Varcarolis Foundations of Psychiatric Mental Health Nursing: A Clinical Approach 5th edition Varcarolis Test Bank

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  • Published: 2006
  • ISBN-10: 1416000887
  • ISBN-13: 978-1416000884

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Foundations of Psychiatric Mental Health Nursing 5th edition Varcarolis Test Bank

Varcarolis: Foundations of Psychiatric Mental Health Nursing: A 

Clinical Approach, 5th Edition

Test Bank

Chapter 1: Mental Health and Mental Illness 

MULTIPLE CHOICE

1)A nurse explaining the multiaxial DSM-IV-TR to a psychiatric technician can accurately say that it

A. focuses on plans for treatment.
B. includes nursing and medical diagnoses.
C. includes assessments of several aspects of functioning.
D. uses the framework of a specific biopsychosocial theory.

ANS: C

The use of five axes requires assessment beyond diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. Option A: The DSM-IV-TR does not include a treatment plan. Option B: Nursing diagnoses are not included. Option D: The DSM-IV-TR does not use a specific biopsychosocial theory.

DIF:Cognitive Level: ApplicationREF:Text Page: 9

TOP:Nursing Process: Implementation

MSC:NCLEX: Safe, Effective Care Environment;

2)A 23-year-old college student wrote about herself, “Most of the time I’m happy and feel pretty good about myself. I’ve learned that what I get out of something is often proportional to the effort I put into it. My grades are OK.” Based on this information, what number on the mental health continuum should the nurse select as best reflecting the individual’s state of mental health/illness?

Mental Illness    Mental Health

1 2 3 4

A. 1
B. 2
C. 3
D. 4

ANS: D

The student states she’s happy. Her self-concept is adequate. She is reality oriented, effective in her work, and has control over her behavior. Option A would be appropriate for an individual with severe impairment of functioning. Option B would be appropriate for an individual with moderate impairment of functioning. Option C would be appropriate for an individual with mild impairment of functioning.

DIF: Cognitive Level: Analysis REF: Text Page: 5, Text Page: 7

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3)A client has been admitted to the psychiatric hospital for assessment and evaluation. What behavior might indicate that the client has a mental disorder? The client

A. is able to see the difference between the “as if” and the “for real.”
B. describes her mood as consistently sad, discouraged, down in the dumps, and hopeless.
C. responds to the rules, routines, and customs of any group to which she belongs.
D. can perform tasks she attempts within the limits set by her abilities.

ANS: B

Option B describes a mood alteration. Options A, C, and D describe mentally healthy behaviors.

DIF:Cognitive Level: ApplicationREF:Text Page: 5

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4)An outcome for a client is that he will demonstrate mentally healthy behavior. The behavior that indicates the outcome is being met is that the client

A. behaves without considering the consequences of his actions.
B. sees himself as approaching his ideals and as capable of meeting demands.
C. passively allows others to assume responsibility for major areas of his life.
D. is aggressive in meeting his own needs without considering the rights of others.

ANS: B

Option B describes an adaptive, healthy behavior. Options A, C, and D are considered maladaptive behaviors.

DIF:Cognitive Level: AnalysisREF:Text Page: 5

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

5)A float nurse working at a behavioral health clinic notes a diagnosis of a psychiatric disorder with which he is unfamiliar on a client’s insurance form. To discern the criteria used to establish this diagnosis, the nurse should consult the

A. DSM-IV-TR.
B. Nursing Diagnosis Manual.
C. a psychiatric nursing textbook.
D. a behavioral health reference manual.

ANS: A

The DSM-IV-TR gives the criteria used to diagnose each mental disorder. Option B focuses on nursing diagnoses. Options A and D may not contain diagnostic criteria.

DIF:Cognitive Level: ApplicationREF:Text Page: 8

TOP:Nursing Process: Assessment

MSC:NCLEX: Safe, Effective Care Environment;

6)The nurse must assess the mental health/mental illness of several new clients at the mental health clinic. Conclusions about current functioning should be made on the basis of

A. the degree of conformity of the individual to society’s norms.
B. the degree to which an individual is logical and rational.
C. the rate of intellectual and emotional growth.
D. a continuum from healthy to psychotic.

ANS: D

Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Option A: Mental health is not based on conformity. Some mentally healthy individuals do not conform to society’s norms. Option B: Most individuals occasionally display illogical or irrational thinking. Option C: The rate of intellectual and emotional growth is not the most useful criteria to assess mental health or mental illness.

DIF: Cognitive Level: Application REF: Text Page: 3, Text Page: 4

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7)A 22-year-old college student is highly confident of his own intellectual abilities and strives to excel to the point of always wanting to be first or better than others in academic standing, sports, and other endeavors. Peers find him aggressive, but he ignores this opinion, stating “Too bad. I’m happy when I’m getting ahead. I get my work done and don’t break any laws.” The nurse assessing this individual would be most concerned about the aspect of mental health known as

A. control over behavior.
B. appraisal of reality.
C. effectiveness in work.
D. healthy self-concept.

ANS: A

The individual accurately appraises reality, is effective in his work, and is self-confident. The trait of control over behavior is of greatest concern because he is not sensitive to the rules, routines, and customs of his peer group, and he violates the rights of others.

DIF:Cognitive Level: ApplicationREF:Text Page: 5

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8)A 40-year-old woman who lives with her parents and works at a highly routine clerical job states “I’m as happy as the next person even though I don’t socialize much outside of work. My work is routine, but when new things come up my boss explains things a few times to make sure I catch on. At home, my parents make all the decisions for me and I go along with their ideas.” The nurse should identify interventions to increase this client’s

A. self-concept.
B. overall happiness.
C. appraisal of reality.
D. control over behavior.

ANS: A

The client sees herself as needing multiple explanations of new tasks at work and allows her parents to make decisions for her even though she is 40 years old. These behaviors indicate a poorly developed self-concept.

DIF:Cognitive Level: ApplicationREF:Text Page: 5

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

9)A client tells the nurse, “I’m a real freak. I’m a psychiatric patient, in and out of hospitals all the time. None of my friends or relatives is crazy like this.” The reply that would help the client understand the prevalence of mental illness is

A. “Comparing yourself with others has no real advantages.”
B. “Mental illness affects 50% of the adult population in any given year.”
C. “Nearly 50% of all people aged 15 to 55 years have had a psychiatric disorder at some time in their lives.”
D. “You are not to blame for having a psychiatric illness. The important thing is to recognize your need for treatment.”

ANS: C

The question calls for an answer relating to the prevalence of mental illness. Only options B and C address this, and option B is untrue.

DIF:Cognitive Level: ApplicationREF:Text Page: 8

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10)The best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis would be

A. “There is no functional difference between the two; both serve to identify a human deviance.”
B. “The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.”
C. “The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.”
D. “The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a client is experiencing.”

ANS: D

The medical diagnosis is concerned with the client’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the client’s response to stress and possible caring interventions. Options A and B are not true statements. Both consider culture. Option C: The DSM-IV-TR is multiaxial. Nursing diagnoses also consider potential problems.

DIF: Cognitive Level: Analysis REF: Text Page: 11, Text Page: 12

TOP:Nursing Process: Implementation

MSC:NCLEX: Safe, Effective Care Environment;

11)A client mentions to a nursing student, “I’d never want to be a nurse working with psychiatric clients because none of us ever gets well.” The reply by the nursing student that best addresses the stated bias is

A. “People with mental disorders should not be stereotyped as hopeless cases.”
B. “The media tend to focus on the sensational, so the public hears only about the poorest outcomes.”
C. “Treatment of bipolar disorder has an 80% success rate, whereas angioplasty is successful 41% of the time.”
D. “Some mental disorders such as panic disorder are highly treatable, whereas other disorders result in progressive deterioration.”

ANS: C

Providing information about treatment efficacy is a concrete way to refute the myth that clients with mental disorders are untreatable. Option A does not provide information to refute the myth. Option B gives general information, whereas option C is more specific. Option D provides general information, some of which is discouraging.

DIF: Cognitive Level: Application REF: Text Page: 3, Text Page: 4

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

12)The nurse caring for a client finds the client uncommunicative about recent life events. The nurse suspects marital and perhaps economic problems exist. The social worker’s intake note has been dictated, but not typed, and is placed in the medical record. The most effective action the nurse could take is to

A. focus questions on these two topics.
B. ask the client who shares a room with this client.
C. try to work around the lack of pertinent information.
D. look at axis IV of the DSM-IV-TR in the medical record.

ANS: D

The intake physician would use axis IV to note psychosocial and environmental problems pertinent to the client’s situation, providing another source of information for the nurse. Option A: Persistent questioning will likely result in client withdrawal. Option B violates client privacy rights. Option C is not an effective solution.

DIF:Cognitive Level: Application

REF:Text Page: 9, Text Page: 10, Text Page: 11

TOP:Nursing Process: Assessment

MSC:NCLEX: Safe, Effective Care Environment;

13)The nurse making an admission assessment notes the client is profoundly depressed to the point of being mute and motionless. The client has refused to bathe and eat for a week, according to her parents. The nurse should code the client’s global assessment of functioning as

A. 100.
B. 50.
C. 25.
D. 10.

ANS: D

The client is unable to maintain personal hygiene, oral intake, or verbal communication. She is a persistent danger to herself because she refuses to eat. Option A indicates high-level functioning. Options B and C suggest higher functional abilities than the client presently displays.

DIF:Cognitive Level: AnalysisREF:Text Page: 10

TOP:Nursing Process: Assessment

MSC:NCLEX: Safe, Effective Care Environment;

14)The nurse tells a peer, “I’m assigned to an interdisciplinary team working with a group of depressed clients, half of whom are receiving supportive interventions and antidepressant medication. The others are receiving only antidepressants. We are concerned with treatment outcomes for each group.” The peer should identify the work described as

A. analytical epidemiology.
B. clinical epidemiology.
C. descriptive epidemiology.
D. experimental epidemiology.

ANS: B

Clinical epidemiology is a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. This study is concerned with the effectiveness of various interventions. Option A explores the rates of variation in illness among different groups, seeking to identify risk factors contributing to development of the disorder. Option C provides estimates of the rates of disorders in a general population and its subgroups. Option D tests presumed assumptions between a risk factor and a disorder.

DIF: Cognitive Level: Comprehension REF: Text Page: 4, Text Page: 5

TOP:Nursing Process: N/A

MSC:NCLEX: Safe, Effective Care Environment;

15)The husband of a client with schizophrenia tells the nurse, “I simply don’t understand why how my wife was nurtured or toilet trained has anything to do with the incredibly disabling illness she has!” The response by the nurse that will help the husband better understand his wife’s condition is

A. “It must be frustrating for you that your wife is sick so much of the time.”
B. “You can count on the fact that her illness is the result of genetic factors.”
C. “Although it seems impossible, psychological stress really is at the root of most mental disorders.”
D. “New findings tell us that your wife’s condition is more likely biological than psychological in origin.”

ANS: D

Many of the most prevalent and disabling mental disorders have been found to have strong biological influences. Option A is empathetic but does not address increasing the husband’s level of knowledge about the cause of his wife’s condition. Option B is not an established fact. Option C is not true.

DIF:Cognitive Level: ApplicationREF:Text Page: 6

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

16)The understanding on the part of the nurse that should result in the nurse providing the highest degree of client advocacy during a multidisciplinary client care planning session is

A. all mental illnesses are culturally determined.
B. schizophrenia and bipolar disorder are cross-cultural disorders.
C. symptoms of mental disorders are unchanged from culture to culture.
D. symptoms of mental disorders reflect a person’s cultural patterns.

ANS: D

A nurse who understands that a client’s symptoms are influenced by culture will be able to advocate for the client to a greater degree than a nurse who believes that culture is of little relevance. Option A is an untrue statement. Option B is a true statement but has little relevance to client advocacy. Option C is an untrue statement.

DIF: Cognitive Level: Analysis REF: Text Page: 11, Text Page: 12

TOP:Nursing Process: Implementation

MSC:NCLEX: Safe, Effective Care Environment;

17)The nurse reading a client’s medical record determines that the client’s relationships with both men and women tend to be intense and unstable, with the client initially idealizing the significant other and then devaluing him or her when the individual does not meet the client’s needs. Furthermore, the client experiences feelings of emptiness and resorts to self-mutilation. The aspect of mental health the nurse can assess as lacking is

A. effectiveness in work.
B. communication skills.
C. productive activities.
D. fulfilling relationships.

ANS: D

The information given centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities (options A, B, and C).

DIF:Cognitive Level: AnalysisREF:Text Page: 5

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

18)In the majority culture of the United States, the individual at greatest risk for being labeled mentally ill is

A. one who is wealthy and goes around the city giving away $20 bills to needy individuals.
B. one who attends a charismatic church and describes hearing God’s voice speaking to her.
C. one who always has an optimistic viewpoint about her life situation and the possibility of having her needs met.
D. one who is usually pessimistic about possible outcomes but strives to meet personal goals.

ANS: B

Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. In this situation cultural norms vary, making it more difficult to make an accurate DSM-IV-TR diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill.

DIF:Cognitive Level: AnalysisREF:Text Page: 12

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

19)To effectively use the DSM-IV-TR the nurse must be cognizant of the fact that this tool classifies

A. deviant behavior.
B. people with mental disorders.
C. disorders that people have.
D. present disability or distress.

ANS: C

The DSM-IV-TR classifies disorders that people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example. Option A: Deviant behavior is generally not considered a mental disorder. Option D: Present disability or distress is associated with having a mental disorder.

DIF:Cognitive Level: ComprehensionREF:Text Page: 8

TOP:Nursing Process: Implementation

MSC:NCLEX: Safe, Effective Care Environment;

20)The psychiatric nurse addresses axis I of the DSM-IV-TR as the focus of treatment but must also consider the presence of a long-term disorder that affects treatment. This information is accessed by noting axis

A. II.
B. III.
C. IV.
D. V.

ANS: A

Axis II refers to personality disorders and mental retardation. Together they constitute the classification of abnormal behavior diagnosed in the individual. Option B: Axis III indicates any relevant general medical conditions. Option C: Axis IV reports psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis. Option D: Axis V is the global assessment of functioning.

DIF: Cognitive Level: Comprehension REF: Text Page: 9, Text Page: 10

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21)For the psychiatric nurse whose client care focus is holistic, awareness of which DSM-IV-TR axes is most important?

A. I and II
B. III and IV
C. V
D. I through V

ANS: D

A holistic focus requires the nurse to be aware of the entire client, thus allowing more comprehensive and appropriate interventions.

DIF:Cognitive Level: ApplicationREF:Text Page: 13

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

22)When the nurse providing psychoeducation about mental disorders is asked “What is the most prevalent mental disorder in the United States?” the response should be

A. “Why do you ask?”
B. schizophrenia.
C. affective disorders.
D. substance abuse.

ANS: D

The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (depression, dysthymia, bipolar) is 9.5%, and the prevalence of substance abuse is 11.3%. Option A does not provide an answer.

DIF:Cognitive Level: KnowledgeREF:Text Page: 7

TOP:Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

1)A nurse visiting a U.S. senator’s office to lobby for greater insurance parity for psychobiological disorders can establish need for parity by accurately stating that approximately 1 in ____________________ adults per year in the United States has a diagnosable mental disorder.

ANS:

5

five

Rationale: An estimated 21.1% of Americans aged 18 years and older have a diagnosable mental disorder each year. This statistic is roughly equivalent to 1 in 5 adults.

DIF: Cognitive Level: Knowledge REF: Text Page: 4, Text Page: 5, Text Page: 6

TOP:Nursing Process: Implementation

MSC:NCLEX: Safe, Effective Care Environment;

OTHER

1)A client asks the nurse, “The pamphlet I read about depression mentions that psychosocial factors influence depression. What does that mean?” Examples a nurse could cite to support the premise that a client’s depression can be influenced by psychosocial factors include (more than one answer may be correct)

A. having a hostile and overinvolved family.

B. having two first-degree relatives with bipolar disorder.

C. feeling strong guilt over having an abortion when one’s religion forbids it.

D. experiencing the death of a parent a month before the onset of depression.

E. experiencing symptom remission when treated with antidepressant medication.

ANS:

A, C, D

Rationale: Option A: Family influence is considered a psychosocial factor affecting a client’s mental health. A hostile, overinvolved family is critical of the client and contributes to low self-esteem. Option B: This example would be considered a genetic factor that influences the individual’s risk for mental disorder, not a psychosocial factor. Option C: Religious influences are considered psychosocial in nature. Option D: Life experiences, especially crises and losses, are considered psychosocial influences on mental health. Option 5: Treatment with a biological agent such as antidepressant medication is an example of a biological influence.

DIF:Cognitive Level: AnalysisREF:Text Page: 8

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2)A client comes to the emergency department with the chief symptom of “I’m hearing voices telling me that someone is stalking me. They want to kill me because I have developed a cure for cancer.” The client tells the nurse that he carries a knife and will stab anyone he thinks is a threat to him. Which aspects of mental health should be of greatest immediate concern to the nurse? (More than one answer may be correct.)

A. Happiness

B. Appraisal of reality

C. Control over behavior

D. Effectiveness in work

E. Healthy self-concept

ANS:

B, C, E

Rationale: The aspects of mental health of greatest concern are the client’s appraisal of and his control over behavior. His appraisal of reality is inaccurate. He has auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the client’s control over behavior is tenuous, as evidenced by his plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness [option A] and effectiveness in work [option D]) are of immediate concern.

DIF:Cognitive Level: AnalysisREF:Text Page: 5

TOP:Nursing Process: Assessment

MSC:NCLEX: Safe, Effective Care Environment;

Foundations of Psychiatric Mental Health Nursing 5th edition Varcarolis Test Bank