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Essentials of Psychiatric Mental Health Nursing 5th Edition Townsend Test Bank
ISBN-13: 978-0-8036-2338-5
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Chapter 7: The Nursing Process in Psychiatric/Mental Health Nursing
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Which data gathering technique can be employed during the assessment phase of the nursing process?
| A. | Asking the client to rate mood after administering an antidepressant. |
| B. | Asking the client to verbalize understanding of previously explained unit rules. |
| C. | Asking the client to describe any thoughts of self-harm. |
| D. | Asking the client if the group on assertiveness skills was helpful. |
____ 2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?
| A. | Medical history is of little significance and can be eliminated from the nursing assessment. |
| B. | Assessment provides a holistic view of the client, including biopsychosocial aspects. |
| C. | Comprehensive assessments can be performed only by advanced practice nurses. |
| D. | Psychosocial evaluations are gained by subjective reports rather than objective observations. |
____ 3. Which nursing diagnosis should a nurse identify as being correctly formulated?
| A. | Schizophrenia related to biochemical alterations as evidenced by altered thought. |
| B. | Self-care deficit: hygiene related to altered thought as evidenced by disheveled appearance. |
| C. | Depressed mood related to multiple life stressors. |
| D. | Developmental disability related to early-onset schizophrenia as evidenced by hallucinations. |
____ 4. Which expected client outcome should a nurse identify as being correctly formulated?
| A. | Client will feel happier by discharge. |
| B. | Client will demonstrate two relaxation techniques. |
| C. | Client will verbalize triggers to anger by end of session. |
| D. | Client will initiate interaction with one peer during free time within 2 days. |
____ 5. Which statement regarding nursing interventions should a nurse identify as correct?
| A. | Nursing interventions are independent from the treatment team’s goals. |
| B. | Nursing interventions are solely directed by written physician orders. |
| C. | Nursing interventions occur independently but in concert with overall treatment team goals. |
| D. | Nursing interventions are standardized by policies and procedures. |
____ 6. Within the nurse’s scope of practice, which function is exclusive to the advance practice psychiatric nurse?
| A. | Teaching about the side effects of neuroleptic medications. |
| B. | Using psychotherapy to improve mental health status. |
| C. | Using milieu therapy to structure a therapeutic environment. |
| D. | Providing case management to coordinate continuity of health services. |
____ 7. A nurse charts “Verbalizes understanding of the side effects of Prozac.” This is an example of which category of focused charting?
| A. | Data |
| B. | Problem |
| C. | Action |
| D. | Response |
____ 8. Which acronym/abbreviation represents problem-oriented charting?
| A. | SOAPIE |
| B. | APIE |
| C. | DAR |
| D. | PQRST |
____ 9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)?
| A. | CIWA scale |
| B. | GGT |
| C. | MMSE |
| D. | CAPS scale |
____ 10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation?
| A. | Mood |
| B. | Perception |
| C. | Orientation |
| D. | Affect |
____ 11. What is the purpose of gathering client information?
| A. | It enables the nurse to modify behaviors related to personality disorders. |
| B. | It enables the nurse to make sound clinical judgments and plan appropriate care. |
| C. | It enables the nurse to prescribe the appropriate medications. |
| D. | It enables the nurse to assign the appropriate Axis I diagnosis. |
____ 12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse?
| A. | Health teacher |
| B. | Case manager |
| C. | Milieu manager |
| D. | Psychotherapist |
____ 13. The following outcome was developed for a client: “Client will list five personal strengths by the end of day 1.” Which nursing diagnostic statement most likely generated the development of this outcome?
| A. | Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements. |
| B. | Self-care deficit R/T altered thought process. |
| C. | Disturbed body image R/T major depressive disorder AEB mood rating of 2/10. |
| D. | Risk for disturbed self-concept R/T hopelessness AEB suicide attempt. |
____ 14. How should a nurse prioritize nursing diagnoses?
| A. | By the established goal of care. |
| B. | By the life-threatening potential. |
| C. | By the physician’s priority of care. |
| D. | By the client’s preference. |
____ 15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB MNA, DFA, and daytime napping. Which is a correctly written and appropriate outcome for this client?
| A. | The client will avoid daytime napping and attend all groups. |
| B. | The client will exercise, as needed, before bedtime. |
| C. | The client will sleep 7 uninterrupted hours by day four of hospitalization. |
| D. | The client’s sleep habits will improve during hospitalization. |
____ 16. The following NANDA nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement?
| A. | The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. |
| B. | The client has a history of four suicide attempts in adolescence. |
| C. | The client expresses hopelessness and helplessness and isolates self. |
| D. | The client has disorganized thought processes and delusional thinking. |
____ 17. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student’s question?
| A. | “You can use NIC, a standardized reference for nursing outcomes.” |
| B. | “Look at your client’s problems and set a realistic, achievable goal.” |
| C. | “Outcomes should be based on client problems that are mutually agreed upon.” |
| D. | “Copy your standard outcomes from a nursing care plan textbook.” |
____ 18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client’s problem?
| A. | Altered thought processes |
| B. | Altered sensory perception |
| C. | Anxiety |
| D. | Chronic confusion |
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 1. Which nursing interventions fall within the standards of psychiatric–mental health clinical nursing practice for a nurse generalist? (Select all that apply.)
| A. | Assist the client to perform activities of daily living. |
| B. | Consult with other clinicians to provide services for clients and effect system change. |
| C. | Encourage the client to discuss triggers for relapse. |
| D. | Use prescriptive authority in accordance with state and federal laws. |
| E. | Educate the family about signs and symptoms of alcohol dependence and withdrawal. |
____ 2. Which characteristics of client outcomes should a nurse identify as correct? (Select all that apply.)
| A. | Client outcomes are specifically formulated by nurses. |
| B. | Client outcomes are not restricted by time frames. |
| C. | Client outcomes are specific and measurable. |
| D. | Client outcomes are realistically based on client capability. |
| E. | Client outcomes are formally approved by the psychiatrist. |
Chapter 7: The Nursing Process in Psychiatric/Mental Health Nursing
Answer Section
MULTIPLE CHOICE
- ANS: C
The nurse should ask the client to describe any thoughts of self-harm during the assessment phase of the nursing process. Assessment involves collecting and analyzing data about the client that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, functional abilities, developmental, economic, and lifestyle. The other options involve the evaluation step of the nursing process.
PTS: 1 REF: Page: 131
KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Assessment
- ANS: B
The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, functional abilities, developmental, economic, and lifestyle.
PTS: 1 REF: Page: 131
KEY: Cognitive Level: Comprehension | Integrated Process: Assessment
- ANS: B
The nurse should determine that the correct diagnosis would be Self-care deficit: hygiene related to altered thought as evidenced by disheveled appearance. The nursing diagnosis should describe the client’s condition, facilitating the prescription of interventions.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis
- ANS: D
The statement “Client will initiate interaction with one peer during free time within 2 days” is an example of a correctly formulate expected outcome. Outcomes should be measurable, expected, client-focused goals that should translate into client behavior.
PTS: 1 REF: Page: 141
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis
- ANS: C
The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved with the client.
PTS: 1 REF: Page: 141
KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Implementation
- ANS: B
The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. Education, case management, and milieu therapy can be provided by registered psychiatric mental health nurses.
PTS: 1 REF: Page: 142
KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Implementation
- ANS: D
“Verbalizes understanding of the side effects of Prozac” is an example of the response category of focused charting. The response is a description of the client’s responses to any part of the medical or nursing care.
PTS: 1 REF: Page: 150
KEY: Cognitive Level: Comprehension | Integrated Process: Communication/Documentation
- ANS: A
The acronym SOAPIE represents problem-oriented charting, which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. Used in nursing, nursing diagnoses (problems) are identified on a written plan of care with appropriate nursing interventions described for each.
PTS: 1 REF: Page: 149
KEY: Cognitive Level: Comprehension | Integrated Process: Communication/Documentation
- ANS: C
The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdraw from substances such as alcohol. The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is used to assess gamma-glutamyl transferase levels, which may be elevated in some liver diseases.
PTS: 1 REF: Page: 140
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment
- ANS: C
The nurse should ask the client to identify name, date, residential address, and situation to assess the client’s orientation. Assessment of the client’s orientation to reality is part of a mental status evaluation.
PTS: 1 REF: Page: 135
KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Assessment
- ANS: B
The purpose of gathering client information is the enable to the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers.
PTS: 1 REF: Page: 131
KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Assessment
- ANS: C
The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. Health teaching involves promoting health and a safe environment. Case management is utilized to organize client care so that outcomes are achieved. Psychotherapy involves conducting individual, couples, group, and family counseling.
PTS: 1 REF: Page: 143
KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation
- ANS: A
The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day 1. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis
- ANS: B
The nurse should prioritize nursing diagnoses by life-threatening potential. Diagnoses should conform to accepted classification systems such as the NANDA International Nursing Diagnosis Classification.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Analysis
- ANS: C
The outcome “The client will sleep seven uninterrupted hours by day four of hospitalization” is accurately written and an appropriate outcome for a client diagnosed with insomnia. Nursing outcomes should be derived from the diagnosis, measurable, and include a time estimate for attainment. The outcome must also be realistic for the client’s capabilities.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Planning
- ANS: A
The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury. History of suicide, hopelessness, and disorganized thoughts would not lead to the diagnostic stem Risk for injury.
PTS: 1 REF: Page: 131
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis
- ANS: C
Nursing outcomes are best developed for clients by basing outcomes of client problems that are mutually agreed upon. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, the client, and significant others.
PTS: 1 REF: Page: 141
KEY: Cognitive Level: Application | Integrated Process: Teaching/Learning
- ANS: B
The nursing diagnosis Altered sensory perception accurately reflects the client’s symptoms of hearing things that others do not. The nursing diagnosis describes the client’s condition and facilitates the prescription of interventions.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis
MULTIPLE RESPONSE
- ANS: A, C, E
Assisting the client to perform daily living activities, encouraging the client to discuss triggers, and educating the family are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatric–mental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority.
PTS: 1 REF: Page: 141
KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation
- ANS: C, D
The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others.
PTS: 1 REF: Page: 147
KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Planning
