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Chapter 1: Roles and Functions of Psychiatric-Mental Health Nurses: Competent Caring
Test Bank
MULTIPLE CHOICE
- In 1952, Hildegard Peplau defined the psychiatric nurse’s role as a:
| a. | professional who helps patients with attitude adjustment. |
| b. | nurse who is extensively trained to care for psychiatric patients. |
| c. | resource person, a teacher, a leader, and a counselor to patients. |
| d. | professional who is certified to conduct psychosocial therapy sessions. |
ANS: C
Nurses were trained as resource persons, teachers, leaders, and counselors who cared for psychiatric patients. The remaining options are incorrect. Ms. Peplau made no mention of the need for extensive training, or special certifications, nursing leadership, or attitude adjustment when defining the role of a psychiatric nurse.
DIF: Cognitive Level: Knowledge REF: Text Page: 5 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The contribution of Linda Richards that remains a part of contemporary psychiatric nursing practice is the idea that:
| a. | psychiatric nurses should have advanced preparation. |
| b. | nurses should assess both the physical and the emotional needs of patients. |
| c. | psychotic behavior must be controlled before serious psychotherapy begins. |
| d. | basic physical needs must always be met before emotional needs are addressed. |
ANS: B
Early nursing education made a distinction between physical and emotional needs, and nurses were taught in either a general hospital or a psychiatric hospital. Richards maintained that nurses should be competent to assess both physical and emotional needs.
DIF: Cognitive Level: Knowledge REF: Text Page: 2 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- A nurse states, “I plan ways for patients assigned to me to participate in their own care and to be actively involved in all of the activities on the unit.” This approach demonstrates the concept of:
| a. | social accountability. |
| b. | therapeutic community. |
| c. | nurse-patient relationship. |
| d. | multidisciplinary mental health team. |
ANS: B
Maxwell Jones published The Therapeutic Community in 1953. It encouraged making use of the patient’s social environment as a means of providing therapeutic experiences.
DIF: Cognitive Level: Comprehension REF: Text Page: 5 TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
- Hildegard Peplau’s classic article “Interpersonal Techniques: The Crux of Psychiatric Nursing” directed psychiatric nursing’s future growth by stating that the primary role of the psychiatric nurse was that of:
| a. | leader. |
| b. | teacher. |
| c. | counselor. |
| d. | surrogate parent. |
ANS: C
Hildegard Peplau’s 1962 article identified the heart of psychiatric nursing as fulfillment of the role of counselor or psychotherapist.
DIF: Cognitive Level: Knowledge REF: Text Page: 5 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- When teaching the orientation portion of a psychiatric nursing course, which statement would the instructor be most likely to make to the students?
| a. | “There is one approved theoretical framework for psychiatric nursing practice.” |
| b. | “Psychiatric nursing has yet to be recognized as a core mental health discipline.” |
| c. | “Contemporary practice of psychiatric nursing is primarily focused on inpatient care.” |
| d. | “The psychiatric nursing patient may be an individual, a family, a group, or even a community.” |
ANS: D
Psychiatric nursing is concerned with individuals, families, groups, and entire communities. The other statements listed are false.
DIF: Cognitive Level: Comprehension REF: Text Page: 6
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- For psychiatric nurses in the 1980s and 1990s, the scope of practice began to change to include:
| a. | psychiatric care and medical care given by the home care nurse. |
| b. | new advances in the fields of psychobiology and technology. |
| c. | psychoanalytical therapy provided by the psychiatric nurse in the outpatient setting. |
| d. | new advances in the psychodynamic model of therapy made by the psychiatric nurse in the inpatient setting. |
ANS: B
Psychobiology and technology experienced dramatic growth in the 1980s and 1990s including advanced understanding of brain function, understanding the relationships of the brain, behavior, emotion, cognition, neurotransmitters and neuronal receptors, as well as improved brain imaging. The options related to home care and outpatient care settings are not true. The option related to the psychodynamic model of therapy is also incorrect because advances in the psychodynamic model of psychiatric care were made by psychiatrists and psychologists, not by psychiatric nurses.
DIF: Cognitive Level: Comprehension REF: Text Page: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- During orientation to the inpatient psychiatric unit, new staff members are told, “Address all patients by their title and surname unless you are directed by the patient to do otherwise.” The belief that underlies this directive is that:
| a. | every person is worthy of respect. |
| b. | every individual has the potential to change. |
| c. | the goals of the individual are growth, health, autonomy, and self-actualization. |
| d. | the person functions as a holistic being who reacts to the environment as a whole person. |
ANS: A
Addressing an individual using his or her title and surname implies dignity and worth and conveys respect.
DIF: Cognitive Level: Comprehension REF: Text Page: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A psychiatric aide says, “I don’t know why that patient does all that silly giggling and posturing. It’s senseless!” The best reply to this comment would address the psychiatric nursing principle that states:
| a. | every individual has the potential to change. |
| b. | illness can be a growth-producing experience for the individual. |
| c. | all behavior is meaningful, arising from personal needs and goals. |
| d. | everyone has the right to self-determination that includes the pursuit of health. |
ANS: C
This principle best addresses the aide’s comment that the patient’s behavior is “senseless” by explaining that all behavior has meaning that can be understood when the patient’s internal frame of reference and the context of the situation are known.
DIF: Cognitive Level: Application REF: Text Page: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- The role of the psychiatric nurse in today’s contemporary practice settings is:
| a. | centered on the nurse-patient partnership. |
| b. | concentrated on psychosomatic therapies. |
| c. | centered on management of the patient’s daily needs. |
| d. | caring for chronically ill psychiatric patients in acute-care settings. |
ANS: A
The role of the psychiatric nurse today is multifocused. The psychiatric nurse must have a broader perspective on patient needs, psychiatric needs, personal needs, financial needs, and legal needs that encompass the patient’s quality of life.
DIF: Cognitive Level: Comprehension REF: Text Page: 6 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The primary opportunity provided by psychiatric clinical rotations for nursing students is an opportunity to:
| a. | become familiar with patients who have chronic psychiatric mental health issues. |
| b. | work with patients who have psychiatric as well as physical health issues. |
| c. | learn to work with patients with various psychiatric mental health issues. |
| d. | learn to care for patients who have emotional disorders. |
ANS: C
Students who have the opportunity to work in a psychiatric-mental health setting benefit because of the opportunities to work directly with a specific population of patients with psychiatric-mental health illnesses. In acute care, medical-surgical units, general outpatient clinical settings, or long-term care settings, students can only care for the patients served in the setting and hope that they will acquire some knowledge about the psychiatric disorder process and how it affects patients. Unfortunately, in these settings, the chances for learning about advances in the field of psychiatry or behavioral health would not be available.
DIF: Cognitive Level: Comprehension REF: Text Page: 6 TOP: Nursing Process: N/A
MSC: NCLEX: Psychosocial Integrity
- Case supervision is a psychiatric nursing activity that falls within the nursing practice domain of:
| a. | community education. |
| b. | communication. |
| c. | management. |
| d. | direct care. |
ANS: D
Management is a direct care activity. Figure 1-3 depicts this graphically.
DIF: Cognitive Level: Knowledge REF: Text Page: 7 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- When one considers the roles and functions of psychiatric nursing, the overlap of communication and management roles is seen in the function of:
| a. | teaching. |
| b. | delegation. |
| c. | direct care. |
| d. | collaboration. |
ANS: D
Collaboration is defined as the shared planning, decision making, problem
solving, goal setting, and assumption of responsibilities by people who work together cooperatively and with open communication. Figure 1-3 depicts this graphically.
DIF: Cognitive Level: Comprehension REF: Text Page: 7 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The major determinants of the roles in which a psychiatric nurse engages are:
| a. | personal preference and age. |
| b. | local custom and physician support. |
| c. | state law and personal qualifications. |
| d. | work setting and personal preference. |
ANS: C
While the other options may be contributors to role identification, state law is the primary determinant of the roles nurses may assume in any state.
DIF: Cognitive Level: Comprehension REF: Text Page: 9 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- Nursing should increase its role in the advocating of funding for outcome studies because these studies:
| a. | increase patient compliance with therapeutic regimens. |
| b. | document quality, cost, and effectiveness of psychiatric nursing. |
| c. | update psychiatric nursing specialists on new practice developments. |
| d. | lead to the implementation of untried interventions and practice guidelines. |
ANS: B
It is important to prove that psychiatric nursing contributes to positive outcomes in the prevention of illness, the promotion of health, and the provision of cost-effective treatment of psychiatric disorders. Without such information, the specialty of psychiatric nursing may be discounted by users and others.
DIF: Cognitive Level: Comprehension REF: Text Page: 10
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- New opportunities for psychiatric nursing practice have emerged as psychiatric hospitals have changed from large institutions providing custodial care to:
| a. | small units providing acute inpatient care. |
| b. | integrated clinical systems providing a full continuum of care. |
| c. | community-based home care systems focused on the chronically mentally ill. |
| d. | agencies more concerned with mental health promotion than providing direct care. |
ANS: B
Alternative treatment settings have emerged throughout the continuum of mental health care, and hospitals have responded by creating integrated clinical systems that provide inpatient care, partial hospitalization, day treatment, residential care, home care, and ambulatory care as part of the parent organization. Psychiatric nurses provide care in each of these settings as well as in community-based treatment settings such as shelters, schools, and HMOs.
DIF: Cognitive Level: Comprehension REF: Text Page: 9 TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- A psychiatric nurse uses leadership skills to strengthen the profession by:
| a. | working as a change agent advocating for patients, families, and communities. |
| b. | volunteering time each week to outpatient clinics in poor neighborhoods. |
| c. | voting for candidates in local elections who will advocate for nurses. |
| d. | working for state government representatives at local voting sites. |
ANS: A
Psychiatric nurse leaders need to be change agents who work not only in the profession but also with other interdisciplinary colleagues to advance the care of patients with psychiatric disorders.
DIF: Cognitive Level: Comprehension REF: Text Page: 10
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- In the 1960s, the psychiatric nurse began to shift to primary prevention and psychiatric nursing practice began to focus more on community care. This focus was initiated by which act?
| a. | The Primary Prevention Act of 1960 |
| b. | The Deinstitutionalization Act of 1961 |
| c. | The Therapeutic Community Act of 1962 |
| d. | The Community Mental Health Centers Act of 1963 |
ANS: D
The only act that is genuine is the Community Mental Health Centers Act of 1963.
DIF: Cognitive Level: Comprehension REF: Text Page: 5 TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- A nurse is contemplating a change from a medical-surgical nursing psychiatric nursing unit in a community hospital. Which intervention would help the nurse identify the supportiveness of the new unit?
| a. | Orientation to last at least 2 weeks with the charge nurse of the day and a scheduled daily task assignment |
| b. | A mentor for the first 6 weeks in the unit and a schedule for progression of learning throughout the orientation phase into the unit |
| c. | Nursing team meetings for each shift daily to discuss patients’ conditions, unit census, and an orientation schedule to include the nurses’ responsibilities |
| d. | A consistent daily patient assignment to help the nurse become more autonomous and daily reading assignments to be discussed with a preceptor daily |
ANS: D
All but the correct option are concentrated on other disciplines. A nurse’s support group would concentrate on the advancement and support of nurses and the discipline of nursing. Both the facilitation of an autonomous nursing practice and the discussion of related reading material with a designated preceptor are indicative of a supportive nursing environment.
DIF: Cognitive Level: Application REF: Text Page: 10
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- It is essential that psychiatric nurses become aware of their ability in the area of positive political action. The nurse can best achieve this goal by:
| a. | raising donations for a local community health center. |
| b. | becoming involved in an election campaign for a local sheriff. |
| c. | becoming an active volunteer working regularly at a crisis center. |
| d. | working on a city committee to help register local voters. |
ANS: D
For a psychiatric nurse to be politically active, helping others to become involved in their local area is a good step toward political awareness. Raising donations would be health care related rather than political action. Involvement in specific election campaigns would not have a direct correlation with psychiatric mental health issues, and being an active volunteer would be beneficial to the community that the crisis center serves but not a direct political action.
DIF: Cognitive Level: Application REF: Text Page: 12
TOP: Nursing Process: N/A MSC: NCLEX: Health Promotion and Maintenance
MULTIPLE RESPONSE
- When considering psychiatric nursing roles and functions, in order to delegate effectively the nurse must have knowledge of the domains of: (Select all that apply.)
| a. | management. |
| b. | communication. |
| c. | direct care. |
| d. | teaching. |
| e. | collaboration. |
ANS: A, C
Delegation includes the domains of management and direct care. Collaboration includes management and communication; teaching includes direct care and communication; and coordination includes direct care, communication, and management. Teaching and collaboration are not specific to psychiatric nursing delegation.
DIF: Cognitive Level: Comprehension REF: Text Page: 10
TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- To derive the theoretical framework of psychiatric nursing, knowledge from which sciences is included? (Select all that apply.)
| a. | Psychosocial |
| b. | Biophysical |
| c. | Personality behavior |
| d. | Human behavior |
| e. | Psychodynamics |
| f. | Psychobiology |
ANS: A, B, C, D
The psychiatric nurse uses knowledge from the psychosocial and biophysical sciences and theories of personality and human behavior. From these the nurse derives a theoretical framework on which nursing practice is based.
DIF: Cognitive Level: Comprehension REF: Text Page: 6 TOP: Nursing Process: N/A
MSC: NCLEX: Psychosocial Integrity
Chapter 5: Biological Context of Psychiatric Nursing Care
Test Bank
MULTIPLE CHOICE
- When a patient asks the nurse, “What are neurotransmitters?” The nurse replies that neurotransmitters are:
| a. | “the chemical messengers that cause brain cells to turn on or off.” |
| b. | “small clumps of cells that alert the other brain cells to receive messages.” |
| c. | “tiny areas of the brain that are responsible for controlling our emotions.” |
| d. | “weblike structures that provide connections among various parts of the brain.” |
ANS: A
Neurotransmitters are chemicals manufactured in the brain responsible for exciting or inhibiting brain cells in the production of an action.
DIF: Cognitive Level: Comprehension REF: Text Page: 73
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A patient tells a nurse, “My doctor says my problem may be with the neurotransmitters in my brain but I don’t understand what that means.” The nurse responds:
| a. | “Let’s begin with exploring what your doctor has told you about your problem.” |
| b. | “We should start with a discussion about any concerns you have about having a neurotransmitter disorder.” |
| c. | “First let me say that neurotransmitter problems can usually be treated or cured with medication therapy.” |
| d. | “What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication.” |
ANS: A
The correct option assesses the patient’s understanding of his condition, the initial step in any educationally focused discussion. None of the remaining options—defining the role of a neurotransmitter, exploring the patient’s concerns, or providing an explanation of a typical treatment plan—address the patient’s question concerning a lack of understanding.
DIF: Cognitive Level: Comprehension REF: Text Page: 73
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Which part of the brain is responsible for fine motor coordination?
| a. | Medulla |
| b. | Thalamus |
| c. | Cerebellum |
| d. | Temporal lobe |
ANS: C
The cerebellum is responsible for fine motor coordination, posture, balance, and integration of emotional processes.
DIF: Cognitive Level: Knowledge REF: Text Pages: 73-74
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression?
| a. | Norepinephrine |
| b. | Acetylcholine |
| c. | Dopamine |
| d. | Serotonin |
ANS: D
Serotonin, also called 5-HT, is derived from tryptophan, a dietary amino acid. It is located only in the brain, particularly in the raphe nuclei of the brainstem. It plays a role in regulation of mood through its mood-elevating capacity.
DIF: Cognitive Level: Comprehension REF: Text Page: 76
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body’s temperature?
| a. | Thalamus |
| b. | Cerebellum |
| c. | Limbic system |
| d. | Hypothalamus |
ANS: D
The hypothalamus is responsible for regulation of metabolism, temperature, and emotions.
DIF: Cognitive Level: Knowledge REF: Text Page: 73
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?
| a. | Dopamine |
| b. | Melatonin |
| c. | Serotonin |
| d. | Norepinephrine |
ANS: A
Dopamine is derived from tyrosine, is located mostly in the brainstem, and is involved in control of complex movements, motivation, and cognition. It is involved in movement disorders such as Parkinson disease and in many of the deficits seen in schizophrenia and other forms of psychosis. This is not necessarily true of the other options.
DIF: Cognitive Level: Knowledge REF: Text Page: 76
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure?
| a. | Computed tomography (CT) |
| b. | Positron emission tomography (PET) |
| c. | Brain electrical activity mapping (BEAM) |
| d. | Single-photon emission computed tomography (SPECT) |
ANS: A
CT can image brain structures through a series of radiographs that are computer constructed into “slices” of the brain that can be stacked by the computer, giving the image a three-dimensional appearance. PET and SPECT image brain activity and function through the tracking of radioactive substances as they travel through the brain. BEAM images brain activity and function through recordings of the brain’s electrical activity.
DIF: Cognitive Level: Comprehension REF: Text Pages: 74-77
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following?
| a. | Genetic studies |
| b. | Patient histories |
| c. | Comparisons of blood chemistries |
| d. | Magnetic resonance imaging (MRI) studies |
ANS: D
When results of studies such as MRI are coupled with neuropsychological test results, the deficits in a person’s performance, such as language or cognitive or sensory information processing, can be linked to the activity in the region of the brain responsible for those functions.
DIF: Cognitive Level: Knowledge REF: Text Pages: 74-77
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak?
| a. | A pregnant patient with sickle cell anemia |
| b. | A patient who has made a recent suicide attempt |
| c. | A patient prescribed the most drugs for the treatment of chronic disorders |
| d. | A patient with schizophrenia who had multiple hospital admissions in the last year |
ANS: A
Several hundred genetic tests are in clinical use for illnesses such as muscular dystrophies, cystic fibrosis, and sickle cell anemia. Although research is being conducted, there is no proof of a definitive genetic cause for schizophrenia. The remaining options do not deal with conditions that have a proven link to a genetic cause.
DIF: Cognitive Level: Analysis REF: Text Pages: 81-83
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient tells a nurse, “My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?” Which response is best?
| a. | “This is not an inherited disorder.” |
| b. | “You should speak to a genetic counselor.” |
| c. | “Science has not yet developed gene testing for this disease.” |
| d. | “There are new treatments for this illness that are readily available.” |
ANS: B
Genetic counselors are trained to diagnose and explain disorders from a genetic perspective. They can review available options for testing and treatment and provide emotional support to individuals or families who have genetic disorders, are at risk for them, or need information about risks to their offspring.
DIF: Cognitive Level: Application REF: Text Pages: 81-82
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- Pharmacogenetics will eventually allow researchers to do which of the following?
| a. | Remove the genes that cause illness. |
| b. | Allow the design of custom drugs. |
| c. | Develop foods that fight disease. |
| d. | Splice genes to improve health. |
ANS: B
Pharmacogenetics is a discipline that blends pharmacology with genomic capabilities and will eventually allow researchers to match DNA variants with individual responses to medical treatments. It will allow for custom drugs based on individual genetic profiles.
DIF: Cognitive Level: Comprehension REF: Text Page: 82
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient tells a nurse, “My doctor thinks my problem is serious but it can be treated with medications. Does that mean I’ll always have to be treated with drugs?” The nurse replies:
| a. | “How would you feel about being on medications for a lifetime?” |
| b. | “What concerns do you have about having a serious mental disorder?” |
| c. | “Did your doctor suggest your problem was related to neurotransmitter problems?” |
| d. | “What do you know about this condition that the doctor is preparing to treat with medications?” |
ANS: A
The initial concern expressed by the patient is being prescribed medications for a lifetime. The correct option explores this concern.
DIF: Cognitive Level: Application REF: Text Pages: 83-84
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- The function of the limbic system is to:
| a. | regulate emotional behavior. |
| b. | perform abstract reasoning. |
| c. | facilitate critical decision making. |
| d. | coordinate stress-related responses. |
ANS: A
The limbic system is concerned with subjective emotional experiences and with changes in body functions associated with emotional states.
DIF: Cognitive Level: Comprehension REF: Text Page: 73
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
- A patient states, “I’m going to have a positron emission tomography (PET) scan. What are the doctors going to learn from it?” The best reply would be that they focus on:
| a. | “identifying structures like tumors and scars.” |
| b. | “highlighting activity in various portions of the brain.” |
| c. | “outlining the structures of the brain more clearly.” |
| d. | “providing data to support new treatment modalities.” |
ANS: B
PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan.
DIF: Cognitive Level: Application REF: Text Pages: 75-77
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient mentions, “My doctor told me I was going to have a PET scan that would show where my brain has bright spots. Does that mean I’m getting an electrical jolt like in electroconvulsive therapy (ECT)?” The best reply would be:
| a. | “PET scans and ECT treatments are entirely different.” |
| b. | “A PET scan is a diagnostic test, and an ECT treatment is a form of therapy.” |
| c. | “A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active.” |
| d. | “PET scans show us the electrical activity of the brain in the form of light bands.” |
ANS: C
PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan. There is no electrical “jolt” involved. Two of the options address an assumption made by the nurse that the patient is referring to ECT, and PET scans do not produce light bands of measurable degrees of brightness.
DIF: Cognitive Level: Application REF: Text Pages: 77-78
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient diagnosed with depression tells a nurse, “I don’t feel rested. It’s as though I didn’t sleep at all.” Comments by night shift staff show that the patient slept through most of the night. How can these two observations be reconciled?
| a. | The patient is considered the more accurate reporter. |
| b. | The staff observations are more objective than the patient’s statement. |
| c. | Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation. |
| d. | People with depression characteristically underreport sleep satisfaction because of cognition flaws. |
ANS: C
Studies show that with depression, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense, leading to patient reports of fatigue, poor concentration, and irritability associated with sleep deprivation.
DIF: Cognitive Level: Application REF: Text Pages: 79-80
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
- The spouse of a patient recently diagnosed with cancer asks, “What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer.” The answer that best reflects the current thinking about psychoneuroimmunology is:
| a. | “It’s thought that the immune system is negatively affected by high stress.” |
| b. | “The research hasn’t been focused directly on the link between cancer and stress.” |
| c. | “Your spouse’s situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness.” |
| d. | “Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers.” |
ANS: A
Natural killer cells, which are believed to play a role in tumor surveillance and the control of viral infections, seem to decrease with increasing levels of stress.
DIF: Cognitive Level: Application REF: Text Page: 81
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient’s spouse asks a nurse, “Why are they wasting money doing all these tests on my spouse? The hallucinations and delusions make the mental illness obvious!” The best reply would be:
| a. | “Don’t be upset. We are using the most modern approach to caring for your spouse.” |
| b. | “I know you must be worried about costs, but having these tests is very necessary.” |
| c. | “Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating.” |
| d. | “I think that you are upset about your spouse’s illness and not thinking clearly. To avoid harm, physical illness must be ruled out.” |
ANS: C
Only after a patient has been carefully screened can it be determined that the problems are amenable to psychiatric intervention. These symptoms can be a result of a physiological problem and this situation must be assessed appropriately. It is never appropriate to be disrespectful or demeaning to a patient or family members.
DIF: Cognitive Level: Application REF: Text Pages: 83-84
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A couple tells a nurse that they are concerned about having children because there is bipolar disorder in first-degree relatives of each of them. What advice should the nurse give?
| a. | “Do not have children.” |
| b. | “Seek genetic counseling.” |
| c. | “Do as your conscience dictates.” |
| d. | “Bipolar disorder is not hereditary.” |
ANS: B
Current evidence suggests that there is a significant genetic role in the cause of recurrent depression and bipolar disorder. A genetic counselor is well prepared to discuss the concerns of these individuals.
DIF: Cognitive Level: Application REF: Text Page: 82
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain’s _____ lobe.
| a. | frontal |
| b. | parietal |
| c. | occipital |
| d. | temporal |
ANS: A
The frontal lobe is responsible primarily for intellectual functioning, including learning, abstracting, reasoning, and inhibition of impulses.
DIF: Cognitive Level: Application REF: Text Pages: 71-72
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A family member asks a mental health nurse, “I am reading a lot of information about gene therapy in the news lately. Will gene therapy be able to help my spouse, who has schizophrenia?” Which response by the nurse is best?
| a. | “Gene therapy for schizophrenia is common in Europe but has not yet become popular in the United States.” |
| b. | “Gene therapy for schizophrenia is available, but the high cost prohibits most people from taking advantage of it.” |
| c. | “Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future.” |
| d. | “Gene therapy has already shown promise in treating schizophrenia, but not enough large-scale studies have been carried out to date.” |
ANS: C
Gene therapy is still an experimental field. It holds potential for treating or even curing genetic and acquired diseases such as cancer or AIDS, but it is not likely to be clinically applicable in psychiatry in the near future.
DIF: Cognitive Level: Application REF: Text Page: 82
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient with a history of depression reports not feeling well rested in recent weeks. Before making the assumption that the complaint is related to depression, a nurse should investigate whether the patient has had any recent changes in:
| a. | work schedule that affect the hours of sleep. |
| b. | vacations taken within the same time zone. |
| c. | fluid intake with reduced overall intake of water. |
| d. | food intake with decreased intake of heavy foods before bedtime. |
ANS: A
Changes in schedule that affect circadian rhythms, such as work shifts that alter usual sleep patterns, can result in fatigue that is not related to mental health status. Other factors that alter sleep include changes in light and darkness and temperature changes. Vacations in the same time zone should not affect sleep, whereas food and fluid intake should enhance sleep by reducing risk of nocturia or indigestion.
DIF: Cognitive Level: Application REF: Text Page: 79
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
MULTIPLE RESPONSE
- A depressed patient scheduled for an MRI asks about the purpose of the test and whether it will hurt. The response would include that the test: (Select all that apply.)
| a. | takes a picture of the brain. |
| b. | is used to diagnose mental illness. |
| c. | should not produce any physical pain. |
| d. | may be uncomfortable if tight spaces bother you. |
| e. | machinery produces loud noises while the test is being conducted. |
ANS: A, C, D, E
The function of an MRI is to visualize brain structure and detect abnormal brain formations. MRIs are not painful but require that the patient lie still in a confined space. The MRI machine produces a loud noise during the test. MRIs are not used in the diagnosis of mental illness.
DIF: Cognitive Level: Application REF: Text Page: 77
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
