level A and provides the strongest evidence for changing practice. Expert c ommittee recommendatio ns and descri ptaivbierb.sctoumd/tieesst lend less po werful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed. DIF: Cognitive Level: Comprehension (Understanding) MSC: NCLEX: Safe, Effective Care Environmen t abirbT.cOomP/:tesNt ursing Process: Planning 9. A bill introduced in Congress would reduce funding for t haebicrba.croemo/tfespt eople diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence -based practice ANS: A abirb.com/test abirb.com/test An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for him or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a commun itaybisrbc.acolem,/taesdtvocacy inclu des political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter -writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. DIF: Cognitive Level: Comprehension (Understanding) abirb.com/test TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 10. An inform al group of p atients discuss the ir perceptions of anbuirbr.scionmg/tecsat re. Which co mment best indicates a patient’s perception that his or her nurse is caring? a. “My nurse always asks me which type of juice I want to help me swallow my medication.” abirb.com/test b. “My nurse explained my treatment plan to me and asked for my ideas about how to make it better.” c. “My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon.” abirb.com/test d. “My nurse spends time listening to me talk about my problems. That helps me feel like I’m not alone.” ANS: D abirb.com/test Caring evidences empathic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The inco rrect options gi ve exampl es of statemenatbsirbth.caotmd/teesmt onstrate adv ocacy or giving advice. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM 11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no impr ovement. Which resource shou ld the treatment team caobinrbs.ucolmt /ftoesrt information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline abirb.com/test d. International Statistical Classification of Diseases and Related Health Problems (ICD) ANS: A abirb.com/test A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions c ognizant of an individ ual patie nt’s needs, such aabsirbe.tchonmi/tcesot rigin, age, or ge nder. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases. abirb.com/test DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment abirb.com/test 12. A team of nurses wants to integrate evidence -based practice into a facility’s clinical pathways. Which step should the team implement first? a. Acquire findings from published literature. b. Apply the research findings to clinical practice. c. Assess the outcomes of using new research findings. abirb.com/test d. Ask questions to identify clinical problems that should be changed. ANS: D abirb.com/test Integrating evidence -based practice is a multistep process rather than a single change event. The first step is to identify clinical problems that should be changed. Each step must proceed in order when integrated into a clinical environment. abirb.com/test DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment abirb.com/test 13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction reported by a patient indicates this nurse is most effective? a. Feeling less distrustful of others b. Sensing a connection with others abirb.com/test c. Experiencing only minimal uneasiness about the future d. Being somewhat encouraged with efforts to improve ANS: B abirb.com/test A patient is likely to respond most to caring with a sense of connectedness with others. The absence of caring can make patients feel some degree of distrustful, disconnection, unease, and discouragement. abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM MULTIPLE RESPONSE 1. An experie nced nurse says to a new gradua te, “When you ’avbierbp.croamc/tteiscted as long as I have, you will instantly know how to take care of psychotic patients.” What is the new graduate’s best analysis of this comment? ( Select all that apply. ) a. The experienced nurse may have lost sight of patients’ individuality, which may compromise the integrity of practice. abirb.com/test b. New research findings must be continually inte grated into a nurse’s practice to provide the most effective care. c. Experience provides mental health nurses with the t o oalsb i rabn.cdoms/kteisltls needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective p sychia tric nurses should be contin ually gui daebidrb.bcoyma/tnesitntuitive sense of patients’ needs. ANS: A, B Evidence -based pra ctice involves u sing rese arch findings taobirpb.rcoovmi/dteest the most e ffective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgener alization co mpromi ses that persp ective. Intu itioanbiarbn.cdomtr/tieaslt and error are unsystematic approaches to care. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment abirb.com/test 2. Which patient statements identify qualities of nursing practice with high therapeutic value? “My nurse: (Select all that apply .) a. “The nurses talk in language I can understand.” abirb.com/test b. “The nursing staff helps me keep track of my medications.” c. “My nurse is willing to go to social activities with me.” d. “The staff lets me do whatever I ch oose without interfeabriirnb.gco.”m/test e. “My nurses look at me as a whole person with different needs.” ANS: A, B, E Each cor rect answer de monstr ates caring is an example ofaabpirbp.croomp/rteisatte nur sing foc i: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez -faire attitude on the pa rt of the nurse when the nur se should in stead provid eabtirhbo.cuomg/htetsftul feedback and help patients test alternative solutions or violate boundaries. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psaybcirhb.ocsoomc/tieaslt Integrity abirb.com/test abirb.com/test Chapter 02: Mental Health and Mental Illness Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence -Based Care, 4th Edition MULTIPLE CHOICE abirb.com/test abirb.com/test 1. An 86 year old, previously healthy and independent, falls after an episode of vertigo. Which statement made by this patient best demonstrates resilie nce? a. “I knew this would happen eventually.” abirb.com/test b. “Attending my weekly water aerobics class is too risky.” c. “I don’t need that silly walker to get around by myself.” d. “Maybe some physical therapy will help me with my balance.” abirb.com/test ANS: D Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the pat ient is hopeful and thinking apboirsbi.ctiovme/tleyst about ways to ad apt to the vertigo. Saying “I knew this would happen eventually” and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial. DIF: Cognitive Level: Analysis (Analyzing) abirb.com/test TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. Which ba sic intervention should a p sychia tric mental h ealathbirnb.ucorsme/tepsltan to provide f or a pat ient diagnosed with a mood disorder? a. Sharing clinical expertise to enhance patient treatment b. Performing individu al or group psyc hotherapy for the apbairtbi.econmt /test c. Using appropriate diagnostic tests to monitor patient condition d. Conducting stress reduction and health maintenance classes ANS: D abirb.com/test Conducting stress reduction and health maintenance classes is the basic intervention that should be performed by a psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress mana gement clasasbeirbs.caorme/teesxtamples of he alth maintenance classes. Consulting nurses from other disciplines to share clinical expertise and enhance patient treatment is an advanced practice psychiatric mental health nursing intervention. Performing individ ual and group p sychothe raapbiyrb.aconmd/tepsetrforming d iagnostic tests like blood pressure, etc., are also advanced practice psychiatric mental health nursing interventions. DIF: Cognitive Level: Application (Applying) MSC: NCLEX: Psychosocial Integrity abirbT.cOomP/:tesNt ursing Process: Planning 3. A patient is admitted to the psychi atric hosp ital. Which assaebisrbs.mcoemn/tet sftinding best in dicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can pe rform tasks attempted within the limits of own aabbiirlbi.tcioems./test d. reports occasional problems with insomnia. WWW.THENURSINGMASTERY.COM WWW.NURSYLAB.COM abirb.com/test abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM ANS: B A patient who reports having a consistently negative mood is describing a mood alteration that affects the abi lity to function op timistically. The inco rarbeircbt.coomp/ttieostns describe mentally healthy behaviors and common problems that do not indicate mental illness. DIF: Cognitive Level: Application (Applying) abirb.com/test TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 4. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care to be achieved within 3 days? abirb.com/test a. Patient describes feelings associated with loss and stress. b. Patient meet own needs before considering the rights of others. c. Patient will identify hea lthy coping behaviors in respoanbsireb.tcooms/ttreestssful eve nts. d. Patient will allow others to assume responsibility for major areas of own life. ANS: C The patie nt’s ability to identify hea lthy coping behaviors ianbdiribc.caotme/steastdaptive, hea lthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Outcomes Identification MSC: NCLEX: Psychosocial Integrity abirb.com/test abirb.com/test 5. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis o n a patient’s insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. A psychiatric nursing textbook b. NANDA International (NANDA -I) c. A behavioral health reference manual abirb.com/test d. Diagnostic and Statistical Manual of Mental Disorderasb(irDb.cSoMm/-te5s)t ANS: D The DSM -5 gives the criteria used to diagnose each mental disorder. The NANDA -I focuses on nursing d iagnoses. A psychia tric nursing te xtbook or beh aavbiiorbr.caolmh/teeastlth reference manual may not contain diagnostic criteria. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Analysis | Nursing Process: Diagnosis MSC: NCLEX: Safe, Effective Care Environment abirb.com/test 6. A nurse mu st asse ss several new patients at a commun ity mabeirbn.tcaolmh/teesat lth center. Conclusions concerning current functioning should be made on the basis of what factor? a. The degree of conformity of the individual to society’s norms. b. The degree to which an individual appears logical and rational. c. A continu um from me ntally hea lthy to me ntally unhe aalbthirby.c.om/test d. The rate of their intellectual and emotional growth. ANS: C WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM abirb.com/test WWW.THENURSINGMASTERY.COM abirb.com/test abirb.com/test WWW.NURSYLAB.COM Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individ uals do not conf orm to s ociety’s nor ms. Most in divaibdiruba.closmo/tcesctasionally display illogic al or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Diagnosis | Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity abirb.com/test abirb.com/test 7. A 40 -year-old adult living with parents’ states, “I’m happy but I don’t socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them.” A nurse should ide ntify interventions to improve which patie nt chaarbaircbt.ceormis/tteisct? a. Self-concept b. Overall happiness c. Appraisal of reality d. Control over behavior ANS: A abirb.com/test The patie nt feels the ne ed for m ultiple explan ations of ne wabtirabs.ckosma/tetswt ork and, desp ite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self -concept. Although the patient reports being happy, the subsequent comments refute that self -appraisal. The patient’s comments do not indicate that he/she is out of touch with reality. The patie nt’s needs a re broader than contr ol oavbierbr.coowm/ntesbt ehavior. DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity abirb.com/test 8. A patient tells a nurse, “I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems.” What is the nurse’s best response? abirb.com/test a. “Comparing yourself with others has no real advantages.” b. “Why do you blame yourself for having a psychiatric illness?” c. “Mental illness affects 50% of the adult population in any given year.” d. “Are you are concer ned that others don’t exp erience t haebirsba.cmome/tceshtallenges as you.” ANS: D Mental illness affects many people at various times in their lives. No class, culture, or creed is immu ne to the cha llenges of mental illness. The correct reasbpirobn.csoem/atelssto demonst rates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing. abirb.com/test DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity abirb.com/test 9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM -5) and a nursing diagnosis. What is the psychiatric nurse’s best response? abirb.com/test