Chapter 28: Psychotherapies

MULTIPLE CHOICE

1. Which intervention best reflects the nursing role regarding effective implementation of
behavioral therapy goals?

a. Administering the prescribed medications accurately

b. Interacting effectively with members of the health care team

c. Being aware of all the patient related therapeutic modalities

d. Evaluating patient behaviors to reward economic tokens appropriately

ANS: D

The primary role of the nurse who is involved in behavioral therapy is to assess and identify the
patients problem behaviors in collaboration with the multidisciplinary team. A token economy is
a system of behavior reinforcements in which patients earn tokens by performing predetermined
desired behaviors. The remaining options are generalized responsibilities that are relevant to any
therapy format.

2. A new nurse asks the mentor, How can I be sure Im developing a therapeutic environment for
my unit? The mentor uses as a basis for the response the fact that a therapeutic milieu is
characterized by:

a. Rigid adherence to timelines and unit routine

b. Relaxation of boundaries when doing so is accepted by all

c. The focus of the staff is directed to the most critically disturbed patients

d. Specific patient-centered goals are established mutually by patient and staff

ANS: D

Factors that determine the therapeutic effectiveness of the social environment includes the
presence of two-way communication between the patients and the members of the
multidisciplinary team for purposes of goal setting. In a therapeutic relationship, boundaries are
established early and maintained throughout and although adherence to routine is important,
there is room for adjustment when it benefits the therapeutic nature of the milieu. Although
short-term attention may require focus on the patient in crisis, attention of the staff is equally
shared.

3. To plan care for a patient with a psychiatric disorder, the nurse keeps in mind that the primary
nursing role related to therapeutic activities is:

a. Assisting the patient in accomplishing the activity

b. Ensuring that the patient will comply with the rules of the activity

c. Ensuring that the patient can accomplish the activity in a timely manner

d. Providing a support system for the patient if they fail to complete the activity

ANS: A

The nurses role in therapeutic activities is that of a professional observer and participant who
works with the therapist to enhance the patients capabilities and functioning within the
parameters of the assigned activity. Assuring accomplishment, compliance, or providing failure
support are not nursing roles.

4. Which statement would the nurse use to describe the primary purpose of boundaries?

a. Boundaries define responsibilities and duties to ones self in relation to others.

b. Boundaries determine objectives of the various working stage of the relationship.

c. Boundaries differentiate the assumed roles of both the nurse and of the patient.

d. Boundaries prevent undesired material from emerging during the interaction.

ANS: A

Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve
to define the responsibilities and duties of the nurse in relation to the patient. Objectives and
roles are determined during the orientation stage. Emergence of undesired material may be a
significant issue for the patient.

5. Which action will best facilitate the development of trust between a nurse and patient?

a. Responding positively to the patients demands

b. Following through with whatever was promised

c. Clarifying with the patient whenever there is doubt

d. Staying available to the patient for the entire shift

ANS: B

Being consistent in keeping ones word implies that the nurse is trustworthy and does what is
agreed upon. Being responsive to demands may not be therapeutic. Instead, the patient will need
to learn new techniques for meeting needs. Clarification is important but is not the best method
for promoting trust. Trust is better served by shorter contacts at agreed-upon intervals.

6. Which statement best defines the nurses initial role as the patients source of help in addressing
interpersonal problems?

a. Ill work with your doctor to help you get better.

b. Ill be working with you to help solve your marital troubles.

c. Your medications will help you feel better as soon as they take effect.

d. You will be expected to attend the group activities while you are here.

ANS: B

This statement clearly specifies the nurses purpose as a helping professional, and establishes the
relationship as therapeutic, rather than social. The nurse has independent functions and does not
work exclusively with the doctor. Identifying only medication overlooks the contributions of
staff and the therapeutic milieu. Giving information is appropriate, but this statement does not
define the nurses role as resource.
7. The nurse is determining whether the patients needs could be best met in a task or a process
group. The decision is based on the understanding that a task group focuses on:

a. Content issues

b. The here and now

c. Communication styles

d. Relations among the members

ANS: A

Content-oriented groups focus on goals and tasks of the group. Thus a task-oriented group would
focus on content issues. Process groups focus on interpersonal relationships. Communication
styles are not relevant to describing task-oriented groups. Here and now refers to dealing with
issues that are taking place at the present time.

8. The treatment team was engaged in planning how group therapy could be included as a part of
the structured daily activities of the unit. A new team member asked, Why is it so important to
include group therapy for the patients? The most accurate response would be based on the
assumption that:

a. Hidden agendas frequently surface in group sessions.

b. Some persons do not relate well on an individual basis.

c. Group therapy is far more cost-effective for the patients.

d. Psychopathology has its source in disordered relationships.

ANS: D

A key assumption of group therapy is that psychopathology has its source in disordered
relationships. It follows that individuals will behave in the group as they do in other settings, so
group provides an opportunity to help individuals develop more functional relationships. Ability
to relate is not relevant to group work. It is dealt with in one-to-one therapy. Hidden agenda is
not a reason to offer group therapy. Cost-effectiveness is not an assumption about the reason
group therapy is effective.
9. Which patient would the group co-leaders determine is demonstrating Yaloms therapeutic
factor termed universality?

a. Patient A, who states he realizes he is not the only person who has a problem
with loneliness

b. Patient B, who displays dysfunctional interaction patterns learned in his family

of origin

c. Patient C, who states he finally feels a strong sense of belonging

d. Patient D, who openly expresses his anger about his work

ANS: A

Universality is the factor that refers to understanding that one is not unique, that others share
thoughts, reactions, and discomforts like your own. Dysfunctional interaction refers to corrective
recapitulation of the family group. A strong sense of belonging provides an example of
cohesiveness. Display of anger is an example of catharsis.

10. A nurse, leading an inpatient group dealing with womens issues, identifies a patient who is
assuming the role of aggressor. Which behavior characterizes this role?

a. Attempting to manipulate others

b. Mediating conflicts and disagreements

c. Criticizing the contributions of others

d. Seeking a position between contending sides

ANS: C

An aggressor acts in negative ways, displaying hostility, attacking the group, or criticizing the
members. Seeking a position between contending sides describes the compromiser. Mediating
conflicts and disagreements describes the harmonizer. Attempting to manipulate others describes
the dominator.

11. Which statement by a 16-year-old is considered as positive evidence that the familys
involvement in therapy is moving them towards effective functioning?
 a. My dad has finally stopped giving me advice on how to live my life.

b. I stopped playing football since practice required me to be away from home so

often.

c. Since my mother quit her job, she is more available to keep the home running
smoothly.

d. Eating dinner with my parents on Sunday nights has helped us be more aware of
each others needs.

ANS: D

This statement shows the family has made an effort to improve communication and deal with
alienation without any one member bearing complete responsibility. Withdrawing from the team
suggests he felt solely responsible for the family problem. Quitting the job suggests the mother
saw herself as responsible; however, being home does not guarantee unification. A lack of
advisement suggests withdrawal of the father from participation in family matters.

12. In response to the nurses statement, Tell me about your family, the patient became silent and
displayed nonverbally that he is uncomfortable. Which statement by the nurse reflects sensitivity
to the patient?

a. Im so sorry. I didnt realize your family was a problem for you.

b. Learning to express negative feelings will assist you in getting well.

c. Perhaps you can talk about your feelings to the physician next time you meet.

d. That seems to be a difficult subject for you. We can discuss when you are ready.

ANS: D

This response acknowledges the situation, is respectful, and allows the patient to choose when to
refocus the therapeutic interaction. Referring to the family as a problem is not sensitively
worded. Offering false reassurance implies that feelings are negative. Suggesting postponing the
discussion represents avoidance of dealing with the patients feelings.
13. When sharing her feelings about separating from a therapy group, the patient stated, I feel a
bit sad and empty that I wont be seeing you folks again. What is the most accurate evaluation of
the patients statement?

a. It indicates regression and her lack of readiness to terminate.

b. Unconsciously, she is hoping she will be permitted to continue the group.

c. She is demonstrating normal feelings associated with termination of therapy.

d. She needs further evaluation by her therapist to determine readiness to terminate.

ANS: C

The patient is expressing feelings of sadness over the loss of the therapeutic group relationships
that have been helpful to her. Such feelings are considered normal, just as they are considered
normal when the nurse-patient relationship terminates. The feelings expressed are normal, not
regressive. No hidden meaning is present; the patient openly expressed genuine feelings. Further
evaluation is not needed.

14. A patient asks the nurse manager to help resolve a situation between her and another patient.
Which action would best support the patients feelings of safety when experimenting with new
ways of being?

a. Encouraging the patient to report the incident to the other patients physician

b. Intervening on the patients behalf and sorting out the incident with the other
patient

c. Suggesting that the patient ignore the situation since the other patient was
probably not aware of her behavior

d. Offering to be present and help the patient discusses her feelings about the
incident with the other patient

ANS: D

Offering to be with the patient affords her a safe nonthreatening opportunity to assume
responsibility for meeting her own needs assertively by encouraging skills that affect positive
communication. Intervening removes the responsibility from the patient. Ignoring supports
passive behavior. There is no need to bring in another person. The patient is capable of
addressing the problem herself.

15. A patient tells the nurse, I really like you. Youre the only true friend I have. The patients
remarks call for the nurse to revisit the issue of:

a. Trust

b. Safety

c. Boundaries

d. Countertransference

ANS: C

The patients remarks call for the nurse to remind the patient of the parameters of the nurse-
patient relationship. The remark would also give the nurse the opening to go on to discuss the
matter of friendship. The patients remarks do not suggest the need to deal with trust, safety, or
countertransference.

16. By the end of the orientation phase, which outcome can be identified for a newly admitted
patient? The patient will demonstrate:

a. Ability to problem solve one issue

b. Trust in at least one nurse on the unit

c. Positive transference with a staff member

d. Ability to ask for help in meeting needs

ANS: B

Establishing trust in the nurse is a fundamental task of the orientation phase of the relationship;
thus it is an appropriate outcome to identify. When trust is present, the patient is free to focus on
the work and tasks of therapy. The ability to problem solve is an outcome appropriate for the
working phase. Positive transference would not be an identified outcome. The ability to ask for
help would not be an identified outcome for the orientation phase.
17. The patient and the nurse have agreed on problems to be addressed during a short course of
outpatient therapy. At the beginning of the appointment, the patient states, Id like to work on the
issue of relationships today. Which assessment can be made?

a. Nurse-patient roles have not been clearly delineated.

b. The nurse should suggest several alternative behaviors.

c. The patient must be able to manage emotions before continuing.

d. The relationship is moving from orientation to working phase.

ANS: D

Once the patient and nurse have collaborated to define and prioritize problems, the relationship
moves from orientation to working phase. The remaining options have no relevance to the
scenario since there is no reference to roles, alternative behaviors, or managing behaviors.

18. A nurse and patient are entering the termination phase in the group experience. An important
nursing intervention will be to:

a. Encourage the group to describe goals for change.

b. Inquire whether the group needs more time to accomplish goals.

c. Assist the group to explore alternative coping strategies for problems.

d. Discuss feelings about leaving the group and the support found with the group.

ANS: D

Healthy termination is facilitated when the group and nurse express reactions to termination. The
nurse serves as a role model by being open and genuine as the feelings about the losses incurred
with ending are discussed. On a positive note, accomplishments and growth are acknowledged
and the transfer of safety and trust to the group members is accomplished. Describing goals is
accomplished in the orientation phase. Accomplishing goals is part of the working phase in a
relationship that does not have a strict time limit. Exploring alternative coping strategies would
be part of the working stage.
19. A patient attending group therapy mentions, In the beginning, I was so sick that everyone had
to help me. For the last few days, its felt good to be able to give something back to the group.
This statement can be assessed as an example of Yaloms factor of:

a. Altruism

b. Harmonizing

c. Cohesiveness

d. Imitative behavior

ANS: A

Altruism refers to the experience of being helpful to others and is clearly what the patient is
displaying in the scenario. The other factors are not applicable.

20. During the first family therapy session, the mother of a child being treated for truancy and
emotional outbursts asks the nurse, Why are you bothering to ask the rest of us questions? My
son is the one with the problems. The best response for the nurse would be:

a. Well get more accurate information if the entire family is involved.

b. It may seem strange to you, but well get better results doing it this way.

c. When one family member is sick, the whole family system is sick as well.

d. Every family members perceptions are very important to the total picture.

ANS: D

This response orients the family to the idea that each persons opinion will be valued. Having the
family present for assessment prepares them for working together to identify family issues,
identify outcomes, and solve problems. It may or may not be true that this will result in accurate
information. Getting better results doesnt convey the real reason. Referring to the family as sick
is pessimistic and conveys a threatening message.
21. A novice mental health nurse shares that, Ill never get used to playing cards or other games
with patients. It seems like a poor use of scarce nursing time. The best response for the nurses
mentor would be:

a. Perhaps youll want to rethink your transfer to this unit if youre really
uncomfortable.

b. Your comments make a point about scarce resources. Ill ask the treatment team
to review our position on activities.

c. Activity co-leadership puts us in a position to help patients develop social skills

and support them as they take small risks.

d. Managed care has cost us activities therapists. Activities are necessary to give
patients something to do, so we have to fill in.

ANS: C

Nurses who engage in co-leadership of therapeutic activities recognize that each activity
contributes to outcome attainment. During activities, patients practice skills needed in life
situations, process emotions, and give and receive validation and feedback. Suggesting a rethink
is not supportive of the nurse. The remaining options do not acknowledge the value of activities
therapy.

22. What is the primary reason for the nurse to have an understanding of the various types of
activity and adjunct therapies?

a. The nurse chooses the most cost-effective therapy group.

b. The nurse is expected to encourage patients involvement in the therapies.

c. The nurse is responsible for placing the patient in the appropriate group.

d. The nurse needs to be supportive of the treatment team members who direct
these therapies.

ANS: B

The nurse must interpret to patients and others that the purpose of activity therapies is to increase
patient awareness of feelings and behaviors and to minimize pathology and promote mental
health. Although they are important, supportiveness, encouragement, and economics are not the
primary reason.

23. Which activity therapy should the nurse recommend to the treatment team to assist the
patient to relieve tension and achieve increased body awareness?

a. Psychodrama

b. Music therapy

c. Dance therapy

d. Recreation

ANS: C

The large movements involved in dance therapy would enable the patient to relieve tension and
move with greater body awareness and freedom. The other options will not promote body
awareness.

24. To effectively plan care for a patient, the nurse will understand that activity and adjunct
therapies may be more useful in some situations than verbal therapies because adjunct therapies:

a. Are readily available in the treatment setting

b. Do not require specific training or expertise to facilitate

c. Provide the patient the opportunity to use ego-protective mechanisms

d. Allow the patient to express feelings on multiple levels at the same time

ANS: D

A patient is able to express feelings on the emotional, physical, and symbolic levels during
activity therapy, whereas verbal therapies are limited to one dimension. The primary facilitator
of the selected therapy is required to have formal education and supervised experience. Adjunct
therapy does not provide this opportunity, which would be considered nontherapeutic. Treatment
settings are not always readily available.
25. A patient is scheduled to attend an occupational therapy group to work on the identified goal
of recognizing and using more effective coping techniques. What measure can the nurse use to
continue to support the patients attainment of this goal after he returns to the unit?

a. Isolating him from more seriously ill patients

b. Praising him for positive behavioral changes

c. Avoiding setting limits that would increase his anxiety level

d. Permitting him to make mistakes prior to intervening on his behalf

ANS: B

Recognizing and pointing out positive changes provides encouragement to continue pursuing
change. The remaining option would not achieve the nurses goal of supporting the patients use of
effective coping techniques.

26. How can the nurse encourage an extremely shy patient to participate therapeutically in a
dance activity group?

a. Offer to dance with the patient.

b. Ask the patient if this is the first dance he has attended.

c. Sit with the patient away from the group.

d. Encourage another patient to ask him to dance.

ANS: A

If trust has been established, the patient may feel safe enough to dance with the nurse. If trust has
not yet been established, the patient will see the nurses invitation as demonstrating respect and
reaching out to him. Either way, the action will encourage participation. The nurse should not
make another patient responsible for this patients participation. The remaining options do not
encourage participation.

27. When leading a therapeutic group, the nurse demonstrates an understanding of the need to act
as the groups executive when:
 a. Restating rules when a new member joins

b. Being available to orient the new members

c. Helping a member defuse the anger they are experiencing

d. Working with a member to help improve their communication skills

ANS: A

Executive functioning refers to monitoring and attending to group rules and procedures. Caring
demonstrates expressions of kindness. Meaning attribution includes accepting of feelings,
although emotional stimulation would reflect working communication skills.

28. When another patient serves as alter ego during an outpatient group session, the nurse
documents that the group had been engaged in:

a. Role-playing

b. Psychodrama

c. Cognitive therapy

d. Consensus building

ANS: B

Psychodrama uses spontaneous dramas to act out emotional problems to promote health through
development of new perceptions, behaviors, and connections with others. Others in the group
take the role of significant others. Role-playing and cognitive therapy do not use the technique of
alter egos. Consensus building is not a form of therapy.

29. The nurse is collecting the paintings from the patients after the art session is over. After art
therapy, a patient hands the nurse a paper that consists of several black scribbles. Which
statement demonstrates the nurse understands the goals and objectives of the therapy?

a. Do you want to complete your painting?

b. I see that you dont take this very seriously.

 c. Can you tell me what happened to prompt such work?

d. Thank you. Ill put this away in a safe place for you.

ANS: D

Art therapy is used to help resolve conflicts and promote self-awareness. The nurse should not
comment on the quality of the art or the patients talents, but rather treat the project with respect
and value. The work is simply each patients self-expression. The other options make judgments
about the work or the patients willingness to participate.

30. When asked, Why do you go to music therapy every morning at 10? The nurse explains that
the nurses role in music therapy as:

a. Fostering and encouraging performance talent

b. Teaching patients about various styles of music

c. Noting patient verbal and nonverbal expression of feelings

d. Selecting and playing numbers that will reduce anxiety and stress

ANS: C

A goal of music therapy is to promote expression and social connection. The nurse should
observe and document expression of feelings as they occur. The observations may be used later,
as a basis for further consideration by the nurse and patient. The other options do not reflect
aspects of the nurses role in music therapy.

31. When a novice nurse asks why the unit has a multidisciplinary approach to therapeutic
activities, the nurse should explain that multidisciplinary collaboration:

a. Produces a higher level of insurance reimbursement

b. Reduces the incidence of aggressive behavior by patients

c. Produces quicker results and earlier discharge to the community

d. Produces better outcomes than when only one perspective is used

ANS: D

Broader input in problem identification and resolution enhances patient outcomes. The remaining
options are either untrue or irrelevant.

32. When a patient asks the nurse, How can jolting me with an electrical shock possibly do me
any good? the answer most reflective of current biologic theory would be:

a. ECT must sound like a very frightening treatment alternative to you.

b. ECT produces a change in brain chemistry that results in improved mood.

c. ECT interrupts brain impulses that are causing hallucinations and delusions.

d. ECT provides you with external punishment so you can stop punishing yourself.

ANS: B

Current theory regarding use of ECT is that the electrical stimulus causes electrochemical
changes within the brain, resulting in increased availability of neurotransmitters at the synapses
and improvement of mood. To suggest that the treatment is frightening does not answer the
patients question. The treatment is not appropriate for hallucinations or delusions. The remaining
option is not appropriate or founded in psychiatric therapy.

33. Which statement made by a patient just prior to being transported for a scheduled ECT
treatment would result in cancellation of the treatment?

a. Ill be so glad when this treatment is over.

b. Will I remember having this treatment?

c. Did eating some crackers cause any problems?

d. Im so tired of being depressed; I dont think I can go on.

ANS: C

Because the patient is to receive general anesthesia and has orders to remain without food or
liquids (NPO), the nurse should notify the physician immediately. The introduction of food into
the stomach could result in aspiration of stomach contents during treatment. An expression of
hopelessness related to depression would be reason to continue with the treatment. The other
options offer no contraindication to treatment.

34. The physician has ordered atropine 0.5 mg intramuscularly (IM) for a patient to be
administered 30 minutes prior to ECT. The rationale for use of this medication is that it reduces
secretions and:

a. Protects against vagal bradycardia

b. Improves the scope of convulsive activity

c. Reduces the need for recovery room staff

d. Prevents incontinence of bladder and bowel

ANS: A

Atropine is used for its ability to prevent vagal bradycardia associated with the electrical
stimulus. The other options are neither relevant nor true.

35. Which statement by a patient who has given informed consent for ECT confirms that the
patient understands the side effects of this treatment?

a. I wont remember the pain.

b. It will take several weeks before I feel good again.

c. My short-term memory loss will be only temporary.

d. I will be at increased risk for developing epilepsy later.

ANS: C

Temporary impairment of recent memory is an expected side effect that occurs to some degree
during the course of ECT. The other options suggest the patients understanding of treatment and
side effects is flawed.

36. In the ECT treatment preparation period the morning of treatment, the nurse should:

a. Adequately hydrate the patient.

 b. Assess the patients cognitive function.

c. Have the patient exercise for 10 minutes.

d. Ensure that the patient produces a urine sample.

ANS: B

Patient assessment is advisable to provide a baseline against which changes resulting from ECT
can be measured. Although taking vital signs and performing other preparatory tasks, the nurse
can assess orientation, immediate memory, thought processes, and attention span. The other
options are interventions the nurse should not undertake.

37. Immediately after electroconvulsive therapy (ECT), nursing care of the patient is most
similar to care of a patient:

a. With severe dementia

b. With delirium tremens

c. Recovering from conscious sedation

d. Recovering from general anesthesia

ANS: D

The patient who has ECT receives a short-acting IV anesthetic and a skeletal muscle relaxant.
Thus care is most similar to the patient recovering from general anesthesia. The nurse will assess
vital signs, quality of respirations, presence or absence of the gag reflex, level of consciousness,
orientation, and motor abilities during the post-treatment period.

38. A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT) asks
her mentor, What sort of memory impairment is present after several ECT treatments? The best
response for the mentor would be:

a. Its hard to say. Treatment affects everyone differently.

b. Usually the patient has severe difficulty remembering remote events.

 c. Patients have mild difficulty remembering recent events, like what was eaten for
breakfast.

d. Both recent and remote memory is affected, producing profound confused,

cognitive states.

ANS: C

Most patients experience transient recent memory impairment after electroconvulsive therapy
(ECT). The cognitive deficit becomes more pronounced as the number of treatments increases.
When the course of treatments is completed, cognitive deficit generally improves to the
pretreatment level. The other options are incorrect.

39. About an hour after the patient has ECT, he complains of having a headache. The
nurse should:

a. Notify the physician stat.

b. Administer an as needed (prn) dose of acetaminophen.

c. Take the patient through a progressive relaxation sequence.

d. Advise going to activities to expend energy and relieve tension.

ANS: B

Post-ECT headache is common. Most physicians routinely write an as needed (prn) order for a
headache remedy. Notifying the physician is unnecessary, because this is an expected side effect.
Options c and d would not be as useful as medication in this instance.

40. For which patient is the nurse most likely to need to schedule a pre-ECT workup and
teaching?

a. Patient A, who is newly diagnosed with dysthymic disorder

b. Patient B, who has melancholic depression that responded well to ECT 2 years
ago

c. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant

therapy
 d. Patient D, who has depression associated with diagnosis of inoperable brain
tumor

ANS: B

Indications for ECT include patients with major mood disorders; patients who have responded to
ECT in the past; patients who are unresponsive to antidepressants or unable to tolerate their side
effects; and patients who are acutely suicidal or in danger of fluid and electrolyte imbalance
related to inability to eat due to depression, severe mania, or severe catatonia. Patients with
dysthymia are not candidates for ECT. The patient has not run out of medication options when
prescribed only an SSRI. Patients with space-occupying lesions of the brain are not candidates
for ECT.

41. Which intervention will the nurse implement in the first half hour after the patient has
received ECT?

a. Continually stimulate patient to respond, using physical and verbal means.

b. Continue bagging patient to improve respiratory function until patient is

responsive for 10 minutes.

c. Reorient as necessary to time, place, and person as level of consciousness

improves.

d. Encourage walking and eating breakfast as quickly as possible.

ANS: C

Patient memory is likely to be impaired in the immediate post-ECT period. Reorientation will be
necessary to help the individual return to a functional state. Continual stimulation is not
necessary. Bagging is unnecessary. The patient may be allowed to rest and recover at his own
pace.

42. What milieu factor would need most attention from the nurse who is caring for a patient who
has received six ECT treatments and has two more scheduled?

a. Safety
 b. Trust attainment

c. Therapeutic activities

d. Boundary maintenance

ANS: A

To feel safe, patients need to know what is expected of them in their role as patients. The patient
receiving ECT often has impaired recent memory and may become confused about the milieu
and expectations. The nurse will need to reorient and reteach the patient with cognitive deficit.
Options b, c, and d will require attention but not to the same extent as safety.

MULTIPLE RESPONSE

1. Which behaviors are reflective of legitimate phases of a groups development? Select all that
apply.

a. Stating the goals of the group

b. Establishing who will assume the leadership role

c. Inviting family members to attend and provide their input

d. Feeling safe enough to discuss painful personal situations

e. Showing concern about assuming personal responsibility for life

ANS: A, B, E

All groups progress through the phases of development that are governed by group dynamics and
include orientation where goals are identified, conflict where leadership is determined and tested,
cohesion where a sense of safety is achieved, and termination where discharge concerns are
acted out and addressed. Family input may not necessarily be introduced unless it was a defined
goal of the group.
Chapter 33: Geriatric Psychiatry

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. An 85-year-old patient is admitted to the hospital with the diagnosis of cerebrovascular
accident and depression. The symptom that is unrelated to depression would be?

A. Crying and refusing to perform task

B. Answering I forgot to questions

C. Having positive self-esteem

D. Neglecting ADLs

____ 2. The Omnibus Budget Reconciliation Act (OBRA) provides standards of care for which
of the following:

A. Very young

B. Older adults

C. Those who have certain intellectual communication difficulties

D. Those without medical insurance

____ 3. In the elderly, administering medication is a great concern for the nurse since these
patients are more prone to side effects. The primary cause of this is:

A. Altered circulation and renal function

B. Accelerated gastrointestinal system

C. Enlarged Lymph nodes

D. Musculoskeletal system weakness

Completion
Complete each statement.

4. The federal act that establishes the standards of care for older adults is known as the Omnibus
Budget ______________ Act.

5. Major concerns of the elderly living alone in their home are: (Name 2)
____________________________________________

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 6. When assessing the elderly for depression, the nurse may find that a depressed person
over 70 years of age without a medical diagnosis, may have the following symptoms of
depression (select all that apply):

A. Aches

B. Pains

C. Constipation

D. One-sided weakness

E. Sleep disturbances

Answer Section

MULTIPLE CHOICE

1. ANS: C

The patient may suffer from depression as a result of limitations produced by the stroke. The
patients cerebrovascular event also will have an impact on the patient and his family. Depression
can be evidenced by sadness, confusion, and lack of self-care.

2. ANS: B
OBRA provides regulations for proper assessment of the elderly; for this reason, registered
nurses have to provide the initial physical assessment.

3. ANS: A

LPNs/LVNs are accountable for medications administered to their patients. It is important to

know the side effects of all medications distributed. Document and report any signs of toxicity.
The elderly are more likely to have side effects when there is altered metabolism through the
kidneys and liver as well as altered circulatory function.

PTS: 1

COMPLETION

4. ANS:

Reconciliation

The Omnibus Budget Reconciliation Act (OBRA) ensures that proper assessment of elderly
people will be provided in the health care facility and in the home.

5. ANS:

Safety, quality of life, support system, access to medical care, financial support, emotional
support

The elderly remaining in the home have a greater chance of remaining healthier longer.

Integrated Process: Caring | Content Area: Mental Health: Aging | Cognitive Level: Application |
Client Need: Health Promotion and Maintenance: Aging Process

MULTIPLE RESPONSE

6. ANS: A, B, C, E

These symptoms can be confused with other conditions, such as electrolyte imbalance, drug
reactions, and dementia. Observation and documentation by the practical nurse can assist the
physician in ruling out a medical diagnosis. The elderly are more likely to have physical
symptoms with depression.

Chapter 34: End of Life Issues

MULTIPLE CHOICE

1. Which physical disturbance is commonly assessed in patients experiencing acute grief?

a. Hypersomnia

b. Increased appetite

c. Tightness in the chest

d. Cardiovascular problems

ANS: C

Chest discomfort is common with the bereaved person. Anorexia is more common. There is no
research to support the connection with cardiovascular involvement. Insomnia is more frequent
than sleepiness.

2. When differentiating between bereavement symptoms and depression, the nurse will base the
formulation on knowledge that in bereavement:

a. Suicide thoughts are common.

b. Symptoms remit and exacerbate.

c. Guilt feelings are overwhelming.

d. Psychomotor retardation is obvious.

ANS: B

Acute exacerbations are common especially around holidays and significant milestones. The
remaining options are more common with depression.
3. A grief support group is held at the local community center to assist persons who are dealing
with issues of loss. Which remark by one of the members would the nurse interpret as indicating
unresolved feelings of guilt?

a. I know that my husband had a good life.

b. It seems I miss my son more as time goes on.

c. I am still wishing I had gotten help to him sooner.

d. The Christmas season is always a sad time for me.

ANS: C

Unresolved guilt reflects that the person should have done more. Expressing peace with a
situation indicates closure on the husbands life. Missing indicates continued grieving but not
guilt. Reflection on difficult times is not guilt.

4. A young woman had just learned of the accidental death of her husband. She begins to cry and
states, Its not fair! How could he do this to me? This remark is assessed as:

a. A plea for help

b. An explosive episode

c. An expression of anger

d. Fear of making decisions alone

ANS: C

The remark indicates anger that her husband died on purpose. She is not asking for help nor is
there data to support an explosive response. She is not stating fear.

5. Family and friends rush to offer support to a friend who has lost her teenage son. Which of
these persons, through an intended act of kindness, may contribute to prolonging the womans
grief?

a. The physician who prescribed antianxiety agents

 b. The nurse who offered to spend the night at her home

c. The next-door teenager who provided care for the sons pet

d. The accountant who assisted with stabilizing their financial affairs

ANS: A

Frequent use of anxiolytic medications can mask grief. The other options are usual offers of
assistance.

6. When a hospitalized patient dies, his wife stares blankly at the nurse and states, It cant be. The
nurse assesses this as indicating:

a. Despair and protest

b. Shock and disbelief

c. Anger and hostility

d. Disorganization and confusion

ANS: B

Shock and disbelief are often the first responses to a death, followed by protest and despair. The
wifes statement does not indicate confusion or anger.

7. When asked, the nurse explains that grief work refers to:

a. Establishing new methods of coping with stress

b. Evaluating progress made toward accepting the loss

c. The means by which one moves through the grief process

d. Actively seeking assistance to cope with the loss experiences

ANS: C

Grief work is moving through the stages of grief. The remaining options can be components of
grief work.
8. A teen is grieving the loss of her pet dog. She states to her mother, I miss my dog so much, but
I know that if I start crying, I will never stop. The teen is expressing a fear of:

a. Losing control over her emotions

b. Appearing emotionally immature

c. Embarrassing herself by crying in public

d. Losing the support of her friends and family

ANS: A

The teens statement that she will never stop indicates a control concern. The statement does not
indicate embarrassment, immaturity concerns, or lack of support.

9. During a grief-processing group, an elderly patient stated, For the first time since my husband
died, Im having more good days than bad. This statement suggests that the patient has:

a. Replaced old memories with new ones

b. Reached the phase of reestablishment

c. Completed her grief work successfully

d. Determined she is ready to terminate the support group

ANS: B

Reestablishment is the gradual decrease in symptoms. There are not enough data to support the
remaining options.

10. A patient returned from attending the service memorializing his wife, who died after a
sudden illness. Although those around him were visibly saddened, he smiled and remained in
control. He refused support from friends, stating, I can handle anything that comes my way. The
patients behavior is an example of _____ grief.

a. Normal

b. Inhibited
 c. Distorted

d. Conflicted

ANS: B

The statement indicates inhibited grief that is characterized by minimal emotional expression of
grief. There is not enough data to support conflicted grief, which involves ambivalence in the
relationship with the departed. Distorted grief is not one of the standard types, and normal grief
is not characterized by this behavior.

11. Which person would the nurse assess as experiencing chronic sorrow?

a. The mother of a child diagnosed with asthma

b. The father of an adult son who is a schizophrenic

c. The daughter whose father experienced a hip replacement

d. The wife whose husband has recently requested a trial separation

ANS: B

The only situation that presents as a long-term, chronic loss is having a child with a chronic
disorder like schizophrenia. The other situations are resolving or at least hopeful for recovery.

12. A patient is being seen for symptoms of insomnia and significant weight loss that has
occurred during the 2 months since her husbands death. What is the purpose of the query,
Describe how it has been for you since your husband died?

a. To display an attitude of concern and sympathy to the patient

b. To learn whether the patient has a significant support system

c. To rule out factors that may interfere with diagnosing her illness

d. To determine the risk for pathologic grief and the need for grief therapy

ANS: D
The question is a common assessment question to determine the grief work that has been done.
The query does not ask about support systems or specific factors, and the query is more than a
display of concern.

13. A nurse plans care based upon the fact that anticipatory grief:

a. Is associated with a high risk for depression

b. Is associated with fewer expressions of guilt

c. Prevents development of symptoms of depression

d. Requires a longer period of time to effect resolution

ANS: A

Pre-mourning or anticipatory grief is associated with a high risk for depression or family
withdrawal from the patient. It is normative and does not necessarily require a longer period of
resolution or indicate fewer guilt expressions. It does not prevent depression.

14. A woman whose abusive husband was killed in an automobile accident 3 years earlier
continues to idealize him and repeatedly talks about their wonderful relationship. Which
outcome is most appropriate for the patient? Patient will:

a. Enlist the emotional support of both family and friends.

b. Keep a daily journal recording memories of time spent with her husband.

c. Read information on the affects of physical abuse and the support groups
available to her.

d. Express both positive and negative feelings about her husband and their life
together.

ANS: D

Chronic grief involves unresolved issues in a relationship with the person who died. In this case,
a more realistic expression of their life together is needed. The remaining options are appropriate
but do not address the primary need to establish realistic memories of the relationship.
MSC: NCLEX: Psychosocial Integrity

15. During a bereavement group, one of the members states, I should have been the one to die.
My husband had so much to offer. The member was expressing:

a. An intention to commit suicide

b. Ambivalence and low self-esteem

c. Unresolved anger toward her husband

d. A need for attention from group members

ANS: B

The statement suggests low self-esteem. There is no mention of suicidal ideation. This is not
simply an attention-getting statement. The statement does not imply anger.

16. The community health nurse is visiting a patient diagnosed with dysfunctional grieving since
the death of his wife and child over a year ago. Which actions should the nurse implement first?

a. Promote interaction with others.

b. Assess risk of self-directed violence.

c. Facilitate expression of feelings related to the loss.

d. Determine the degree of ambivalence toward the loss.

ANS: B

Safety issues would be the priority in cases of depression and dysfunctional grief. The remaining
options are appropriate actions after risk is assessed.

17. An adult patient shares that, When my mother died when we were children, I never saw my
father show any emotion. What do you think will happen with those unexpressed feelings?
Which response is most appropriate?

a. Pent-up emotions may lead to depression or other disorders.

 b. Your father probably has worked through his grief by this time.

c. Maybe you can teach him how to best express his own feelings.

d. If feelings are not effectively expressed, the person can become suicidal.

ANS: A

Inhibited expression of grief can lead to depression. It cannot be assumed that the grieving
process has been completed. The adult child should not be made to feel responsible for
counseling the father. Unexpressed feelings do not necessarily lead to suicidality.

18. An elderly couple who lived in the same home for the past 50 years have moved into an adult
retirement center in a nearby town. Changes in lifestyle such as this couple is experiencing
should alert the nurse to the possibility of:

a. Acute grief

b. Traumatic grief

c. Chronic sorrow

d. Adventitious crisis

ANS: A

Adjustment to life cycle transitions may initiate acute grief. This could be a situational crisis but
not an adventitious crisis. There are no indications that this will become chronic and lacks the
magnitude needed to result in traumatic grief.

19. A teenage boy has lost his best friend as a result of a hunting accident. His parents report that
he is eating and sleeping very little and expresses little interest in school. They are concerned
that he talks about the accident repeatedly. These behaviors are generally seen as:

a. Expressing responsibility for his friends death

b. Attempts to avoid dealing with his pain

c. Expressions of a normal grief reaction

 d. Indications of a risk for self-harm

ANS: C

The teen is displaying normal grief responses. He is not avoiding his pain but rather expressing it
various ways. There are no data to support that he feels responsible. He has not expressed
suicidal ideation.

20. An outcome for a patient experiencing anticipatory grieving for a spouse diagnosed with
terminal cancer would be that the patient will:

a. Continue to be emotionally involved with the dying spouse

b. Develop protective mental mechanisms to allay the pain of spousal loss

c. Not voice threats of physical violence that is either self or others directed

d. Agree to stay at home and care for the spouse with appropriate assistance

ANS: A

Some families who are experiencing anticipatory grieving withdraw prematurely from the ill
member, so this is an important outcome. There are no protective mechanisms to prevent loss
experiences. Anticipatory grieving does not imply violence. A contract to stay home and care for
the spouse even with assistance is not helpful.

21. Which patient would the nurse determine to be at highest risk for dysfunctional grief? The
patient:

a. Whose 16-year-old daughter was raped and killed while going on an errand for
the patient

b. Whose 86-year-old mother, with whom she has shared her home, died after a
long illness.

c. Who attended a support group and had been assisted by hospice to care for her
terminally ill husband

d. Who attended a bereavement group, where she learned to express feelings after
the deaths of her twin daughters
ANS: A

The traumatic nature of the death makes this patient at highest risk. The death of the mother was
of an elderly person and expected. The remaining options involve patients involved with hospice
or support groups that lessen the likelihood for dysfunctional grief.

22. Which intervention will the nurse planning care for a patient with acute grief implement?

a. Providing information about the grief process

b. Encouraging dependence on the nurse for support

c. Suggesting utilization of community resources in a few weeks

d. Advising the patient to minimize contact with nonfamily members

ANS: A

Patient education is always helpful. Limiting contact with support is not helpful. Postponing use
of resources and encouraging dependence on the nurse are unhelpful and therefore incorrect.

23. The nurse determines that the most effective point of intervention for bereavement is:

a. Promotion of mental and spiritual health across the life span

b. At the time a newly discovered loss is impending

c. Immediately after the loss has occurred

d. When requested by the patient

ANS: A

Effective health promotion before stress and loss regardless of age is most helpful. The
remaining options provide help around the time of loss, which is helpful but not as effective as
long-term help throughout a persons life.

24. The nurse counseling a patient with acute grief would assess the patient for:

a. Severe depressive symptoms

 b. Conflicted and unresolved issues

c. Increased arousal and hypervigilance

d. Preoccupation with the image of the deceased

ANS: D

Acute grief can involve images of the deceased. Acute grief does not include severe depression
or conflicted issues. Hypervigilance is a PTSD symptom.

25. Which person has the greatest potential for developing dysfunctional grief?

a. A teen who has always been one of the popular kids

b. A widow who regularly states, I really loved my deceased wife

c. A woman whose husband died as a result of a sudden, traumatic injury

d. An adult who has dealt with the loss of several family members over the years

ANS: C

A sudden separation could increase risk for dysfunctional grieving. An extensive social support
network and a loving relationship do not predispose to dysfunctional grief. Appropriate grief
work in the past would not increase the risk for dysfunction.

26. The common element seen in every type of bereavement is:

a. Bereavement is a predictable process that is a result of loss.

b. The individual has experienced the loss of something of importance.

c. Acute depression is generally experienced by all who grieve for a loss.

d. The course of the grieving will be determined by the seriousness of the loss.

ANS: B
Each type of loss means that something meaningful has been taken away, whether it is physical,
psychological, social, or symbolic. The remaining options are not true statements regarding
bereavement.

27. Which statement best explains how a mother of several children should prepare to help them
cope with the loss of a dear aunt?

a. Children are resilient and simply need love as they grieve.

b. People regardless of age or gender experience stages of grief.

c. Each child will grieve in a unique way and on their own timetable.

d. Extreme reactions are more commonly observed in the young griever.

ANS: C

No two people regardless of age will grieve the same way, even in the same family. Each
persons grief has unique characteristics and a timetable all its own. It is not necessarily true that
young grievers experience severe reactions to loss and require only love during this experience.
Although most individuals do experience the various stages of grief, that information is not the
most instructive for the mother.

MULTIPLE RESPONSE

1. The patients daughter was murdered while they were customers in a local bank. Which
statements would support the patients diagnosis of posttraumatic stress disorder (PTSD)? Select
all that apply:

a. I feel numb, like a robot going through the motions of existing.

b. Im so nervous and jump at the slightest noise.

c. I have not slept very well at all since I lost her.

d. I cant stop reliving the last time I saw her alive.

e. Id love nothing better than to kill that murderer.

ANS: A, B, C, D
The traumatic nature of the murder and the patients symptoms of hypervigilance, intrusive
thoughts, and numbness indicate PTSD. Homicidal thoughts are not generally associated with
PTSD.

Chapter 35: Public Psychiatry

MULTIPLE CHOICE

1. In addition to excellent assessment skills and keen insight into human behavior, what
additional ability is most critical to effective community mental health nursing?

a. Attention to economical nursing practice

b. Willingness to advocate for the patient

c. Familiarity with local patient-focused resources

d. Working relationship with community medical professionals

ANS: C

The role of the community mental health nurse is to help the patient to maintain his or her
highest level of functioning and independence within the community. It is critical for the nurse to
be familiar with the available community resources and community networks, so they can work
with the multidisciplinary treatment team to help patients and their families adjust to the
community. The remaining options are appropriate but are not unique to community mental
health nursing and its role in facilitating the patients ability to live and function as a member of a
community.

2. What factor had the greatest impact on the limited success of the deinstitutionalization of the
mentally ill population?

a. The initiative was never funded by the federal government.

b. The mentally ill population found it too difficult to function autonomously.

c. Community support systems were unprepared to provide the required services.

d. The communities were biased against having the mentally ill living among them.
ANS: A

During deinstitutionalization, federal dollars were designated for community mental health
facilities; however, the enacted legislation was never funded. The effects of the other options
would have been directly related to the lack of sufficient funding.

3. What is the primary event that results in many eccentric individuals being initially diagnosed
with a psychiatric disorder?

a. They commit a crime and are incarcerated.

b. They become both homeless and destitute.

c. They are unable to meet their own physical needs.

d. There is proof that they are a danger to themselves or others.

ANS: D

The family may describe the persons behavior as odd or eccentric without realizing or being
willing to admit that the family member has a psychiatric illness that needs professional help.
The family generally seeks treatment for the ill member when the behavior becomes irrational,
threatening, assaultive, or self-destructive. Although the remaining options are characteristic of
mental illness, they are generally not sufficient to warrant a mental illness diagnosis.

4. To best respect the mentally ill patients rights, no restricting intervention can be implemented
without:

a. First securing the patients informed consent

b. Proof that the patient is a danger to self or others

c. Initially attempting to secure the patients cooperation

d. Securing an order from the patients psychiatric care provider

ANS: B

Mentally ill persons who are disturbed or actively psychotic are not required to obtain psychiatric
treatment unless they are a threat to themselves or others. In cases where safety is a concern,
informed consent is not required and actions can be approved by the care provider
postintervention.

5. Which nursing intervention by a community mental health nurse demonstrates an

understanding of the potential health risks that psychotropic medications present?

a. Discussing the risk of food interactions when taking buspirone (BuSpar)

b. Monitoring the blood glucose levels of a patient prescribed risperidone

(Risperdal)

c. Stressing the importance of using alprazolam (Xanax) only as a short-term

therapy

d. Evaluating a patients understanding of the possible weight gain resulting from

escitalopram oxalate (Lexapro) therapy

ANS: B

The onset of type 2 diabetes is one of the less known side effects of commonly used
antipsychotic medications. Diabetes associated with psychotropic medications has been
demonstrated to be more frequent with risperidone (Risperdal).

Weight gain is a possible side effect of the antidepressant escitalopram oxalate (Lexapro). Drugs
used to treat anxiety, including buspirone (BuSpar), have known food interactions such as
grapefruit. Benzodiazepines, like alprazolam (Xanax), are prescribed for depression and anxiety
but should not be used on a long-term basis.

6. Which behavior engaged in by a patient diagnosed with both schizophrenia and hepatitis C
presents the community mental health nurse with the greatest need to share information
ordinarily protected by the patients right to confidentiality?

a. Engaging in unprotected sex

b. Wearing the uniform of a police officer

c. Expressing a real hatred for the government

d. Stealing clothing and food from stores in the neighborhood

ANS: A

Legal and ethical issues continually challenge community mental health nurses. Nurses need to
be aware of state laws that mandate patient confidentiality while sharing necessary information
about a patient. For example, a nurse who learns this patient is engaging in high-risk sexual
behavior needs to report such findings to the appropriate professionals in order to protect the
public. The other options, although problematic, do not have this level of seriousness regarding
the good of the general public.

7. Regarding freedom-of-choice care systems, what information must the patient receive
regarding the criteria for terminating treatment of a patient with mental health disorders?

a. Patients inability to pay for the services

b. Aggressive behavior on the part of the patient

c. Facility finds it uneconomical to provide the treatment

d. Patients noncompliance with an appropriate treatment plan

ANS: D

Freedom-of-choice systems have experienced some common problems with patient care
resulting in many agencies choosing not to develop treatment options for severe mental disorders
because they disagree with the premise of freedom of choice. Both the provider and the patient
have the freedom to make decisions; however, treatment providers in these systems have the
right to refuse to treat anyone whose symptoms make that person resistant to accept treatment.
The remaining options are not considered as criteria for treatment termination regarding freedom
of choice.

8. Which interview question demonstrates cultural competency when conducting an admission

interview for a Jewish patient being admitted for severe depression?

a. Is there a history of depression in your family?

b. Do you find comfort in your religious beliefs?

c. Has been being Jewish contributed to your depression?

 d. How has your family responded to you since you have been depressed?

ANS: D

Every cultural group has traditions and beliefs about the acceptance of mental illness and the
ability and willingness to trust health care providers. Members of the Jewish community
generally view severe mental illness as a stigma. The other options do not directly address this
culturally stigma.

9. Which intervention demonstrates cultural competency regarding the care provided an African
American who is experiencing depression after the death of a child?

a. Providing information regarding local grief support groups

b. Assessing the patients ability to understand the grief process

c. Encouraging family members to be present when discharge planning is discussed

d. Consulting with the patient before discussing treatment plans with her adult
children

ANS: A

African Americans are more likely to rely on family and religious groups for support. The
remaining options are appropriate for all patients regardless of cultural considerations.

10. What understanding is the most critical to the delivery of effective culturally-congruent
nursing care to the mentally ill patient?

a. Willingness to learn about the cultural beliefs of the affected population

b. Consciousness of the role cultural beliefs play regarding the acceptance of

mental health nursing interventions

c. Attentiveness to the individuals expression of cultural beliefs and reliance on the

culture for various support

d. Awareness of the biases the culturally diverse population experiences when

experiencing mental illness
ANS: B

Understanding the cultural beliefs about mental illness and being sensitive to diverse ethnic and
cultural groups is a critical goal for community mental health nurses since this has an immense
impact on the planning and acceptance of nursing interventions. The other options, although
impactful, lack the direct relationship to the patients willingness to accept and comply with
mental health treatment

11. Which activity best reflects the role of the mental health nurse case manager?

a. Advocating for the patient in all aspects of care

b. Attending to the patients physical and emotional needs

c. Acting as the leader of a patients multidisciplinary care team

d. Assuming responsibility for maintaining the patients mental health records

ANS: C

Case management facilitates and promotes the coordination of patient care, thereby minimizing
the fragmentation of treatment which is a major factor in the relapsing of the patients
symptomology. The other options are roles of the case manager but they lack the attention to the
basic concept of integrated, focused, and supervised care of the patient.

12. Which statement supports the fact that a patient diagnosed with chronic schizophrenia who is
being prepared for placement in an adult family home understands the unique expectations of
such an arrangement?

a. Ill have a safe, clean place to live.

b. Im excited about having a bedroom of my own.

c. I will help wash dishes and sweep floors but I like doing that.

d. I cant wait to live my life like I want to and make my own decisions.

ANS: C
Adult family homes (supportive housing programs) provide a quieter and more personal living
arrangement for patients who need supervision. The patient becomes a part of the family
structure and is expected to fit into the normal routines of the household performing routine tasks
of daily living when appropriate. The patient may not have a private bedroom and will have only
the independence they are capable of managing effectively and safely. Any placement is
intended to ensure a clean, safe place to live.

13. Which intervention demonstrates the community mental health nurses understanding of the
potential risks that home visits present?

a. Calling ahead to make an appointment to visit

b. Being sure to have access to a telephone during the actual visit

c. Asking family members to describe the patients recent behavior

d. Taking a small gift to give to the patients family during the visit

ANS: C

It is crucial that the nurse who is planning a home visit evaluate the potential risks of that visit
before beginning the actual interventions. Risk evaluation always includes the patients history,
especially current emotional and behavioral status. Calling ahead to make an appointment is
standard procedure and is more directed towards respect than safety. Having access to a
telephone is good practice but has little impact on minimizing risk. It is not recommended to set
the expectation that the family will receive a gift with each visit.

14. Which action provides the nurse with evidence that a Hispanic patient diagnosed with
schizophrenia 10 years ago is likely to continue to benefit from social support after being
discharged for a psychotic break?

a. The patients brother and sister-in-law offer suggestions concerning the support
they can provide after discharge

b. The patients mother expresses an understanding of the need for compliance with
the treatment plan

c. The familys religious leader visits the patient regularly and suggests part-time
employment at the church
 d. Friends of the patient offer to provide transportation to and from therapy
sessions that the patient is scheduled to attend

ANS: A

Racial and ethnic differences play a significant role in the familys response to mentally ill
members. Some cultural groups are protective of the ill individual, whereas others soon become
exhausted and emotionally drained with the care, dependency needs, and symptoms of the ill
person. The familys continued involvement in the patients care is the most positive example of
continued support. The other options are positive but lack the element of long-term active
involvement with the patient.

MULTIPLE RESPONSE

1. Which intervention is considered an essential element of a community nurses mental health

home visit? Select all that apply.

a. Documenting the patients current level of function

b. Evaluating the patients compliance with the plan of care

c. Ensuring that the patients family is supportive of the patient

d. Assessing the patients ability to understand their condition

e. Determining whether the patient has access to prescribed medication

ANS: A, B, D, E

The psychiatric nurses visit needs to include psychiatric evaluation, medication compliance,
health teaching, crisis intervention, and documentation. It would not be possible for the nurse to
ensure the familys support regardless of its impact on the patients prognosis.