Diagnostic and Statistical Manual of Mental Disorders 5th Edition Test Bank

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Diagnostic and Statistical Manual of Mental DisordersTestbank/Study GuideChapter1 IntroductionMULTIPLE CHOICE1. Which understanding is the basis for the nursing actions focused on minimizing mental healthpromotion of families with chronically mentally ill members?a.Family members are at an increased risk for mental illness.b.The mental health care system is not prepared to deal with family crises.c.Family members are seldom prepared to cope with a chronically ill individual.d.The chronically mentally ill receive care best when delivered in a formal setting.ANS: AWhen families live with a dominant member who has a persistent and severe mental disorder theoutcomes are often expressed as family members who are at increased risk for physical andmental illnesses. The remaining options are not necessarily true.2. Which nursing activity shows the nurse actively engaged in the primary prevention of mentaldisorders?a.Providing a patient, whose depression is well managed, with medication on timeb.Making regular follow-up visits to a new mother at risk for post-partumdepressionc.Providing the family of a patient, diagnosed with depression, information onsuicide preventiond.Assisting a patient who has obsessive compulsive tendencies prepare andpractice for a job interviewANS: B

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Primary prevention helps to reduce the occurrence of mental disorders by staying involved with apatient. Providing medication and information on existing illnesses are examples of secondaryprevention which helps to reduce the prevalence of mental disorders. Assisting a mentally illpatient with preparation for a job interview is tertiary prevention since it involves rehabilitation.3. Which intervention reflects attention being focused on the patients intentions regarding hisdiagnosis of severe depression?a.Being placed on suicide precautionsb.Encouraging visits by his family membersc.Receiving a combination of medications to address his emotional needsd.Being asked to decide where he will attend his prescribed therapy sessionsANS: DA primary factor in patient treatment includes consideration of the patients intentions regardinghis or her own care. Patients are central to the process that determines their care as their abilitiesallow. Underthe guidance of PMH nurses and other mental health personnel, patients areencouraged to make decisions and to actively engage in their own treatment plans to meet theirneeds. The remaining options are focused on specifics of the determined plan of care.4. When a patients family asks why their chronically mentally ill adult child is being dischargedto a community-based living facility, the nurse responds:a.It is a way to meet the need for social support.b.It is too expensive to keep stabilized patients in acute care settings.c.This type of facility will provide the specialized care that is needed.d.Being out in the community will help provide hope and purpose for living.ANS: DHospitalization may be necessary for acute care, but, when patients are stabilized, they move intocommunity-based, patient-centered settings or are discharged home with continued outpatient

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treatment in the community. Concentrated efforts are made to reduce the patients sick role byproviding opportunities for the development of a purposeful life and instilling hope for eachpatients future. Although social support is important, such a living arrangement is not the onlyway to achieve it. Although acute care is expensive, it is not the major concern when determininglong-term care options. Community-based facilities are not the only option for specialized care.5. What is the best explanation to offer when the mother of a chronically ill teenage patient asks,Under what circumstances would he be considered incompetent?a.When you can provide the court with enough evidence to show that he is notable to care for himself safely.b.It is not likely that someone his age would be determined to be incompetentregardless of his mental condition.c.He would have to engage inbehavior that would result in harm to himself or tosomeone else; like you or his siblings.d.If the illness becomes so severe that his judgment is impaired to the point wherethe decisions he makes are harmful to himself or to others.ANS: DWhen a person is unable to cognitively process information or to make decisions about his or herown welfare, the person may be determined to be mentally incompetent. Providing self-care isnot the only criteria considered. Age is not a factor considered. The decision is often based onthe potential for such behavior.6. Which psychiatric nursing intervention shows an understanding of integrated care?a.A chronically abused woman is assessed for anxiety.b.A manic patient is taken to the gym to use the exercise equipment.c.The older adult diagnosed with depression is monitored for suicidal ideations.d.A teenager who refuses to obey the units rules is not allow to play video games.ANS: A

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The majority of health disciplines now recognize that mental disordersand physical illnesses areclosely linked. The presence of a mental disorder increases the risk for the development ofphysical illnesses and vice versa. Assessing a chronically abused individual for anxiety callshould attention to the psychiatric disorder that could develop from the abuse. The remainingoptions show interventions that are appropriate for the mental disorder.7. What reason does the nurse give the patient for the emphasis and attention being paid to therecovery phase of their treatment plan?a.Recovery care, even when intensive, is less expensive than acute psychiatriccare.b.Effective recovery care is likely to result in fewer relapses and subsequenthospitalizations.c.Planning for recovery care is time consuming and involves dealing with manycomplicated details.d.Recovery care is usually done on an outpatient basis and so is generally betteraccepted by patients.ANS: BMuch attention is paid to recovery care since effective recovery care helps improve patientoutcomes and thus minimize subsequent hospitalizations. Recovery care is not necessarily lessexpensive than acute care. Although effective recovery care planning may be time consumingand detail oriented, that is not the reason for implementing it. Recovery care is notnecessarilywell accepted by patients.8. The nurse is attending a neighborhood meeting where a half-way house is being proposed forthe neighborhood when a member of the community states, We dont want the facility; weespecially dont want violent people living near us. The response by the nurse that best addressesthe publics concern is:a.In truth, most individuals with psychiatric disorder are passive and withdrawnand pose little threat to those around them.b.The mentally ill seldom behave in the manner they are portrayed by movies; theyare people just like the rest of us.

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c.Patients with psychiatric disorder are so well medicated that they do not displayviolent behaviors.d.The mentally ill deserve a safe, comfortable place to live among people whotruly care for them.ANS: AA major reason for the existence of the stigma placed on persons with mental illness is lack ofknowledge. The main fear is of violence, although only a small percentage of patients withmental illness display this behavior. Providing the public with accurate information can helpreduce stigma. The remaining options do not directly address the concerns stated.9. Which activity shows that a therapeutic alliance has been established between the nurse andpatient?a.The nurse respects the patients right to privacy when visitors are spending timewith the patient.b.The patient is eagerly attending all group sessions and working independently onidentifying their personal stressors.c.The patient is freely describing their feelings related to the physical andemotional trauma they experienced as a child with the nurse.d.The nurse dutifully administers the patients medications on time and withappropriate knowledge of the potential side effects.ANS: CA primary aspectof working with patients in any setting and particularly in the psychiatricsetting is the development of a therapeutic alliance with the patient. Such an alliance isestablished on trust. It is a professional bond between the nurse and the patient that serves as avehicle for patients to freely discuss their needs and problems in the absence of the nursescriticism or judgment. Any nurse has an obligation to respect the patients rights and administercare effectively. The patients willingness to participate in the plan of care reflects selfmotivation.

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10. Mental health care reform has called for parity between psychiatric and medical diagnoses.Which is an example of such parity?a.Depression treatment is not paid for as readily as is treatment for asthma.b.The mentally ill patient will be protected by law against social stigma.c.Medical practitioners are trained to be proficient at treating mental disorders.d.Psychiatric service reimbursement will be equivalent to that of medical services.ANS:DThe termparityas used here refers to payments for mental health services that equal paymentschedules for medical or surgical conditions. The remaining options(B and C) do not relate tofinancial reimbursement or funds allocated for mental health carebeing equal to those of medicaldiagnoses.MULTIPLE RESPONSE1. Which assessment findings suggest to the nurse that this patient has characteristics seen in anindividual who has reached self-actualization? Select all that apply.a.Reports to have, foundpeace and security in my religious faithb.Effectively changed occupations when a chronic vision problem worsenedc.Has consistently earned a six-figure salary as an architect for the last 10 yearsd.Has been in a supportive, loving relationship withthe same individual for 15yearse.Provides free literacy tutoring help at the local homeless shelter 3 evenings aweekANS: A, B, D, ECharacteristics of self actualization would include: spiritual well-being, openand flexible, relationally fulfilled, and generosity toward others. Salary doesnt necessarily reflectself-actualization.2. Which nursing activities represent the tertiary level of mental health care? Select all thatapply.

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a.Providing a depression screening at a local collegeb.Helpinga mental-challenged patient learn to make correct changec.Reporting an incidence of possible elder abuse to the appropriate legal agencyd.Regularly assessing a patients understanding of their prescribed antidepressantse.Providing a 6-week parenting class to teenage parents through a local highschoolANS: B, DTertiary prevention reduces the residual effects of the disorder such as depression andmental retardation. There is no quaternary level of prevention. Primary prevention reducesoccurrencesof mental disorders such as screenings and parenting classes, and secondaryprevention reduces the prevalence of disorders as evidenced by assessing knowledge.3. Which nursing actions indicate an understanding of the priority issues currently facingpsychiatric mental health nursing today? Select all that apply.a.Working on the facilitys Safe Use of Restraints Policy revision committeeb.Advocating for increased salaries for all levels of psychiatric mental healthnursesc.Attending a political rally for increased state funding for mental health serviceprovidersd.Offering an in-service to facility staff regarding the cultural implications ofcaring for the Hispanic patiente.Joining the state nursing committee working on the role and scope of practice ofthe advanced practice psychiatric nurseANS: A, C, D, EPriority issues include funding, safety issues in psychiatric treatmentcentersparticularly the use of patient restraints, quality-of-care issues, access to health care forminority populations, and standardization of advanced practice nurse roles.4. Which assessment findings describe risk factors that increase the potential risk for mentalillness? Select all that apply.a.Possesses high tolerance for stress

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b.Is very curious about howthings workc.Admits to being a member of an ethnic gangd.Only practicing Jew among school classmatese.Has a younger sibling who is mentally challengedANS: C, D, ERisk factors are internal predisposing characteristics and external influences thatincrease a persons vulnerability and potential for developing mental disorders. Types of riskfactors and examples include the following: having a mentally-challenged family member in thehome; belonging to a punitive gang; and being the object of reject or bullying. The remainingoptions are protective factors.5. Which nursing actions show a focus on the fundamental goals that guide psychiatric mentalhealth nurses in providing patient care? Select all that apply.a.Offering an informational session of identifying signs of depression at a localsenior centerb.Attending a workshop on evidence practice interventions for the chronicallydepressed patientc.Keeping strict but appropriate boundaries with a patient diagnosed with apersonality disorderd.Asking a parent who has just experienced the death of a child if they couldconsider talking with a grief counselore.Identifying what help a patient diagnosed with Alzheimers disease will needwith instrumental activities of daily living (IADLs)ANS: A, B, D, EStandard objectives guide PMH nurses and members of related disciplines inthe care of patients (individuals, families, communities, and organizations). The objectives andcriteria are as follows: the promotion and protection of mental health, the prevention of mentaldisorders, the treatment of mental disorders, and recovery and rehabilitation. Keepingappropriate boundaries is a generalized nursing responsibility.

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Chapter2 Use of the Manual1.What are the 5 different dimension of the DSM Manual that were removed?ANS. The DSM-IV-TR described disorders using five different dimensions.Axis I: Clinical SyndromesThis axis describedclinical symptomsthat cause significant impairment. Disorders weregrouped into different categories such as mood disorders,anxiety disorders, or eatingdisorders.Axis II: Personality and Mental RetardationThis axis described long-term problems in functioning that were not considered discreteAxis I disorders.Personality disorderscause significant problems in how a patient relatesto the world and includeantisocial personality disorderandhistrionic personality disorder.Mental retardation is characterized by intellectual impairment and deficits in other areassuch as self-care and interpersonal skills.Axis III: Medical ConditionsThese included physical and medical conditions that influence or worsen Axis 1 and AxisII disorders. Some examples include HIV/AIDS and brain injuries.Axis IV: Psychosocial and Environmental ProblemsAny social or environmental problems that may impact Axis I or Axis II disorders wereaccounted for in this axis. These include such things as unemployment, relocation, divorce,or the death of a loved one.Axis V: Global Assessment of FunctioningThis axis allowed the clinician to rate the client's overall level of functioning. Based on thisassessment, clinicians could better understand how the other four axes interacted and theeffect on the individual's life.2.Which of the following did not change in new DSM-5?Answer: C.The diagnostic model for personality disordersRationale: Despite multiple proposed categorical or dimensional changes, only a few wereadoptedinthefinalversionofDSM-5One of the major proposals rejected was the revision ofthe hybrid categorical-dimensionalmodel forpersonality disorders. Implementation of this proposed new model by October2014 would probably have imposed significant burden on clinical practice and the researchcommunity and would have required a revision of academic curricula for residencyprogramsand clinical practice guidelines Instead, this model was included in Section IIIfor further research.

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3.A 7-year-old boy in second grade displays significant delays in his ability to reason,problem-solve, and learn from his experiences. He has been slowto develop reading,writing, and mathematics skills in school. All through development, these skills laggedbehind peers’, though he is making slow progress. These deficits significantly impair hisability to play in an age-appropriate manner with peers and to begin to acquire independentskills at home. He requires ongoing assistance with basic skills (dressing, feeding, andbathing himself, doing any type of schoolwork) on a daily basis. Which DSM-5 diagnosisbest fits this boy?a) child onset major neurocognitive disorderb) specific learning disorderc) intellectual development disorder, moderated) communication disordere) autistic spectrum disorderCorrect Answer: C. intellectual development disorder, moderate Rationale: Although IQtestingwould be informative (in previous DSM classifications, subtypes of mild, moderate,severe, and profound were categories based on IQ scores), DSM-5 specifies, “Severity isbased on adaptive functioning, not on IQ scores, and reflects limitations in adaptivefunctioning that originate from the intellectual disability.” Thus, the specifiers of “mild,”“moderate,” “severe,” and “profound” relate to adaptive functioning, not IQ. Adaptivefunctioning involves adaptive reasoning in three domains: conceptual, social, and practical.The conceptual (academic) domain involves competence in memory, language, reading,writing, math reasoning, acquisitionof practical knowledge, problemsolving,andjudgment in novel situations, among others. The social domain involves awareness ofothers’ thoughts, feelings, and experiences, empathy, interpersonal communication skills,friendship abilities, and social judgment, among others. The practical domain involveslearningandselfmanagementacrosslifesettings,includingpersonalcare,jobresponsibilities, money management, recreation, managing one’s behavior, and organizingschool and work tasks, among others. Assessment is based on both clinical assessment andstandardized testing. With respect to severity, the “moderate” qualifier reflects skills thathave chronically lagged behind peers and the need for assistance in most activities of dailyliving, but the fact that the child is slowly developing these skills (which would peak atroughly the elementary school level according to DSM-5). In specific learning disordersand communication disorders, there is no general intellectual impairment.4.A 7-year-old girl presents with a history of normal language skills (vocabulary andgrammar intact) but is unable to use language in asocially pragmatic manner to share ideasand feelings. She has never made good eye contact and has difficulty reading social cues.Consequently, she has had difficulty making friends, which is further complicated by herbeing somewhat obsessed with cartooncharacters, which she repetitively scripts. She tendsto excessively smell objects and it is difficult for her to get dressed, as she insists onwearing the same shirt and shorts every day, regardless of the season. These symptomshave dated from early childhood and cause significant impairment in her functioning.According to DSM5, what diagnosis would she receive?

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a) Asperger’s disorderb) autism spectrum disorderc) pervasive developmental disorder NOSd) social communicationdisordere) Rett syndromeCorrect Answer: B. autism spectrum disorder Rationale: This child might have met criteriafor Asperger’s or PDD NOS in DSM-IV. Autism spectrum disorder in DSM-5 subsumedAsperger’s disorder and PDD NOS. Although she has intactformal language skills, “it isthe use of language for social communication that is particularly affected in autisticspectrum disorder.” A specific language delay is not required. She meets all threecomponents of Criteria A (deficits in social-emotionalreciprocity, deficits in nonverbalcommunication behaviors used for social interaction, and deficits in developing andmaintaining friendships) and two components of Criteria B (highly restricted, fixatedinterests that are abnormal in intensity or focus;and hyper-or hypo-reactivity to sensoryinput or unusual interest in sensory aspects of environment.5.A 52-year-old man presents to a psychiatrist on the advice of his primary care doctor withraw, chafed hands. He reports that he washes at least fourhours a day, using abrasive cleansersand scalding hot water. Although he admits his hands are uncomfortable, he is entirelyconvinced that unless he washes in this manner, he will become gravely ill. Outside of hishands, a medical workup is unrevealing,and he takes no medications. Which of the followingis the most appropriate diagnosis for this man?a)delusional disorder, somatic typeb)illness anxiety disorderc)c)obsessive-compulsive disorder with absent insightd)d)obsessive-compulsive personality disordere)e)generalized anxiety disorderCorrect Answer: C. obsessive-compulsive disorder with absent insight Rationale: DSM-5 hasaddedaninsightspecifiertothediagnosisofobsessive-compulsivedisorder(OCD)toacknowledge that persons with the disorder can range from having good insight into theirrationality of their behaviors to persons who have no insight (that is, are delusional). In DSM-5if the delusional belief is limited to the obsessions and compulsions, a separate psychotic disorderdiagnosis isnot required. Individuals with illness anxiety disorder worry about having an illness;however, they do not have the classic obsessions and compulsions found in OCD. Individuals withgeneralized anxiety disorder may constantly worry; however, their worries are usually about real-life concerns.6.A 19-year-old woman is referred to a psychiatrist by her internist after she admits to him thatshe repetitively pulls at her eyebrows to the point that she has scarring and has little or no eyebrowhair. She confides that her normal eyebrows look repulsive to her: she sees them as too bushy,

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saying that she “looks like a caveman.” Pictures of her prior to the hair pulling show a normallooking teenager. Which of the following is the most likely diagnosis?a)hairpulling disorder (trichotillomania)b)body dysmorphic disorderc)delusional disorder, somatic typed)normal age appropriate appearance concernse)obsessive-compulsive disorderCorrect Answer: B. body dysmorphic disorder Rationale: There can be a variety of causes for hairpulling. Individuals with hair pulling disorder (trichotillomania) pull hair out of anxiety orboredom; the behavior provides distraction, pleasure, or a relief from anxiety. When hair pullingis purely for the purpose of improving aperceived defect in appearance, the behavior is betterconceptualized as symptomatic of a body dysmorphic disorder (BDD).7. Which of the following is new in DSM-5 for the diagnosis of ODD?a) Categorization of ODD symptomsb) Failure to resist an impulse, drive, or temptation to perform an act that is harmful to the personor to othersc) The individual feels an increasing sense of tension or arousal before the act, pleasure,gratification, or relief during the actd) The individual experiences a sense of relief from the urge after the acte) Premeditation of the actCorrect Answer: A. Categorization of ODD symptoms. Rationale: DSM-5 has instituted a newcategorization of ODD symptoms that groups together symptoms based on whether they have anemotionalcomponent (for example, angry, irritable, resentful), a behavioral element (for example,argumentative, defiant), or a spiteful/ vindictive aspect to them. This classification structure isimportant because recent research suggests that the emotional symptoms are linked to thedevelopment of future mood and anxiety disorders and spiteful and vindictive behaviors arepredictive of conduct disorder and delinquent behaviors.8. Which disorder is most commonly comorbid with ODD?a) ADHD b) Mood disorderc)Conduct disorderd) Bipolar disordere) Learning disordersCorrect Answer: A. ADHD Rationale: The most common disorderthat coexists with ODD is (ADHD, with comorbidity rates reportedly reaching up to 39%. Otherdisorders that frequently occur with ODDinclude anxiety and depressive disorders.

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9. A 21-year-old male with history of oppositional defiant disorder presents with frequentimpulsive behavioral outbursts that are grossly out of proportion to the stressor. He reports that heis unable to control himself and worried that he might lose his job if this behavior continues. Whatis his most likely diagnosis?a) Bipolar disorderb) ADHDc) Intermittent explosive disorderd) Conduct disordere) Adjustment disorderCorrect Answer: C. Intermittentexplosive disorder Rationale: The diagnosis of intermittentexplosive disorder can be made in older adolescents and young adults aged 18 or older in additionto the diagnosis of ADHD, oppositional defiant disorder, conduct disorder, or autistic spectrumdisorder when recurrent impulsive aggressive outbursts warrant independent clinical attention.

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Chapter3 Cautionary Statement for Forensic Use of DSM-51.How does the use of an established and widely accepted system of diagnosis add valueand reliability of determination of relevance of mental illness in legal uses?ANS. The use of an established and widely accepted system of diagnosis adds to the value andreliability of determinations of the relevance of a mental illness in three ways:1.Provides a compendium based on a review of the pertinent clinical and researchliterature and offers a possible understanding of the relevant characteristics of mentaldisorders2.The literature related to diagnoses serve to prevent ungrounded speculation aboutmental disorders and about the functioning of a particularindividual3.Diagnostic information about the course of an illness may improve decision makingwhen the legal issue concerns an individual’s mental functioning at a past or futurepoint in time.2.Can somone who is not trained on DSM-5 assess a presence of a mental disorder?ANS. The authors of DSM-5 say that it is “not advised” that nonclinical, nonmedical, orotherwise insufficiently trained individuals use DSM-5 to assess for the presence of a mentaldisorder. This clearly indicates that lawyers, attorneys, and/or other legal personnel who are notspecifically training regarding mental illness and diagnoses should not be using the manual.Further, those decision makers are cautioned that a diagnosis does not carry any implicationsabout the causes of the mental disorder, or the degree to which the individual might have controlover the behaviors that are associated with the disorder. It is noted that, even when a disorderdoes involve diminished capacity as a symptom, that factbyitself does not demonstrate that aspecific person did or did not have voluntary control of his/her behavior at a specifictime.3.Does a diagnosis of a mental illness imply that any legal criteria are met in thejudicialsystem?ANS.Itis noted that a diagnosis of a mental illness does not at all imply that any legal criteriaare met,such as competence, criminal responsibility, disability, etc.). Almost always, additionalcriteria would be necessary, along withspecialized clinical/forensic skills, in order to make theproper legal recommendation.Thiscouldincludeinformationaboutthe individual’sfunctional impairments and how those impairments affect the person’s specific abilities inquestion. These impairments often vary widely, even within a particular diagnostic. Theassignment of a specific diagnosis does not imply a specific level of impairment ordisability.

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Chapter4 Neurodevelopmental Disorders1. A patient with depression mentions to thenurse, My mother says depression is a chemicaldisorder. What does she mean? The nurses response is based on the theory that depressionprimarily involves which of the following neurotransmitters?a.Cortisol and GABAb.COMT and glutamatec.Monamine and glycined.Serotonin and norepinephrineANS: DOne possible cause of depression is thought to involve one or more neurotransmitters. Serotoninand norepinephrine have been found to be important in the regulation of depression. There is noresearch to support that the other options play a significant role in the development ofdepression.2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damage tothe Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis?a.Observing the patient pick up a spoonb.Asking the patient to recite the alphabetc.Monitoring the patients blood pressured.Comparing the patients grip strength in both handsANS: BAccidents or strokes that damage Brocas area mayresult in the inability to speak (i.e., motoraphasia). Fine motor skills, blood pressure control, and muscle strength are not controlled by theBroca area of the left frontal lobe.

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3. The patient diagnosed with schizophrenia asks why psychotropic medications are alwaysprescribed by the doctor. The nurses answer will be based on information that the therapeuticaction of psychotropic drugs is the result of their effect on:a.The temporal lobe; especially Wernickes areab.Dendrites and their ability totransmit electrical impulsesc.The regulation of neurotransmitters especially dopamined.The peripheral nervous system sensitivity to the psychotropic medicationsANS: CMedications used to treat psychiatric disorders operate in and around the synaptic cleft and haveaction at the neurotransmitter level, especially in the case of schizophrenia, on dopamine. TheWernickes area, dendrite function, or the sensitivity of the peripheral nervous system are notrelevant to either schizophrenia or psychotropicmedications.4. A student nurse mutters that it seems entirely unnecessary to have to struggle withunderstanding the anatomy and physiology of the neurologic system. The mentor would base aresponse on the understanding that it is:a.Necessary but generally for psychiatric nurses who focus primarily onbehavioral interventionsb.A complex undertaking that advance practice psychiatric nurses frequently usein their practicec.Important primarily for the nursing assessment of patients with braintraumacaused cognitive symptomsd.Necessary for planning psychiatric care for all patients especially thoseexperiencing psychiatric disordersANS: DNurses must understand that many symptoms of psychiatric disorders have a neurologic basis,although the symptoms are manifested behaviorally. This understanding facilitates effective careplanning. The foundation of knowledge is not used exclusively by advanced practice psychiatric

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nurses nor is it relevant for only behavior therapies or brain trauma since dealing with the resultsof normal and abnormal brain function is a responsibility of all nurses providing all types of careto the psychiatric patient.5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her chronicdepression? Whichresponse is supported by research data?a.Too much stress has been proven to cause all kinds of cancer.b.There have been no research studies done on stress and disease yet.c.Stress does cause the release of factors that suppress the immune system.d.There appears to be little connection between stress and diseases of the bodyANS: CResearch indicates that stress causes a release of corticotropin-releasing factors that suppress theimmune system. Studies indicate that psychiatric disorders such asmood disorders aresometimes associated with decreased functioning of the immune system. Research does notsupport a connection between many cancers and stress. There is a significant amount of researchabout stress and the body. Research has shown that there are some connections between stressand physical disease.6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitation needs.Of the aspects of functioning listed, which will the nurse identify as a focus of nursingintervention?a.Expression of emotionb.Detecting auditory stimulic.Receiving visual imagesd.Processing associationsANS: D

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The parietal lobe is responsible for associating and processing sensory information that allowsfor functions such as following directions on a map, reading a clock, dressing self, keepingappointments, and distinguishing right from left. Emotional expression is associated with frontallobe function. Detecting auditory stimuli is a temporal lobe function. Receiving visual images isrelated to occipital lobe function.7. At admission, the nurse learns that some time ago the patient had an infarct in the rightcerebral cortex. During assessment, the nurse would expect to find that the patient:a.Demonstrates major deficiencies inspeechb.Is unable to effectively hold a spoon in the left handc.Has difficulty explaining how to go about using the telephoned.Cannot use his right hand to shave himself or comb his own hairANS: BThe cerebral hemispheres are responsible for functions such as control of muscles. The righthemisphere mainly controls the motor and sensory functions on the left side of the body. Damageto the right side would result in impaired function on the left side of the body. The motor cortexcontrols voluntary motor activity. Brocas area controls motor speech. Cognitive functions areattributed to the association cortex. The right side of the bodys motor activity is controlled by theleft cerebral cortex.8. A patient with chronic schizophrenia had a strokeinvolving the hippocampus. The patient willbe discharged on low doses of haloperidol. The nurse will need to individualize the patientsmedication teaching by:a.Including the patients caregiver in the educationb.Being careful to stress the importanceof taking the medication as prescribedc.Providing the education at a time when the patient is emotionally calm andrelaxedd.Encouraging the patient to crush or dissolve the medication to help withswallowing

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ANS: AThe hippocampus plays a major role in short-term memory and, hence, in learning. Taking themedication as prescribed and providing the education at a time when the patient is calm andrelaxed is information or considerations that all patients should be given. The medication doesnot necessarily need to be crushed or dissolved since the stroke would not have caused difficultywith swallowing.9. The physician tells the nurse, The medication Im prescribing for the patient enhances the g-aminobutyric acid (GABA) system. Which patient behaviorwill provide evidence that themedication therapy is successful?a.The patient is actively involved in playing cards with other patients.b.The patient reports that, I dont feel as anxious as I did a couple of days ago.c.The patient reports that both auditory and visual hallucinations have decreased.d.The patient says that, I am much happier than before I came to the hospital.ANS: BGABA is the principle inhibitory neurotransmitter. The medication should provide an antianxietyeffect. Alertness,psychotic behaviors, and mood elevation are not generally affected by g-aminobutyric acid.10. The patients family asks whether a diagnosis of Parkinsons disease creates an increased riskfor any mental health issues. What question would the nurse ask toassess for such a comorbidcondition?a.Has your father exhibited any signs of depression?b.Does your father seem to experience mood swings?c.Have you noticed your father talking about seeing things you cant see?d.Is your dad preoccupied with behaviors that he needs to repeat over and over?ANS: A

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Serotonin and its close chemical relatives, dopamine and norepinephrine, are theneurotransmitters that are most widely involved in various forms of depression. Most researchersagree that the immediatecause of parkinsonism is a deficiency of dopamine and so a patient withParkinsons disease should be monitored for depression, The other mental health disorders(bipolar disorder, hallucinations, and obsessive compulsive disorder) have not been connectedtoParkinsons disease.11. Which explanation for the prescription of donepezil (Aricept) would the nurse provide for apatient in the early stage of Alzheimers disease?a.It will increase the metabolism of excess GABA.b.Excess dopamine will be prevented from attaching to receptor sites.c.Serotonin deficiency will be managed through a prolonged reuptake period.d.The acetylcholine deficiency will be managed by inhibiting cholinesterase.ANS: DDecreased levels of acetylcholine are thought to produce many of the behavioral symptoms ofAlzheimers disease. The inhibiting action the drug has on cholinesterase will slow down thebreakdown of acetylcholine and so delay the onset of symptoms. The other neurotransmitters(GABA, dopamine, and serotonin) arenot currently believed to play a role in Alzheimersdisease.12. There remains a stigma attached to psychiatric illnesses. The psychiatric nurse makes thegreatest impact on this sociological problem when:a.Providing educational programming for patientsand the publicb.Arranging for adequate and appropriate social support for the patientc.Assisting the patient to achieve the maximum level of independent functioningd.Regularly praising the patient for seeking and complying with appropriatetreatmentANS: A

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Much of the stigma attached to psychiatric illness is due to a lack of understanding of thebiologic basis of these disorders. Therefore, effective patient, family, and public teaching is animportant function of the role of the psychiatric mental health nurse. While the remainingoptions are appropriate, they are not directed towards eliminating social stigma but ratherempowering the patient.13. The wife of a patient with paranoid schizophrenia tells the nurse, Ive learned that myhusband hasseveral close relatives with the same disorder. Does this problem run in families?The response based on recent discoveries in the field of genetics would be:a.Your children should be monitored closely for the disorder.b.Research tends to support a familiar tendency to schizophrenia.c.There is no concrete evidence; it is just as likely a coincidence.d.Only bipolar disorder has been identified to have a genetic component.ANS: BFamilial tendencies appear with several psychiatric disorders including schizophrenia. Toinsinuate that the children are at such risk would not be supported by research.14. A patient whose symptoms of mild depression have been managed with antidepressants isconcerned about the affect of accepting a promotion that will require working the night shift.What will be the basis of the response the nurse gives to address the patients concern?a.The connection between a new job and possible depression does exist.b.The medication can be adjusted to manage any increase in depression.c.The interruption in normal wake-sleep patterns can influence mood disorders.d.The change in sleep routine can be managed with a healthy sleep hygieneroutine.ANS: CMany psychiatric and medical disorders occur more frequently or are exacerbated when sleeppatterns and biologic rhythms are disrupted. While the remaining options contain true

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information regarding the management of depression that is a result of sleep disruption, they donot effectively address the patients concern.15. The nurse is discouraged because the patient exhibiting negative symptoms of schizophreniahas shown no improvement with the planned interventions to reduce the symptoms. The mentorsremark that helps place the problem in perspective is:a.You arent responsible for the behavior of any other person.b.Patients can be perverse and cling to symptoms despite our efforts.c.Negative symptoms have been associated with genetic pathology.d.It will take several trail and error attempts to get the right combination care.ANS: CA complex disorder, such as schizophrenia, most likely has multiple contributing factors,including genetic predisposition, prenatal development, and the environment. Nurse frustrationcan be alleviated by helping the nurse realize that negative symptoms may be the result of actualbrain dysfunction, rather than psychologically determined behaviors; thus the remaining optionsare not appropriate since they do not address the complexity of the problem.MULTIPLE RESPONSE1. What assessment data would reinforce the diagnosis of temporal lobe injury in patient whoexperienced head trauma? Select all that apply.a.Inability to balance a checkbookb.Uncharacteristically aggressivec.Affect fluctuates dramaticallyd.Increased interest in sexual behaviorse.Difficulty remembering the names of family membersANS: C, D, E

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The temporal lobe is involved with memory as well as increased sexual focus and alteredemotional responses. Personality and intellectual function is not centered in the temporal lobe.2. A patient has begun experiencing dysfunction of the hypothalamus. What nursinginterventions will the nurse include in the patients plan of care? Select all that apply.a.Reinforcing clear physical boundariesb.Assisting the patient with completing daily menusc.Learning about healthy sleep hygiene habitsd.Monitoring and recording temperature every 4 hourse.Monitoring and recording blood pressure every 4 hoursANS: B, C, DThe hypothalamus is responsible for regulation of sleep-rest patterns, body temperature, andphysical drives of hunger. Social appropriateness and blood pressure is not controlled by thehypothalamus.3. The nurse is preparing a patient for a positron emission tomography (PET) scan. Whichinstructions will the nurse include? Select all that apply.a.There will likely be a 30 to 45 minute wait between the injection and thebeginning of the scan.b.A blindfold and earplugs may be used to help decrease reaction to theenvironment during the scan.c.Make every attempt to lie still during the scan because movement will affect theimaging produced.d.No food or fluids are to be ingested for at least 8 full hours before the scan andnone during the scan.e.Staying awake during the scan is important since the results are altered when thepatient is in any phase of the sleep state.ANS: A, B, C, E

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Appropriate patient preparation for a PET scan would include information regarding the timeinterval between injection of the isotope and the actual scan, the fact that steps will be taken tominimize the effects of sights and sounds during the scan, lying still is critical to achieving aquality image, and that being asleep during the scan will alter the results. It is not necessary tofast before or during the scan.4. Apatient with schizophrenia is described as having difficulty with executive functions. Whatpatient dysfunction can the nurse expect to assess behaviorally? Select all that apply.a.Invades the personal space of others frequentlyb.Consistently fails tobring money when going to buy snacksc.Cannot remember the names of staff who often provide cared.Requires repeated reinforcement on how to make a sandwiche.Frequently speaks of hurting himself or of hurting other patientsANS: A, B, DExecutivefunctions include reasoning, planning, prioritizing, sequencing behavior, insight,flexibility, judgment, focusing on tasks, responding to social cues, and attending in appropriateways to incoming stimuli. Memory is not considered an executive function and risk for harm toself and others is not generally a diagnosis appropriate for such a patient.5. The unit physicians have ordered magnetic resonance imaging (MRI) tests for the followingpatients. For which patients would the nurse decline to make test arrangements without furtherdiscussion with the physician? Select all that apply.a.A patient who is claustrophobicb.A patient who is breastfeedingc.A patient who has an allergy to iodined.A patient who had a total knee replacemente.A patientwho is taking a neuroleptic medication

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ANS: A, DPatients with claustrophobia are often unable to complete this type of study, because the MRImachine is enclosed, and patients are required to remain motionless. Metal implants arecontraindications for MRIs since metal affects the scan. Breastfeeding, iodine sensitivity, andneuroleptic medication therapy are not contraindications for an MRI.

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Chapter5Schizophrenia Spectrum and Other Psychotic DisordersMultiple ChoiceIdentify the choice that best completes the statement or answers the question.____ 1. Your patient reports a hallucination where he is aware of strange smells that no one elseis aware of. What type of hallucination is this?A.OlfactoryB.TactileC.GustatoryD.Auditory____ 2. You are asked to report any extrapyramidal symptoms (EPSs) of your patient. Which ofthe following are examples of EPS?A.Dry mouth, anorexiaB.Heart palpitationsC.Muscle rigidity, tremorsD.Constipation, nausea____ 3. Which of the following is characteristic of a paranoid delusion?A.Suspicion and jealousyB.Self-pity and self-depreciationC.Making up words and phrasesD.Exposing beliefs of inflated self-importance____ 4. Your new patient is admitted witha diagnosis of schizophrenia. Which of the followingis he most likely to demonstrate?A.Concrete thinking

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B.Effective ego boundariesC.Inflated self-imageD.Fatigue and loss of appetite____ 5. When is schizophrenia most likely to be diagnosed?A.Grade schoolB.College ageC.After the birth of the first childD.After retirement____ 6. The schizophrenic patient tells you, I know that the man down the hall wants to kill me.How should you respond?A.I will protect you from him.B.What makes you say that?C.Lets walk over here to join in afternoon activities.D.You need to go to your room.____ 7. The statement made by the patient in question 6 is an example of a(n):A.Paranoid delusion.B.Visual hallucination.C.Idea of reference.D.Flight of ideas.____ 8. Your patient with schizophrenia who is English speaking says no acu moona to you.What is this called?A.NeologismB.Echolalia

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C.EchopraxiaD.Concretism____ 9. Which statement is most true about schizophrenia treatment today?A.Most require lifelong institutionalization.B.Patients can stop taking their antipsychotics once stabilized.C.Psycho-education for the family is part of the treatment plan.D.Most can function normally in society with little support after treatment for thefirst episode.____ 10. A young man with severe schizophrenia is being discharged home. Which of thefollowing medications would he most likely be taking?A.AmitriptylineB.Fluphenazine decanoateC.LithiumD.Lorazepam____ 11. Which of the following is not a positive sign of schizophrenia?A.HallucinationsB.AvolitionC.Flat affectD.Social withdrawal____ 12. Which of the following is not an atypical antipsychotic?A.AripiprozoleB.ClozarilC.Olanzapine

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D.Haloperidol____ 13. Your hospitalized schizophrenic patient has been taking clozapine (Clozaril) for severalmonths. You recognize this medication is effective by which of the following patient reports?A.He no longer has a memory of past psychotic behavior.B.He is drowsier, so less bothered by the hallucinations.C.He no longer hears voices.D.He is more uncomfortable around others.____ 14. Which of the following is most important to monitor for your patient on Clozaril?A.White blood cell countB.Clozaril blood levelC.Urine outputD.Vision____ 15. Your psychotic patient states my arms and legs are on fire. What would be yourbestresponse?A.Thats silly. There is nothing wrong with your legs.B.Does the fire travel from one side of your body to the other?C.That must be distressing. How do you stop it?D.I will get you some ice to put out the burning feeling.____ 16. Your schizophrenic patient is sitting in her room with her hands over her ears andcrying. Which is the best way toapproach her?A.Take her hands away from her ears and hold her hands in a sympathetic manner.B.Leave her alone as she most likely wants privacy.C.Make eye contact with her and ask her what is going on.

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D.Leave the room and call the charge nurse to determine if she needs anadjustment in her medication.____ 17. Later in the day you find this patient standing in the lounge in a strange position: on oneleg with both arms extended. How should you respond?A.Ignore the behavior, as this must be something she needs to do.B.Tell the patient sternly that this is not appropriate and to move to her room.C.Calmly acknowledge the position and ask the patient to stand on both legs.D.Encourage other patients in the lounge to do the same position tomake thepatient more comfortable.____ 18. Which of the following medications would this schizophrenic patient beleastlikely tohave prescribed?A.FluphenazineB.CarbamazepineC.OlanzapineD.Quetiapine____ 19. This schizophrenic patient has been taking Prolixin for 6 months. She now isexperiencing extrapyramidal symptoms (EPS). Which medication is most likely to be added?A.Acetaminophen (Tylenol)B.Alprazolam (Xanax)C.Benztropine (Cogentin)D.Amitriptyline (Elavil)____ 20. Which ofthe following side effects is most common with olanzapine?A.Weight gainB.Orthostatic hypotension

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