Test Bank For Principles of Anatomy and Physiology, 15th Edition

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Chapter 01: Me, Meds, MilieuMULTIPLE CHOICE1.Select the best description of nursing practice in the psychiatric setting.a.The nurse primarily serves in a supportive role to other members of the team.b.The multidisciplinary approach eliminates the need to clearly define theresponsibilities of nursing.c.Clearly differentiated nursing actions have been identified that distinguish nursingfrom other professions.d.Although professional role overlap exists, nursing offers unique contributions topsychotherapeutic management.ANS:DProfessional role overlap cannot be denied; however, nursing is unique in its focus on andapplication of psychotherapeutic management. Psychiatric social workers do not haveexpertise in physical care. Ideally, all team members support each other.DIF:Cognitive level: ApplyingREF:p. 3TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment2.The primary element required to match individual patient needs with appropriate services isproper:a.planning.b.evaluation.c.assessment.d.implementation.ANS:CProper assessment is critical for being able to determine the appropriate level of services thatwill provide the patient with optimal care at the lowest cost. The decision tree for thecontinuum of care establishes this fact.DIF:Cognitive level: UnderstandingREF:p. 7TOP:Nursing process: AssessmentMSC: NCLEX: Safe, Effective Care Environment3.An adult with paranoid schizophrenia is hospitalized. This patient has frequent auditoryhallucinations and walks about the unit, muttering. To use psychotherapeutic managementeffectively, it is most important for the nurse to:a.understand the disease process of schizophrenia.b.minimize contact between this patient and other patients.c.administer PRN medication before interacting with the patient.d.use behavior modification to decrease the frequency of hallucinations.ANS:A

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An understanding of psychopathology is the foundation on which the three components ofpsychotherapeutic management rest; it facilitates therapeutic communication and provides abasis for understanding psychopharmacology and milieu management. Minimizing contactbetween the patient and others and administering PRN medication indiscriminately arenontherapeutic interventions. Using behavior modification to decrease the frequency ofhallucinations would need to be incorporated into the plan of care.DIF:Cognitive level: ApplyingREF:pp. 1-2TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment4.A depressed adult is hospitalized after a suicide attempt. The patient receives anantidepressant medication, is closely supervised, attends a variety of group therapies andactivities, watches television during free time, and talks to visitors in the evening. Whichadditional intervention is needed in the patient’s care?a.Milieu therapyb.Adequate drug therapyc.Increased contact with significant othersd.Meaningful communication with nursing staffANS:DTwo of the three elements of psychotherapeutic management are present:psychopharmacology and milieu management. There is no evidence that thepsychotherapeutic nurse–patient relationship exists. Maintaining contact with significantothers is not considered an element of the psychotherapeutic management model.DIF:Cognitive level: ApplyingREF:pp. 1-2TOP:Nursing process: PlanningMSC: NCLEX: Psychosocial Integrity5.A patient attends outpatient programs at a community mental health center and meets with theprimary nurse regularly. Last week, the patient’s haloperidol (Haldol) dose was reduced from5 mg to 2 mg daily to decrease side effects. The nurse will need to monitor changes in:a.the activity schedule at the center.b.the nature of the patient’s symptoms.c.attention given to the patient by other staff.d.balance among psychotherapeutic management elements.ANS:BIt will be necessary for the nurse to assess for exacerbation of the patient’s symptoms ofpsychosis as well as for an amelioration of side effects. Dosage decrease might lead to thereturn or worsening of positive symptoms such as hallucinations and delusions, and negativesymptoms such as blunted affect, social withdrawal, and poor grooming.DIF:Cognitive level: ApplyingREF:p. 2TOP:Nursing process: AssessmentMSC: NCLEX: Physiologic Integrity6.Which guideline should a nurse use when applying the components of psychotherapeuticmanagement to the care of a patient with mental illness?a.The nurse’s role in milieu management is secondary to that of social work.b.Omitting any one component usually will result in less effective treatment.c.The most important element of psychotherapeutic management is drug therapy.d.A therapeutic nurse–patient relationship is the most important aspect of treatment.

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ANS:BThe three components listed as choices a, c, and d above work together to provide the besttreatment outcomes. When one element is missing, treatment is usually compromised. Nosingle element is more important than the others; however, patients’ needs govern theapplication of the components and permit judicious use.DIF:Cognitive level: ApplyingREF:pp. 1-2TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment7.Which statement most accurately describes a nurse’s role regarding psychopharmacology?The psychiatric nurse:a.frequently makes decisions regarding administration of PRN medications.b.might adjust a medication dose if a patient is not responding positively.c.administers medications but is not responsible for monitoring drug effectiveness.d.should refer a patient’s questions about drug side and adverse effects to thepsychiatrist.ANS:ANursing assessment and analysis of data might suggest the need for PRN medication aspatient anxiety increases or psychotic symptoms become more acute. The nurse is the healthteam member who makes this determination. Nurses are responsible for monitoring drugeffectiveness as well as administering medication. Nurses should assume responsibility forteaching patients about the side effects of medications. Nurses cannot alter prescribed dosagesof medications unless they have prescriptive privileges.DIF:Cognitive level: UnderstandingREF:2TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment8.A nurse considers environmental aspects of milieu management while planning care for anewly admitted patient. Which element has the highest priority?a.Normsb.Safetyc.Balanced.StructureANS:BMilieu management provides a proactive approach to care. Safety overrides all otherdimensions of the milieu.DIF:Cognitive level: AnalyzingREF:2TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment9.When the treatment team in an inpatient psychiatric unit institutes a new unit schedule thatprovides for all patients to be involved in activities continuously throughout both the day andearly evening, which element of milieu management needs reflection and reconsideration?a.Normsb.Balancec.Limit settingd.Environmental modificationANS:B

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The situation described suggests a milieu in which patients have no time for plannedtherapeutic encounters with staff; hence, it is a milieu lacking balance. Environmentalmodification is not a core element of milieu management. Data are insufficient to permit thestudent to choose either the component of norms or limit setting.DIF:Cognitive level: AnalyzingREF:p. 2TOP:Nursing process: EvaluationMSC: NCLEX: Safe, Effective Care Environment10.During an interaction with a patient, a nurse encourages the patient to express feelings,identify stressors, and review coping strategies. These nursing interventions relate most to theuse of:a.risk assessment.b.behavior modification.c.therapeutic communication.d.environmental manipulation.ANS:CA nurse uses therapeutic communication techniques as part of the therapeutic nurse–patientrelationship. Being therapeutic does not imply that the nurse is providing therapy, a formal,structured process. Risk assessment has a different purpose related to provision of anappropriate level of care. Environmental manipulation is more related to milieu managementthan to therapeutic use of self.DIF:Cognitive level: UnderstandingREF:p. 2TOP:Nursing process: ImplementationMSC: NCLEX: Psychosocial Integrity11.During the risk assessment phase of care for a psychiatric patient, the nurse will:a.make an initial assessment.b.confirm the patient’s problem.c.assess potential dangerousness to self or others.d.determine the level of supervision needed for the patient.ANS:CRisk assessment involves looking at dangerousness to self or others, the degree of disability,and whether or not the individual is acutely psychotic to determine the feasibility ofcommunity-based care versus hospital-based care. Risk assessment usually follows the initialassessment. Confirmation of the patient’s problem is not part of the risk assessment protocol.Arranging entry into the mental health system will follow risk assessment if the patient isassessed as needing service.DIF:Cognitive level: ApplyingREF:pp. 2-3TOP:Nursing process: AssessmentMSC: NCLEX: Safe, Effective Care Environment12.Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic atthe moment; not a danger to self or others; lives in parents’ home. Which decision regardingplacement on the continuum of care is appropriate?a.Hospitalize the patient.b.Discharge the patient from the system.c.Refer the patient to outpatient services.d.Refer the patient to self-help resources in the community.ANS:C

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Referral should be made to the least restrictive, most effective, and most cost-conscioussource of services. Because the patient is not a danger to self or others, hospitalization is notneeded. However, follow-up as an outpatient would be more appropriate than referral to aself-help group, in which structure might be lacking, or discharge from the system.DIF:Cognitive level: AnalyzingREF:pp. 2-3TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment13.A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take itanymore. Do you?” The most effective reply that the nurse could make is based on thepsychotherapeutic management model component of:a.psychopathology.b.milieu management.c.psychopharmacology.d.therapeutic nurse–patient relationship.ANS:CConcerns about medication voiced by patients require the nurse to have knowledge aboutpsychotherapeutic drugs to make helpful responses. The nurse–patient relationship componentis based on use of self. Milieu management is concerned with the environment of care.Psychopathology provides foundational knowledge of mental disorders but would be lessrelevant in framing a response to the patient than knowledge of psychopharmacology.DIF:Cognitive level: ApplyingREF:p. 2TOP:Nursing process: ImplementationMSC: NCLEX: Physiologic Integrity14.A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take itanymore. Do you?” Select the nurse’s best response.a.“I wonder why you think that.”b.“Tell me how it makes you feel.”c.“One must never stop taking medication.”d.“You need to discuss this with your psychiatrist.”ANS:BAs part of the psychopharmacology component of psychotherapeutic management, theresponsibility of the nurse is to gather data about patients’ responses to medication and to bealert for side and adverse effects of the medication. The other responses are tangential to thereal issue.DIF:Cognitive level: ApplyingREF:2TOP:Nursing process: ImplementationMSC: NCLEX: Physiologic Integrity15.The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has apermanent disorder and will have many hospitalizations in the future. I wonder how I will beable to raise our children alone.” The nurse’s reply should be based on knowledge of:a.psychopathology.b.milieu management.c.psychopharmacology.d.nursing relationship therapy.ANS:A

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An understanding of psychopathology will enable the nurse to communicate reassurance tothe spouse regarding the treatment of panic attacks in an outpatient setting.DIF:Cognitive level: ApplyingREF:p. 2TOP:Nursing process: ImplementationMSC: NCLEX: Psychosocial Integrity16.Which observation during morning rounds should receive a nurse’s priority attention?a.Breakfast is late being served.b.A sink is leaking, leaving water on the bathroom floor.c.The daily schedule has not been posted on the unit bulletin board.d.A small group of patients is complaining that one patient turned down the TVvolume.ANS:BSafety is the component of therapeutic milieu management that takes priority over the othercomponents. A patient could be injured if he or she slipped and fell. The other problems donot pose a threat to patient safety.DIF:Cognitive level: AnalyzingREF:p. 2TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment17.A community mental health nurse assesses a person with a psychiatric disorder on an initialvisit. The nurse should refer this person to services on the care continuum that:a.are the least costly.b.are the least restrictive.c.offer psychoeducation.d.promote rapid symptom stabilization.ANS:BThe concept of least restrictive treatment environment preserves individual rights to freedom.Many patients are healthy enough to receive community-based treatment. Hospitalization isreserved for short periods when patients are assessed as being a danger to self or others. Costis a consideration but is of lesser concern than safety. All facets of the continuum should offerpsychoeducation as needed by patients and families. Some aspects of the care continuum aremore concerned with a patient’s need for symptom stabilization than others (e.g., hospitalsversus psychiatric rehabilitation programs). The outcome of symptom stabilization is not aneed for some patients, so it is not a correct answer.DIF:Cognitive level: ApplyingREF:pp. 2-3TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment18.An acutely psychotic patient is restricted to an inpatient unit. Which milieu element has beenadapted?a.Normsb.Balancec.Therapyd.PsychopathologyANS:B

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Balance refers to negotiating the line between dependence and independence. The morepsychotic the individual, the less independence he or she can usually handle safely. Unitrestriction with careful supervision by staff helps compensate for lack of patient judgment.Norms refers to behavioral expectations for patients. Therapy is provided byadvanced-practice nurses or others with advanced education. Psychopathology is notconsidered an environmental element.DIF:Cognitive level: ApplyingREF:pp. 1-2TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment19.When inpatient psychiatric care is not indicated, an individual with schizophrenia who has ahistory of medication noncompliance should be referred to which service?a.Primary careb.Outpatient counselingc.Apartment residential livingd.A group home with 24-hour supervisionANS:DAlthough inpatient hospitalization is unnecessary, the individual requires an environment inwhich medication compliance can be fostered. In this case, the group home would provide thebest alternative. The other options do not provide adequate supervision.DIF:Cognitive level: AnalyzingREF:pp. 2-3TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment20.A patient with bipolar disorder has stabilized and is being discharged from the hospital. Thepatient will live independently at home but lacks social skills and transportation. Whichreferral would be most appropriate?a.A group homeb.A self-help groupc.A day treatment programd.Assertive community treatment (ACT)ANS:DAssertive community treatment (ACT) provides intensive supervision, which includesassistance with medications and transportation that would support the goal of minimizingfuture hospitalizations. A group home is unnecessary, because the patient will reside at home.A day treatment program would provide a therapeutic program directed toward symptoms, butthe patient’s symptoms have stabilized so this service is not indicated. A self-help groupwould not provide the intensity of service this patient needs.DIF:Cognitive level: AnalyzingREF:p. 4TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment21.A patient with long-standing bipolar disorder comes to the mental health center. The patientsays, “I lost my job and home. Now, I eat in soup kitchens and sleep at a shelter. I am sodepressed that I thought about jumping from a railroad bridge into a river.” Which factor haspriority for the nurse who determines the appropriate level of care?a.Long-standing bipolar disorderb.Risk for suicidec.Homelessness

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d.Lack of incomeANS:BRisk assessment shows the patient to have suicidal thoughts, and a plan for the suicide that ishighly lethal, executable, and with low potential for rescue. The other factors do not have asgreat an effect on the determination of the level of services needed.DIF:Cognitive level: AnalyzingREF:pp. 2-3TOP:Nursing process: EvaluationMSC: NCLEX: Safe, Effective Care Environment22.When explaining risk assessment, the nurse would indicate that the highest priority foradmission to hospital-based care is:a.safety of self and others.b.confusion and disorientation.c.withdrawal from harmful substances.d.medical illness complicating a psychiatric disorder.ANS:AThe highest priority is safety. In the other situations, threats to safety might or might not exist.DIF:Cognitive level: AnalyzingREF:pp. 2-3TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment23.What explanation about the unit milieu would be most important for the nurse to give to anewly admitted patient?a.“Your behavior will be carefully monitored during your hospital stay.”b.“Unit activities will help you cope with immediate needs and stressors.”c.“You will be given enough medication to bring your symptoms under control.”d.“I will be gathering information about you to plan your care and your discharge.”ANS:BThis choice best reflects the purpose of milieu management in psychotherapeuticmanagement. Stating that behavior will be monitored creates suspicion. Discussingmedication administration is a psychopharmacology issue and is not pertinent to unit milieu.Stating that assessment will take place is not directly related to milieu.DIF:Cognitive level: ApplyingREF:pp. 1-3TOP:Nursing process: ImplementationMSC: NCLEX: Psychosocial Integrity24.Referral to a psychiatric extended-care facility would be most appropriate for which of thefollowing patients?a.An adult with generalized anxiety disorderb.A severely depressed 70-year-old retireec.A patient with personality disorder who frequently self-mutilatesd.A severely ill person with schizophrenia who is regressed and withdrawnANS:DExtended care often serves those with severe and persistent mental illness and those with acombination of psychiatric and medical illnesses. Patients with anxiety disorders can bereferred to outpatient services. Severely depressed patients would need more intensive care, aswould a self-mutilating individual.

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DIF:Cognitive level: AnalyzingREF:p. 6TOP:Nursing process: AnalysisMSC: NCLEX: Safe, Effective Care EnvironmentMULTIPLE RESPONSE1.What data should a nurse analyze when deciding to refer a patient with a psychiatric disorderto community-based care? Select all that apply.a.Need for PRN medicationb.Severity of the patient’s illnessc.Need for structured formal therapyd.Presence of suicidal or homicidal ideatione.Amount of supervision required by the patientANS:B, D, EThe decision tree for the continuum of care calls for the assessment of severity of the illness,the presence or absence of suicidal or homicidal ideation, whether or not the disability is sogreat that the patient is unable to provide for his or her own basic needs, and the amount ofsupervision required for patient safety. The frequency of need for PRN medication and theneed for structured formal therapy are not considerations mentioned in the decision tree.DIF:Cognitive level: ApplyingREF:p. 2TOP:Nursing process: EvaluationMSC: NCLEX: Safe, Effective Care Environment2.Which scenarios demonstrate that a nurse is functioning within the scope of psychotherapeuticmanagement? The nurse (select all that apply)a.structures meaningful unit activities.b.administers electroconvulsive therapy.c.encourages a patient to express feelings.d.interprets the results of psychological testing.e.assesses a patient for medication side effects.ANS:A, C, EElectroconvulsive therapy is a medical treatment and, therefore, should be administered by aphysician. Psychological testing is interpreted by a psychologist. All other scenarios arewithin the scope of practice of the nurse.DIF:Cognitive level: AnalyzingREF:pp. 1-2TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

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Chapter 02: Historical IssuesMULTIPLE CHOICE1.A person says, “Now that many state hospitals are closed, patients with psychiatric problemsare free in our community. It is not safe for me.” The nurse’s reply should be based onknowledge that:a.depressed patients are nonviolent.b.state hospitals are no longer needed.c.major depression is very prevalent.d.bizarre behavior is viewed as sensational.ANS:CFour of the top medical disorders causing disability are psychiatric disorders (i.e., majordepression, schizophrenia, bipolar disorder, and alcohol abuse). The other options are not truestatements.DIF:Cognitive level: UnderstandingREF:p. 9TOP:Nursing process: ImplementationMSC: NCLEX: Psychosocial Integrity2.Select the most accurate characterization of treatment of the mentally ill prior to the Period ofEnlightenment.a.Large asylums provided custodial care.b.Care for the mentally ill was more compassionate.c.Care focused on reducing stress and meeting basic human needs.d.Patients were banished from communities or displayed for public amusement.ANS:DIn the 1700s it was common practice for caretakers to display mentally ill patients for theamusement of the paying public. The creation of large asylums took place during the Periodof Enlightenment. Mental illness was first studied during the Period of Scientific Study.Dealing with stress and meeting basic needs are concerns of the modern era.DIF:Cognitive level: UnderstandingREF:p. 10TOP:Nursing process: AssessmentMSC: NCLEX: Safe, Effective Care Environment3.What concerns were shared by society during both the Period of Enlightenment and the Periodof Community Mental Health?a.Moving patients out of asylumsb.Studying brain structure and functionc.Meeting basic human needs humanelyd.Providing medication to control symptomsANS:CThe use of asylums signaled concern for meeting basic needs of the mentally ill, who inearlier times often wandered the countryside. With deinstitutionalization, many patients whowere poorly equipped to provide for their own needs were returned to the community. Thecurrent system must now concern itself with ensuring that patients have such basic needs asfood, shelter, and clothing. Studying brain structure and function is more a concern of moderntimes, as is the provision of medication.

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DIF:Cognitive level: ApplyingREF:pp. 10-11TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment4.A key factor motivating passage of the Community Mental Health Centers Act in 1963 wasthat mentally ill individuals had been:a.hospitalized only if they demonstrated violent behavior.b.geographically isolated from family and community.c.discharged before receiving adequate treatment.d.used as subjects in pharmacologic research.ANS:BState hospitals were often located a great distance from the patients’ homes, making familyvisits difficult during hospitalization. The Community Mental Health Centers Act in 1963served as the impetus for deinstitutionalization, allowing patients and families to receive careclose to home. Admission only for behavior that endangers self or others is more consistentwith current admission criteria. Early discharge rarely occurred before the community mentalhealth movement. Unethical pharmacologic research was not a major issue leading tocommunity mental health legislation.DIF:Cognitive level: UnderstandingREF:p. 13TOP:Nursing process: PlanningMSC: NCLEX: Safe, Effective Care Environment5.Freud’s contribution to psychiatry that most affects current psychiatric nursing is:a.the challenge to look at humans objectively.b.recognition of the importance of human sexuality.c.theories about the importance of sleep and dreams.d.discoveries about the effectiveness of free association.ANS:AFreud’s work created a milieu for thinking about mental disorders in terms of the individualhuman mind. This called for therapists to look objectively at the individual, a principle that isbasic to nursing. The correct answer is the most global response. Freud’s theories ofpsychosexual development are an aspect of holistic nursing practice, but not the entire focus.Free association is not a pivotal issue in nursing practice.DIF:Cognitive level: UnderstandingREF:p. 12TOP:Nursing process: AssessmentMSC: NCLEX: Psychosocial Integrity6.The greatest impact in the care of the mentally ill over the past 50 years has resulted fromprogress and improvement in which area?a.Self-help groupsb.Outpatient therapyc.Psychotropic drugsd.Patients’ rights awarenessANS:CThe advent of psychotropic drugs allowed patients to normalize thinking and feeling. Aspsychosis diminished, the individual became accessible for psychotherapeutic interventions.Hospital stays were shortened. Hospital milieus improved. Though important, none of theother choices has had such a significant impact.

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DIF:Cognitive level: UnderstandingREF:p. 12TOP:Nursing process: EvaluationMSC: NCLEX: Physiologic Integrity7.An adult with schizophrenia is discharged from a state mental hospital after 20 years ofinstitutionalization. When planning care in the community, which premise applies? Thispatient is likely to:a.independently find support services to aid transition from hospitalization tocommunity.b.adjust smoothly to the community if provided with sufficient support services.c.self-administer antipsychotic medications correctly if provided with education.d.need crisis or emergency psychiatric interventions from time to time.ANS:DPatients with serious mental illness are rarely considered cured at the time of hospitaldischarge. Decompensation is likely from time to time, even when good community support isprovided. The emergency room may become a first-line resource in the continuum of caredesigned to prevent rehospitalization. Unfortunately, transitional services are not alwaysreadily available. Adjustment to a community environment after long institutionalization isoften a slow process.DIF:Cognitive level: UnderstandingREF:p. 15TOP:Nursing process: PlanningMSC: NCLEX: Psychosocial Integrity8.A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient’sinsurance form. Which resource should the nurse use to discern the criteria used to establishthis diagnosis?a.TheDiagnostic and Statistical Manual of Mental Disorders(DSM)b.Nursing Diagnosis Manualc.A psychiatric nursing textbookd.A behavioral health reference manualANS:ATheDSMgives the criteria used to diagnose each mental disorder. The distracters do notcontain diagnostic criteria for mental illness.DIF:Cognitive level: UnderstandingREF:pp. 17-18TOP:Nursing process: AssessmentMSC: NCLEX: Safe, Effective Care Environment9.A shift in the psychiatric nursing focus during the community mental health period of the1960s resulted in:a.disillusionment with the high numbers of people seeking treatment.b.focusing more attention on complications associated with substance abuse.c.spending more time providing services to persons with serious mental illness.d.shifting focus away from the most acutely ill and to persons with a perceivedgreater potential for improvement.ANS:D

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The community mental health movement brought with it a broadening of areas of concern tothe psychiatric nurse. It became acceptable, even desirable, for psychiatric nurses to focus onwhat was called theworried well,as opposed to providing care for acutely ill psychoticindividuals. Neither disillusionment with the numbers seeking treatment nor providing moreservices to those with severe mental illness occurred.DIF:Cognitive level: UnderstandingREF:p. 16TOP:Nursing process: EvaluationMSC: NCLEX: Safe, Effective Care Environment10.An adult with serious mental illness is being admitted to a community behavioral healthinpatient unit. Recognizing current trends in hospitalization, this patient is likely to:a.comply readily with the prescribed treatment.b.have a clear understanding of the illness.c.display aggressive behavior.d.stabilize within 24 hours.ANS:CCompared with patients of the 1960s and 1970s, today’s patients are likely to display moreaggressive behavior. This understanding is critical to making astute assessments that lead toplanning for the provision of safety for patients and staff. Treatment compliance,understanding of the illness process, and discharge against medical advice are possible issueswith which the nurse might deal, but these are less relevant when admission assessment isperformed.DIF:Cognitive level: AnalyzingREF:p. 14TOP:Nursing process: AssessmentMSC: NCLEX: Safe, Effective Care Environment11.When a nurse working in a well-child clinic asks a parent’s address, the parent responds, “Mychildren and I are homeless.” The nurse can assess this response as:a.a common occurrence, because 1 out of 50 children are homeless.b.a signal to investigate the possibility that the parent has severe mental illness.c.evidence of child abuse or neglect that should be reported to social serviceagencies.d.unusual because most homeless individuals have severe mental illness or substanceabuse problems.ANS:AThe current belief is that the homeless are people (including entire families) who have beendisplaced by social policies over which they have no control. One out of 50 children ishomeless. Although homelessness might be associated with serious mental illness, it mightalso be the result of having a weak support system and of social policies over which theindividual or family has no control. Clinic users come from all socioeconomic backgrounds.DIF:Cognitive level: UnderstandingREF:p. 16TOP:Nursing process: AssessmentMSC: NCLEX: Psychosocial Integrity12.Which individual should the nurse assess as having the highest risk for homelessness?a.An older adult woman with mild dementia who resides in an assisted-living facilityb.An adult with serious mental illness and no familyc.An adolescent with an eating disorderd.A married person with alcoholism

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ANS:BThe adult has both a serious mental illness and a potentially weak support system. Both arerisk factors for homelessness. The other individuals have psychiatric disorders but have betterestablished support systems.DIF:Cognitive level: ApplyingREF:p. 16TOP:Nursing process: AssessmentMSC: NCLEX: Psychosocial Integrity13.A former pediatric nurse begins working in a clinic housed in a homeless shelter. The nurseasks the clinic director, “What topic should I review to improve my effectiveness as I beginmy new job?” Which topic should the clinic director suggest?a.Care of school-age childrenb.Psychiatric and substance abuse assessmentc.Communicable disease prevention strategiesd.Sexually transmitted disease signs and symptomsANS:BIt is estimated that significant numbers of the homeless population have a serious mentalillness and/or suffer from substance abuse or dependence. Although the other conditions mayexist, the numbers are not as significant.DIF:Cognitive level: ApplyingREF:p. 16TOP:Nursing process: AssessmentMSC: NCLEX: Psychosocial Integrity14.Which skill is most important to a nurse working as a member of a community mental healthteam that strives to use a seamless continuum of care?a.Case managementb.Diagnostic abilityc.Physical assessment skillsd.Patients’ rights advocacyANS:ATo effectively use a seamless continuum of care, a nurse must have case management skillswith which he or she can coordinate care using available and appropriate communityresources. Psychosocial assessment and physical assessment are functions that can be fulfilledby another health care worker. Patients’ rights advocacy is one aspect of case management.DIF:Cognitive level: AnalyzingREF:p. 16TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment15.The broadened scope of psychiatric nursing practice is attributable primarily to:a.increased use of psychotropic drugs.b.opening of community mental health centers.c.legislation that changed nurse practice acts across the country.d.recidivism of seriously mentally ill patients in public mental hospitals.ANS:B

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Community mental health centers were designed and organized to provide services in additionto inpatient hospitalization, thus giving nurses opportunities to practice in a variety oftreatment settings (e.g., emergency rooms, partial hospitalization settings, outpatient care) andto have new roles, such as consultant, liaison, and case manager. Increased use ofpsychotropic drugs is not as important a factor as are community mental health centers.Legislation changing nurse practice acts broadened the scope of practice for nursepractitioners only by allowing prescriptive privileges. Recidivism is not a relevant factor.DIF:Cognitive level: ApplyingREF:p. 16TOP:Nursing process: ImplementationMSC: NCLEX: Safe, Effective Care Environment16.A patient with mental illness was initially treated in an outpatient setting and then hospitalizedfor a week when the disorder became acute. After discharge to a halfway house, this patient’scare was managed by a community mental health nurse. Which inference applies to thiscommunity?a.Additional mental health services should be made available for the severelymentally ill.b.A seamless continuum of services is in place to serve persons with severe mentalillness.c.Case management services should be expanded to care for acute as well aslong-term system consumers.d.There are insufficient data to make a conclusion.ANS:BData are sufficient to suggest that a seamless continuum of service is in place, because theindividual is able to move between continuum treatment sources and is given the services of acase manager to coordinate care. Data provided are insufficient to warrant any of the otherassessments.DIF:Cognitive level: AnalyzingREF:p. 16TOP:Nursing process: EvaluationMSC: NCLEX: Safe, Effective Care EnvironmentMULTIPLE RESPONSE1.Which changes in psychiatric nursing practice are directly attributable to events occurringduring the Decade of the Brain? Select all that apply.a.Homeless shelters became practice sites.b.Nurses upgraded knowledge of psychopharmacology.c.Nurses provided psychoeducation to patients and families.d.Nurses viewed psychiatric symptoms as resulting from brain irregularities.e.Nurses were more likely to advocate for patients’ rights related to involuntarycommitment.ANS:B, C, D

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