PSYCHIATRIC WARD

Select all that apply.

Which descriptors exemplify consistency regarding nurse-patient relationships?
a. Encouraging a patient to share initial impressions of staff
b. Having the same nurse care for a patient on a daily basis
c. Providing a schedule of daily activities to a patient
d. Setting a time for regular sessions with a patient
e. Offering solutions to a patient's problems
ANS: B, C, D
Consistency implies predictability. Having the same nurse see the patient daily and provide a daily schedule of
patient activities and a set time for regular sessions will help a patient predict what will happen during each day
and develop a greater degree of security and comfort. Encouraging a patient to share initial impressions of staff
and giving advice are not related to consistency and would not be considered a therapeutic intervention.

Select all that apply.

A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination
phase?
a. Focus dialogues with the patient on problems that may occur in the future.
b. Help the patient express feelings about the relationship with the nurse.
c. Help the patient prioritize and modify socially unacceptable behaviors.
d. Reinforce expectations regarding the parameters of the relationship.
e. Help the patient to identify strengths, limitations, and problems.
ANS: A, B
The correct actions are part of the termination phase. The other actions would be used in the working and
orientation phases.

Select all that apply.

A novice psychiatric nurse has a parent with bipolar disorder. This nurse angrily recalls feelings of embarrassment
about the parent's behavior in the community. Select the best ways for this nurse to cope with these feelings.
a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses.
b. Recognize that these feelings are unhealthy. The nurse should try to suppress them when working with patients.
c. Recognize that psychiatric nursing is not an appropriate career choice. Explore other nursing specialties.
d. The nurse should begin new patient relationships by saying, "My own parent had mental illness, so I accept it
without stigma."
e. Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important.
ANS: A, E
The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource that may be
helpful. The knowledge and experience gained from the nurse's relationship with a mentally ill parent may
contribute sensitivity to compassionate practice. Self-disclosure and suppression are not adaptive coping
strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the
memories.

Select all that apply.

A novice nurse tells a mentor, "I want to convey to my patients that I am interested in them and that I want to
listen to what they have to say." Which behaviors will be helpful in meeting the nurse's goal?
a. Sitting behind a desk, facing the patient
b. Introducing self to a patient and identifying own role
c. Maintaining control of discussions by asking direct questions
d. Using facial expressions to convey interest and encouragement
e. Assuming an open body posture and sometimes mirror imaging
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ANS: B, D, E
Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey
interest and encouragement support the nurse's verbal statements to that effect and strengthen the message. An
open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient
comfort. A desk would place a physical barrier between the nurse and patient. A face-to-face stance should be
avoided when possible and a less intense 90- or 120-degree angle used to permit either party to look away without
discomfort.

Inpatient hospitalization for persons with mental illness is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medication at home.
c. have limited support systems in the community.
d. develop new symptoms during the course of an illness.
ANS: A
Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs
intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment.

A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge,
the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the
case manager's most appropriate action.
a. Postpone the patient's discharge from the hospital.
b. Contact the landlord who evicted the patient to further discuss the situation.
c. Arrange a temporary place for the patient to stay until new housing can be arranged.
d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.
ANS: C
The case manager should intervene by arranging temporary shelter for the patient until an apartment can be
found. This activity is part of the coordination and delivery of services that falls under the case manager role. None
of the other options is a viable alternative.

Select the example of tertiary prevention.

a. Helping a person diagnosed with a serious mental illness learn to manage money
b. Restraining an agitated patient who has become aggressive and assaultive
c. Teaching school-age children about the dangers of drugs and alcohol
d. Genetic counseling with a young couple expecting their first child
ANS: A
Tertiary prevention involves services that address residual impairments, with a goal of improved independent
functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about
substance abuse and dependence are examples of primary prevention.

A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was
hospitalized for 5 days. The patient's thoughts are now more organized, and discharge is planned. The patient's
family says, "It's too soon for discharge. We will just go through all this again." The nurse should:
a. ask the case manager to arrange a transfer to a long-term care facility.
b. notify hospital security to handle the disturbance and escort the family off the unit.
c. explain that the patient will continue to improve if the medication is taken regularly.
d. contact the health care provider to meet with the family and explain the discharge rationale.
ANS: C
Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to
advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for
 PSYCHIATRIC WARD

the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting
blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and
the janitor's closet is locked. These observations relate to:
a. coordinating care of patients.
b. management of milieu safety.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
ANS: B
Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question
directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to
the observations cited.

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available.
Which patient should be admitted? The patient:
a. feeling anxiety and a sad mood after separation from a spouse of 10 years.
b. who self-inflicted a superficial cut on the forearm after a family argument.
c. experiencing dry mouth and tremor related to taking haloperidol (Haldol).
d. who is a new parent and hears voices saying, "Smother your baby."
ANS: D
Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have
issues that can be handled with less restrictive alternatives than hospitalization.

A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining
daily food allowance on cigarettes. Select a community psychiatric nurse's best initial action.
a. Explore ways to help the patient stop smoking.
b. Report the situation to the manager of the shelter.
c. Assess the patient's weight; determine foods and amounts eaten.
d. Arrange hospitalization for the patient in order to formulate a new treatment plan.
ANS: C
Assessment of biopsychosocial needs and general ability to live in the community is called for before any other
action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be
able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action.
Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.

A nurse surveys medical records. Which finding signals a violation of patients' rights?
a. A patient was not allowed to have visitors.
b. A patient's belongings were searched at admission.
c. A patient with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a patient was assaultive toward a staff member.
ANS: A
The patient has the right to have visitors. Inspecting patients' belongings is a safety measure. Patients have the
right to a safe environment, including the right to be protected against impulses to harm self.

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?
a. Resolve the crisis with the least restrictive intervention possible.
b. Swift intervention is justified to maintain the integrity of a therapeutic milieu.
c. Rights of an individual patient are superseded by the rights of the majority of patients.
 PSYCHIATRIC WARD

d. Patients should have opportunities to regain control without intervention if the safety of others is not
compromised.
ANS: A
The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the
patient's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the
patient threatens harm to self.

Clinical pathways are used in managed care settings to:

a. stabilize aggressive patients.
b. identify obstacles to effective care.
c. relieve nurses of planning responsibilities.
d. streamline the care process and reduce costs.
ANS: D
Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a
designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical
pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize
aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of
the responsibility of planning; pathways may, however, make the task easier.

A nurse receives these three phone calls regarding a newly admitted patient.
• The psychiatrist wants to complete an initial assessment.
• An internist wants to perform a physical examination.
• The patient's attorney wants an appointment with the patient.
The nurse schedules the activities for the patient. Which role has the nurse fulfilled?
a. Advocate
b. Case manager
c. Milieu manager
d. Provider of care
ANS: B
Nurses on psychiatric units routinely coordinate patient services, serving as case managers as described in this
scenario. The role of advocate would require the nurse to speak out on the patient's behalf. The role of milieu
manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the
patient.

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient?
a. Hygiene assistance
b. Diversional activities
c. Assistance with job hunting
d. Building assertiveness skills
ANS: D
Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal
hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are
usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social
worker or vocational therapist.

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an
operating room?
a. Kindness
b. Autonomy
 PSYCHIATRIC WARD

c. Compassion
d. Professionalism
ANS: B
A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to
both nurses.

Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed
with:
a. a phobic fear of crowded places.
b. a single episode of major depression.
c. a catastrophic reaction to a tornado in the community.
d. schizophrenia and four hospitalizations in the past year.
ANS: D
Assertive community treatment (ACT) provides intensive case management for persons with serious persistent
mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The
distracters identify mental health problems of a more episodic nature.

The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks
information about the patient's projected length of stay. How should the nurse instruct the unit secretary to
handle the request?
a. Obtain the information from the patient's medical record and relay it to the caller.
b. Inform the caller that all information about patients is confidential.
c. Refer the request for information to the patient's case manager.
d. Refer the request to the health care provider.
ANS: C
The case manager usually confers with insurers and provides the treatment team with information about available
resources. The unit secretary should be mindful of patient confidentiality and should neither confirm that the
patient is an inpatient nor disclose other information.

Select the example of primary prevention.

a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder
b. Helping school-age children identify and describe normal emotions
c. Leading a psychoeducational group in a community care home
d. Medicating an acutely ill patient who assaulted a staff person
ANS: B
Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring.
Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed
throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of
tertiary prevention. Medicating an acutely ill patient who assaulted a staff person is a secondary prevention.
Leading a psychoeducational group in a community care home is an example of tertiary prevention.

Which level of prevention activities would a nurse in an emergency department employ most often?
a. Primary
b. Secondary
c. Tertiary
ANS: B
An emergency department nurse would generally see patients in crisis or with acute illness, so secondary
prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary
prevention applies to rehabilitative activities.
 PSYCHIATRIC WARD

The nurse assigned to assertive community treatment (ACT) should explain the program's treatment goal as:
a. assisting patients to maintain abstinence from alcohol and other substances of abuse.
b. providing structure and a therapeutic milieu for mentally ill patients whose symptoms require stabilization.
c. maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental
illness.
d. providing services for mentally ill individuals who require intensive treatment to continue to live in the
community.
ANS: D
An assertive community treatment (ACT) program provides intensive community services to persons with serious,
persistent mental illness who live in the community but require aggressive services to prevent repeated
hospitalizations.

Which scenario best depicts a behavioral crisis? A patient is:

a. waving fists, cursing, and shouting threats at a nurse.
b. curled up in a corner of the bathroom, wrapped in a towel.
c. crying hysterically after receiving a phone call from a family member.
d. performing push-ups in the middle of the hall, forcing others to walk around.
ANS: A
This behavior constitutes a behavioral crisis because the patient is threatening harm to another individual.
Intervention is called for to defuse the situation. The other options speak of behaviors that may require
intervention of a less urgent nature because the patients in question are not threatening harm to self or others.

The case manager plans to discuss the treatment plan with a patient's family. Select the case manager's first
action.
a. Determine an appropriate location for the conference.
b. Support the discussion with examples of the patient's behavior.
c. Obtain the patient's permission for the exchange of information.
d. Determine which family members should participate in the conference.
ANS: C
The case manager must respect the patient's right to privacy, which extends to discussions with family. Talking to
family members is part of the case manager's role. Actions identified in the distracters occur after the patient has
given permission.

A patient usually watches television all day, seldom going out in the community or socializing with others. The
patient says, "I don't know what to do with my free time." Which member of the treatment team would be most
helpful to this patient?
a. Psychologist
b. Social worker
c. Recreational therapist
d. Occupational therapist
ANS: C
Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist
with a broad range of skills, including those for employment. Psychologists conduct testing and provide other
patient services. Social workers focus on the patient's support system.

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient's spouse calls the nurse to
report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to
refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.
 PSYCHIATRIC WARD

a. The patient's spouse will mark dates for prescription refills on the family calendar.
b. The nurse will obtain prescription refills every 90 days and deliver to the patient.
c. The patient will call the nurse weekly to discuss medication-related issues.
d. The patient will report to the clinic for medication follow-up every week.
ANS: A
The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of
medication by the nurse should be unnecessary for the nurse to do if patient or a significant other can be
responsible. The patient may not need more intensive follow-up as long as medication is taken as prescribed.

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious
patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says,
"Only a traitor would make me go to the hospital." Select the nurse's best initial intervention.
a. With the patient's consent, contact resources to provide medications without charge temporarily.
b. Arrange a bed in a local homeless shelter with nightly on-site supervision.
c. Hospitalize the patient until the symptoms have stabilized.
d. Ask the patient, "Do you feel like I am a traitor?"
ANS: A
Hospitalization may damage the nurse-patient relationship, even if it provides an opportunity for rapid
stabilization. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a
little longer. Programs are available to help patients who are unable to afford their medications. A homeless
shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution
should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention?
a. Medication follow-up
b. Teaching parenting skills
c. Substance abuse counseling
d. Making a referral for family therapy
ANS: B
Primary prevention activities are directed to healthy populations to provide information for developing skills that
promote mental health. The distracters represent secondary or tertiary prevention activities.

A health care provider prescribed depot injections every 3 weeks at the clinic for a patient with a history of
medication noncompliance. For this plan to be successful, which factor will be of critical importance?
a. The attitude of significant others toward the patient
b. Nutrition services in the patient's neighborhood
c. The level of trust between the patient and nurse
d. The availability of transportation to the clinic
ANS: D
The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot
medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the
injection at 3-week intervals, non-adherence will again be the issue. Attitude toward the patient, trusting
relationships, and nutrition are important but not fundamental to this particular problem.

Which assessment finding for a patient in the community deserves priority intervention by the psychiatric nurse?
The patient:
a. receives Social Security disability income plus a small check from a trust fund every month.
b. was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.
c. lives in an apartment with two patients who attend partial hospitalization programs.
 PSYCHIATRIC WARD

d. has a sibling who was recently diagnosed with a mental illness.

ANS: B
Patients who use alcohol or illegal substances often become medication noncompliant. Medication
noncompliance, along with the disorganizing influence of substances on cellular brain function, promotes relapse.
The distracters do not suggest problems.

The nurse should refer which of the following patients to a partial hospitalization program? A patient who:
a. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
b. needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
c. spent yesterday in a supervised crisis care center and continues to have active suicidal ideation.
d. states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."
ANS: D
This patient could profit from the structure and supervision provided by spending the day at the partial
hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility
for supervision. A suicidal patient needs inpatient hospitalization. The other patients can be served in the
community or with individual visits.

A Category V tornado hits a community, destroying many homes and businesses. Which nursing intervention
would best demonstrate compassion and caring?
a. Encouraging persons to describe their memories and feelings about the event
b. Arranging transportation to the local community mental health center
c. Referring a local resident to a community food bank
d. Coordinating psychiatric home care services
ANS: A
Disaster victims benefit from telling their story. Nurses show compassion by listening and offering hope. The
distracters identify other aspects of psychological first aid and services on the mental health continuum.

A nurse makes an initial visit to a homebound patient diagnosed with a serious mental illness. A family member
offers the nurse a cup of coffee. Select the nurse's best response.
a. "Thank you. I would enjoy having a cup of coffee with you."
b. "Thank you, but I would prefer to proceed with the assessment."
c. "No, but thank you. I never accept drinks from patients or families."
d. "Our agency policy prohibits me from eating or drinking in patients' homes."
ANS: A
Accepting refreshments or chatting informally with the patient and family represent therapeutic use of self and
help to establish rapport. The distracters fail to help establish rapport.

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated
patients' rights?
a. Prohibited a patient from using the telephone
b. In patient's presence, opened a package mailed to patient
c. Remained within arm's length of patient with homicidal ideation
d. Permitted a patient with psychosis to refuse oral psychotropic medication
ANS: A
The patient has a right to use the telephone. The patient should be protected against possible harm to self or
others. Patients have rights to send and receive mail and be present during package inspection. Patients have
rights to refuse treatment.

Select all that apply.

 PSYCHIATRIC WARD

A nurse can best address factors of critical importance to successful community treatment by including making
assessments relative to:
a. housing adequacy.
b. family and support systems.
c. income adequacy and stability.
d. early psychosocial development.
e. substance abuse history and current use.
ANS: A, B, C, E
Early psychosocial developmental history is less relevant to successful outcomes in the community than the
assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other
treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is
a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with
community adjustment.

Select all that apply.

The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be
included in the final version of the admission policy?
a. Clear risk of danger to self or others
b. Adjustment needed for doses of psychotropic medication
c. Detoxification from long-term heavy alcohol consumption needed
d. Respite for caregivers of persons with serious and persistent mental illness
e. Failure of community-based treatment, demonstrating need for intensive treatment
ANS: A, C, E
Medication doses can be adjusted on an outpatient basis. The goal of caregiver respite can be accomplished
without hospitalizing the patient. The other options are acceptable, evidence-based criteria for admission of a
patient to an inpatient service.

Select all that apply.

A psychiatric nurse discusses rules of the therapeutic milieu and patients' rights with a newly admitted patient.
Which rights should be included? The right to:
a. have visitors
b. confidentiality
c. a private room
d. complain about inadequate care
e. select the nurse assigned to their care
ANS: A, B, D
Patients' rights should be discussed shortly after admission. Patients have rights related to receiving/refusing
visitors, privacy, filing complaints about inadequate care, and accepting/refusing treatments (including
medications). Patients do not have a right to a private room or selecting which nurse will provide care.

Select all that apply.

Which statements by patients diagnosed with a serious mental illness best demonstrate that the case manager has
established an effective long-term relationship? "My case manager:

a. talks in language I can understand."

b. helps me keep track of my medication."
c. gives me little gifts from time to time."
d. looks at me as a whole person with many needs."
e. lets me do whatever I choose without interfering."
 PSYCHIATRIC WARD

ANS: A, B, D
Each correct answer is an example of appropriate nursing foci: communicating at a level understandable to the
patient, providing medication supervision, and using holistic principles to guide care. The distracters violate
relationship boundaries or suggest a laissez faire attitude on the part of the nurse.

Select all that apply.

Which statements most clearly reflect the stigma of mental illness?
a. "Many mental illnesses are hereditary."
b. "Mental illness can be evidence of a brain disorder."
c. "People claim mental illness so they can get disability checks."
d. "Mental illness results from the breakdown of American families."
e. "If people with mental illness went to church, their symptoms would vanish."
ANS: C, D, E
Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental
illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.

Select all that apply.

A person in the community asks, "People with mental illnesses went to state hospitals in earlier times. Why has
that changed?" Select the nurse's accurate responses.
a. "Science has made significant improvements in drugs for mental illness, so now many persons may live in their
communities."
b. "There's now a better selection of less restrictive treatment options available in communities to care for people
with mental illness."
c. "National rates of mental illness have declined significantly. There actually is not a need for state institutions
anymore."
d. "Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe
conditions."
e. "Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than
institutional settings."
ANS: A, B, E
The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding
for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional
care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric
disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because
funding shifted to the community. Conditions in institutions have improved.

Select all that apply.

A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse
case manager learns that the patient:
• wants to attend an activity group at the mental health outreach center.
• is worried about being able to pay for the therapy.
• does not know how to get from home to the outreach center.
• has an appointment to have blood work at the same time an activity group meets.
• wants to attend services at a church that is a half-mile from the patient's home.
Which tasks are part of the role of a community mental health nurse?
a. Rearranging conflicting care appointments
b. Negotiating the cost of therapy for the patient
c. Arranging transportation to the outreach center
d. Accompanying the patient to church services weekly
 PSYCHIATRIC WARD

e. Monitoring to ensure the patient's basic needs are met

ANS: A, C, E
The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating
the cost of therapy and accompanying the patient to church services are interventions the nurse would not be
expected to undertake. The patient can walk to the church services; the nurse can provide encouragement.

A parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you
think is wrong?" Select the nurse's best reply.
a. "Your child needs firmer control. It is important to set limits now."
b. "This is normal for your child's age. The child is striving for independence."
c. "There may be developmental problems. Most children are toilet trained by age 2."
d. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan."
ANS: B
This behavior is typical of a child around the age of 2 years, whose developmental task is to develop autonomy.
The distracters indicate the child's behavior is abnormal.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which stage of
psychosexual development is evident?
a. Oral
b. Anal
c. Phallic
d. Genital
ANS: B
The anal stage occurs from age 1 to 3 years and has as its focus toilet training and learning to delay immediate
gratification. The oral stage occurs between birth and 1 year. The phallic stage occurs between 3 and 5 years, and
the genital stage occurs between age 13 and 20 years.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis
is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
ANS: D
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and
environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood.
Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-
aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.

A 4-year-old grabs toys from siblings and says, "I want that now!" The siblings cry, and the child's parent becomes
upset with the behavior. According to Freudian theory, this behavior is a product of impulses originating in which
system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator
of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the
 PSYCHIATRIC WARD

mother's wrath. The superego would oppose the impulsive behavior as "not nice." The preconscious is a level of
awareness. This item relates to an audience response question.

The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good
manners. The nurse supports this use of praise related to these behaviors. These qualities are likely to be
internalized and become part of which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: C
The superego contains the "thou shalts," or moral standards internalized from interactions with significant others.
Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is
the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates
solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved
easily with conscious effort. This item relates to an audience response question.

A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness
and helpfulness in adulthood, which feeling will most likely result?
a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options
are incorrect because each represents a negative feeling.

An adult says, "I never know the answers," and "My opinion doesn't count." Which psychosocial crisis was
unsuccessfully resolved for this adult?
a. Initiative versus guilt
b. Trust versus mistrust
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption
ANS: C
These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was
not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt.
Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and
suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-
absorption that limits the ability to grow as a person.

Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of
infancy?
a. "I have very warm and close friendships."
b. "I'm afraid to allow anyone to really get to know me."
c. "I'm always absolutely right, so don't bother saying more."
d. "I'm ashamed that I didn't do things correctly in the first place."
ANS: B
According to Erikson, the developmental task of infancy is the development of trust. The correct response is the
only statement clearly showing lack of ability to trust others. Warm, close relationships suggest the developmental
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task of infancy was successfully completed; rigidity and self-absorption are reflected in the belief one is always
right; and shame for past actions suggests failure to resolve the crisis of initiative versus guilt.

A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate?
a. Oral
b. Anal
c. Phallic
d. Genital
ANS: A
The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first
learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their
opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties
with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships
with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the
opposites of these traits.

A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of
psychosexual development is most relevant to the patient's needs?
a. Latency
b. Phallic
c. Anal
d. Oral
ANS: D
Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often
result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and
inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation
sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an
audience response question.

A nurse listens to a group of recent retirees. One says, "I volunteer with Meals on Wheels, coach teen sports, and
do church visitation." Another laughs and says, "I'm too busy taking care of myself to volunteer to help others."
Which developmental task do these statements contrast?
a. Trust and mistrust
b. Intimacy and isolation
c. Industry and inferiority
d. Generativity and self-absorption
ANS: D
Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-
absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would
show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to
negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as
opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and
the ability to love and commit oneself.

Although ego defense mechanisms and security operations are mainly unconscious and designed to relieve
anxiety, the major difference is that:
a. defense mechanisms are intrapsychic and not observable.
b. defense mechanisms cause arrested personal development.
c. security operations are masterminded by the id and superego.
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d. security operations address interpersonal relationship activities.

ANS: D
Sullivan's theory explains that security operations are interpersonal relationship activities designed to relieve
anxiety. Because they are interpersonal, they are observable. Defense mechanisms are unconscious and
automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviors. Frequent,
continued use of many defense mechanisms often results in reality distortion and interference with healthy
adjustment and emotional development. Occasional use of defense mechanisms is normal and does not markedly
interfere with development. Security operations are ego-centered. This item relates to an audience response
question.

A student nurse says, "I don't need to interact with my patients. I learn what I need to know by observation." An
instructor can best interpret the nursing implications of Sullivan's theory to this student by responding:
a. "Interactions are required in order to help you develop therapeutic communication skills."
b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal
skills."
c. "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate
interventions."
d. "It is important to pay attention to patients' behavioral changes, because these signify adjustments in
personality."
ANS: B
The nurse's role includes educating patients and assisting them in developing effective interpersonal relationships.
Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan's theory.
The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide
only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data
from the patient. The other distracters relate to Maslow and behavioral theory. This item relates to an audience
response question.

A nurse consistently encourages patient to do his or her own activities of daily living (ADLs). If the patient is unable
to complete an activity, the nurse helps until the patient is once again independent. This nurse's practice is most
influenced by which theorist?
a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
ANS: C
Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this has relevance to the
seriously and persistently mentally ill patient.

A nurse uses Maslow's hierarchy of needs to plan care for a patient with mental illness. Which problem will receive
priority? The patient:
a. refuses to eat or bathe.
b. reports feelings of alienation from family.
c. is reluctant to participate in unit social activities.
d. is unaware of medication action and side effects.
ANS: A
The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in
care planning.
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Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which
technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
ANS: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and
reinforce speech through positive reinforcement.

The parent of a child diagnosed with schizophrenia tearfully asks the nurse, "What could I have done differently to
prevent this illness?" Select the nurse's best response.
a. "Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict
how a child will respond to parental guidance."
b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You
are not to blame for your child's illness."
c. "There is still hope. Changing your parenting style can help your child learn to cope effectively with the
environment."
d. "Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting."
ANS: B
The parent's comment suggests feelings of guilt or inadequacy. The nurse's response should address these feelings
as well as provide information. Patients and families need reassurance that the major mental disorders are
biological in origin and are not the "fault" of parents. One distracter places the burden of having faulty genes on
the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions
should focus on:
a. rewarding desired behaviors.
b. use of assertive communication.
c. changing the patient's self-concept.
d. administering medications to relieve anxiety.
ANS: B
The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be
generalized to others. Helping the patient learn to use assertive communication will improve the patient's
interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy.

A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and
facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to
this method.
a. Rational-emotive behavior therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning
ANS: B
The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.

Consider this comment from a therapist: "The patient is homosexual but has kept this preference secret. Severe
anxiety and depression occur when the patient anticipates family reactions to this sexual orientation." Which
perspective is evident in the speaker?
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a. Theory of interpersonal relationships

b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory
ANS: A
The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet
interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual
formulation would focus on uncovering unconscious material that relates to the patient problem.

A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with
psychoanalytic psychotherapy?
a. Identifying the patient's strengths and assets
b. Praising the patient for describing feelings of isolation
c. Focusing on feelings developed by the patient toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
ANS: C
Positive or negative feelings of the patient toward the therapist indicate transference. Transference is a
psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to
biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common "homework"
assignment used in cognitive therapy.

A person says, "I was the only survivor in a small plane crash. Three business associates died. I got depressed and
saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I'm better
now." Which type of therapy was used?
a. Milieu therapy
b. Psychoanalysis
c. Behavior modification
d. Interpersonal psychotherapy
ANS: D
Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms
with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy.
Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would
focus on changing a behavior rather than helping the patient understand what is going on in his life.

Which technique is most applicable to aversion therapy?

a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement
ANS: A
Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a
noxious stimulus, punishment, and avoidance training.

A patient says to the nurse, "My father has been dead for over 10 years, but talking to you is almost as comforting
as the talks he and I had when I was a child." Which term applies to the patient's comment?
a. Superego
b. Transference
c. Reality testing
d. Counter-transference
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ANS: B
Transference refers to feelings a patient has toward the health care workers that were originally held toward
significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker
has toward the patient. The superego represents the moral component of personality; it seeks perfection.

A college student received an invitation to attend the wedding of a close friend who lives across the country. The
student is afraid of flying. Which type of therapy would be most helpful for this patient?
a. Psychoanalysis
b. Milieu therapy
c. Systematic desensitization
d. Short-term dynamic therapy
ANS: C
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying.
Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental
factors.

A patient would benefit from therapy in which peers as well as staff have a voice in determining patients' privileges
and psychoeducational topics. Which approach would be best?
a. Milieu therapy
b. Cognitive therapy
c. Short-term dynamic therapy
d. Systematic desensitization
ANS: A
Milieu therapy is based on the idea that all members of the environment contribute to the planning and
functioning of the setting. The distracters are individual therapies that do not fit the description.

A patient repeatedly stated, "I'm stupid." Which statement by that patient would show progress resulting from
cognitive behavioral therapy?
a. "Sometimes I do stupid things."
b. "Things always go wrong for me."
c. "I always fail when I try new things."
d. "I'm disappointed in my lack of ability."
ANS: A
"I'm stupid" is a cognitive distortion. A more rational thought is "Sometimes I do stupid things." The latter thinking
promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an
audience response question.

A patient says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American
workforce is incompetent." This patient is experiencing a:
a. self-esteem deficit.
b. cognitive distortion.
c. deficit in motivation.
d. deficit in love and belonging.
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations.
See related audience response question.
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A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and
patient then stand in an elevator with the door open for five minutes and later with the elevator door closed for
five minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback
ANS: B
Systematic desensitization is a form of behavior modification therapy that involves the development of behavior
tasks customized to the patient's specific fears. These tasks are presented to the patient while using learned
relaxation techniques. The patient is incrementally exposed to the fear.

A patient says, "I always feel good when I wear a size 2 petite." Which type of cognitive distortion is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations.
The stem offers an example of overgeneralization. See related audience response question.

Which comment best indicates a patient is self-actualized?

a. "I have succeeded despite a world filled with evil."
b. "I have a plan for my life. If I follow it, everything will be fine."
c. "I'm successful because I work hard. No one has ever given me anything."
d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."
ANS: D
The self-actualized personality is associated with high productivity and enjoyment of life. Self-actualized persons
experience pleasure in being alone and an ability to reflect on events.

A nurse and patient discuss a problem the patient has kept secret for many years. Afterward the patient says, "I
feel so relieved that I finally told somebody." Which term best describes the patient's feeling?
a. Catharsis
b. Superego
c. Cognitive distortion
d. Counter-transference
ANS: A
Freud initially used talk therapy, known as the cathartic method. Today we refer to catharsis as "getting things off
our chests." The superego represents the moral component of personality.

Which patient is the best candidate for brief psychodynamic therapy?

a. An accountant with a loving family and successful career who was involved in a short extramarital affair
b. An adult with a long history of major depression who was charged with driving under the influence (DUI)
c. A woman with a history of borderline personality disorder who recently cut both wrists
d. An adult male recently diagnosed with anorexia nervosa
ANS: A
The best candidates for psychodynamic therapy are relatively healthy and well-functioning individuals, sometimes
referred to as the "worried well," who have a clearly circumscribed area of difficulty and are intelligent,
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psychologically minded, and well-motivated for change. Patients with psychosis, severe depression, borderline
personality disorders, and severe character disorders are not appropriate candidates for this type of treatment.

Select all that apply.

A patient states, "I'm starting cognitive-behavioral therapy. What can I expect from the sessions?" Which
responses by the nurse would be appropriate?
a. "The therapist will be active and questioning."
b. "You will be given some homework assignments."
c. "The therapist will ask you to describe your dreams."
d. "The therapist will help you look at your ideas and beliefs about yourself."
e. "The goal is to increase subjectivity about thoughts that govern your behavior."
ANS: A, B, D
Cognitive therapists are active rather than passive during therapy sessions because they help patients reality-test
their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually
discussed at the next therapy session. The goal of cognitive therapy is to assist the patient in identifying inaccurate
cognitions and in reality- testing and formulating new, accurate cognitions. One distracter applies to
psychoanalysis. Increasing subjectivity is not desirable.

Select all that apply.

Which comments by an elderly person best indicate successful completion of the developmental task?
a. "I am proud of my children's successes in life."
b. "I should have given to community charities more often."
c. "My relationship with my father made life more difficult for me."
d. "My experiences in the war helped me appreciate the meaning of life."
e. "I often wonder what would have happened if I had chosen a different career."
ANS: A, D
The developmental crisis for an elderly person relates to integrity versus despair. Pride in one's offspring indicates
a sense of fulfillment. Recognition of the wisdom gained from difficult experiences (such as being in a war)
indicates a sense of integrity. Blaming and regret indicate despair and unsuccessful resolution of the crisis.

Select all that apply.

Which comments by an adult best indicate self-actualization?
a. "I am content with a good book."
b. "I often wonder if I chose the right career."
c. "Sometimes I think about how my parents would have handled problems."
d. "It's important for our country to provide basic health care services for everyone."
e. "When I was lost at sea for 2 days, I gained an understanding of what is important."
ANS: A, D, E
Self-actualized persons enjoy privacy, have a sense of democracy, and show positive outcomes associated with
peak experiences. Self-doubt, defensiveness, and blaming are not consistent with self-actualization.

Select all that apply.

Which activities represent the art of nursing?
a. Administering medications on time to a group of patients
b. Listening to a new widow grieve her husband's death
c. Helping a patient obtain groceries from a food bank
d. Teaching a patient about a new medication
e. Holding the hand of a frightened patient
ANS: B, C, E
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Peplau described the science and art of professional nursing practice. The art component of nursing consists of the
care, compassion, and advocacy nurses provide to enhance patient comfort and well-being. The science
component of nursing involves the application of knowledge to understand a broad range of human problems and
psychosocial phenomena, intervening to relieve patients' suffering and promote growth. See related audience
response question.

A patient tells members of a therapy group, "I hear voices saying my doctor is poisoning me." Another patient
replies, "I used to hear voices too. They sounded real, but I found out later they were not. The voices you hear are
not real either." Which therapeutic factor is exemplified in this interchange?
a. Catharsis
b. Universality
c. Imitative behavior
d. Interpersonal learning
ANS: D
Here a member gains insight into his own experiences from hearing about the experiences of others through
interpersonal learning. Catharsis refers to a therapeutic discharge of emotions. Universality refers to members
realizing their feelings are common to most people and not abnormal. Imitative behavior involves copying or
borrowing the adaptive behavior of others.

A leader plans to start a new self-esteem building group. Which intervention would be most helpful for assuring
mutual respect within the group?
a. Describe the importance of mutual respect in the first session and make it a group norm.
b. Exclude potential members whose behavior suggests they are likely to be disrespectful.
c. Give members a brochure describing the purpose, norms, and expectations of the group.
d. Explain that mutual respect is expected and confront those who are not respectful.
ANS: A
It is helpful to motivate members to behave respectfully by describing how mutual respect benefits all members
and is necessary for the group to be fully therapeutic. Setting a tone and expectation of mutual respect from the
outset is the most helpful intervention listed. Excluding members because of how they might behave could exclude
members who would have been appropriate, depriving them of the potential benefits of the group. Conveying
expectations by brochure is less effective than doing so orally, because it lacks the connection to each member a
skilled leader can create to motivate members and impart the expectation of respect. Confronting inappropriate
behavior is therapeutic but only addresses existing behavior rather than preventing all such undesired behavior.

A young female member in a therapy group says to an older female member, "You are just like my mother, always
trying to control me with your observations and suggestions." Which therapeutic factor of a group is evident by
this behavior?
a. Instillation of hope
b. Existential resolution
c. Development of socializing techniques
d. Corrective recapitulation of the primary family group
ANS: D
The younger patient is demonstrating an emotional attachment to the older patient that mirrors patterns within
her own family of origin, a phenomenon called corrective recapitulation of the primary family group. Feedback
from the group then helps the member gain insight about this behavior and leads to more effective ways of
relating to her family members. Instillation of hope involves conveying optimism and sharing progress. Existential
resolution refers to the realization that certain existential experiences such as death are part of life, aiding the
adjustment to such realities. Development of socializing techniques involves gaining social skills through the
group's feedback and practice within the group.
 PSYCHIATRIC WARD

During group therapy, one patient says to another, "When I first started in this group, you were unable to make a
decision, but now you can. You've made a lot of progress. I am beginning to think that maybe I can conquer my
fears too." Which therapeutic factor is evident by this statement?
a. Hope
b. Altruism
c. Catharsis
d. Cohesiveness
ANS: A
The patient's profession that he may be able to learn to cope more effectively reflects hope. Groups can instill
hope in individuals who are demoralized or pessimistic. Altruism refers to doing good for others, which can result
in positive feelings about oneself. Catharsis refers to venting of strong emotions. Cohesion refers to coming
together and developing a connection with other group members.

During a group therapy session, a newly admitted patient suddenly says to the nurse, "How old are you? You seem
too young to be leading a group." Select the nurse's most appropriate response.
a. "I am wondering what leads you to ask. Please tell me more."
b. "I am old enough to be a nurse, which qualifies me to lead this group."
c. "My age is not pertinent to why we are here and should not concern you."
d. "You are wondering whether I have enough experience to lead this group?"
ANS: D
A question such as this is common in the initial phase of group development when members are getting to know
one another, dealing with trust issues, and testing the leader. Making explicit the implied serves to role model
more effective communication and prompts further discussion of the patient's concern. Asking the patient to tell
the leader more about the question focuses on the reason for the member's concern rather than on the issue
raised (the experience and ability of the leader) and is a less helpful response. "I am old enough to be a nurse" and
"age is not pertinent" are defensive responses and fail to address the patient's valid concern.

A patient in a group therapy session listens to others and then remarks, "I used to think I was the only one who felt
afraid. I guess I'm not as alone as I thought." This comment is an example of:
a. altruism.
b. ventilation.
c. universality.
d. group cohesiveness.
ANS: C
Realizing that one is not alone and that others share the same problems and feelings is called universality.
Ventilation refers to expressing emotions. Altruism refers to benefitting by being of help to others. Group
cohesiveness refers to the degree of bonding among members of the group.

A nurse at the well child clinic realizes that many parents have misconceptions about effective ways of disciplining
their children. The nurse decides to form a group to address this problem. What should be the focus of the group?
a. Support
b. Socialization
c. Health education
d. Symptom management
ANS: C
The nurse has diagnosed a knowledge deficit. The focus of the group should be education. Support and
socialization are beneficial but should not be the primary focus of the group, and symptoms are not identified for
intervention here.
 PSYCHIATRIC WARD

Which outcome would be most appropriate for a symptom-management group for persons with schizophrenia?
Group members will:
a. state the names of their medications.
b. resolve conflicts within their families.
c. rate anxiety at least two points lower.
d. describe ways to cope with their illness.
ANS: D
An appropriate psychoeducational focus for patients with schizophrenia is managing their symptoms; coping with
symptoms such as impaired memory or impaired reality testing can improve functioning and enhance their quality
of life. Names of medications might be appropriate for a medication education group but would be a low priority
for symptom management. Addressing intra-family issues would be more appropriate within a family therapy
group or possibly a support group. Rating anxiety lower would be an expected outcome for a stress-management
group.

A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other
members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse
leader would be most effective?
a. Say to everyone, "Most of you have become quiet. I wonder if it might be related to concerns you may have
about how the group is progressing today."
b. Say to everyone, "One person has done most of the talking. I think it would be helpful for everyone to say how
that has affected your experience of the group."
c. Say to everyone, "I noticed that as our group progressed, most members became quiet, then disinterested, and
now seem almost angry. What is going on?"
d. Say to the talkative patient, "You have been doing most of the talking, and others have not had a chance to
speak as a result. Could you please yield to others now?"
ANS: A
The most effective action the nurse leader can take will be the one that encourages the group to solve its own
problem. Pointing out changes in the group and asking members to respond to them lays the foundation for a
discussion of group dynamics. Asking members to respond to the talkative patient puts that patient in an awkward
position, likely increasing her anxiety. As anxiety increases, monopolizing behavior tends to increase as well, so this
response would be self-defeating. Asking members what is going on is a broader opening and might lead to
responses unrelated to the issue that bears addressing; narrowing the focus to the group process more directly
addresses what is occurring in the group. Focusing on the talkative patient would be less effective and involves the
leader addressing the issue instead of members first attempting to do so themselves (giving them a chance to
practice skills such as assertive communication).

Guidelines followed by the leader of a therapeutic group include focusing on recognizing dysfunctional behavior
and thinking patterns, followed by identifying and practicing more adaptive alternate behaviors and thinking.
Which theory is evident by this approach?
a. Behavioral
b. Interpersonal
c. Psychodynamic
d. Cognitive-behavioral
ANS: D
The characteristics described are those of cognitive-behavioral therapy, in which patients learn to reframe
dysfunctional thoughts and extinguish maladaptive behaviors. Behavioral therapy focuses solely on changing
behavior rather than thoughts, feelings, and behaviors together. Interpersonal theory focuses on interactions and
relationships. Psychodynamic groups focus on developing insight to resolve unconscious conflicts.
 PSYCHIATRIC WARD

The nurse is planning a new sexuality group for patients. Which location would best enhance the effectiveness of
this group?
a. The hospital auditorium
b. A small conference room
c. A common area, such as a day room
d. The corner of the music therapy room
ANS: B
The conference room would provide a quiet, private area with few distractions, separate from other patient areas
and effective for teaching and learning about a private topic. The auditorium is too large, and members' anxiety or
lack of trust might lead them to spread out too far from each other, interfering with group process. The day room
and the music therapy room are too busy and exposed, reducing privacy and increasing distractions.

Which remark by a group participant would the nurse expect during the working stage of group therapy?
a. "My problems are very personal and private. How do I know people in this group will not tell others what you
hear?"
b. "I have enjoyed this group. It's hard to believe that a few weeks ago I couldn't even bring myself to talk here."
c. "One thing everyone seems to have in common is that sometimes it's hard to be honest with those you love
most."
d. "I don't think I agree with your action. It might help you, but it seems like it would upset your family."
ANS: D
In the working stage, members actively interact to help each other accomplish goals, and because trust has
developed, conflict and disagreement can be expressed. Focusing on trust and confidentiality typically occur in the
orientation phase as part of establishing group norms. Commonality and universality are also themes typically
expressed in the orientation phase, whereas reflecting on progress is a task addressed in the termination phase.

Three members of a therapy group share covert glances as other members of the group describe problems. When
one makes a statement that subtly criticizes another speaker, the others nod in agreement. Which group dynamic
should the leader suspect?
a. Some members are acting as a subgroup instead of as members of the main group.
b. Some of the members have become bored and are disregarding others.
c. Three members are showing their frustration with slower members.
d. The leadership of the group has been ineffective.
ANS: A
Subgroups, small groups isolated within a larger group and functioning separately from it, sometimes form within
therapy groups. When this occurs, subgroup members are cohesive with other subgroup members but not with
the members of the larger group. Members of the subgroup may be bored or frustrated or expressing passive
aggression, but the primary dynamic is the splitting off from the main group.

A therapy group adds new members as others leave. What type of group is evident?
a. Open
b. Closed
c. Homogeneous
d. Heterogeneous
ANS: A
An open group is a group that adds members throughout the life of the group as other members leave and as
more persons who would benefit from the group become available. A closed group does not add new members;
the membership is established at the beginning and, except for the occasional losses as some members leave, does
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not change thereafter. A homogeneous group includes members who are similar, and a heterogeneous group
includes dissimilar members; not enough data are provided here to determine which applies in this case.

During a therapy group that uses existential/Gestalt theory, patients shared feelings that occurred at the time of
their admission. After a brief silence, one member says, "Several people have described feeling angry. I would like
to hear from members who had other feelings." Which group role is evident by this comment?
a. Energizer
b. Encourager
c. Compromiser
d. Self-confessor
ANS: B
The member is filling the role of encourager by acknowledging those who have contributed and encouraging input
from others. An energizer encourages the group to make decisions or take an action. The compromiser focuses on
reducing or resolving conflict to preserve harmony. A self-confessor verbalizes feelings or observations unrelated
to the group.

A group begins the working phase. One member has a childhood history of neglect and ridicule by parents. Which
comment would the group leader expect from this member?
a. "My boss is always expecting more of me than the others, but talking to him would only make it worse."
b. "I'm sorry for talking all the time, but there is so much going on in my life. I can't remember what I already said."
c. "Thanks for the suggestions everyone. Maybe some of them will help. It won't hurt to give them a try."
d. "This group is stupid. Nobody here can help anybody else because we are all so confused. It's a waste."
ANS: A
People who frequently complain, yet reject help or suggestions when offered, tend to have histories of severe
deprivation as children, often accompanied by neglect or abuse. The other comments reflect dynamics other than
the help-rejecting complainer, such as the monopolizer who apologizes for talking too much, the person who is
insightful and agrees to try a peer's suggestion, and the demoralizing member.

A group is in the working phase. One member says, "That is the stupidest thing I've ever heard. Everyone whines
and tells everyone else what to do. This group is a total waste of my time." Which comment by the group leader
would be most therapeutic?
a. "You seem to think you know a lot already. Since you know so much, perhaps you can tell everyone why you are
back in the hospital?"
b. "I think you have made your views clear, but I wonder if others feel the same way. How does everyone else feel
about our group?"
c. "It must be hard to be so angry." Direct this comment to another group member, "You were also angry at first
but not now. What has helped you?"
d. "I would like to remind you that one of our group rules is that everyone is to offer only positive responses to the
comments of others."
ANS: C
The member's comments demean the group and its members and suggest that the member is very angry. Labeling
the emotion and conveying empathy would be therapeutic. Focusing on members who are likely to be more
positive can balance the influence of demoralizing members. "You seem to know a lot..." conveys hostility from the
leader, who confronts and challenges the member to explain how he came to be readmitted if he was so
knowledgeable, implying that he is less knowledgeable than he claims. This comment suggests
countertransference and is non-therapeutic. Shifting away from the complaining member to see if others agree
seeks to have others express disagreement with this member, but that might not happen. In the face of his anger,
they might be quiet or afraid to oppose him, or they could respond in kind by expressing hostility themselves. A
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rule that only positive exchanges are permitted would suppress conflict, reducing the effectiveness of the therapy
group.

A group is in the working phase. One member states, "That is the stupidest thing I've ever heard. Everyone whines
and tells everyone else what to do. This group is a waste of my time." Which initial action by the group leader
would be most therapeutic?
a. Advise the member that hostility is inappropriate. Remove the member if it continues.
b. Keep the group's focus on this member so the person can express the anger.
c. Meet privately with the member outside of group to discuss the anger.
d. Change to a more positive topic of discussion in this group session.
ANS: C
Meeting privately with the member can convey interest and help defuse the anger so that it is less disruptive to
the group. Removing the member would be a last resort and used only when the behavior is intolerably disruptive
to the group process and all other interventions have failed. Decreasing the focus on the hostile member and
focusing more on positive members can help soften the anger. Angry members often hide considerable
vulnerability by using anger to keep others at a distance and intimidated. Changing the subject fails to respond to
the behavior.

A group has two more sessions before it ends. One member was previously vocal and has shown much progress
but has now grown silent. What explanation most likely underlies this behavior? The silent member:
a. has participated in the group and now has nothing more to offer.
b. is having trouble dealing with feelings about termination of this group.
c. wants to give quieter members a chance to talk in the remaining sessions.
d. is engaging in attention-seeking behavior aimed at continuation of the group.
ANS: B
A chief task during the termination phase of a group is to take what has been learned in group and transition to life
without the group. The end of a group can be a significant loss for members, who may experience loss and grief
and respond with sadness or anger. It is unlikely he would have nothing to say; at the very least, he could be
responding to the comments of others even if not focusing on his own issues. He may wish to give quieter
members a chance to talk, but again, this would not require or explain his complete silence. Some members, faced
with only two remaining sessions, may be becoming more dominant under this pressure of time, but here too this
is unlikely to lead a previously active participant to fall completely silent. The member is not attention-seeking.

A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I will be glad when I can
help someone else." This statement reflects:
a. altruism.
b. universality.
c. cohesiveness.
d. corrective recapitulation.
ANS: A
Altruism refers to the experience of being helpful or useful to others, a condition that the patient anticipates will
happen. The other options are also therapeutic factors identified by Yalom.

During a support group, a patient diagnosed with schizophrenia says, "Sometimes I feel sad that I will never have a
good job like my brother. Then I dwell on it and maybe I should not." Select the nurse leader's best comment to
facilitate discussion of this issue.
a. "It is often better to focus on our successes rather than our failures."
b. "How have others in the group handled painful feelings like these?"
c. "Grieving for what is lost is a normal part of having a mental disorder."
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d. "I wonder if you might also experience feelings of anger and helplessness."
ANS: B
Asking others to share their experiences will facilitate discussion of an issue. Giving information may serve to close
discussion of the issue because it sounds final. Suggesting a focus on the positives implies a discussion of the issue
is not appropriate. Suggesting other possible feelings is inappropriate at this point, considering the patient has
identified feelings of sadness and seems to have a desire to explore this feeling. Focusing on other feelings will
derail discussion of the patient's grief for his perceived lost potential.

A nurse leads a psychoeducational group for patients in the community diagnosed with schizophrenia. A realistic
outcome for group members is that they will:
a. discuss ways to manage their illness.
b. develop a high level of trust and cohesiveness.
c. understand unconscious motivation for behavior.
d. demonstrate insight about development of their illness.
ANS: A
Patients with schizophrenia almost universally have problems associated with everyday living in the community, so
discussing ways to manage the illness would be an important aspect of psychoeducation. Discussing concerns
about daily life would be a goal to which each could relate. Developing trust and cohesion is desirable but is not
the priority outcome of a psychoeducational group. Understanding unconscious motivation would not be
addressed. Insight would be difficult for a patient with residual schizophrenia because of the tendency toward
concrete thinking.

A patient in a detoxification unit asks, "What good it will do to go to Alcoholics Anonymous and talk to other
people with the same problem?" The nurse's best response would be to explain that self-help groups such as AA
provide opportunities for:
a. newly discharged alcoholics to learn about the disease of alcoholism.
b. people with common problems to share their experiences with alcoholism and recovery.
c. patients with alcoholism to receive insight-oriented treatment about the etiology of their disease.
d. professional counselors to provide guidance to individuals recovering from alcoholism.
ANS: B
The patient needs basic information about the purpose of a self-help group. The basis of self-help groups is sharing
by individuals with similar problems. Self-help is based on the belief that an individual with a problem can be truly
understood and helped only by others who have the same problem. The other options fail to address this or
provide incorrect information.

Which type of group is a staff nurse with 2 months' psychiatric experience best qualified to conduct?
a. Psychodynamic/psychoanalytic group
b. Medication education group
c. Existential/Gestalt group
d. Family therapy group
ANS: B
All nurses receive information about patient teaching strategies and basic information about psychotropic
medications, making a medication education group a logical group for a beginner to conduct. The other groups
would need a leader with more education and experience.

The next-to-last meeting of an interpersonal therapy group is taking place. The leader should take which actions?
Select all that apply.
a. Support appropriate expressions of disagreement by the group's members.
b. Facilitate discussion and resolution of feelings about the end of the group.
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c. Encourage members to reflect on their progress and that of the group itself.
d. Remind members of the group's norms and rules, emphasizing confidentiality.
e. Help members identify goals they would like to accomplish after the group ends.
f. Promote the identification and development of new options for solving problems.
ANS: B, C, E
The goals for the termination phase of groups are to prepare the group for separation, resolve related feelings, and
prepare each member for the future. Contributions and accomplishments of members are elicited, post-group
goals are identified, and feelings about the group's ending are discussed. Group norms are the focus of the
orientation phase, and conflict and problem solving are emphasized in the working phase.

A leader begins the discussion at the first meeting of a new group. Which comments should be included? Select all
that apply.
a. "We use groups to provide treatment because it's a more cost-effective use of staff in this time of budget
constraints."
b. "When someone shares a personal experience, it's important to keep the information confidential."
c. "Talking to family members about our group discussions will help us achieve our goals."
d. "Everyone is expected to share a personal experience at each group meeting."
e. "It is important for everyone to arrive on time for our group."
ANS: B, E
The leader must set ground rules for the group before members can effectively participate. Confidentiality of
personal experiences should be maintained. Arriving on time is important to the group process. Talking to family
members would jeopardize confidentiality. While groups are cost-effective, blaming the budget would not help
members feel valued. Setting an expectation to share may be intimidating for a withdrawn patient.

Which factor presents the highest risk for a child to develop a psychiatric disorder?
a. Having an uncle with schizophrenia c. Living with an alcoholic parent
b. Being the oldest child in a family d. Being an only child
C
Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that
increases the risk of a child developing a psychiatric condition. Being in a middle-income family and being the
oldest child do not represent psychosocial adversity. Having a family history of schizophrenia presents a risk, but
an alcoholic parent in the family offers a greater risk.

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders?
a. Impaired social interaction related to difficulty relating to others
b. Chronic low self-esteem related to excessive negative feedback
c. Deficient fluid volume related to abnormal eating habits
d. Anxiety related to nightmares and repetitive activities
A
Children diagnosed with autism spectrum disorders display profoundly disturbed social relatedness. They seem
aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed
and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all
cases

Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was
effective? The child:
a. plays with one toy for 30 minutes.
b. repeats words spoken by a parent.
c. holds the parent's hand while walking.
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d. spins around and claps hands while walking.

C
Holding the hand of another person suggests relatedness. Usually, a child with an autism spectrum disorder would
resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern.
The incorrect options reflect behaviors that are consistent with autism spectrum disorders.

A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the
teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans
interventions designed to:
a. promote integration of self-concept.
b. provide inpatient treatment for the child.
c. reduce loneliness and increase self-esteem.
d. improve language and communication skills.
C
Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers,
and peers, leading to self-esteem disturbance. These behaviors also cause peers to avoid the child with ADHD,
leaving the child with ADHD vulnerable to loneliness. The child does not need inpatient treatment at this time. The
incorrect options might or might not be relevant.

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit
hyperactivity disorder (ADHD). Which medication will the information focus on?
a. Paroxetine (Paxil) c. Methyphenidate (Ritalin)
b. Imipramine (Tofranil) d. Carbamazepine (Tegretol)
C
CNS stimulants are the drugs of choice for treating children with ADHD: Ritalin and dexedrine are commonly used.
None of the other drugs are psychostimulants used to treat ADHD.

What is the nurse's priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for
attention deficit hyperactivity disorder (ADHD)?
a. Dystonia, akinesia, and extrapyramidal symptoms
b. Bradycardia and hypotensive episodes
c. Sleep disturbances and weight loss
d. Neuroleptic malignant syndrome
C
The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention,
dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with the child's growth and
development. The distracters relate to side effects of conventional antipsychotic medications.

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve
relationships with other children. Which treatment modality should the nurse suggest for the plan of care?
a. Reality therapy c. Social skills group
b. Simple restitution d. Insight-oriented group therapy
C
Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction,
role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no
impact on peer relationships.
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The parent of a 6-year-old says, "My child is in constant motion and talks all the time. My child isn't interested in
toys but is out of bed every morning before me." The child's behavior is most consistent with diagnostic criteria
for:
a. communication disorder.
b. stereotypic movement disorder.
c. intellectual development disorder.
d. attention deficit hyperactivity disorder.
D
Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit hyperactivity disorder
(ADHD). The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or
communication disorder.

A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social
interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others.
Which finding indicates the plan of care was effective? The child:
a. has an improved ability to identify anxiety and use self-control strategies.
b. has increased expressiveness in communication with others.
c. shows increased responsiveness to authority figures.
d. engages in cooperative play with other children.
D
The goal should be directly related to the defining characteristics of the nursing diagnosis, in this case,
improvement in the child's aggressiveness and play. The distracters are more relevant for a child with autism
spectrum or anxiety disorder.

When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs
over and slaps another child, what is the nurse's best action?
a. Instruct the parents to take the aggressive child home.
b. Direct the aggressive child to stop immediately.
c. Call for emergency assistance from other staff.
d. Take the aggressive child to another room.
D
The nurse should manage the milieu with structure and limit setting. Removing the aggressive child to another
room is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is
not an emergency. Intervention is needed rather than sending the child home.

A child diagnosed with attention deficit hyperactivity disorder will begin medication therapy. The nurse should
prepare a plan to teach the family about which classification of medications?
a. Central nervous system stimulants c. Antipsychotics
b. Tricyclic antidepressants d. Anxiolytics
A
Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the
brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit
hyperactivity disorder. The other medication categories listed would not be appropriate.

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and
avoided former friends. The child told the school nurse, "If my parents loved me, they would work out their
problems." Which nursing diagnosis has the highest priority?
a. Social isolation c. Chronic low self-esteem
b. Decisional conflict d. Disturbed personal identity
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A
This child shows difficulty coping with problems associated with the family. Social isolation refers to aloneness that
the patient perceives negatively, even when self-imposed. The other options are not supported by data in the
scenario.

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with
the child's disorder? The child:
a. has occasional toileting accidents.
b. is unable to read children's books.
c. cries when separated from a parent.
d. continuously rocks in place for 30 minutes.
D
Autism spectrum disorder involves distortions in development of social skills and language that include perception,
motor movement, attention, and reality testing. Body rocking for extended periods suggests autism spectrum
disorder. The distracters are expected findings for a 3-year-old.

A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents ask the nurse, "What
should we do?" Select the nurse's best response.
a. "Ask the teacher to let the child call you at play time."
b. "Withdraw the child from preschool until maturity increases."
c. "Remain with your child for the first hour of preschool time."
d. "Give your child a kiss before you leave the preschool program."
D
The child demonstrates age-appropriate behavior for a 4-year-old. The nurse should reassure the parents. The
distracters are over-reactions.

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of
mental illness?
a. The child has been raised by a parent with chronic major depression.
b. The child's best friend was absent from the child's birthday party.
c. The child was not promoted to the next grade one year.
d. The child moved to three new homes over a 2-year period.
A
Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk
factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large
families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The
chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk-
enhancing.

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with:
a. attention deficit hyperactivity disorder.
b. posttraumatic stress disorder.
c. communication disorder.
d. an anxiety disorder.
A
Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with
attention deficit hyperactivity disorder. If medication were prescribed for a child with an anxiety disorder, it would
be a benzodiazepine. Medications are generally not needed for children with communication disorder. Treatment
of PTSD is more often associated with SSRI medications.
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A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse's best
first action?
a. Give notice to the chief administrator at the school regarding the events.
b. Encourage the victimized child to share feelings about the experience.
c. Encourage the victimized child to ignore the bullying behavior.
d. Discuss the events with the aggressive classmate.
B
The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should
first listen to the child's complaints and validate the child for reporting the events. Later, school authorities should
be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior
should not be ignored; it will only get worse.

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a
question is complete, and frequently interrupting others' conversations. How should the nurse document these
behaviors?
a. Disobedience c. Impulsivity
b. Hyperactivity d. Anxiety
C
These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such
as running, pushing, and the inability to sit. Inattention is demonstrated by failure to listen. Defiance is
demonstrated by willfully doing what an authority figure has said not to do.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and
impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for
which desired behavior?
a. Increased expressiveness in communication with others
b. Abilities to identify anxiety and implement self-control strategies
c. Improved abilities to participate in cooperative play with other children
d. Tolerates social interactions for short periods without disruption or frustration
C
The goal is improvement in the child's hyperactivity, aggression, and play. The remaining options are more relevant
for a child with intellectual development disorder or an anxiety disorder.

When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a
group that uses:
a. guided imagery.
b. talk focused on a specific issue.
c. play and talk about a play activity.
d. group discussion about selected topics.
C
Group therapy for young children takes the form of play. For elementary school children, therapy combines play
and talk about the activity. For adolescents, group therapy involves more talking.

Which child demonstrates behaviors indicative of a neurodevelopmental disorder?

a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling
b. A 9-month-old who does not eat vegetables and likes to be rocked
c. A 3-month-old who cries after feeding until burped and sucks a thumb
d. A 3-year-old who is mute, passive toward adults, and twirls while walking
 PSYCHIATRIC WARD

D
Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. Autistic spectrum
disorder is one type of neurodevelopmental disorder. The behaviors of the other children are within normal
ranges.

The parent of a child diagnosed with Tourette's disorder says to the nurse, "I think my child is faking the tics
because they come and go." Which response by the nurse is accurate?
a. "Perhaps your child was misdiagnosed."
b. "Your observation indicates the medication is effective."
c. "Tics often change frequency or severity. That doesn't mean they aren't real."
d. "This finding is unexpected. How have you been administering your child's medication?"
C
Tics are sudden, rapid, involuntary, repetitive movements or vocalizations characteristic of Tourette's disorder.
They often fluctuate in frequency, severity, and are reduced or absent during sleep.

When a 5-year-old is disruptive, the nurse says, "You must take a time-out." The expectation is that the child will:
a. go to a quiet room until called for the next activity.
b. slowly count to 20 before returning to the group activity.
c. sit on the edge of the activity until able to regain self-control.
d. sit quietly on the lap of a staff member until able to apologize for the behavior.
C
Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a
designated room or sitting on the periphery of an activity until the child gains self-control and reviews the episode
with a staff member. Time-out may not require going to a designated room and does not involve special attention
such as holding. Counting to 10 or 20 is not sufficient.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting
relationship with a shelter volunteer. The child says, "My three friends and I got an A on our school science
project." The nurse can assess that the child:
a. displays resiliency.
b. has a passive temperament.
c. is at risk for posttraumatic stress disorder.
d. uses intellectualization to deal with problems.
A
Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can adapt to changes in
the environment, take advantage of nurturing relationships with adults other than parents, distance themselves
from emotional chaos occurring within the family, learn, and use problem-solving skills.

A nurse prepares to lead a discussion at a community health center regarding children's health problems. The
nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse
to use? Select all that apply.
a. Autism
b. Bullying
c. Mental retardation
d. Autism spectrum disorder
e. Intellectual development disorder
B, D, E
Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. It's
important for the nurse to use current terminology.
 PSYCHIATRIC WARD

A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder.
What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will: (select all that
apply)
a. graduate from high school.
b. live independently in an apartment.
c. independently perform own personal hygiene.
d. obtain employment in a local sheltered workshop.
e. correctly use public buses to travel in the community.
C, D, E
Individuals with moderate intellectual developmental disorder progress academically to about the second grade.
These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, the
person can function in the community, but independent living is not likely.

At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal
online communication device. Each member of the family is in a different area of the home. Which nursing actions
are appropriate? Select all that apply.
a. Report the finding to the official child protection social services agency.
b. Educate all members of the family about risks associated with cyberbullying.
c. Talk with the parents about parental controls on the children's communication devices.
d. Encourage the family to schedule daily time together without communication devices.
e. Obtain the family's network password and examine online sites family members have visited.
B, C, D
Education and awareness-based approaches have a chance of effectively reducing harmful online behavior,
including risks associated with cyberbullying. Parental controls on the children's devices will support safe Internet
use. Family time together will promote healthy bonding and a sense of security among members. There is no
evidence of danger to the children, so a report to child protective agency is unnecessary. It would be inappropriate
to seek the family's network password and an invasion of privacy to inspect sites family members have visited.

A nurse works with a child who is sad and irritable because the child's parents are divorcing. Why is establishing a
therapeutic alliance with this child a priority?
a. Therapeutic relationships provide an outlet for tension.
b. Focusing on the strengths increases a person's self-esteem.
c. Acceptance and trust convey feelings of security to the child.
d. The child should express feelings rather than internalize them.
C
Trust is frequently an issue because the child may question their trusting relationship with the parents. In this
situation, the trust the child once had in parents has been disrupted, reducing feelings of security. The correct
answer is the most global response.

A 16-year-old diagnosed with a conduct disorder has been in a residential program for 3 months. Which outcome
should occur before discharge?
a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences.
b. The adolescent identifies friends in the home community who are a positive influence.
c. Temporary placement is arranged with a foster family until the parents complete a parenting skills class.
d. The adolescent experiences no anger and frustration for 1 week.
A
The adolescent and the parents must agree on a behavioral contract that clearly outlines rules, expected
behaviors, and consequences for misbehavior. It must also include rewards for following the rules. The adolescent
 PSYCHIATRIC WARD

will continue to experience anger and frustration. The adolescent and parents must continue with family therapy
to work on boundary and communication issues. It is not necessary to separate the adolescent from the family to
work on these issues. Separation is detrimental to the healing process. While it is helpful for the adolescent to
identify peers who are a positive influence, it's more important for behavior to be managed for an adolescent
diagnosed with a conduct disorder.

A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the court, "We can't
manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. Which
diagnosis is supported by this adolescent's behavior?
a. Attention deficit hyperactivity disorder (ADHD)
b. Posttraumatic stress disorder (PTSD)
c. Intermittent explosive disorder
d. Conduct disorder
D
Conduct disorders are manifested by a persistent pattern of behavior in which the rights of others and age-
appropriate societal norms are violated. Intermittent explosive disorder is a pattern of behavioral outbursts
characterized by an inability to control aggressive impulses in adults 18 years and older. Criteria for ADHD and
PTSD are not met in the scenario.

A 15-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the
program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which
approach by nursing staff will be most therapeutic?
a. Planned ignoring c. Neutrally permit refusals
b. Establish firm limits d. Coaxing to gain compliance
B
Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other
patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment
plan, ignoring, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or
structure.

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They
focus all attention on my brother, who's perfect in their eyes." Which type of therapy might promote the greatest
change in the adolescent's behavior?
a. Family therapy c. Play therapy
b. Bibliotherapy d. Art therapy
A
Family therapy focuses on problematic family relationships and interactions. The patient has identified problems
within the family. Play therapy is more appropriate for younger patients. Art therapy and bibliotherapy would not
focus specifically on the identified problem.

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They
focus all attention on my brother, who's perfect in their eyes." Which nursing diagnosis is most applicable?
a. Disturbed personal identity related to acting out as evidenced by prostitution
b. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents
c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out
d. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one
child over another
C
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The patient demonstrates a failure to follow age-appropriate social norms and an inability to problem solve by
using adaptive behaviors to meet life's demands and roles. The defining characteristics are not present for the
other nursing diagnoses. The patient never mentioned hopelessness or disturbed personal identity. The problem
relates to the patient's perceptions of parental behavior rather than the actual behavior.

A 12-year-old has engaged in bullying for several years. The parents say, "We can't believe anything our child says."
Recently this child shot a dog with a pellet gun and set fire to a neighbor's trash bin. The child's behaviors support
the diagnosis of:
a. attention deficit hyperactivity disorder.
b. intermittent explosive disorder.
c. defiance of authority.
d. conduct disorder.
D
The behaviors mentioned are most consistent with criteria for conduct disorder, for example, aggression against
people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or
occupational functioning. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an
inability to control aggressive impulses in adults 18 years and older. The behaviors are not consistent with
attention deficit and are more pervasive than defiance of authority.

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential
treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation.
a. Ignore the child's behavior.
b. Send the child to time-out.
c. Accompany the child to the gym and shoot baskets.
d. Role-play a more appropriate behavior with the child.
C
The child's behavior warrants an active response. Redirecting the expression of feelings into nondestructive age-
appropriate behaviors, such as a physical activity, helps defuse the situation here and now. This response helps the
child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative
and should be tried before resorting to a more restrictive measure. Role-playing is appropriate after the child's
anger is defused.

An adolescent acts out in disruptive ways. When this adolescent threatens to throw a pool ball at another
adolescent, which comment by the nurse would set appropriate limits?
a. "Attention everyone: we are all going to the craft room."
b. "You will be taken to seclusion if you throw that ball."
c. "Do not throw the ball. Put it back on the pool table."
d. "Please do not lose control of your emotions."
C
Setting limits uses clear, sharp statements about prohibited behavior and guidance for performing a behavior that
is expected. The incorrect options represent a threat, use of restructuring (which would be inappropriate in this
instance), and a direct appeal to the child's developing self-control that may be ineffective.

The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which
aspect of the child's plan of care will be provided by an advanced practice nurse rather than a staff nurse?
a. Leading an activity group c. Formulating nursing diagnoses
b. Providing positive feedback d. Dialectical behavioral therapy (DBT)
D
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The advanced practice nurse role includes individual, group, and family psychotherapist; educator of nurses, other
professions, and the community; clinical supervisor; consultant to professional and nonprofessional groups; and
researcher. Dialectical behavioral therapy (DBT) is an aspect of psychotherapy. The distracters describe actions of a
nurse generalist.

Shortly after the parents announced that they were divorcing, a 15-year-old became truant from school and
assaulted a friend. The adolescent told the school nurse, "I'd rather stay in my room and listen to music. It's easier
than thinking about what is happening in my family." Which nursing diagnosis is most applicable?
a. Chronic low self-esteem related to role within the family
b. Decisional conflict related to compliance with school requirements
c. Ineffective coping related to adjustment to changes in family relationships
d. Disturbed personal identity related to self-perceptions of changing family dynamics
C
Depression is often associated with impulse control disorder. The correct nursing diagnosis refers to the patient's
dysfunctional management of feelings associated with upcoming changes to the family. The teen displays self-
imposed isolation. The distracters are not supported by data in the scenario.

A child known as the neighborhood bully says, "Nobody can tell me what to do." After receiving a poor grade on a
science project, this child secretly loaded a virus on the teacher's computer. These behaviors support a diagnosis
of:
a. conduct disorder.
b. oppositional defiant disorder.
c. intermittent explosive disorder.
d. attention deficit hyperactivity disorder.
B
Oppositional defiant disorder is a repeated and persistent pattern of having an angry and irritable mood in
conjunction with demonstrating defiant and vindictive behavior. Loading a virus is a vindictive behavior in
retribution for a poor grade. Persons with conduct disorder are aggressive against people and animals; destroy
property; are deceitful; violate rules; and have impaired social, academic, or occupational functioning. There is no
evidence of explosiveness or distractibility.

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential
treatment program and begins shouting at the nurse. What is the nurse's initial action to defuse the situation?
a. Say to the child, "Tell me how you're feeling right now."
b. Take the child swimming at the program's pool.
c. Establish a behavioral contract with the child.
d. Administer an anxiolytic medication.
B
Redirecting the expression of feelings into nondestructive, age-appropriate behaviors such as a physical activity
helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive
alternative and should be tried before resorting to measures that are more restrictive. A shouting child will not
likely engage in a discussion about feelings. A behavioral contract could be considered later, but first the situation
must be defused.

Parents of an adolescent diagnosed with a conduct disorder say, "We don't know how to respond when our child
breaks the rules in our house. Is there any treatment that might help us?" Which therapy is likely to be helpful for
these parents?
a. Parent-child interaction therapy (PCIT)
b. Behavior modification therapy
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c. Multi-systemic therapy (MST)

d. Pharmacotherapy
A
In parent-child interaction therapy (PCIT), the therapist sits behind one-way mirrors and coaches parents through
an ear audio device while they interact with their children. The therapist can suggest strategies that reinforce
positive behavior in the adolescent. The goal is to improve parenting strategies and thereby reduce problematic
behavior. Behavior modification therapy may help the adolescent, but the parents are seeking help for themselves.
Multi-systemic therapy is much broader and does not target the parents' need.

An adolescent diagnosed with an impulse control disorder said, "I just want to die. I spend all my time getting even
with people who have done wrong to me." When asked about a suicide plan, the adolescent replied, "I'll jump
from the bridge near my home. My father threw kittens off that bridge, and they died because they couldn't
swim." Rate the suicide risk.
a. Absent c. Moderate
b. Low d. High
D
The suicide risk is high. The child is experiencing feelings of hopelessness and helplessness. The method described
is lethal, and the means to carry out the plan are available.

An adolescent diagnosed with conduct disorder has aggression, impulsivity, hyperactivity, and mood symptoms.
The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care
provider will prescribe which type of medication?
a. Second-generation antipsychotic c. Calcium channel blocker
b. Anti-anxiety medication d. Beta-blocker
A
Medications for conduct disorder are directed at problematic behaviors such as aggression, impulsivity,
hyperactivity, and mood symptoms. Second-generation antipsychotics are likely to be prescribed. Beta-blocking
medications may help to calm individuals with intermittent explosive disorder by slowing the heart rate and
reducing blood pressure. Calcium channel blockers reduce blood pressure but are not used for persons with
impulse control problems. An anti-anxiety medication will not assist with impulse control.

An adolescent was recently diagnosed with oppositional defiant disorder. The parents say to the nurse, "Isn't there
some medication that will help with this problem?" Select the nurse's best response.
a. "There are no medications to treat this problem. This diagnosis is behavioral in nature."
b. "It's a common misconception that there is a medication available to treat every health problem."
c. "Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use."
d. "There are many medications that will help your child manage aggression and destructiveness. The health care
provider will discuss them with you."
C
The parents are seeking a quick solution. Medications are generally not indicated for oppositional defiant disorder.
Comorbid conditions that increase defiant symptoms, such as attention deficit hyperactivity disorder, should be
managed with medication, but no comorbid problem is identified in the question. The nurse should give
information on helpful strategies to manage the adolescent's behavior.

An adolescent diagnosed with a conduct disorder stole and wrecked a neighbor's motorcycle. Afterward, the
adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous
system best explains the adolescent's reaction?
a. Serotonin dysregulation and increased testosterone activity impair one's capacity for remorse.
b. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules.
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c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy.
d. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of
behavior.
C
Adolescents with conduct disorder have been found to have significantly reduced gray matter bilaterally in the
anterior insulate cortex and the amygdala. This reduction may be related to aggressive behavior and deficits of
empathy. The less gray matter in these regions of the brain, the less likely adolescents are to feel remorse for their
actions or victims. People with intermittent explosive disorder may have differences in serotonin regulation in the
brain and higher levels of testosterone. Neuron destruction in the hippocampus is associated with memory
deficits. The occipital lobe is involved with visual stimuli but not the processing of emotions.

Which assessment findings support a diagnosis of oppositional defiant disorder?

a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior.
b. Exhibits involuntary facial twitching and blinking; makes barking sounds.
c. Violates others' rights; cruelty toward people or animals; steals; truancy.
d. Displays poor academic performance and reports frequent nightmares.
A
Oppositional defiant disorder is a repeated and persistent pattern of having an angry and irritable mood in
conjunction with demonstrating defiant and vindictive behavior. The distracters identify findings associated with
conduct disorder, anxiety disorder, and Tourette's syndrome.

A nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old. An impulse control disorder is
suspected. Which aspects of the patient's history support the suspected diagnosis? Select all that apply.
a. Family history of mental illness
b. Allergies to multiple antibiotics
c. Long history of severe facial acne
d. Father with history of alcohol abuse
e. History of an abusive relationship with one parent
A, D, E
Parents who are abusive, rejecting, or overly controlling cause a child to suffer detrimental effects. Other stressors
associated with impulse control disorders can include major disruptions such as placement in foster care, severe
marital discord, or a separation of parents. Substance abuse by a parent is common. Acne and allergies are not
aspects of the history that relate to the behavior.

What are the primary distinguishing factors between the behavior of persons diagnosed with oppositional defiant
disorder (ODD) and those with conduct disorder (CD)? Select all that apply. The person diagnosed with:
a. ODD relives traumatic events by acting them out.
b. ODD tests limits and disobeys authority figures.
c. ODD has difficulty separating from loved ones.
d. CD uses stereotypical or repetitive language.
e. CD often violates the rights of others.
B, E
Persons diagnosed with ODD are negativistic, disobedient, and defiant toward authority figures without seriously
violating the basic rights of others, whereas persons with conduct disorder frequently behave in ways that do
violate the rights of others and age-appropriate societal norms. Reliving traumatic events occurs with
posttraumatic stress disorder. Stereotypical language behaviors are seen in persons with autism spectrum
disorders.
 PSYCHIATRIC WARD

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at
school. Establishing rapport with this adolescent is a priority because: (select all that apply)
a. it is a vital component of implementing a behavior modification program.
b. a therapeutic alliance is the first step in a nurse's therapeutic use of self.
c. the adolescent has demonstrated resistance to other authority figures.
d. acceptance and trust convey feelings of security for the adolescent.
e. adolescents usually relate better to authority figures than peers.
B, D
Trust is frequently an issue because the adolescent may never have had a trusting relationship with an adult. Trust
promotes feelings of security and is the basis of the nurse's therapeutic use of self. Adolescents value peer
relationships over those related to authority. Rewards for appropriate behavior are the main component of
behavior modification programs.

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person
wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is
most likely?
a. Binge eating
b. Bulimia nervosa
c. Anorexia nervosa
d. Eating disorder not otherwise specified
ANS: C
Overly controlled eating behaviors, extreme weight loss, preoccupation with food, and wearing several layers of
loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual
with bulimia usually is near normal weight. The binge eater is often overweight. The patient with eating disorder
not otherwise specified may be obese. See relationship to audience response question.

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which
outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake is within required parameters of treatment plan
c. Weight reaches established normal range for the patient
d. Patient expresses satisfaction with body appearance
ANS: D
Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or
her own appearance and body function. This is a subjective consideration. The other indicators are more objective
but less related to the nursing diagnosis.

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating
patterns, the nurse should ask the patient:
a. "Do you often feel fat?"
b. "Who plans the family meals?"
c. "What do you eat in a typical day?"
d. "What do you think about your present weight?"
ANS: C
Although all the questions might be appropriate to ask, only "What do you eat in a typical day?" focuses on the
eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family
meal planning are unrelated to eating patterns. Asking for the patient's thoughts on present weight explores the
patient's feelings about weight.
 PSYCHIATRIC WARD

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A
nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient
is most consistent with the diagnosis?
a. "I am fat and ugly."
b. "What I think about myself is my business."
c. "I'm grossly underweight, but that's what I want."
d. "I'm a few pounds overweight, but I can live with it."
ANS: A
Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be
overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with
anorexia does not recognize his or her thinness and will persist in trying to lose more weight.

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months
ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?
a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as
evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and
hyperkalemia
d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of
body weight and hypokalemia
ANS: D
The patient's history and lab result support the nursing diagnosis Imbalanced nutrition: less than body
requirements. Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The
patient has hypokalemia rather than hyperkalemia.

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired
outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the
patient will:
a. weigh self accurately using balanced scales.
b. limit exercise to less than 2 hours daily.
c. select clothing that fits properly.
d. gain 1 to 2 pounds.
ANS: D
Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient.
The focus of an outcome would not be on the patient weighing self. Limiting exercise and selecting proper clothing
are important, but weight gain takes priority.

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain
weight?
a. Assess for depression and anxiety.
b. Observe for adverse effects of refeeding.
c. Communicate empathy for the patient's feelings.
d. Help the patient balance energy expenditures with caloric intake.
ANS: B
The nursing intervention of observing for adverse effects of refeeding most directly relates to weight gain and is a
priority. Assessing for depression and anxiety, as well as communicating empathy, relate to coping. Helping the
patient achieve balance between energy expenditure and caloric intake is an inappropriate intervention.
 PSYCHIATRIC WARD

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a
contract with the patient to participate in measures designed to produce a specified weekly weight gain?
a. Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable.
b. Patient involvement in decision making increases sense of control and promotes compliance with treatment.
c. Because of increased risk of physical problems with refeeding, the patient's permission is needed.
d. A team approach to planning the diet ensures that physical and emotional needs will be met.
ANS: B
A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient
fears of too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not
a guarantee that needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an
additional aspect of treatment.

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for
complications of refeeding." Which system should a nurse closely monitor for dysfunction?
a. Renal
b. Endocrine
c. Integumentary
d. Cardiovascular
ANS: D
Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused
assessment is a necessity to ensure the patient's physiological integrity. The other body systems are not initially
involved in the refeeding syndrome.

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia
nervosa. Which statement by the staff nurse supports this type of therapy?
a. "What are your feelings about not eating foods that you prepare?"
b. "You seem to feel much better about yourself when you eat something."
c. "It must be difficult to talk about private matters to someone you just met."
d. "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
ANS: D
The correct response is the only strategy that attempts to question the patient's distorted thinking.

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the
patient:
a. to eat a small meal after purging.
b. not to skip meals or restrict food.
c. to increase oral intake after 4 PM daily.
d. the value of reading journal entries aloud to others.
ANS: B
One goal of health teaching is normalization of eating habits. Food restriction and skipping meals lead to rebound
bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce
vomiting. Teaching the patient to eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-
day bingeing. Journal entries are private.

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse
indicates that additional clinical supervision is needed?
a. The nurse interacts with the patient in a protective fashion.
b. The nurse's comments to the patient are compassionate and nonjudgmental.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
 PSYCHIATRIC WARD

d. The nurse refers the patient to a self-help group for individuals with eating disorders.
ANS: A
In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse
must take care not to cross the line toward authoritarianism and assumption of a parental role. Protective
behaviors are part of the parent's role. The helpful nurse uses a problem-solving approach and focuses on the
patient's feelings of shame and low self-esteem. Referring a patient to a self-help group is an appropriate
intervention.

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of
loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related
to this diagnosis is that within 2 weeks the patient will:
a. appropriately express angry feelings.
b. verbalize two positive things about self.
c. verbalize the importance of eating a balanced diet.
d. identify two alternative methods of coping with loneliness.
ANS: D
The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective
coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are
outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not
measurable.

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?
a. Assist the patient to identify triggers to binge eating.
b. Provide corrective consequences for weight loss.
c. Assess for signs of impulsive eating.
d. Explore needs for health teaching.
ANS: A
For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the
triggers are anxiety-producing situations. Identification of triggers makes it possible to break the binge-purge cycle.
Because binge eating and purging directly affect physical status, the need to promote physical safety assumes
highest priority.

One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed? The
patient whose weight decreased from:
a. 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood
pressure 60/40 mm Hg
b. 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure
70/50 mm Hg
c. 110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood
pressure 80/66 mm Hg
d. 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood
pressure 74/48 mm Hg
ANS: A
Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months,
temperature below 36° C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than
70 mm Hg.

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse
should provide relates to:
 PSYCHIATRIC WARD

a. self-monitoring of daily food and fluid intake.

b. establishing the desired daily weight gain.
c. how to recognize hypokalemia.
d. self-esteem maintenance.
ANS: C
Hypokalemia results from potassium loss associated with vomiting. Physiological integrity can be maintained if the
patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of
daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient
with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the dangers associated
with hypokalemia.

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by
fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented?
a. Amenorrhea
b. Alopecia
c. Lanugo
d. Stupor
ANS: C
The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa.
None of the other conditions can be supported by the data the nurse has gathered.

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the
trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, "I won't eat until I look thin."
Select the priority initial nursing diagnosis.
a. Anxiety related to fear of weight gain
b. Disturbed body image related to weight loss
c. Ineffective coping related to lack of conflict resolution skills
d. Imbalanced nutrition: less than body requirements related to self-starvation
ANS: D
The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-
starvation is the priority.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for
the primary purpose of:
a. maintaining patients' concentration and attention.
b. shifting the patients' focus from food to psychotherapy.
c. promoting processing of anxiety associated with eating.
d. focusing on weight control mechanisms and food preparation.
ANS: C
Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to
be successful in attaining therapeutic goals. Shifting the patients' focus from food to psychotherapy and focusing
on weight control mechanisms and food preparation are not desirable. Maintaining patients' concentration and
attention is important, but not the primary purpose of the schedule.

Physical assessment of a patient diagnosed with bulimia often reveals:

a. prominent parotid glands.
b. peripheral edema.
c. thin, brittle hair.
d. 25% underweight.
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ANS: A
Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa
and not usually seen in bulimia.

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?
a. Carefree flexibility
b. Rigidity, perfectionism
c. Open displays of emotion
d. High spirits and optimism
ANS: B
Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients
with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, controlled
emotions, and pessimism are more the rule.

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?
a. Urine output 40 mL/hr
b. Pulse rate 58 beats/min
c. Serum potassium 3.4 mEq/L
d. Systolic blood pressure 62 mm Hg
ANS: D
Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders
have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hr. A potassium level of
3.4 mEq/L is within the normal range.

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon
weekly weight. Which response by the nurse is appropriate?
a. "You and I will have to sit down and discuss this problem."
b. "It bothers me to see you exercising. I am afraid you will lose more weight."
c. "Let's discuss the relationship between exercise, weight loss, and the effects on your body."
d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."
ANS: D
A matter-of-fact statement that the nurse's perceptions are different will help to avoid a power struggle.
Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients
must be held accountable for required behaviors.

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake
and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?
a. Powerlessness
b. Ineffective coping
c. Disturbed body image
d. Imbalanced nutrition: less than body requirements
ANS: D
The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia
nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia
nervosa or bulimia nervosa.

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments,
the patient gained 8 pounds. The nurse should:
a. assess lung sounds and extremities.
 PSYCHIATRIC WARD

b. suggest use of an aerobic exercise program.

c. positively reinforce the patient for the weight gain.
d. establish a higher goal for weight gain the next week.
ANS: A
Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart's capacity to pump, leading to cardiac
failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are
undesirable because they increase the risk for cardiac complications.

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was
prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The
patient:
a. now weighs 196 pounds.
b. says, "I am using contraceptives."
c. says, "I feel full after eating a small meal."
d. reports problems with dry mouth and constipation.
ANS: A
Lorcaserin is designed to make people feel full after eating smaller meals by activating a serotonin 2c receptor in
the brain and blocking appetite signals. According to the FDA, this drug should be stopped if a patient does not
have 5% weight loss after 12 weeks of use. If the patient now weighs 196 pounds, the medication has not been
effective. The distracters indicate patient learning was effective and expected side effects of this medication.

A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated
with this diagnosis? The child:
a. frequently smears feces on clothing and toys.
b. experiences frequent nocturnal episodes of bedwetting.
c. has accidents of defecation at kindergarten three times a week.
d. has occasional episodes of voiding accidents at the day care center.
ANS: C
Encopresis refers to unsuccessful bowel control. Bowel control is expected by age 5, so frequent involuntary
defecation is associated with this diagnosis. Smearing feces is behavioral. Enuresis refers to the voiding of urine
during the day (diurnal) or at night (nocturnal).

Select all that apply.

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations
of anorexia nervosa should a nurse assess?
a. Peripheral edema
b. Parotid swelling
c. Constipation
d. Hypotension
e. Dental caries
f. Lanugo
ANS: A, C, D, F
Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often
present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation.
Parotid swelling is associated with bulimia. Dental caries are associated with bulimia. See relationship to audience
response question.

Select all that apply.

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide?
 PSYCHIATRIC WARD

a. Flexible mealtimes
b. Unscheduled weight checks
c. Adherence to a selected menu
d. Observation during and after meals
e. Monitoring during bathroom trips
f. Privileges correlated with emotional expression
ANS: C, D, E
Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close
supervision of the patient's eating and prevention of exercise, purging, and other activities. There is strict
adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor
all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule.
Privileges are correlated with weight gain and treatment plan compliance.

A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to
perform which additional intervention?
a. Conduct mental health assessments.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANS: B
In most states, prescriptive privileges are granted to master's-prepared nurse practitioners who have taken special
courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health
assessments, establish relationships, and provide individualized care planning.

When a nursing student expresses concerns about how mental health nurses "lose all their nursing skills," the best
response by the mental health nurse is:
a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better
because of the nature of the patients' problems."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional
problems. I am challenged by those situations."
c. "That's a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage
complex intravenous therapies."
d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That
appeals to me."
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is
substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health
problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in
psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just
documentation. Psychosocial pain and suffering are as real as physical pain and suffering.

When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses
writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Recovery
b. Attending
c. Advocacy
d. Evidence-based practice
ANS: C
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An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for
self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a
community scale, advocacy includes political activity, public speaking, and publication in the interest of improving
the human condition. Since funding is necessary to deliver quality programming for persons with mental illness,
the letter- writing campaign advocates for that cause on behalf of patients who are unable to articulate their own
needs.

Which comment best indicates that a patient perceived the nurse was caring? "My nurse:
a. always asks me which type of juice I want to help me swallow my medication."
b. explained my treatment plan to me and asked for my ideas about how to make it better."
c. spends time listening to me talk about my problems. That helps me feel like I am not alone."
d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner."
ANS: C
Caring evidences empathetic 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 distracters give examples
of statements that demonstrate advocacy or giving advice.

Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient:
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between "as if" and "for real."
d. perceives difficulty making a decision about whether to change jobs.
ANS: B
The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors
that are mentally healthy or within the usual scope of human experience.

Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient:
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of own life.
ANS: A
The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.

A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. Which resource should
the nurse consult to determine criteria used to establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. A behavioral health reference manual
d. Wikipedia
ANS: B
The DSM-5 gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic
criteria for a psychiatric illness.

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the
most complete information?
a. Nursing Outcomes Classification (NOC)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice
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d. International Statistical Classification of Diseases and Related Health Problems (ICD-10)

ANS: B
The DSM-5 details the diagnostic criteria for psychiatric clinical conditions. The other references are good
resources but do not define the diagnostic criteria.

Which individual is demonstrating the highest level of resilience? One who:

a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for two years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
ANS: D
Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and
severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being.
Repression and depression are unhealthy. Living in a shelter for two years shows a failure to move forward after a
tragedy. See related audience response question.

Complete this analogy. NANDA: clinical judgment: NIC: _________________

a. patient outcomes
b. nursing actions
c. diagnosis
d. symptoms
ANS: B
Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies
diagnostic statements regarding human responses to actual or potential health problems. These statements
represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that
enhance patient outcomes. Nursing care activities may be direct or indirect.

A college student said, "Most of the time I'm happy and feel good about myself. I have learned that what I get out
of something is proportional to the effort I put into it." Which number on this mental health continuum should the
nurse select?

Mental Illness Mental Health

12345

a. 1
b. 2
c. 3
d. 4
e. 5
ANS: E
The student is happy and has an adequate self-concept. The student is reality-oriented, works effectively, and has
control over own behavior. Mental health does not mean that a person is always happy.

Which disorder is a culture-bound syndrome?

a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depression
ANS: C
 PSYCHIATRIC WARD

Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those
cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs
around engaging in furious, almost indiscriminate violent behavior.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies:

a. deviant behaviors.
b. present disability or distress.
c. people with mental disorders.
d. mental disorders people have.
ANS: D
The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this
distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example.
Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of
the diagnosis.

A citizen at a community health fair asks the nurse, "What is the most prevalent mental disorder in the United
States?" Select the nurse's best response.
a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer's disease
ANS: D
The 12-month prevalence for Alzheimer's disease is 10% for persons older than 65 and 50% for persons older than
85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue
is a rare disorder. See related audience response question.

In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One
who:
a. describes hearing God's voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals.
d. always has an optimistic viewpoint about life and having own needs met.
ANS: A
The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious
groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more
difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled
mentally ill.

A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then
devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to
develop which aspect of mental health?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANS: D
The information given centers on relationships with others that are described as intense and unstable. The
relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to
describe work effectiveness, communication skills, or activities.
 PSYCHIATRIC WARD

Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care
planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are unchanged from culture to culture.
d. Assessment findings in mental disorders reflect a person's cultural patterns.
ANS: D
A nurse who understands that a patient's symptoms are influenced by culture will be able to advocate for the
patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue
statements.

A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive
supportive interventions and antidepressant medication. The other half receives only medication. The team
measures outcomes for each group. Which type of study is evident?
a. Incidence
b. Prevalence
c. Co-morbidity
d. Clinical epidemiology
ANS: D
Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no
treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and
observational and experimental studies of interventions used to treat people with the illness or symptoms.
Prevalence refers to numbers of new cases. Co-morbidity refers to having more than one mental disorder at a
time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given
period. See related audience response question.

The spouse of a patient diagnosed with schizophrenia says, "I don't understand how events from childhood have
anything to do with this disabling illness." Which response by the nurse will best help the spouse understand the
cause of this disorder?
a. "Psychological stress is the basis of most mental disorders."
b. "This illness results from developmental factors rather than stress."
c. "Research shows that this condition more likely has a biological basis."
d. "It must be frustrating for you that your spouse is sick so much of the time."
ANS: C
Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one
part of biological factors. Empathy does not address increasing the spouse's level of knowledge about the cause of
the disorder. The other distracters are not established facts.

A category 5 tornado occurred in a community of 400 people resulting in destruction of many homes and
businesses. In the 2 years after this disaster, 140 individuals were diagnosed with posttraumatic stress disorder
(PTSD). Which term best applies to these newly diagnosed cases?
a. Prevalence
b. Co-morbidity
c. Incidence
d. Parity
ANS: C
Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of
time. Prevalence describes the total number of cases, new and existing, in a given population during a specific
 PSYCHIATRIC WARD

period of time, regardless of when they became ill. Parity refers to equivalence, and legislation required insurers
that provide mental health coverage to offer annual and lifetime benefits at the same level provided for
medical/surgical coverage. Co-morbidity refers to having more than one mental disorder at a time.

Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for
Nurses (QSEN)?
a. All genomes are unique.
b. Care is centered on the patient.
c. Healthy development is vital to mental health.
d. Recovery occurs on a continuum from illness to health.
ANS: B
The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence-based
practice, quality improvement, safety, and informatics.

Select the best response for the nurse who receives a question from another health professional seeking to
understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and
a nursing diagnosis.
a. "There is no functional difference between the two. Both identify human disorders."
b. "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.
c. The DSM-5 diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology."
d. "The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for
identifying interventions for issues a patient is experiencing."
ANS: D
The medical diagnosis is concerned with the patient's disease state, causes, and cures, whereas the nursing
diagnosis focuses on the patient's response to stress and possible caring interventions. Both tools consider culture.
The DSM-5 is multiaxial. Nursing diagnoses also consider potential problems.

Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse
only?
a. Coordination of care
b. Health teaching
c. Milieu therapy
d. Psychotherapy
ANS: D
Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a staff
nurse's scope of practice.

Select all that apply.

An experienced nurse says to a new graduate, "When you've practiced as long as I have, you instantly know how to
take care of psychotic patients." What information should the new graduate consider when analyzing this
comment?
a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of
practice.
b. New research findings should be integrated continuously into a nurse's practice to provide the most effective
care.
c. Experience provides mental health nurses with the essential tools and skills needed for effective professional
practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and
error.
 PSYCHIATRIC WARD

e. An intuitive sense of patients' needs guides effective psychiatric nurses.

ANS: A, B
Evidence-based practice involves using research findings and standards of care to provide the most effective
nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse
also maintains respect for each patient as an individual. Overgeneralization compromises that perspective.
Intuition and trial and error are unsystematic approaches to care.

Select all that apply.

Which findings are signs of a person who is mentally healthy?
a. Says, "I have some weaknesses, but I feel I'm important to my family and friends."
b. Adheres strictly to religious beliefs of parents and family of origin.
c. Spends all holidays alone watching old movies on television.
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
ANS: A, D, E
Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with
the normal stresses of life, work productively, and make a contribution to the community. Mental health provides
people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and
self-esteem.