Answer Options:
a. Attention-deficit/hyperactivity disorder (ADHD)
b. Childhood depression
c. Conduct disorder (CD)
d. Autism spectrum disorder (ASD)
Answer: c. Conduct disorder (CD)
Question: A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic?
Answer Options:
a. Neutrally permit refusals.
b. Coax to gain compliance.
c. Offer rewards in advance.
d. Establish firm limits.
Answer: d. Establish firm limits.
Question: A terminally ill patient says, “I know I’m not going to get well, but still.” and the patient’s voice trails off. Which response by the nurse is therapeutic?
Answer Options:
a. “What do you hope for?”
b. “No, you’re not going to get well.”
c. “Do you have questions about what is happening?”
d. “I’m happy you are being realistic about your future.”
Answer: a. “What do you hope for?”
Question: A patient tells the nurse, “I don’t think I will ever get out of here.” Select the nurse’s most therapeutic response.
Answer Options:
a. “Don’t talk that way. Of course, you will leave here.”
b. “Keep up the good work and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”
Answer: C. “You don’t think you’re making progress?”
Question: A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, “No one cares about me anymore. I’m not worth anything.” Select an appropriate initial outcome.
Answer Options:
a. The patient will verbalize realistic positive characteristics about self by (date).
b. The patient will consent to take antidepressant medication regularly by (date).
c. The patient will initiate social interaction with another person daily by (date).
d. The patient will identify two personal behaviors that alienate others by (date).
Answer: A. The patient will verbalize realistic positive characteristics about self by (date).
Question: As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario?
Answer Options:
a. The invitation facilitates dependency on the nurse.
b. The nurse’s action blurs the boundaries of the therapeutic relationship.
c. The invitation is therapeutic for the patient’s diversional activity deficit.
d. The nurse’s action assists the patient’s integration into community living.
Answer: B. The nurse’s action blurs the boundaries of the therapeutic relationship.
Question: A nurse psychotherapist works with an anxious, dependent patient. What therapeutic strategy is most consistent with the framework of psychoanalytic psychotherapy?
Answer Options:
a. Emphasizing medication compliance
b. Identifying the patient’s strengths and assets
c. Offering psychoeducational materials and groups
d. Focusing on feelings developed by the patient toward the nurse
Answer: d. Focusing on feelings developed by the patient toward the nurse
Question: An individual was killed during a store robbery 2 weeks ago. The widowed spouse, who was diagnosed 6 years ago with schizoaffective disorder, cries spontaneously when talking about the death. Which is the nurse’s most therapeutic comment?
Answer Options:
a. “I’m worried about how much you’re crying. You grief over your spouse’s death has gone on too long.”
b. “The unexpected death of your spouse must be painful. I’m glad you’re able to talk to me about your feelings.”
c. “This loss is harder to accept because of your mental illness. Let’s refer you for a partial hospitalization program.”
d. “Your crying shows you aren’t coping well. I made an appointment for you to see the psychiatrist for medication adjustment.”
Answer: b. “The unexpected death of your spouse must be painful. I’m glad you’re able to talk to me about your feelings.”
Question: A person consistently rationalizes their cruel and abusive behavior. Which comment is most characteristic of this person defense mechanism?
Answer Options:
a. “I don’t know why it happens.”
b. “I have always had poor impulse control.”
c. “That person should not have provoked me.”
d. “Inside I am a coward who is afraid of being hurt.”
Answer: C. “That person should not have provoked me.”
Question: A new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients?
Answer Options:
a. Perform mental health assessment interviews.
b. Establish therapeutic relationships.
c. Prescribe psychotropic medication.
d. Individualize nursing care plans.
Answer: C. Prescribe psychotropic medication.
Question: An 80-year-old patient with depression reacts with aggression and pessimism to the staff. Every day is a struggle. No one cares about old people. Which is the nurse’s most therapeutic response?
Answer Options:
A. “Everyone here cares about old people. That’s why we work here.”
B. “It sounds like you’re having a difficult time. Tell me about it.”
C. “Let’s not focus on the negative. Tell me something good.”
D. “You are still able to get around, and your mind is alert.”
Answer: B. “It sounds like you’re having a difficult time. Tell me about it.”
Question: A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?
Answer Options:
a. Phenytoin
b. Clonidine
c. Carbamazepine
d. Chlorpromazine
Answer: C
Multiple Choice Question 946
A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
Answer Options
a. Increased muscle tension and anxiety
b. Vegetative signs and poor grooming
c. Poor judgment and hyperactivity
d. Cognitive deficit and sad mood
C
Multiple Choice Question 947
A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient uses whistle twirling and shadowboxing. Then the patient says gaily, “Do you like my scarves? Here…they are my gift to you.” How should the nurse document the patient’s mood?
Answer Options
a. Labile and euphoric
b. Imitable and belligerent
c. Highly suspicious and arrogant
d. Excessively happy and confident
A
Multiple Choice Question 948
A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority?
Answer Options
a. Risk for injury
b. Ineffective coping
c. Impaired social interaction
d. Ineffective therapeutic regimen management
A
Question: A student nurse participates weekly for 3 years. The student nurse has an opportunity to observe many different therapeutic techniques. The technique used for the patient who engages in free association, dreams, and the transference phenomenon is most likely which therapy?
Answer Options:
a. Transactional analysis
b. Cognitive therapy
c. Short-term dynamic therapy
d. Psychoanalysis
Answer: d. Psychoanalysis
Question: A school-age child tells the school nurse, “Other kids call me racial names and will not sit with me at lunch. Nobody likes me.” Select the nurse’s most therapeutic response.
Answer Options:
a. “Just ignore them and they will leave you alone.”
b. “You should make friends with other children.”
c. “Call them names if they do that to you.”
d. “Tell me more about how you feel.”
Answer: D. “Tell me more about how you feel.”
Question: Termination of a therapeutic nurse-patient relationship with a patient has been successful when nurse engages in what action?
Answer Options:
a. Avoids upsetting the patient by shifting focus to other patients before the discharge.
b. Gives the patient a personal telephone number and permission to call after discharge.
c. Discusses with the patient changes that have happened during the relationship and evaluates the outcomes.
d. Offers to meet the patient for coffee and conversation three times a week after discharge.
Answer: C. Discusses with the patient changes that have happened during the relationship and evaluates the outcomes.
Question: A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, “I have three good friends at school. We talk and sit together at lunch.” What is the nurse’s best suggestion to the treatment team?
Answer Options:
a. Suggest foster home placement.
b. Seek assistance from an intimate partner violence program.
c. Make referrals for existing and emerging developmental needs.
d. Encourage healthy characteristics evidenced in relationships.
Answer: d. Encourage healthy characteristics evidenced in relationships.
Question: Which descriptors exemplify consistency regarding therapeutic nurse–patient relationships? (Select all that apply.)
Answer Options:
a. (Which) Having the same nurse care for a patient on a daily basis
b. Giving a time for regular sessions with a patient
c. Providing a schedule of daily activities to a patient
d. Setting a time for regular sessions with a patient
e. Offering solutions to a patient’s problems
Answer: A. (Which) Having the same nurse care for a patient on a daily basis
C. Providing a schedule of daily activities to a patient
D. Setting a time for regular sessions with a patient
Question: Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, “Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.” Select the best response by the student interested in psychiatric nursing.
Answer Options:
a. “Psychiatric nurses’ practice in safer environments than other specialties.”
b. “Psycho-to-patient ratios are better because of the nature of patient care.”
c. “Psychiatric nurses use complex communication skills, as well as therapeutic listening skills to solve multidimensional problems. The skillset is those ‘soft’ skills.”
d. “I think I will be good in the mental health field. I do not want to be a bedside nurse.”
e. “Surgical nurses do not have to deal with as much suffering as psychiatric nurses do.”
Answer: C. “Psychiatric nurses use complex communication skills, as well as therapeutic listening skills to solve multidimensional problems. The skillset is those ‘soft’ skills.”
Question: Which action by the nurse is best associated with the demonstration of empathy?
Answer Options:
a. Observing the patient’s physical behavior and nonverbal communications
b. Encouraging the patient time to express their concerns and physical needs
c. Providing a therapeutic milieu where the patient is provided safety
d. Encouraging the patient to communicate with their support system
Answer: A. Observing the patient’s physical behavior and nonverbal communications
Question: A patient tells the nurse, “I am so ashamed of being bipolar. When I’m manic, my behavior embarrasses my family. Even if I take my medication, there’s no guarantee I won’t have a relapse. I am such a burden to my family.” These statements support which nursing diagnoses? (Select all that apply.)
Answer Options:
a. Powerlessness
b. Defensive coping
c. Chronic low self-esteem
d. Impaired social interaction
e. Risk-prone health behavior
Answer: A, C
Multiple Choice Question 976 (Chapter 17)
A person diagnosed with schizophrenia has had difficulty keeping a job because of severe paranoia. Today the person shouts, “They’re all plotting to destroy me.” Select the nurse’s most therapeutic response.
Answer Options
a. “Everyone here is trying to help you. No one wants to harm you.”
b. “Feeling that people want to destroy you must be very frightening.”
c. “That is not true. People here are trying to help if you will let them.”
d. “Staff members are health care professionals who are qualified to help you.”
B
Multiple Choice Question 977 (Chapter 17)
A patient diagnosed with schizophrenia is hyperverbal and states, “I saw two doctors talking together. They’re plotting to poison me.” What term identifies this patient’s perception of the environment?
Answer Options
a. Ideas of reference
b. Echolalia
c. A delusion of infidelity
d. An auditory hallucination
A
Multiple Choice Question 978 (Chapter 17)
A patient diagnosed with schizophrenia says, “My coworkers are out to get me. I also saw two doctors plotting to overdose me.” What term identifies how this patient is perceiving the environment?
Answer Options
a. Disorganized
b. Unpredictable
c. Dangerous
d. Bizarre
C
Question: A patient diagnosed with schizophrenia tells the community mental health nurse, “I threw away my pills because they interfere with God’s voice.” The nurse identifies what as the likely cause of the patient’s ineffective management of the medication regimen?
Answer Options:
a. Inadequate discharge planning
b. Poor therapeutic alliance with clinicians
c. Impaired reasoning secondary to schizophrenia
d. Dislike of the side effects of antipsychotic medications
Answer: c. Impaired reasoning secondary to schizophrenia
Question: What is the priority intervention for a nurse beginning a therapeutic relationship with a patient diagnosed with a schizotypal personality disorder?
Answer Options:
a. Respect the patient’s need for periods of social isolation.
b. Prevent the patient from violating the nurse’s rights.
c. Engage the patient in many community activities.
d. Teach the patient how to match clothing.
Answer: A. Respect the patient’s need for periods of social isolation.
Question: Which patient would a nurse refer to partial hospitalization?
Answer Options:
a. One who spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
b. One who is experiencing agoraphobia and panic episodes and who would benefit from psychoeducation for relaxation therapy.
c. One who has a therapeutic lithium level and reports a history of blood tests and clinic follow-up.
d. One who hears auditory hallucinations and has failed to show up for group work every morning.
Answer: a. One who spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
Question: A psychiatric technician says, “Little of what takes place on the behavioral health unit seems to be theory based.” A nurse educates the technician by identifying which common use of Sullivan’s theory?
Answer Options:
a. Structure of the therapeutic milieu of most behavioral health units
b. Frequent use of restraint and seclusion for behavior modification
c. Assessment tools based on age-appropriate versus arrested behaviors
d. Use of the nursing process to determine the best sequence for nursing actions
Answer: a. Structure of the therapeutic milieu of most behavioral health units