“Nursing Test Banks, Inside Of Your Mind, Is Where It BELONGS!”
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CHAPTER 4—FOUNDATIONS OF PSYCHIATRIC NURSING
1. When psychiatric nurses closely assess older adults who are poor, whose relatives have a history of mental illness, who are unemployed, and clients from families that have disintegrated, the nurses have identified that these clients need this in-depth assessment because they:
a. are less likely to seek help
b. have little self-care agency
c. are in high-risk groups for mental illness
d. need help in getting more public assistance
High-risk groups for mental illness include older adults who are poor, people with acquired immune deficiency syndrome, those with family members who have a diagnosis of mental illness, substance abusers, victims and perpetrators of violence, the unemployed, the homeless, and those from families that have disintegrated.
2. Which of the following actions by psychiatric nurses is an example of an initial move to incorporate a primary prevention measure into practice?
a. identifying persons at risk for mental illness
b. teaching clients with mental illness about medications
c. assessing for side effects of psychotropic medications
d. comparing a client’s symptoms with the diagnostic manual
Psychiatric nurses can incorporate primary prevention measures into practice by initially identifying persons at risk for mental illness. High-risk groups include older adults who are poor; those with acquired immune deficiency syndrome-related illnesses; those with a family history of dementia, anxiety, and mood disorders; substance abusers; and victims and perpetrators of violence. Individuals who are unemployed, homeless, or from dysfunctional families are also vulnerable to mental illness. Teaching clients with mental illness about their medications, assessing side effects of medications, and comparing client’s symptoms to the diagnostic manual would be secondary prevention measures.
3. Which of the following activities by psychiatric nurses is the best example of secondary prevention?
a. giving immunizations at a clinic for 2 year olds
b. teaching teenagers about the problems of alcohol abuse
c. working with a terminally ill client in the hospice program
d. implementing measures that reduce symptoms of mental illness
Secondary prevention is the stage in which measures are used to reduce symptoms of a disease process. Immunizations and teaching about the problems of alcohol abuse are primary prevention measures. Hospice care is an example of tertiary prevention.
4. An elderly client describes being recently frightened by a snake and then suddenly having increased energy in preparation for running away. The nurse realizes that this client is describing which of the following stages identified in Selye’s general adaptation syndrome?
a. alarm c. response
b. resistance d. stabilizing
There are three stages to the general adaptation syndrome described by Selye. The first stage is the alarm stage in which the person prepares for “fight or flight.” The alarm reaction mobilizes the body’s defenses and protective responses against stressors. As the autonomic nervous system reacts to stress, large amounts of adrenaline and cortisone are activated.
5. You are working with a group of clients who ask you to explain what is meant by mental health. You would explain that there are many definitions, but the broadest agreement is that a key component is the ability to:
a. amass material property c. get one’s needs met without delay
b. be optimistic in all situations d. respond to stress effectively
Key components of mental health that have broad acceptance include the ability to respond to stress effectively; the capacity to tolerate anxiety, stress, and frustration; to delay gratification of needs; and the capacity to realistically and objectively appraise events and situations in one’s world.
6. Caplan believed that which of the following was most essential in predicting mental heath?
a. ego function c. strong father figure
b. strong superego d. church attendance
According to Caplan, the most essential factor that predicts mental health is ego function. Ego is defined as the major personality mechanism that mediates between the person and his environment. Major ego functions include adaptation to reality, modulation of anxiety, and problem solving.
7. You rate yourself on the Holmes and Rahe Social Readjustment Rating Scale by measuring a number of stressful events occurring to you over a 12-month period. Your accumulated stressful events score of 300 indicates that your chance of becoming ill is:
a. minimally increased c. increased by 80%
b. increased by 25% d. diminished slightly
If a person’s score on the Holmes and Rahe Social Readjustment Rating Scale reaches 300, the chance of illness is said to increase by 80%.
8. You are working with a client who feels hate toward her husband and is very angry with him for not making more money and spending it on her. Yet, she is very pleasant and loving toward him and tells him that money is not important. You realize that this client is using the defense mechanism of:
a. rationalization c. displacement
b. sublimation d. reaction formation
Reaction formation is the repression of painful or offensive attitudes or traits with unconscious opposite ones. The client’s hatred toward her husband is repressed and replaced with being very pleasant and loving toward him.
9. A client gets the results of laboratory tests from the physician and the news is not good. The nurse goes into the client’s room a short while later and the client acts angry at the nurse, telling the nurse to get out of the room. Which of the following actions by the nurse would be best?
a. Talk to the client about the tests and focus on any good news.
b. Say to the client, “You sound like you are upset about something.”
c. Tell the client, “I am sorry if I upset you,” and leave the client’s room.
d. Ask the registered nurse to talk with the client about being upset with you.
The client is angry about the laboratory test results and becomes angry with you instead. This is an example of displacement. It is safer for the client to focus his anger on you than to think about the lab tests. The best action is to use an open-ended question to more safely allow the client to ventilate his anger.
10. Criticism of the Holmes and Rahe Social Readjustment Rating Scale has led to the development of other tools to determine how people handle daily stress. Which of the following tests is best for measuring how people handle daily stress?
a. Beck Depression Inventory c. Jalowiec Coping Scale
b. Thermatic Apperception Test d. Mini-Mental State Examination
The Jalowiec Coping Scale determines how people cope with various life stressors. It consists of 40 coping behaviors that are rated on a scale of 1 to 5 and indicate the magnitude of use, with 1 indicating “never” and 5, “always.”
11. The psychiatric nurse clinical specialist is assessing a client on Axis V of the DSM-IV-TR. The nurse is trying to determine:
a. the presenting clinical problem
b. physical disorders and conditions
c. the client’s highest level of functioning in the past year
d. the severity of psychosocial stressors the client is experiencing
Axis V is the highest level of adaptive functioning in the past year. Physical disorders and conditions would be Axis III, and severity of psychosocial stressors would be Axis IV.
12. When reviewing the chart of an assigned client with a psychiatric disorder and a personality disorder, where would you find the personality disorder on the DSM IV-TR axis?
a. I c. III
b. II d. IV
The placement of personality disorders on Axis II is practiced by all clinicians. Axis I is used for clinical disorders and other disorders such as marital problems or other family circumstances. Physical disorders and conditions would be Axis III, and severity of psychosocial stressors would be Axis IV.
13. When the American Psychiatric Association revised the DSM-IV text revision, what major change occurred?
a. new disorders were added
b. updating of changed ICD-9 Codes
c. the appendix sections were changed
d. major changes in mental disorder criteria
Some ICD-9 Codes changed since the DSM-IV, and these were updated in the treatment review edition of DSM-IV.
14. A client whose father recently died is seen in the clinic with first-time signs and symptoms of rheumatoid arthritis. Using Lazarus’ system which categorizes responses to stressors which he refers to as appraisals of life events, the nurse would categorize the client’s form of appraisal of the father’s death to which of the following categories?
a. stressful c. hazardous
b. injurious d. challenging
Life events that cause damage such as physical illness, injury to self-esteem, and loss of normal functioning are defined as injurious. Rheumatoid arthritis is a physical illness, and it may cause loss of normal functioning and reduced self-esteem.
15. Using Lazarus’ system of categorizing appraisals in describing responses to stressors, comparing the demanding or challenge forms of appraisal with those that are hazardous, the nurse finds a major difference in that the challenge form:
a. takes less time and energy c. produces fewer physical reactions
b. generates more positive thoughts d. involves less interpersonal conflict
The challenge form of appraisal usually produces more positive thoughts than the hazardous forms. Challenging situations generate positive feelings such as enthusiasm and excitement. Hazardous threats are anticipated occurrences that encourage people to mobilize coping skills to reduce anticipated risks. This form of appraisal normally arouses negative thoughts and feelings such as anger, helplessness, anxiety, and fear.
16. The nurse who is using Roy’s model of nursing when working with a client who is dealing with a divorce will most likely base his work with this client on which of the following assumptions?
a. Response to divorce is universal.
b. The client subconsciously wants the divorce.
c. Responses to a stressor vary from person to person.
d. The client has contributed to the marriage breakup.
One of the assumptions and beliefs about the human organism in the Roy Adaptation Model is that stress is part of life and response to it varies from individual to individual based on neurobiological, psychosocial, and cultural factors.
17. You are working with a client who has a mental illness. The client suddenly yells at you, “You think you are so smart. Get out of my sight and don’t come back!” Using Roy’s model of nursing, your best response to this interaction is to:
a. assign the client to a communication class
b. advise the client that this behavior is acceptable
c. tell your supervisor that this client no longer wishes to have any interactions with you
d. recall that all behavior has meaning and purpose while observing the client at a distance
One of Roy’s Adaptation Model assumptions and beliefs is that all human behavior has meaning and purpose. The nurse should employ observation skills to further assess in order to determine the possible reasons for the client’s comments. The client’s behavior is not acceptable and should not be encouraged. The nurse should implement strategies within his scope of practice before contacting the supervisor or referring the client to a communication class.
18. When working with families, the nurse needs to teach families that health promotion and illness prevention must begin at which of the following periods?
a. the prenatal time
b. young adulthood
c. vaccinations as an infant and toddler
d. first signs and symptoms of an illness
Health promotion and illness prevention need to begin in the prenatal period and continue throughout life. Research is showing that anomalies that occur during early gestation may result in dysregulation in the neural circuitry and eventually produce enduring neurodevelopmental abnormalities in the fetus.
19. When working with expectant mothers who are concerned about neuronal development in the growing fetus, the nurse would help the mother in developing the following goals. Which goal, based on recent research, would have the greatest positive impact on fetal development?
a. Reduce caffeine intake.
b. Drink at least two glasses of milk each day.
c. Practice stress reduction techniques at least three times daily.
d. Exercise three times a week for at least 30 minutes to 1 hour.
Research concerning the impact of stress during gestation points to stress playing a role in the loss of neurons. The data suggest that early exposure to prolonged stress may affect neurodevelopmental processes.
20. When teaching parents about attachment and bonding, the nurse using Bowlby’s theories would tell parents that the final stage of attachment occurs at which of the following times?
a. In utero c. Within about a month
b. At the end of 24 hours d. At about 3 years of age
According to Bowlby, there are four stages of attachment. The first stage occurs at 2 to 3 months of age, the second stage occurs between 2 and 6 months, and the third stage occurs between 6 and 35 months of age. The final stage is the fourth stage which occurs at 3 years of age. During the final stage, the child understands his relationship with caregivers.
21. The nurse is working with parents, infants, and small children and is using Bowlby’s theories of attachment. The nurse realizes that the stages of attachment are most consistently a source of which of the following responses for the infant and small child?
a. stress c. pleasure
b. fatigue d. playfulness
Bowlby considered the stages of attachment as a source of stress for the infant and the child.
22. A mother wants to know when an infant learns to discern primary caregivers from others. If the nurse uses Bowlby’s stages of attachment to frame an answer, the answer would be:
a. within 24 hours c. between 2 and 6 months
b. at 1 month d. after 6 months
In Bowlby’s four stages of attachment, he identified that in the second stage, ranging from 2 to 6 months of life, the infant learns to discern primary caregivers from others. In the first stage, the infant can only distinguish people from inanimate objects and has not yet bonded with primary caregivers.
23. A parent is having difficulty with an infant’s crying. The nurse will best help the parent cope with the crying by doing which of the following things?
a. Get the parent to design and follow a stress reduction plan.
b. Offer to care for the infant while the parent takes a break.
c. Get the parent to talk about feelings of being a parent.
d. Provide the parent with a book about child growth and development.
The capacity of parents or early primary caregivers to effectively manage stress is vital to the developmental responses of the infant. The perception of stressors and the level of coping and adaptation govern the quality of parenting.
24. When assessing parents of small children and their parenting styles, the nurse discovers that one set of parents is experiencing unusually high stress levels due to a business failure, bankruptcy, and the father’s having to work long hours in several jobs to provide for the family. The most important thing for the nurse to be aware of and assess is:
a. alcohol and other drug abuse c. inconsistent or harsh discipline
b. support from other sources d. appropriate developmental toys
High stress levels in parents usually parallel inconsistent or harsh discipline. While it is important to assess the other areas listed, inconsistent or harsh discipline is a safety issue and therefore takes priority.
25. As infants in our society become toddlers and begin to experience mobility and autonomy, the greatest stressor in their lives is usually which of the following?
a. playmates c. family meals
b. limit setting d. being babysat
As the child becomes mobile and autonomous, stress arises from limit setting, early discipline, and prolonged separations from primary caregivers.
26. A nurse is working with a family that seems to be proud of never attending their child’s sports events or participating in any school conferences. They explain that they want their child to be independent. The nurse explains the importance of parents showing an interest in their child’s activities. What is the best reason that the nurse can give for parents’ needing to show interest in a child’s academic and sports activities?
a. Parental interest enhances the child’s self-worth and acceptance.
b. Teachers will not help the child when parents are not participating.
c. It is proven the best positions in sports go to children whose parents help.
d. These activities look good when someone falsely accuses you of poor parenting.
Parental interest has been shown to enhance the self-worth and acceptance of children and adolescents.
27. What percentage of adolescents experience psychiatric disorders or mental illness?
a. 5% c. 15%
b. 10% d. 20%
Twenty percent of adolescents experience psychiatric disorders or mental illness with the most common diagnoses being disorders of personality, anxiety, mood, and conduct.
28. Nurses conducting a health assessment on an older adult need to assess for the predominant theme that characterizes stress in older adults. The major stressor of older people is:
a. loss c. money
b. food d. family
Major losses for older people include the loss of close relatives and friends through death, loss of mobility, inability to communicate well, moving, loss of physical ability, loss of health, loss of financial stability, loss of belongings from moving to a smaller home, and many more losses. Loss is the theme for the stressors in older persons’ lives.
29. When you demonstrate empathy as one of your essential qualities as a nurse, you will:
a. lose your own identity as the nurse
b. first try to put the client in your place
c. experience the client’s feelings as your own
d. feel sorry for the client when the client has difficulties
Carkuff stated that empathy occurs when the nurse successfully assumes the “internal frame of reference of the client” and “experiences client feelings as if they were your own.”
30. According to the U.S. Census Bureau (2000), it is projected that by the year 2050 ethnic minority population will reach:
a. 15% c. 35%
b. 25% d. 50%
According to estimates, 50% of the U.S. population will be members of ethnic minority groups by the year 2050.
31. The purpose of defense mechanisms is to protect which of the following structures from intense feelings?
a. id c. libido
b. ego d. superego
Defense mechanisms are predominantly unconscious self-protective processes that seek to shield the ego. When stress occurs, the defense mechanisms prevent awareness of anxiety. Defense mechanisms are a form of self-deception and reality distortion.
32. Which defense mechanism is being used by a paranoid client who blames others for problems he is experiencing?
a. projection c. rationalization
b. displacement d. intellectualization
Projection is the act of blaming others for one’s own feelings or thoughts. The individual cannot consciously attribute these intolerable feelings and thoughts to self and unconsciously attributes them to others.
33. A married woman who expresses hostility toward a male coworker to avoid dealing with her sexual attraction to him is using which defense mechanism?
a. projection c. rationalization
b. displacement d. intellectualization
Rationalization is an effort to offer socially acceptable reasons and logical explanations to justify feelings, beliefs, thoughts, or behaviors, while the true reason is felt to be socially unacceptable.
34. A woman who is unable to bear children and who begins working in a preschool is using which defense mechanism?
a. repression c. suppression
b. projection d. sublimation
Sublimation is a normal form of dealing with undesirable feelings or thoughts by keeping them in an acceptable context. The true feelings or thoughts are blocked from the conscious mind.
35. The nurse assesses that a recently divorced, depressed client, who has incorporated negative feelings and hatred of his wife, is most likely using which defense mechanism?
a. introjection c. intellectualization
b. rationalization d. reaction formation
Introjection is engulfment or incorporation of specific traits, behaviors, or qualities into self or ego structure. Introjection is one of the earliest defense mechanisms used by the child, and it is important in the formation of a conscience. The individual who perceives being hated by others will begin to hate himself.
36. The nurse caring for a client with agoraphobia would most likely administer which of the following medications as part of the treatment plan?
a. Haldol c. Clozapine
b. Ativan d. Risperdal
Individuals with agoraphobia are treated with cognitive-behavioral therapy and a benzodiazepine such as Ativan.
37. A nurse whose care is based on theories of adaptation and coping would utilize concepts from which of the following theorists?
a. Selye and Roy c. Rogers and Sullivan
b. Freud and King d. Erickson and Orem
The theories of both Hans Selye and Sister Callista Roy are based on adaptation and coping. Selye focused on the physiologic aspects of adaptation and Roy focused on the nursing aspects of adaptation.
38. The nurse whose discharge planning includes referring a client to a group home is implementing which level of prevention?
a. primary c. tertiary
b. secondary d. case management
Tertiary treatment refers to measures that minimize relapse and chronic disability and restore the client to an optimal level of functioning. Primary prevention refers to health promotion and health education. Secondary prevention refers to measures or interventions used to curtail disease processes and includes screening for specific diseases. Case management is not a level of prevention.
39. If a nurse geneticist conducted a screening exam on young couples to determine whether they possess a gene which causes schizophrenia, the nurse geneticist would be utilizing which level of prevention?
a. primary c. tertiary
b. secondary d. case management
Secondary prevention refers to measures or interventions used to curtail disease processes. It includes screening for specific diseases. Primary prevention refers to health promotion and health education. Tertiary treatment refers to measures that minimize relapse and chronic disability and restore the client to an optimal level of functioning. Case management is not a level of prevention.