SAMPLE
1.On the first day of a psychiatric-mental health nursing clinical, a student nurse is assigned to work with a 24-year-old male client who is being treated for major depression due to a recent diagnosis of AIDS. Which of the following questions of the nurse would reflect prejudice regarding the client?
A) “Does depression often occur when young people get a diagnosis of AIDS?”
B) “What is the physiological reason that depression might happen in conjunction with this diagnosis?”
C) “Does the client's family know he is depressed and in treatment? I haven't seen any visitors since he was admitted.”
D) “Why do gay men seem to get depressed more often? Could it be related to IV drug abuse?”
Ans: D
Feedback:
Prejudice is a judgment or opinion (“preconceived notion”) that has been made or formed before any knowledge or facts have been gathered. In option D, the student has already assumed that because the client has AIDS, he is gay and also may use IV drugs, and therefore, the student's question reflects prejudice. Asking a question regarding the development of depression following a diagnosis of AIDS in young people, investigating the physiologic reason for depression occurring in a client diagnosed with AIDS, and determining if the client's family has knowledge of the depression are all relevant questions posed by the student nurse.
2.Which of the following would be the most therapeutic student nurse response to the client's question, “Hi. What is your name?”
A) “My name is Dorothy, and I am a student nurse at Oakdale University School of Nursing.”
B) “Why do you ask?”
C) “It is interesting that you would ask about my name. What is your name?”
D) “I would like to tell you; however, it is against the policy at Oakdale Hospital to reveal personal information.”
Ans: A
Feedback:
There are clinical situations in which it is unadvisable to provide personal information about oneself. However, other situations merit the cautious sharing of personal information; this is one. Providing her name gives the student credibility and establishes trust. To withhold this type of information would make the client uncomfortable and possibly suspicious of the student.
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3.The student nurse is beginning her first day of clinical in a mental health unit. The nurse realizes that therapeutic communication can occur even if the nurse is not certain of how to initiate the conversation. This is because?
A) It does not matter what you say to the client.
B) Sincerity, honesty, respect, and caring are the most important elements in communication and will overcome anything you may say that could be
nontherapeutic.
C) Psychiatric-mental health clients do not really understand what you say most of the time anyway.
D) Clients in most mental health settings are cognitively impaired.
Ans: B
Feedback:
Sincerity, honesty, respect, and caring are hallmarks of being an effective psychiatricmental health care provider. If the student nurse is sincere and honest, shows respect for the client, and displays a caring attitude, the staff and clients will give the student their trust.
4.A Hispanic man employed as a sales representative goes into a local department store to pick up a gift for his wife. As he walks around the store, the security guard appraises the man's race, comes up to him, and says, “You need to leave the store because of your suspicious behavior.” This is an example of
A) Cultural isolation
B) Dislocation
C) Prejudice
D) Discrimination
Ans: D
Feedback:
Discrimination occurs when there is treatment or consideration that is based on class or category rather than on individual merit. In this case, the man has been treated differently (asked to leave) based on his race, because there is no other defining characteristic or behavior that he is exhibiting that would lead to his expulsion from the store.
5.A mental health nurse has been assigned to a client diagnosed with schizophrenia. Upon entering the room, the client yells, “Get out of here, you little brat! You're bigger than my kid sister, who is horrible!” The initial action of the nurse would include which of the following?
A) Sit down on the client's bed and initiate a conversation.
B) Run out of the client's room yelling, “I need some help here!”
C) Tell the client that her behavior is not acceptable and will not be tolerated.
D) Slowly back out of the client's room, and summon for help.
Ans: D
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Feedback:
Nursing staff and clinicians are experienced in assessing the client's potential for violence and have specific protocols to utilize when this occurs. The nurse should be familiar with these protocols. The nurse should neither try to confront the client nor create a disruption. Initiating any type of conversation when the client is confrontational would not be appropriate. Running from the room and yelling may cause increased agitation in this client. Telling the client that her behavior is unacceptable does not resolve the current situation. The most appropriate nursing action in this situation would be to leave the client's room and summon help.
6.Which of the following is a characteristic of an introvert?
Outgoing personality
Relates easily to people
C) Exhibits leadership qualities
D) Prefers to be a follower
Ans: D
Feedback:
An introvert is a quiet individual who relates better to the inner world of ideas, thoughts, and feelings. He or she prefers to be a follower and usually lets other initiate and direct interactions. An extrovert is an outgoing person who relates more easily to people and things in the environment, likes to take charge of situations, and has little difficulty socializing.
7.When caring for a depressed client, the nurse made a comment that all depressed people are weak. This is categorized as which type of attitude displayed by the nurse?
A) Affective incongruence
B) Judgmental
C) Jealous
D) Open-minded
Ans: B
Feedback:
Persons who display judgmental attitudes are often inflexible and run the risk of neglecting the perception of others, possibly arriving at an opinion based on their values without enough facts or enough regard for what other people may feel or think. Affective incongruence occurs when the client's mood is not congruent with the situation. The nurse in this instance is not being open-minded or conveying jealousy.
8.One of the students completing her mental health clinical states that “All those people seem very crazy.” It is important that the student display which type of attitude when dealing with mentally ill clients?
A) Biased
B) Judgmental
C) Introverted
D) Open-minded
Ans: D
Feedback:
Individuals who display an open-minded attitude do not make decisions until they are aware of all the facts of the situation. It is especially important to be open-minded when dealing with clients from various cultures and ethnic backgrounds. The student is displaying a judgmental or biased opinion of the mentally ill. Introversion is a personality trait.
9.Frequently, psychiatric clients are stereotyped by the public. Which of the following is a common stereotype of this client population?
Calm
Self-centered
C) Violent
D) Wealthy
Ans: C
Feedback:
Psychiatric clients are often stereotyped or categorized by the public as being poor, violent, confused, or unable to care for themselves.
10.A student nurse is caring for a client with schizophrenia from the local prison who has been incarcerated for illegal drug manufacture and solicitation. The student nurse is overheard stating that “I can't take care of him; he is probably gay and a drug addict.” The student nurse is best described as being which of the following?
A) Introverted
B) Extroverted
C) Prejudiced
D) Open-minded
Ans: C
Feedback:
The student is exhibiting prejudice in this situation. Prejudice is described as feelings of intolerance about persons who are hospitalized in psychiatric-mental health care facilities. Introvert and extrovert are types of personality traits. The student is not being open-minded regarding this client.
11.A nursing student is aware that all psychiatric clients are vulnerable to being stigmatized and stereotyped, a phenomenon that is particularly common when members of the public judge what?
A) Clients who have been diagnosed with depression
B) People with schizophrenia
C) Older adults with anxiety disorders
D) Women who become depressed after giving birth
Ans: B
Feedback:
Research suggests that individuals labeled mentally ill, regardless of the specific psychiatric diagnosis or level of disability, are stigmatized or disgraced more severely than those with other health conditions. Furthermore, some studies suggest that individuals with psychotic disorders, such as schizophrenia, are judged more harshly than people with depression or anxiety disorders.
12.Mr. Ho has seen a progressive decline in his mood, ability to concentrate, and energy
level in recent months. Despite his wife's prompting, he is reluctant to seek care. The nurse should recognize which of the following factors that is known to underlie individuals' reluctance to seek psychiatric care?
The prohibitive cost of psychiatric treatment
Increasing social stigma around seeking psychiatric care
C) Withdrawal of FDA approval for many previously common psychiatric medications D) The perceived lack of effectiveness of psychiatric treatment
Ans: D
Feedback:
Although seeking professional help for mental health problems is now more accepted by Americans, the public's belief in the effectiveness of mental health treatment and the likelihood of recovery without treatment has changed very little over the past ten years. Therefore, many individuals who would benefit from mental health services choose not to pursue them or fail to fully participate once treatment has begun.
13.Kim, a nursing student, is admittedly nervous about beginning her upcoming clinical rotation in a psychiatric setting. Reflection on which of the following questions may aid Kim's readiness for this new care setting?
A) “Why do I have to do this clinical rotation if my goal is to work in obstetrics?”
B) “What do I envision about these clients that makes me uneasy?”
C) “What should I do when I encounter clients who may never recover from their mental illness?”
D) “What if I pick up some of the poor coping strategies that psychiatric clients use?”
Ans: B
Feedback:
Identify one's specific fears and apprehensions around providing care in the psychiatric setting that can foster the self-awareness that is necessary to provide good care. Expressing resentment for the rotation will benefit neither the student nor the clients she cares for. Fears of “catching” mental illness or worrying about what to do with clients who are unlikely to recover are concerns that need to be addressed, but neither question promotes self-awareness.
14.During his psychiatric clinical placement as a nursing student, David has been surprised by the intensity of emotion that he feels when interacting with a client who has been hospitalized with depression. He attributes this to the fact that his own father struggled with depression for many years and ultimately committed suicide when David was in his teens. How should David's clinical instructor understand these events?
A) Recognizing the relationship between David's family history and his present feelings indicates self-awareness.
B) David is at risk of dealing with his depressed client in a prejudiced or judgmental way because of his history.
C) David is failing to carry himself in an open-minded way in his clinical interactions, and it is tainting the care he provides.
D) There is a high risk that David will himself become depressed because of the
combination of family history and present exposure to the illness.
Ans: A
Feedback:
David is showing self-awareness by making the link between what he is currently feeling and experiencing and the factors in his own life that may contribute to those feelings. Therefore, the other options are incorrect.
15.Which of the following nursing students most clearly exhibits open-mindedness?
A) Jeremy tells himself that all clients' behaviors and thought processes are equally valid and beneficial.
B) Kristin realizes that there is nothing that she can do to make a person think or act in a different way.
C) Ravi consciously tries to refrain from making judgments until he has gathered as many facts as possible.
D) Jerome knows that he does not have the right to ask a client to do something that he himself would not want to do.
Ans: C
Feedback:
Individuals who display an open-minded attitude do not make decisions until they are aware of all the facts pertaining to a certain situation. Open-mindedness does not mean that every action and thought are beneficial, that a nurse is powerless to effect change in a client, or that the nurse must be willing to perform any necessary intervention on himself or herself.
16.A nurse who is considered to be judgmental may do what?
A) Be more efficient and effective at making clinical decisions under pressure
B) Choose interventions based on his or her own values
C) Be better able to discern symptoms and signs from personality traits
D) Be paralyzed by fear when interacting with mentally ill clients
Ans: B
Feedback:
Persons who display judgmental attitudes are often inflexible and run the risk of neglecting the perception of others, possibly arriving at an opinion based on their own values without enough facts or enough regard for what other people may feel or think. Being judgmental does not enhance decision-making or clinical judgment. It is more likely to foster overconfidence than fear.
17.Gina is having her clinical orientation on the psychiatric unit of the hospital where she will be starting a clinical placement. Surprised at learning the long average length of stay on the unit, she has asked her instructor how she and her classmates will be received as “new faces” on the unit. How should Gina's instructor respond?
A) “Don't worry. People with mental illness are often oblivious to the people around them.”
B) “You'll be very susceptible to abuse or manipulation during the first few weeks, but you're expected to navigate those challenges.”
C) “Many of the clients will recognize right away that you're new, but they'll be told ahead of time that you're coming.”
D) “You'll find that most of the clients on the unit won't acknowledge the fact that you're new here.”
Ans: C
Feedback:
While many students are understandably nervous about being recognized as new by clients, they are normally informed ahead of time that students will be coming. Clients are usually very aware of who they interact with. No care provider is expected to endure abuse.
18.During her first day on the psychiatric unit, Jennifer has entered a client's room after shift report. The moment she enters the client's room, the client asks, “Well, who do we have here?” How should Jennifer respond?
A) “I'm Jennifer Wilcox. How are you?”
B) “I'm the student who's going to be working with you today.”
C) “I'm Jennifer, and I'll be working with the RN until the end of the shift.”
D) “My name's Jennifer and I'm a student nurse.”
Ans: D
Feedback:
It is important to introduce yourself to clients using your name and your title.
19.A client on the psychiatric unit of the hospital has sensed a student's nervousness and confronted her, saying, “You don't have a bloody clue what you're doing, do you?” How could the student respond in a way that demonstrates emotional stability?
A) By detaching herself from her emotional response to this accusatory statement
B) By responding in a similar tone
C) By acknowledging the validity of the client's statement
D) By trying not to show undue emotion when responding to the client
Ans: D
Feedback:
Emotional stability is not the same as blocking or detaching from emotions. Rather, it is responding to emotional situations without undue emotion. Validating the client's statement and matching the tone would both be inappropriate responses.
20.Which of the following traits is most likely to inhibit the quality of care that a nurse provides in a psychiatric setting?
A) Introversion
B) Emotional stability
C) Extroversion
D) Judgmental
1.Which of the following is an inappropriate example of the role of a psychiatric nurse?
A) Establishing a therapeutic relationship and environment
B) Assisting clients learn positive coping skills concerning real-life problems
C) Providing care for physical symptoms
D) Giving advice to clients on a variety of topics
Ans: D
Feedback:
All except giving advice are appropriate roles for psychiatric nurses. The role of the psychiatric nurse is to assist the client to arrive at his or her own answers to problems, not to give advice to the client.
2.Which of the following factors has the least influence on the development of mental health in the client who has anxiety disorder?
A) The client's mother also suffered from an anxiety disorder.
B) The client was raised in a household with high stress and frequent geographic moves.
C) The client's mother often related to her in ways that reflected her mother's high level of anxiety.
D) The client is often late to school and makes poor grades in most of her subjects.
Ans: D
Feedback:
Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of her anxiety disorder.
3.Which of the following describes an application of Psychiatric–Mental Health Nursing: Scope and Standards of Practice (ANA, 2007)?
A) Diagnosing disorders using the Diagnostic and Statistical Manual III-R published by the American Psychiatric Association
B) Assisting clients in regaining or improving previous coping abilities and preventing further disability
C) Providing psychoanalysis to unravel psychoneuroses common to clients with schizophrenia
D) Applying somatic therapies, such as electroconvulsive therapy, to severely depressed clients
Ans: B
Feedback:
All of these activities except the activity described in option B are not considered to be within the scope of practice of the psychiatric–mental health nurse.
4.An appropriate goal for clients who are learning about the healthy use of ego defense mechanisms is what?
A) Reduce fear and protect self-esteem.
B) Eliminate anxiety and apprehension.
C) Avoid conflict and unpleasant consequences.
D) Reduce workload and communicate better.
Ans: A
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Feedback:
Ego defense mechanisms help to reduce fear and protect self-esteem. It is not a goal to eliminate anxiety, avoid conflict, or reduce workload.
5.A client asks the nurse to help her understand what her psychologist meant when he said that she displaced her anger. The nurse replies that displacement is?
A) Replacing consciously unacceptable emotions, drives, attitudes, or needs by those that are more acceptable
B) Making up for a real or imagined inability or deficiency by engaging in a specific behavior to maintain self-respect or self-esteem
C) Transferring feelings, such as frustration, hostility, or anxiety, from an idea, person, or object to one that is less threatening
D) Negating a previous unconsciously tolerable action or experience to reduce or alleviate feelings of guilt
Ans: C
Feedback:
Displacement means the transferal of feelings from one object to another. It involves neither replacement or making up for feelings nor negating them.
6.When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which of the following beliefs is more applicable to the Middle Ages?
A) Emotional disorders were believed to be an organic dysfunction.
B) Treatment included sedation, good nutrition and hygiene, and music and recreation. C) Mental illness was considered a disturbance of the four body fluids, or “humors.”
D) Belief in demonic possession and exorcism was common.
Ans: D
Feedback:
While some of these answers are true of both ancient Greece and the Middle Ages, belief in demonic possession and exorcism was more common in the Middle Ages.
7.Suppression has been likened to voluntary forgetting and is used to protect one's selfesteem. Which of the following statements alerts the nurse to the use of this mechanism by a 19-year-old woman who lost her leg in a car accident?
A) “I don't remember anything about what happened to me.”
B) “I'd rather not talk about it right now.”
C) “It's all Andy's fault! He was going 90 miles an hour on the freeway.”
D) “My mother is heartbroken about this.”
Ans: A
Feedback:
The correct answer reflects the idea that the client has not remembered the event. The other options imply that the client is able to remember. Suppression protects one's selfesteem by providing a loss of memory about the event.
8.The major goal of the Community Mental Health Act of 1963 was what?
A) Develop centers in which biopsychiatric research could take place within the community.
B) Build mental health centers that would provide mental health care within the local community.
C) Attract more health care providers into local psychiatric clinics.
D) Facilitate the integration of biology with the psychosocial components of treatment.
Ans: B
Feedback:
The 1963 Community Mental Health Act was designed to provide community-centered mental health care.
9.According to Maslow, mentally healthy people who achieve self-actualization have the ability to do what?
A) Use varied approaches to solve problems
B) Form distant relationships with others
C) Be dependent in thought and action
D) Make decisions pertaining to fantasy rather than reality
Ans: A
Feedback:
According to Maslow, mentally healthy people who achieve self-actualization are able to form close relationships with others, make decisions pertaining to reality rather than fantasy, be independent or autonomous in thought and action, and use a variety of approaches as they perform tasks and solve problems.
10.A student nurse states that he does not want to think about the upcoming final exam. He will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism?
A) Denial
B) Suppression
C) Regression
D) Conversion
Ans: B
Feedback:
Suppression is the voluntary rejection of unacceptable thoughts or feelings from conscious awareness. Denial is unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable. Regression is the retreat to past developmental states to meet basic needs. Conversion is the unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.
11.Which of the following criteria is the most important component of a definition of mental health?
A) The individual is financially self-sufficient.
B) The individual is able to cope with daily stressors.
C) The individual has rich social life.
D) The individual carries himself or herself with a joyful demeanor.
Ans: B
Feedback:
Mental health is a positive state in which one is responsible, displays self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions. Financial success, social connectedness, and a joyful demeanor may be outcomes of mental health, but none is a prerequisite for mental health.
12.Dawn, a nursing student, is discussing the patient whom she cared for that morning with a fellow student in the same clinical group. Dawn states that her patient has schizophrenia and mentions that she found out that it “runs in the patient's family.” Dawn's classmate is incredulous, saying that mental illness results from traumatic circumstances. What explanation of the factors that contribute to mental illness is most accurate?
A) Mental health is thought to be determined by genes, circumstances, and childhood nurturing.
B) Mental health and mental illness have been proven to be genetically predetermined.
C) Mental health is primarily a result of the effective use of ego defense mechanisms.
D) Mental health is determined by the interplay of intelligence, ingenuity, and genetic makeup.
Ans: A
Feedback:
Three factors influence the development of mental health: genetic characteristics, nurturing during childhood, and life circumstances.
13.Mrs. Ames is a 68-year-old widow who shares her house with her son Aaron, a 39-yearold man who has a diagnosis of bipolar disorder. Aaron has been experiencing increasingly serious exacerbations of his illness, and the unpredictability of his condition, combined with the fact that she is his sole caregiver, has left her feeling exhausted and defeated. The nurse would recognize that Mrs. Ames is at risk for what?
A) Bipolar disorder
B) Compassion fatigue
C) Failure to thrive
D) Decompensation
Ans: B
Feedback:
Compassion fatigue, also referred to by many as burnout, may occur when one provides
care for others but loses the ability to take care of oneself.
14.Which of the following statements is suggestive of the stigmatization of mental illness?
A) “We're sure not putting enough money into public programs for people who are mentally ill.”
B) “It's too bad that there aren't better medications to treat mental illness.”
C) “I feel bad for the mentally ill, but I wish we didn't have to see them panhandling on every single corner.”
D) “I think that we should look at people who are mentally ill much like we see people who are physically ill.”
Ans: C
Feedback:
Creating a division between “us” and “them” is a component of stigmatization. Being dissatisfied with treatment options for mental illness does not mean that the speaker is stigmatizing mental illness.
15.How can the mental health nurse best advocate for individuals with mental illness and prevent stigmatization?
A) By emphasizing the creativity and freedom that accompany a mental illness
B) By emphasizing that all people with mental illness can eventually be cured
C) By tactfully correcting misperceptions about abnormal behavior and mental illness
D) By informing people that most mental illness is actually a manifestation of substance abuse
Ans: C
Feedback:
There are several perceptions about mental illness and abnormal behavior that have the power to contribute to stigmatization. The nurse should counter these perceptions. It would be inaccurate to characterize mental illness as a positive experience, to state that all people with mental illness can be cured, or to attribute mental illness to substance abuse.
16.The nurse has heard a member of public lamenting the fact that a mentally ill person committed a high-profile crime, saying, “I don't know what no one could see it coming.” What perception about abnormal behavior and mental illness is this person exhibiting? A) Internal forces are responsible for abnormal behavior.
B) Abnormal behavior can be predicted and evaluated.
C) Maladaptive behavior is always inherited.
D) Mental illness is incurable.
Ans: B
Feedback:
If an individual believes that abnormal behavior can always be identified by warning signs ahead of time, he or she agrees that it can be predicted.
17.In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend?
A) Increased numbers of homeless mentally ill people
B) Higher employment rates among previously institutionalized people
C) Increased numbers of for-profit institutions for the mentally ill
D) Increased numbers of training programs for the mentally ill
Ans: A
Feedback:
In 1970, the deinstitutionalization of clients from state mental hospitals to community living was considered a positive move; however, insufficient federal funding resulted in an increase in the number of homeless mentally ill people.
18.Andrew has been unsuccessful in his psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric– Mental Health Nursing Scope and Standards of Practice, which are?
A) Future goals for the nursing profession as a whole
B) The legal documents that allow a nurse to practice
C) Descriptions of the responsibilities for which nurses are accountable
D) Explanations of the ideal character of the psychiatric or mental health nurse
Ans: C
Feedback:
Standards of practice are authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They do not have the same standing as laws, and they are not future goals but are instead current standards.
19.A recent nursing graduate has been hired as a parish nurse in the church that she has attended for many years. How should the nurse understand this new role?
A) The nurse will focus on the assessment and management of acute illnesses among the members of the church.
B) The nurse will implement spiritually based interventions in disease management as an alternative to western biomedicine.
C) The nurse will consider the whole church congregation to be her client using a community health model.
D) The nurse will serve as a specialized health advisor to the leadership of the church.
Ans: C
Feedback:
Parish nursing is a program that promotes health and wellness of body, mind, and spirit using the community health nursing model as its framework. The church congregation is the client.
20.A college's nursing program has added an elective in forensic nursing to the curriculum.
Which of the following phenomena underlies the expanded role for forensic nursing that
A)
B)
C)
D)
Ans:
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1.When the mental health nurse assesses her client, who has been admitted to an inpatient psychiatric unit for depression, she takes into account that the family will not have income while the client is hospitalized. This assessment by the nurse regarding the impact of client's hospitalization on the family system can best be described as what?
A) A theoretical approach, whereby the nurse uses systems-oriented theory to understand her client and to plan his care
B) A practical approach, wherein the nurse can now work to get some funds for the family
C) An outcome-oriented approach, whereby the nurse sees lack of funds as an outcome
D) A somewhat ineffective way to look at this hospitalization because the client is now ill Ans: A
Feedback:
Assessing the client within the context of his family system is a way to use systemsoriented theory to understand the client. This is a theoretical approach; using theory will assist the nurse to understand the client's family as well as to assess and plan care that will best meet his needs.
2.The nursing theorist Peplau identified which of the following as the essence of psychiatric–mental health nursing?
A) Nursing care independent of physicians
B) The nurse's use of self
C) The nurse–patient relationship
D) A neurobiologic approach
Ans: C
Feedback:
Peplau was known for first highlighting the importance of the relationship between the nurse and the patient as the basis for the therapeutic relationship. She believed that this relationship was the essence of psychiatric–mental health nursing.
3.The nurse views her client as an individual who has self-care deficits that need to be addressed. The nurse works with the client to assist him or her to meet self-care needs, such as personal grooming, until the client can care for himself or herself independently. This is an example of which of the following theoretical approaches?
A) Parse's Theory of Human Becoming
B) Roy's Theory of Adaptation
C) Orem's Behavioral Nursing Theory
D) Peplau's Interpersonal Theory
Ans: C
Feedback:
Orem's theory includes the concepts of self-care and self-care deficits; the nurse's role is to assist the client to meet self-care deficits until the client can be independent.
4.A psychiatric–mental health nurse gathers information from several nursing theories and combines the client's resources as a unique person with the most suitable theoretical model. The nurse is using which of the following approaches to applying theory to practice?
A) Outcome
B) Needs
C) Eclectic
D) Interaction
Ans: C
Feedback:
An eclectic approach to practice implies the use of various models along with the client's personality and individualized resources in order to assess and plan nursing care that is tailored to meet his or her unique needs.
5.The theoretical terms “meaning, rhythmicity, and transcendence” are components of which of the following nursing theorists' work?
A) Hildegard Peplau
B) Rosemarie Parse
C) Sister Callista Roy
D) Dorothea Orem
Ans: B
Feedback:
Parse's Theory of Human Becoming posits quality of life from each person's own perspective as the goal of nursing practice. The three themes of meaning, rhythmicity, and transcendence are used by Parse when discussing the role of a nurse in guiding a client or in bearing witness to a client's experiences.
6.A client who had a stroke is experiencing left-sided paralysis. The client has become increasingly depressed because of this inability to complete all his ADLs by himself. This inability is considered a self-care deficit according to which nursing theory?
A) Peplau's Interpersonal Theory
B) Orem's Behavioral Nursing Theory
C) Roy's Theory of Adaptation
D) Parse's Theory of Human Becoming
Ans: B
Feedback:
Orem's Behavioral Nursing Theory focuses on self-care deficit. It proposes that the recipients of nursing care are persons who are incapable of continuous self-care or independent care because of health-related or health-derived limitations. The other options are not self-care deficit theories.
7.A female client is being seen in the emergency room after being physically abused by her husband. The nurse, acting as an advocate for the client, explains to the client the importance of being empowered to leave the abusive situation. Which of the following theorists' works most explicitly promotes empowerment of the client?
A) Roy
B) Peplau
C) Parse
D) Orem
Ans: C
Feedback:
Parse's theory bears witness to the client's experience and respects the individual's capacity for self-knowing and assists the client in cocreating a valuable space for the client to voice the lived experience of health.
8.According to Roy's Theory of Adaptation, coping behaviors occur in four adaptive modes. Which of the following is incongruent with the classification of an adaptive mode?
A) Interdependence
B) Role function
C) Self-concept
D) Psychologic
Ans: D
Feedback:
According to Roy's Theory of Adaptation, coping behavior occurs in four adaptive modes: physiologic, self-concept, role function, and interdependence.
9.The mental health nurse is teaching a client about a psychotropic medication that he has prescribed. The nurse, in this instance, is functioning with which type of approach to nursing practice?
A) Needs
B) Interaction
C) Outcome
D) Eclectic
Ans: B
Feedback:
The interaction-oriented approach is used by nurses who rely on interactions and include themselves in the sphere of their actions. They counsel, guide, and teach clients, helping them to find meaning in their situations. The needs-oriented approach encompasses the nurse performing physiologic and psychosocial activities for the client. The outcomeoriented approach focuses on maintaining and promoting energy and harmony with the environment. The eclectic approach is an individualized style that incorporates the client's own resources as a unique person with the most suitable theoretical model.
10.A mental health nurse is discussing potentially adverse effects of electroconvulsive
therapy (ECT). According to Peplau's Interpersonal Theory, the nurse is functioning in which of the following nursing roles?
A) Therapist
B) Manager
C) Teacher
D) Socializing agent
Ans: C
Feedback:
Peplau believed that the nurse serves as a therapist, counselor, socializing agent, manager, technical nurse, mother surrogate, and teacher. In this situation, the nurse is functioning in the teacher mode.
11.The nurse is providing care for a client of Chinese descent who has been admitted to the hospital for the treatment of depression. It has become clear during the client's time of stay in the hospital that the client and his family understand his illness and treatment options in a way that is informed by their culture. Which of the following nursing theorists prioritizes the role of culture in assessment and care?
A) Roy
B) Orem
C) Leininger
D) Parse
Ans: C
Feedback:
Leininger's Theory of Cultural Care Diversity and Universality states that caring is universal and varies transculturally. It is based on the nurse's need to be aware of and sensitive to the cultural needs of clients.
12.Carolyn's course of treatment for anorexia nervosa has been largely unsuccessful, a fact that has caused frustration for some members of the interdisciplinary team. Which of the following statements would suggest that the team plans to implement the Tidal Model in Carolyn's treatment?
A) “I think we need to accept that this may be the way that Carolyn demonstrates her self-actualization.”
B) “Ultimately, she does have what it takes to recover and she's the only one who truly knows what is best for her.”
C) “We need to stop trying to 'treat' Carolyn and start embracing her.”
D) “I think we've been focusing too much on her physiological health and ignoring her felt needs.”
Ans: B
Feedback:
The Tidal Models is based on the beliefs that recovery is possible, change is inevitable, clients know what is best for them, clients possess all the resources they need to begin recovery, clients are the teachers and nurses are the pupils, and nurses need to be creatively curious to learn what needs to be done to help the client. The other statements do not reflect these beliefs.
13.Which of the following statements most accurately summarizes the basis of the Tidal Model?
A) Mental health is available to all.
B) The human condition is dominated by stressors.
C) Soul, mind, and body are separate entities.
D) Change is inevitable and continuous.
Ans: D
Feedback:
The Tidal Model focuses on the continuous process of change inherent in all people.
14.A psychiatric–mental health nurse is providing care for a client who lives in the community. Which of the following preconditions is necessary before Peplau's Interpersonal Theory becomes an accurate framework for the nurse's practice?
A) Prolonged contact between the nurse and the client
B) Cultural similarity between the nurse and the client
C) Self-awareness and desire to change on the part of the client
D) The client's acknowledgment of the inadequacy of his coping skills
Ans: A
Feedback:
Peplau's theory focuses primarily on the nurse–client relationship in which problemsolving skills are developed. It is considered effective in long-term care, home health, and psychiatric settings where time allows for the development of a nurse–client relationship and, hopefully, a resolution to promote health.
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15.Hans has schizophrenia and uses marijuana heavily. His living situation has been unstable in recent years, and he has been living in a rooming house for the past several months.
His landlord, however, has contacted the home health nurse because of the squalor of Hans' room and frequent disturbances. What aspect of Hans' situation would be prioritized within the framework of Orem's Behavioral Nursing Theory?
A) The cultural meaning that Hans assigns to his illness and substance use
B) Hans' inability to embrace the inevitability of change in his life
C) Hans' relationship with the nurse and the other care providers in his life
D) The gap between what Hans needs and what he can provide for himself
Ans: D
Feedback:
Orem focuses on self-care deficit in nursing. Leininger's theory prioritizes culture, while the Tidal Model emphasizes the inevitability of change. The relationship between the client and the nurse is a primary focus of Peplau's Interpersonal Theory.
16.The wife of a client has said about her husband, “I think that what it comes down to is
that he really has a hard time processing and accommodating the pressures and stressors that come at him as he goes through his life.” The nurse should recognize that the wife's statement summarizes the theoretical perspective of which theorist?
A) Roy
B) Parse
C) Leininger
D) Orem
Ans: A
Feedback:
Roy's Theory of Adaptation, modeled from a behavioral theory, states that human beings are biopsychosocial adaptive systems who use coping mechanisms to adapt to both internal and external stimuli. As such, the theory emphasizes the individual's response to perceived stressors.
17.A new program has been launched with the goal of fostering the development of life skills for community-dwelling clients with mental illness, aiming to teach them how to shop, cook, and manage money more effectively. This program demonstrates what approach to practice?
A) Eclectic approach
B) Outcome-oriented approach
C) Interaction-oriented approach
D) Needs-oriented approach
Ans: D
Feedback:
Supplementing knowledge and teaching skills to clients are activities that are central to the needs-oriented approach to nursing. Such a program is less likely to prioritize the relationship focus of the interaction-oriented approach or the emphasis on health environments that is associated with the outcome-oriented approach. The eclectic approach is more individualized to the nurse's perspectives, priorities, and skills.
18.Which of the following statements best empowers a nursing student to develop and implement the eclectic approach to nursing?
A) “Just as every client is an individual, you too are an individual with particular strengths and skills.”
B) “The ultimate expert on a client's condition is the care team.”
C) “Don't let anyone tell you that you don't have the power to cause positive change in a client's life and health.”
D) “Having a holistic approach to care means that you have to set aside things like theories, models, and frameworks.”
Ans: A
Feedback:
The eclectic approach is an individualized style that incorporates the client's own resources as a unique person with the most suitable theoretical model. The emphasis in this approach is on the uniqueness of clients and nurses. This does not, however,
A)
B)
C)
D) Ans:
A)
B)
C)
D) Ans:
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1.It is important for psychiatric–mental health nurses to understand the basis of the various religious beliefs of their clients due to which of the following?
A) Clients who are religious always have delusions about their specific religious beliefs.
B) Clients' religious beliefs often influence their approach to mental health care and mental illness.
C) Religion is an important tool to use to get the patient to be compliant with psychiatric medications.
D) Psychiatric–mental health nurses have their own strong religious beliefs that may interfere with those of their clients.
Ans: B
Feedback:
Clients' religious beliefs, which are part of their culture, often do influence their views of mental health care and mental illness. The other options are not always true.
2.Researchers have found that when individuals are members of a minority group, they often experience all of the following except what?
A) Prejudice
B) Integration
C) Dislocation
D) Cultural isolation
Ans: B
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Feedback:
Members of minority groups rarely feel integrated into the mainstream culture. Rather, they experience prejudice, dislocation and change, and cultural isolation more often than not.
3.The mental health nurse is interviewing a client of Asian descent regarding his health care practices. The nurse understands that cultural competence is important in the care of this client. Cultural competence in health care can be best described as what?
A) Striving to achieve the ability to work within the cultural context of an individual or community from a diverse cultural or ethnic background
B) Knowing the characteristics of each individual cultural group in America
C) A combination of a person's beliefs about cultural values and knowledge about his or her own culture
D) The patient's ability to tell the health care provider about his or her cultural beliefs and practices
Ans: A
Feedback:
Cultural competence involves the desire and attempt by health care workers to learn about and work within the cultural context of the client from a diverse cultural or ethnic background.
4.Which action is most effective in assisting the nurse to provide culturally competent care?
A) Encouraging acculturation of non-American groups
B) Working with only one cultural group so you can get to know them more intimately
C) Reinforcing segregation
D) Identifying one's own biases and feelings about different cultural groups
Ans: D
Feedback:
It is most effective to identify your biases and feelings about different cultures so that you can be aware of the ideas you might bring into the nurse–client relationship.
5.Asian and African American clients may require lower lithium doses due to lower concentrations of a plasma protein that is known to bind lithium. This phenomenon is an example of what?
A) Ethnopharmacology
B) Pharmacotherapy with ethnic groups
C) Metabopharmacology
D) Ethnicity in pharmacometabolism
Ans: A
Feedback:
Ethnopharmacology is an emerging field of science that explores the relationship of ethnicity to drug metabolism and drug effectiveness.
6.Children learn cultural characteristics as they associate with others. Which of the following entities has the most profound influence on the development of traditional values and practices?
A) Community
B) Church
C) Family
D) School
Ans: C
Feedback:
Children acculturate more quickly than adults as they are exposed to other cultures through schooling. They also learn cultural characteristics as they associate with others. The family has the first and most profound influence on the development of traditional values and practices.
7.The major difference between spirituality and religion encompasses which of the following?
A) Spirituality is one's desire to create meaning in the world.
B) Religion refers to shared beliefs, values, and behavior norms.
C) Spirituality is a personality quality that strives for purpose in life.
D) Religion refers to a way of thinking and behaving that is superior to others.
Ans: C
Feedback:
Spirituality, which goes beyond religion and religious affiliation, is a personal quality that strives for inspiration, reverence, awe, meaning, and purpose in life. Religion is an organized system of beliefs and practices that focus on a higher power that governs the universe.
8.A Native American client is requesting that a medicine man be present during his inpatient hospitalization, a request that the nurse has helped to facilitate. The nurse is functioning within which of the following nursing care modes as described by Leininger?
A) Culture care administration/management
B) Culture care accommodation/negotiation
C) Culture care repatterning/restructuring
D) Culture care preservation/maintenance
Ans: B
Feedback:
In this situation, the nurse is functioning within the culture care
accommodation/negotiation nursing care mode. The nurse adapts nursing care to accommodate the client's beliefs or negotiate aspects of care that would require the client to change certain practices. If rituals and other spiritually focused activities are important to the client, clinicians must respect and work with, not against, this philosophy.
9.Ethnocentrism can be counteracted by the nurse's use of which of the following practices?
A) Self-disclosure
B) Self-discipline
C) Self-esteem
D) Self-analysis
Ans: D
Feedback:
Ethnocentrism, or the tendency to believe that one's own way of thinking, believing, and behaving is superior to that of others, is counteracted by the nurse's use of self-analysis. The other answers are not applicable as a counteraction to ethnocentrism.
10.The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which of the following cultures?
A) Indian
B) American Indian
C) West African
D) Chinese
Ans: B
Feedback:
The culture-bound syndrome of ghost sickness is seen in the American Indian tribal
culture. This culture exhibits a preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur. The other options are not related to the culture-bound syndrome of ghost sickness.
11.Mr. Sangha emigrated from India 20 years ago and sponsored his father and mother to come to the United States 14 years ago. One of Mr. Sangha's major stressors is liaising between his children, who have become “Americanized,” and his parents, who have been minimally influenced by American culture. What term best describes this process of cultural change and adaptation?
A) Transculturalization
B) Cultural shift
C) Acculturation
D) Ethnodynamism
Ans: C
Feedback:
Acculturation is described as the ways in which individuals and cultural groups adapt and change over time.
12.After experiencing a severe gastrointestinal bleed, Mr. Dupont's physician has ordered a transfusion of packed red blood cells. Mr. Dupont is anxious to restore his health, but the teachings of his church categorically prohibit the transfusion of blood products. The nurse should recognize that Mr. Dupont is at risk for what?
A) Spiritual distress
B) Impaired religiosity
C) Ethnopharmacology
D) Conflicted spirituality
Ans: A
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Feedback:
Spiritual distress is described as the state in which an individual or group experiences, or is at risk of experiencing, a disturbance in the belief or value system that provides strength, hope, and meaning to life. This can be treatment related, as when an intervention conflicts with the tenets of a religious group.
13.The nurse should anticipate that an individual's culture will have the most significant influence on which of the following situations?
A) Mr. Tan's physician has prescribed a new antipsychotic medication.
B) Mrs. Al-Aziz has begun grieving because her husband of several decades has just died.
C) Mrs. Ramos will soon begin electroconvulsive therapy for the treatment of her depression.
D) Stephen, a client with schizophrenia, has begun a new class on life skills.
Ans: B
Feedback:
Culture has a profound impact on nearly every aspect of the human experience, but this is especially true in the expression of belief. Ethnopharmacology demonstrates that there are differences in medication responses, but this effect is less influential than the effect of culture on grieving.
14.Jill is scheduled to begin a clinical rotation at an outpatient mental health clinic that is in a neighborhood with a large number of Asian residents. Since Jill does not share this cultural background with her potential clients, how should she begin to promote her own cultural sensitivity?
A) Reflect on, analyze, and foster awareness of her own culture
B) Ask to be paired with a classmate who is of Asian descent
C) Do research on the differences between her own culture and that of her future clients
D) Expose herself to as many different cultures as possible before her rotation begins
Ans: A
Feedback:
Introspection and self-analysis regarding one's own cultural background and membership in particular subcultures are important. Cultural sensitivity requires the nurse to develop awareness of his or her attitudes, beliefs, values, and communication style. This is a more effective starting place than researching or exploring other cultures prior to developing self-awareness.
15.A nurse is aware that members of a particular ethnic group discard the antibody-rich colostrum that a woman produces in the hours and days following the delivery of a baby. Which of the nurse's following actions would demonstrate Leininger's culturally congruent nursing care mode of cultural care repatterning/restructuring?
A) Providing commercial infant formula until the woman wishes to begin breastfeeding
B) Teaching women from this group about the nutritional and immunological benefits of colostrum
C) Ensuring that the other nurses are aware of these women's practices around breastfeeding
D) Advocating for the utilization of this practice among women of other cultures
Ans: B
Feedback:
In cultural care repatterning/restructuring, the nurse educates the client to change practices that are not conducive to health. Accommodating the practice or advocating its spread does not exemplify repatterning/restructuring.
16.An elderly patient in the hospital has not had a bowel movement for three days and the nurse planned to give him a stool softener this morning. The patient declined the medication, however, stating that his wife will be bringing him a herbal medication later in the day that is often used by members of his ethnic group. Which of the following reactions demonstrates cultural care accommodation/negotiation?
A) Documenting the patient's wishes and informing the patient's physician of what he will be taking
B) Teaching the patient about the risks associated with nonstandard doses of herbal remedies
C) Teaching the patient about the benefits of the medication that was ordered for him
D) Ensuring that the herbs are sent to the hospital pharmacy for clearance before he is allowed to take them
Ans: A
Feedback:
In cultural care accommodation/negotiation, the nurse adapts nursing care to accommodate the client's beliefs or negotiate aspects of care that would require the client to change certain practices. Attempting to alter the patient's practice is associated with repatterning/restructuring, and confiscating the herbs is likely not a culturally congruent act, unless they were known to constitute a serious threat to health.
17.Which of the following ethnic groups is considered to be the least sociocentric?
A) Asian
B) European American
C) Hispanic
D) African
Ans: B
Feedback:
European American middle-class culture is primarily individualistic, emphasizing freedom of choice and personal responsibility. However, Hispanic, Asian, and African traditions are more sociocentric, emphasizing balance and cooperation over individualistic concerns.
18.Members of a particular East Asian ethnic group are known to be poor drug metabolizers.
This puts members of this group at risk for what?
A) Decreased therapeutic effect
B) Paradoxical drug effects
C) Adverse drug effects
D) Increased drug resistance
Ans: C
Feedback:
People who are poor drug metabolizers have an increased risk of experiencing adverse drug effects by virtue of decreased enzyme activity.
19.A hospital client's family has approached the nurse and explained that the client would like a healer from his ethnic group to visit him. How should the nurse follow up this request?
A) Facilitate a visit by the healer
B)
C)
D) Ans:
A)
B)
C)
D) Ans:
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1.A client undergoing a colonoscopy tomorrow is receiving preoperative teaching regarding the procedure. Which of the following nursing tasks best describes the explanation of the procedure and the associated risks and benefits?
A) Ascertaining the client's privacy
B) Acquiring informed consent
C) Encouraging the client to be self-determined
D) Acting in a beneficent manner
Ans: B
Feedback:
Informing the client of the risks and benefits of a procedure is best described as obtaining informed consent. Informed consent involves the client's right of self-decision. Client privacy is defined as the right to be left alone and free from intrusion or control by the health care providers. Self-determination allows the client to indicate what treatments he would accept or refuse. Acting in a beneficent manner encompasses doing good acts by the nurse.
2.A client has just been explained the reason that he must undergo an MRI. When the nurse asks the client if he understands the teaching, he correctly describes what has been said to him. The client is said to be what?
A) Logical
B) Congruent
C) Competent
D) Autonomous
Ans: C
Feedback:
Competence involves the ability of the client to understand and make decisions based on information given.
3.When promoting client safety on an inpatient psychiatric unit, which of the following interventions would be used as the measure of last resort?
A) Surveillance
B) Seclusion
C) Room restriction
D) Four-point restraint
Ans: D
Feedback:
Four-point restraint is the most restrictive of the interventions mentioned above, with surveillance being the least. When promoting safety, the method of last resort would be the most restrictive measure.
4.An 86-year-old male admitted for appendectomy is being discharged to a nursing care facility. He has been diagnosed with depression during this hospitalization. According to the Omnibus Reconciliation Act (OBRA), regarding placement of clients in long-term
care (LTC) facilities, which of the following statements is accurate?
A) He may be placed into an LTC facility if there is an open bed.
B) He must go home to recover prior to placement in an LTC facility.
C) He must be placed in an inpatient psychiatric–mental health acute care facility until his depression has resolved.
D) He may not be placed into a long-term nursing care facility at this time because he is diagnosed with a psychiatric disorder.
Ans: D
Feedback:
OBRA of 1987 stated that an LTC care facility must not admit, on or after January 1, 1989, any new resident needing active treatment for mental illness or mental retardation. A screening document called the Preadmission Screening and Annual Resident Review (PSARR) determines whether the client needs active psychiatric treatment.
5.The depressed client is deciding which type of treatment would be beneficial for him. The nurse would document that the patient is utilizing which of the following ethical principles in this situation?
A) Justice
B) Beneficence
C) Autonomy
D) Veracity
Ans: C
Feedback:
The American Nurses' Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment.
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