1. In which scenario is it most urgent for the nurse to act as a patient advocate?
a. An adult cries and experiences anxiety after a near-miss automobile accident on the way to work.
b. A homeless adult diagnosed with schizophrenia lives in a community ex
Answer: B
While all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent danger to the patient's safety and well-being.
2.The nurse interacts with a veteran of World War II. The veteran says, "Veterans of modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself." Select the nurse's best response.
a. "American society in th
ANSWER: C
Trauma occurs in many forms, including physical, sexual, and emotional abuse; war; natural disasters; and other harmful experiences. Trauma-informed care provides guidelines for integrating an understanding of how trauma affects patients into cl
4.The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population?
a. The patient's diagnoses are confirmed using advanced neuroimaging techn
ANSWER:D
The correct response recognizes the recovery model, which has the following tenets: Mental health care is consumer and family driven, with patients being partners in all aspects of care; care must focus on increasing the consumer's success in cop
5.Which scenario best demonstrates empathetic caring?
a. A nurse provides comfort to a colleague after an error of medication administration.
b. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing.
c. A nurse identifies a viola
ANSWER:A
Caring is evidenced by empathic understanding, actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of
Key points Chapter 1
Practicing the Science and the Art of Psychiatric Nursing
� Nursing integrates both scientific knowledge and caring arts into a holistic practice.
� Evidence-based practice (EBP) is a process by which the best available research evidence, clinical expertise, and patient preferences are synthesized while making c
3.A patient reports to a primary care provider about sleeplessness, constant fatigue, and sadness. In our current health care climate, what is the most likely treatment approach that will be offered to the patient?
a. Group therapy
b. Individual psychothe
ANSWER: D
The patient's report suggests that depression is occurring. With the increased understanding of the biology of psychiatric illnesses, treatment approaches have evolved rapidly into more scientifically grounded methods, particularly psychopharmac
KEY POINTS CHAPTER 2:
MENTAL HEALTH AND MENTAL ILLNESS
Mental illness can be difficult to define. The DSM-5 and cultural norms must be considered in evaluating mental health and illness. There are many myths surrounding mental illness, which contribute to stigmatization of individuals. The stereotyping, discr
1. A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness?
a. "Gun control laws are inadequate in our
ANSWER:C
Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear, and misinformation contribute to stigma.
The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response.
a. "There are many reasons why mental illness occurs."
b. "The cause of m
ANSWER:C
In the correct response, the nurse answers rather than evades the question, provides accurate information, and uses terminology a 9- or 10-year-old child can understand. Many of the most prevalent and disabling mental disorders have been found to
3. An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency?
a. "I often pray for a miracle that will heal my paralysis
ANSWER: D
Resiliency is the ability to recover from or adjust successfully to trauma or change. A successful transition through a crisis builds resiliency for the next difficult trial. In the correct response, the person demonstrates acceptance of the par
A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide?
a. "It is more respectful to refer to the
ANSWER:A
Diagnoses classify disorders that people have, not the person. For this reason, it is important to avoid use of expressions such as "a schizophrenic" or "an alcoholic." The nurse has a responsibility to educate the coworker.
5. Which scenario meets the criteria for "normal" behavior?
a. An 8-year-old child's only verbalization is "No no no."
b. A 16-year-old girl usually sleeps for 3 or 4 hours per night.
c. A 43-year-old man cries privately for 1 month after the death of his
ANSWER:C
Many biological, cultural, and environmental factors influence mental health. Persons who are normal also may experience dysfunction during their lives. The death of a spouse is a difficult experience, so crying is expected.
Which institution specific clinical practice resource will the nurse use to integrate evidence-based practice (EBP) into the care of a client hospitalized for the purpose of the evaluation of his or her current therapy plan?
1.Researching current medicati
4
In order to demonstrate the integration of evidence-based practice (EBP) into the care of a client who has been hospitalized for severe depression and prescribed a selective serotonin reuptake inhibitor (SSRI), the novice nurse will include which action i
1
Which statement by the nurse best demonstrates a dilemma associated with the utilization of evidence-based practice (EBP) in the mental health clinical setting?
"The client can't afford the cost of the medication he's being prescribed."
"The client doesn'
4
The decision to intervene as a patient advocate is clearly identified by the American Nurses Association's (ANA) code of ethics in which situation?
1.A client's need for assistance while ambulating post-surgery
2.A suspicion that a staff member is unfit t
2
Considering the administration of medications, the nurse applying evidence-based nursing practice will engage in which nursing activity?
1.Educating the client regarding the side effects of a newly prescribed antidepressant
2.Confirming the client's ident
3
Which client statement supports the nurse's assessment that the client has demonstrated resiliency?
"Losing a parent is a natural part of life."
"I know I'm not the first person to lose a loved one."
"I've learned from experiencing other losses that I'll
I've learned from experiencing other losses that I'll be okay.
When considering prevalence, the nurse will focus on which disorder(s) when identifying the focus of a community mental health screening?
1. Anxiety disorders
2. Affective disorders
3. Any substance abuse
4.alcohol dependence
Anxiety disorders
The nurse, striving to minimize the bias of a Western view on what is considered acceptable behavior, will consult which mental health associated resource?
-Cultural Formulation Interview (CFI)
-The client's past and present mental health assessment
-Glos
Cultural Formulation Interview (CFI)
The nurse recognizes that the greatest barrier to successful mental health treatment and recovery is demonstrated by which client?
The teenager who fears being rejected by his peers
The young homeless adult who cannot keep clinic appointments
The elderly
The teenager who fears being rejected by his peers
Which question will the nurse ask in order to assess a client's ability to think clearly?
"Are you employed full time?"
Do you feel guilty about your recent divorce?"
How do you plan to afford getting your own apartment?"
What do you think is your most va
How do you plan to afford getting your own apartment?
CHAPTER 3 KEY POINTS
THEORIES AND THERAPIES
� Theoretical models and therapeutic strategies provide a useful framework for the delivery of psychiatric nursing care.
� The psychoanalytic model is based on unconscious motivations and the dynamic interplay between the primitive brain (id), the sense o
1. A nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include?
a. Coping with grief and loss
b. The importance of hand washing
c. Strategies for money management
d. Staffing shortages expected over the n
ANSWER: B
A therapeutic milieu provides a healthy social structure within an inpatient setting or structured outpatient clinic. Groups aim to help increase patients' self-esteem, decrease social isolation, encourage appropriate social behaviors, and educa
2. Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need?
a. "Even though I'm 40 years old, I have returned to college so I can get a better job."
b. "I help my community by volunteering at a thrift
ANSWER: B
Maslow's hierarchy of needs are placed conceptually on a pyramid, with the most basic and important needs on the lower level. The higher levels, the more distinctly human needs, occupy the top sections of the pyramid. When lower-level needs are
3. Which patient is likely to achieve maximum benefit from cognitive behavioral therapy (CBT)?
a. Older adult diagnosed with stage 3 Alzheimer's disease
b. Adult diagnosed with schizophrenia and experiencing delusions
c. Adult experiencing feelings of fai
ANSWER C
The goal of cognitive behavioral therapy (CBT) is to identify the negative patterns of thought that lead to negative emotions. Once the maladaptive patterns are identified, they can be replaced with rational thoughts. A person must be able to eng
4. An adult plans to attend an upcoming tenth high school reunion. This person says to the nurse, "I am embarrassed to go. I will not look as good as my classmates. I haven't been successful in my career." Which comment by the nurse addresses this cogniti
ANSWER C
Rapid, unthinking responses are known as automatic thoughts. Often these automatic thoughts, or cognitive distortions, are irrational because people make false assumptions and misinterpretations. Once the negative patterns of thought that lead to
5. A distraught 8-year-old girl tells the nurse, "I had a horrible nightmare and was so scared. I tried to get in bed with my parents but they said, 'No.' I think I could have gone back to sleep if I had been with them." Which family dynamic is likely the
ANSWER A
Rigid or disengaged boundaries are those in which the rules and roles are followed despite the consequences.
A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care?
a. Risk for falls related to loss of balance and equilibrium
b. Unilateral neglect related to impairments to perception
c. Impaired physic
ANSWER A
The cerebellum is critical in both motor and cognitive functions. Alterations in cerebello-thalamo-cortical circuits may manifest as disturbances of coordination, balance, and gait. Safety is the nurse's first concern.
2. A patient begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care?
a. Monitor intake and output daily.
b. Educate patient about foods that contain tyramines.
c. Assess sitting, standing, an
ANSWER C
Risperidone blocks ?1- and H1 receptors. It can cause orthostatic hypotension and sedation, which can lead to falls.
3. Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a patient beginning a new prescription for which medication?
a. Aripiprazole (Abilify)
b. Olanzapine (Zyprexa)
c. Ziprasid
ANSWER B
Olanzapine (Zyprexa) has metabolic side effects, particularly weight gain. Metabolic monitoring for all patients receiving atypicals is recommended, although risperidone (Risperdal) and quetiapine (Seroquel) have a lower weight gain. Ziprasidone
4. A patient tells the community mental health nurse, "I told my health care provider I was having trouble sleeping and he prescribed trazodone 50 mg every night. I read on the internet that drug is an antidepressant, but I'm not depressed. What should I
ANSWER C
At lower doses, trazodone loses its antidepressant action while retaining hypnotic effects through histamine receptor antagonism; therefore it is useful for insomnia. Fifty milligrams is a low dose. High doses of trazodone are required for the se
5. Which patient would the nurse expect to have the most difficulty with problem solving and decision making?
a. An 18-year-old diagnosed with bulimia nervosa at age 14; has taken oral doses of fluoxetine (Prozac) daily for 3 years
b. A 46-year-old diagno
ANSWER D
Executive functions occur in the cerebrum. Loss of cortical tissue has been associated with schizophrenia as well as with treatment involving haloperidol and other typical antipsychotics. In contrast, newer atypical antipsychotics and antidepress
KEY POINTS CHAPTER 4 : BIOLOGICAL BASIS FOR UNDERSTANDING PSYCHOPHARMACOLOGY
All actions of the brain� sensory, motor, intellectual� are carried out through the interactions of nerve cells involving impulse conduction, transmitter release, and receptor response. Alterations in these basic processes can lead to mental disturbances
CHAPTER 5 KEY POINTS: SETTINGS FOR PSYCHIATRIC CARE
� Compared to seeking care for physical disorders, finding care for psychiatric disorders can be complicated by a two-tiered system of care provided in the private and public sectors.
� Nonspecialist primary care providers treat a significant portion of p
1. A patient diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's best action?
a. Re
answer : A
5-1). The patient's comments indicate problems with use of leisure time. Recreational activities improve emotional, physical, cognitive, and social well-being. A recreational therapist is the best member of the treatment team to provide these s
2. The nurse admits a patient experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require which service occurs first?
a. Social history
b. Psychiatric history
c. Medical assessment
. Psychological
ANSWER:C
Begins with a medical assessment to rule out or consider co-occurring/ comorbid conditions.
3. A nurse working in an acute care unit for adolescents diagnosed with mental illness says, "Our patients have so much energy. We need some physical activities for them." In recognition of needs for safety and exercise, which activity could the treatment
ANSWER: D
Safety is a key consideration in selection of activities. The correct response identifies an activity likely to appeal to the population but without physical contact between patients or equipment, which may be associated with injury. 4. Answer
4. As Election Day nears, a mental health nurse studies the position statements of various candidates for federal offices. Which candidate's commentary would the nurse interpret as supportive of services for persons diagnosed with mental illness?
a. "Full
ANSWER:A
Mental health parity refers to third-party (insurance) coverage of care for mental illness and addictions similarly to care of physical illness. Federal and state legislation apply, but coverage varies by state. Some states offer full parity for
5. An experienced nurse in a major medical center requests a transfer from a general medical unit to an acute care psychiatric unit. Which organizational feature would best support this nurse's successful transition?
a. Assignment to medication administra
ANSWER C
The nurse's skills from the medical unit will be valuable, but this nurse will need to expand his or her skill set to effectively care for a psychiatric population. Working with an experienced psychiatric nurse will provide opportunities for lear
1. A nurse's sibling happily says, "I want to introduce you to my fianc�. We're getting married in six months." The nurse has encountered the fianc� in a clinical setting and is aware of the fianc�'s diagnosis of schizophrenia. What is the nurse's best re
D
The patient's thyroid problems may have reemerged and can mimic depression.
2. A patient has been disruptive to the therapeutic milieu for two days. A certified nursing assistant says to the nurse, "We need to seclude this patient because this behavior is upsetting everyone on the unit." Considering patients' rights, the nurse sh
C
The focus of the question is the caregiver. Demands associated with the care of three elderly persons who live at a distance have the potential of overwhelming the caregiver. Because there is no evidence of role strain, a risk diagnosis is formulated.
3. A day shift nurse contacts a nurse scheduled for night shift at home and says, "Ourunit is full and there are eight patients in the emergency department waiting for a bed." The night shift nurse replies, "Thanks for telling me. I am calling in sick." W
A
Fidelity is an ethical principle that involves maintaining loyalty and commitment to patients
4. In a staff meeting at an inpatient mental health facility for persons, the administrator announces that psychiatric technicians will now be supervised by the milieu director rather than by nurses. What is the nurse's best action?
a. Confer with colleag
D
Institutional policies and practices do not absolve an individual nurse of responsibility to practice on the basis of professional standards of nursing care. State nurse practice acts specify that unlicensed assistive personnel (UAP) work under a nurse'
5. A colleague tells the nurse, "I have not been able to sleep for the past three days. I feel like a robot." What is the nurse's best action?
a. Direct the colleague to leave the facility immediately.
b. Observe the colleague closely for evidence of impa
D
Sleep deprivation causes impaired practice, which jeopardizes patient safety. The colleague's comments indicate that impairment is likely. The nurse should confer with the supervisor to determine the appropriate action.
CHAPTER 6 KEY POINTS:
LEGAL AND ETHICAL BASIS
� States' power to enact laws for public health and safety and for the care of those unable to care for themselves often pits the rights of society against the rights of the individual.
� Psychiatric nurses frequently encounter problems requiring ethical
CHAPTER 7 KEYPOINTS
NURSING PROCESS AND QSEN
� The nursing process is a six-step problem-solving approach to patient care to help secure safety and quality care for patients.
� The Institute of Medicine (IOM) and QSEN faculty have established mandates to prepare future nurses with the knowledge, ski
1. A nurse assesses a new patient whose chief concern is "daily crying spells." Which comment from the patient would prompt the nurse to suspect a medical reason is causing the problem rather than depression?
a. "I usually drink two or three cups of coffe
c
The patient's thyroid problems may have reemerged and can mimic depression.
2. A 55-year-old lives 100 miles from her parents and mother-in-law. In the past year, her father had back surgery, her mother broke her hip, and her mother-in-law had a cardiac event. Which nursing diagnosis is most applicable to the 55-year-old?
a. Risk
d
The focus of the question is the caregiver. Demands associated with the care of three elderly persons who live at a distance have the potential of overwhelming the caregiver. Because there is no evidence of role strain, a risk diagnosis is formulated.
.
3. A patient asks the psychiatric mental health registered nurse, "I'm having so much anxiety. I think hypnosis would help me. Will you do that for me?" When determining a response, which factor should the nurse consider? a. The patient's current medicati
b
Hypnosis is not within the scope of practice of a staff level registered nurse. The state nurse practice act details regulations regarding scope of practice. Hypnosis is an advanced practice intervention
4. The nurse plans care for a newly hospitalized patient experiencing panic level anxiety after an automobile accident. The patient has no physical injuries. When selecting goals from the Nursing Outcomes Classification (NOC), the nurse will
a. Select out
c
Outcomes, as well as interventions, must always be individualized to the patient and should reflect the patient's multidimensional needs. While it is important to confer with the patient about which outcomes are desirable, a patient experiencing panic i
5. On an inpatient unit, one patient assaults another patient resulting in a small laceration. Considering the patients' right to confidentiality, how will the nurse effectively document this event?
a. Ensure unit safety by documenting the hostile and com
b
It is important to document the events and actions taken in both patients' records; however, confidentiality must be maintained. Using the initials of patients involved is one way to ensure that confidentiality is maintained.
CHAPTER 8 KEY POINTS:
COMMUNICATION SKILLS
� Knowledge of communication and interviewing techniques is the foundation for development of any patient-centered partnership. Goal-directed professional communication is referred to as therapeutic communication.
� Communication is a complex process. Ber
1. An adult experiencing a recent exacerbation of ulcerative colitis tells the nurse, "I had an accident while I was at the grocery store. It was so embarrassing." Select the nurse's therapeutic response.
a. "Most grocery stores have public restrooms avai
a
2. A nurse counsels a widow whose husband died 5 years ago. The widow says, "If I'd done more, he would still be alive." Select the nurse's therapeutic response.
a. "I understand how you feel after such a terrible loss."
b. "That was a long time ago. Now
d
3. A patient has been out of work 3 weeks with a major illness and anticipates another month of recovery. The patient tells the nurse, "I'm trying to keep up with my work email from home. They hired a new person in my department but the person has no expe
a
4. In which nurse-patient interaction would it be appropriate for the nurse to consider using touch?
a. Comforting a tearful patient of Japanese heritage
b. Counseling a child who was physically abused by a parent
c. Welcoming a person of Hispanic heritag
c
5. A nurse prepares a patient in a rural community for an initial telehealth visit with the health care provider. Select the nurse's priority action.
a. Ensure that the patient's rights to privacy are respected.
b. Ask the patient, "How much do you know a
a
CHAPTER 9 KEY POINTS :
THERAPEUTIC RELATIONSHIPS AND THE CLINICAL INTERVIEW
� The nurse-patient relationship/ partnership is well defined, and the roles of the nurse and the patient must be clearly stated.
� It is important that the nurse be aware of the differences between a therapeutic relationship and a social or intimate rela
1. Which comment by the nurse would be appropriate to begin a new nurse-patient relationship?
a. "Which of your problems is most serious?"
b. "I want you to tell me about your problems."
c. "I'm an experienced nurse. You can trust me."
d. "What would you
d
2. A neighbor telephones the nurse daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit-setting strategy should the nurse employ?
a. Suggest the neighbor call other people in the community.
b. Say to the n
b
3. A patient has been oppositional, demanding, and resistant to working on goals. A mental health nurse tells the nursing supervisor, "We finally had a serious talk. I let that patient know it's time to get right with God and stop this behavior." Recogniz
d
4. A nurse participating in a community health fair interviews an adult who has had no interaction with a health care professional for more than 10 years. The adult says, "I like to keep to myself. Crowds make me nervous." Which action should the nurse em
c
5. A group of nurses privately discuss patients under their care. Which nurse's comment indicates the need for clinical supervision regarding countertransference?
a. "My patient is always asking my permission to do something, just like a child."
b. "When
c
CHAPTER 10 KEY POINTS
TRAUMA AND STRESS RELATED DISORDERS
� Some stress is useful in our lives; eustress is stress that makes us strive to reach our goals, repair important relationships, improve our work, and stimulate creative problem-solving processes and improve critical thinking.
� Stress is common in our l
1. A mature, professional couple plans a large wedding in a city 100 miles from their home. Which response is most likely to be associated with this experience?
a. Distress
b. Eustress
c. Acute stress
d. Depersonalization
b
2. A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions three times a week. Which outcome indicates this activity has been successful?
a. The student reports imp
a
3. An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for five years, never knowing when something
d
4. A veteran of the war in Afghanistan tells the nurse, "Everyday, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the n
a
5. An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times daily. The person tells the nurse, "They're so loud I can't hear myself think." What is the nurse's best first action?
a. Direct the individual to rep
b
CHAPTER 11 KEY POINTS:
ANXIETY,ANXIETY DISORDERS,OCD, AND RELATED DISORDERS
� A simple explanation for the difference between anxiety and fear is that anxiety has an unknown or unrecognized source, whereas fear is a reaction to a specific threat.
� Anxiety can be normal, acute, or chronic, as well as adaptive or maladaptive. � Pe
1. Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous a
b
2. A nurse analyzes reports from four adult patients of frightening events they encountered. Which patient's report most clearly indicates that the resulting fear was mentally healthy?
a. "I saw a large spider crawling along my kitchen wall."
b. "I was at
c
3. A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "I'm always the one who gets caught. You're going to cause me to fail." Select
d
4. Select the best example of altruism.
a. After recovering from a gunshot wound, a police officer attends a local support group.
b. After recovering from open heart surgery, an individual plays tennis three times a week.
c. An individual who received a l
d
5. An outpatient psychiatric nurse assesses a patient diagnosed with hoarding disorder. The patient has lost 12 pounds in the past two months, appears disheveled, and is wearing dirty clothing with poor hygiene. What is the nurse's priority action?
a. Rev
d
CHAPTER 12 KEY POINTS:
SOMATIC SYMPTOM DISORDERS AND DISSOCIATIVE DISORDERS
� Somatic symptom disorders are characterized by the presence of multiple, real physical symptoms for which there is most often no evidence of medical illness.
� Dissociative disorders involve a disruption in consciousness with a significant impairment in
1. A patient at a general medical clinic tells the nurse, "I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me." Which comment should the nurse offer next?
a. "Let's review all the med
a
2. A combat veteran from two tours of the war in Afghanistan tells the nurse, "Some guys in my unit have posttraumatic stress disorder, but I never had any problems other than my hearing is not as good as it once was." Which explanation for this comment s
d
3. A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse's comment should prompt the nursing supervisor to intervene?
a. "I have never ta
c
4. A nurse in an outpatient medical clinic talks to a patient with a long history of malingering and doctor-shopping. The patient continues to express complaints of multiple problems. Select the nurse's best comment to the patient.
a. "The treatment team
b
5. A patient in the emergency department was seen for the third time in a month with complaints of tremors and paresthesia in the lower extremities. Conversion disorder was diagnosed. While preparing for discharge, the patient says, "Now I'm having chest
b
CHAPTER 13 KEY POINTS
PERSONALITY DISORDERS
� People with personality disorders (PDs) present with the most complex, difficult behavioral challenges for themselves and the people around them.
� People with PDs have inflexible and maladaptive ways of handling stress; demonstrate disabilities in both
1. A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder?
a. Antisocial
b. Histrionic
c. Borderl
a
2. After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder?
a. "These sandwiches are probably contaminated with bacteria."
b.
c
3. A nurse plans care for a patient diagnosed with borderline personality disorder. Which nursing diagnosis is most likely to apply to this patient?
a. Ineffective relationships related to frequent splitting
b. Social isolation related to fear of embarras
a
4. The nurse assesses a new patient suspected of having a schizotypal personalitydisorder. Which assessment question is this patient most likely to answer affirmatively?
a. "Do some types of situations frighten you?"
b. "Do you often have episodes of prol
c
5. A mental health nurse assesses a patient diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? '
a. Generalized anxiety
b. Alcohol use and abuse
c. Compulsions and phobia
b
CHAPTER 14 KEYPOINTS
EATING DISORDERS
� A number of theoretical models help explain risk factors for the development of eating disorders. � Neurobiological theories identify an association between eating disorders, depression, and neuroendocrine abnormalities.
� Psychological theories explore
1. The school nurse assesses four adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity?
a. 5'2" tall; weight 104 pounds
b. 5'7" tall; weight 110 pounds
c. 5'5" tall; weight 114 pou
b
2. A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa?
a. "I look good because whenever I overeat, I purge myself."
b. "I love sweets. I make
c
3. While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, "I wish I had an eating disorder; maybe I'd lose a little weight." What is the nurse's best action?
a. Report the clinical observation to the nursing
c
4. Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate?
a. "You need to gain weight to becom
c
. 5. A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results below. Sodium 143 mEq/ L Potassium 3.1 mEq/ L Chloride 102 mEq/ L Magnesium 2.2 mEq/ L Calcium 8.4 mg/ dL Phosphate 3.0 mg/ dL The nurs
d
CHAPTER 15 KEY POINTS:
MOOD DISORDERS
� Depression is the most commonly seen psychiatric syndrome in the health care system.
� There are a number of subtypes of depression and depressive clinical phenomena. Two primary depressive disorders are major depressive disorder (MDD) and chronic depre
1. A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors
c
2. A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action.
a. Assess the patient's current sleep and eating patterns.
b. Explain to the patient, "Everyone feels down from t
d
3. A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response.
a. "Which antidepressant m
c
4. The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger patients, w
c
5. Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous tr
d