DAY 1 & 2 CHAPTER QUESTIONS

Question 1

Resilience, the capacity to rebound from stressors via adaptive
coping, is associated with positive mental health. Your friend
has just been laid off from his job. Which of the following
responses on your part would most likely contribute to his
enhanced resilience?
a. Using your connections to set up an interview with your
employer
b. Connecting him with a friend of the family who owns his
own business
c. Supporting him in arranging, preparing for, and completing
multiple interviews
d. Helping him to understand that the layoff resulted from troubles in the economy and is not his fault

Answer 1

c. Supporting him in arranging, preparing for, and completing
multiple interviews

Question 2

Which of the following situations best supports the diathesis–
stress model of mental illness development?
a. The rate of suicide increases during times of national
disaster and despair.
b. A woman feels mildly anxious when asked to speak to a
large group of people.
c. A man with no prior mental health problems experiences
sadness after his divorce.
d. A man develops schizophrenia, but his identical twin
remains free of mental illness.

Answer 2

d. A man develops schizophrenia, but his identical twin
remains free of mental illness.

Question 3

Of the following statements about mental illness, identify all correct ones:
a. About 20% of Canadians experience a mental disorder
during their lifetime.
b. Mental disorders and diagnoses occur very consistently
across cultures.
c. Most serious mental illnesses are psychological rather than
biological in nature.
d. The Mental Health Commission of Canada’s report
Changing Directions, Changing Lives outlines the mental
health strategy for Canada.

Answer 3

a. About 20% of Canadians experience a mental disorder
during their lifetime.
d. The Mental Health Commission of Canada’s report
Changing Directions, Changing Lives outlines the mental
health strategy for Canada.

Question 4

Jane is a 32-year-old mother of four. She is active with her family and in her community despite having a diagnosis of severe anxiety. Refer to the mental health–mental illness continuum shown in Figure 1-2 and consider where you would place Jane.
a. Optimal mental health with mental illness
b. Optimal mental health without mental illness
c. Poor mental health with mental illness
d. Poor mental health without mental illness

Answer 4

a. Optimal mental health with mental illness

Question 5

Which of the following actions represent the primary focus of psychiatric nursing for a basic-level registered nurse? Select all that apply.
a. Determining a patient’s diagnosis according to the DSM-5
b. Ordering diagnostic tests such as EEGs or MRI scans
c. Identifying how a patient is coping with a symptom such
as hallucinations
d. Guiding a patient to learn and use a variety of
stress-management techniques
e. Helping a patient without personal transportation find a
way to his or her treatment appointments
f. Collecting petition signatures seeking the removal of
stigmatizing images on television

Answer 5

c. Identifying how a patient is coping with a symptom such
as hallucinations
d. Guiding a patient to learn and use a variety of
stress-management techniques
e. Helping a patient without personal transportation find a
way to his or her treatment appointments
f. Collecting petition signatures seeking the removal of
stigmatizing images on television

Question 6

. Asylum care of people with mental illness in Canada began
in which year?
a. 1620
b. 1932
c. 1845
d. 1798

Answer 6

c. 1845

Question 7

The Weir Report was considered influential in which of the
following areas?
a. Asylum reform
b. Nursing education curriculum reform
c. Deinstitutionalization
d. The establishment of the registered psychiatric nurse
designation

Answer 7

b. Nursing education curriculum reform

Question 8

Psychiatric mental health nursing in the community setting
was influenced by which of the following factors?
a. The Weir Report
b. Deinstitutionalization
c. The registered psychiatric nurse designation
d. The increased medicalization of psychiatry

Answer 8

b. Deinstitutionalization

Question 9

A friend recognizes that his depression has returned and tells
you he is suicidal and concerned he will harm himself. He is
afraid that if he seeks help he will be involuntarily admitted
to a psychiatric hospital, an idea that terrifies him. Which of
the following responses best meets his immediate care needs?
a. Provide emotional support and encourage him to contact
his family.
b. Express your concern for his safety, normalize psychiatric
treatment as equal to treatment of any physical condition,
and offer to accompany and support him through assessment at a nearby emergency department.
c. Contact the police or a provincial/territorial magistrate to
initiate involuntary assessment.
d. Assist him to obtain an outpatient counselling appointment
at an area community mental health centre, and call him
frequently to ensure that he is safe until this appointment
occurs.

Answer 9

b. Express your concern for his safety, normalize psychiatric

Question 10

You are about to interview a newly admitted patient on your inpatient mental health unit. This is his first experience with psychiatric treatment. Which of the following interventions would be appropriate for this patient? Select all that apply.
a. Discuss outpatient care options for after discharge.
b. Anticipate and address possible increased anxiety and
shame.
c. Ensure that the individual understands his rights as a patient
on your unit.
d. Assess the patient for physical health needs that may have
been overlooked.
e. Carefully check all clothing and possessions for potentially
dangerous items

Answer 10

b. Anticipate and address possible increased anxiety and
shame.
c. Ensure that the individual understands his rights as a patient
on your unit.
d. Assess the patient for physical health needs that may have
been overlooked.
e. Carefully check all clothing and possessions for potentially
dangerous items

Question 11

Which of the following nursing actions are appropriate in maintaining a safe therapeutic inpatient milieu? Select all that apply.
a. Interact frequently with both individuals and groups on
the unit.
b. Ensure that none of the unit fixtures can be used for suicide
by hanging.
c. Initiate and support group interactions via therapeutic
groups and activities.
d. Stock the unit with standard hospital beds and other sturdy
hospital furnishings.
e. Provide and encourage opportunities to practise social
and other life skills.
f. Collaborate with housekeeping to provide a safe, pleasant
environment.

Answer 11

a. Interact frequently with both individuals and groups on
the unit.
b. Ensure that none of the unit fixtures can be used for suicide
by hanging.
c. Initiate and support group interactions via therapeutic
groups and activities.
e. Provide and encourage opportunities to practise social
and other life skills.
f. Collaborate with housekeeping to provide a safe, pleasant
environment.

Question 12

A patient becomes agitated and hostile, threatening to smash
a chair into the nurses’ station door. Which of the following
responses would be most appropriate for the student nurse
to make?
a. Maintain a safe distance, and attempt to de-escalate the
patient verbally.
b. When the response team arrives, assist in physically
restraining the patient.
c. Assist in promptly moving other patients to a safe distance
or separate location.
d. Meet with the patient immediately after the crisis to help
him process what happened.

Answer 12

c. Assist in promptly moving other patients to a safe distance
or separate location.

Question 13

A student is considering a career in mental health nursing.
Which of the following statements accurately reflects the role
and expectations of mental health nurses in acute care
settings?
a. The primary role of the nurse is to monitor the patients
from the nurses’ station.
b. Psychiatric patients rarely need medical care, so nurses do
not need medical nursing skills.
c. The close relationships developed with patients can lead
to later romantic relationships.
d. Mental health nursing requires a high degree of interpersonal comfort and therapeutic skill.

Answer 13

d. Mental health nursing requires a high degree of interpersonal comfort and therapeutic skill.

Question 14

6. You are a community mental health nurse meeting with a
   patient who has just been discharged from the hospital, where
   he had received psychiatric care for the first time. Which of
   the following activities would you expect to undertake in
   your role as the nurse on the treatment team caring for this
   patient?
   a. Take medications to the patient’s home each day and
   administer them.
   b. Solve day-to-day problems for the patient to minimize his
   exposure to stress.
   c. Refer the patient to counsellors or other providers when
   he indicates a need to talk with someone.
   d. Take a ride on the local bus system with the patient to
   help him learn routes and schedules.

Answer 14

d. Take a ride on the local bus system with the patient to
help him learn routes and schedules.

Question 15

7. Mrs. Chan, a patient at the community mental health centre,
   tends to stop taking her medications at intervals, usually
   leading to decompensation. Which of the following interventions would most likely improve her adherence to her
   medications?
   a. Help Mrs. Chan understand her illness and allow her to share in decisions about her care.
   b. Advise Mrs. Chan that if she stops her medications, her
   doctor will hospitalize her.
   c. Arrange for Mrs. Chan to receive daily home care so her
   use of medications is monitored.
   d. Discourage Mrs. Chan from focusing on adverse effects
   and other excuses for stopping her pills.

Answer 15

a. Help Mrs. Chan understand her illness and allow her to share in decisions about her care.

Question 16

1. The nurse is working with a patient who lacks the ability to
   problem-solve and seeks ways to self-satisfy without regard
   for others. Which system of the patient’s personality is most
   pronounced?
   a. Id
   b. Ego
   c. Conscience (superego)
   d. Ego ideal (superego)

Answer 16

a. Id

Question 17

2. Which behaviour, seen in a 30-year-old patient, would alert
   the nurse to the fact that the patient is not in his appropriate
   developmental stage according to Erikson?
   a. States he is happily married
   b. Frequently asks to call his brother “just to check in”
   c. Looks forward to visits from a co-worker
   d. Says, “I’m still trying to find myself.”

Answer 17

d. Says, “I’m still trying to find myself.”

Question 18

3. A patient has difficulty sitting still and listening to others
   during group therapy. The therapist plans to use operant
   conditioning as a form of behavioural modification to assist
   the patient. Which action would the nurse expect to see in
   group therapy?
   a. The therapist will act as a role model for the patient by
   sitting still and listening.
   b. The patient will receive a token from the therapist for each
   session in which she sits still and listens.
   c. The patient will be required to sit in solitude for 30 minutes
   after each session in which she does not sit still or listen.
   d. The therapist will ask that the patient to sit still and listen
   for only 2 minutes at a time to begin with and will increase
   the time incrementally until the patient can sit and listen
   for 10 minutes at a time.

Answer 18

b. The patient will receive a token from the therapist for each
session in which she sits still and listens.

Question 19

4. The nurse is planning care for a patient with anxiety who
   will be admitted to the unit shortly. Which nursing action is
   most important?
   a. Consider ways to assist the patient to feel valued during
   his stay on the unit.
   b. Choose a roommate for the patient so that a friendship
   can develop.
   c. Identify a room where the patient will have comfortable
   surroundings, and order a balanced meal plan.
   d. Plan methods of decreasing stimuli that could cause
   heightened anxiety in the patient.

Answer 19

c. Identify a room where the patient will have comfortable

Question 20

1. The nurse is assessing a 6-year-old patient. When assessing a child’s perception of a difficult issue, which methods of assessment are appropriate? Select all that apply.
   a. Engage the child in a specific therapeutic game.
   b. Ask the child to draw a picture.
   c. Provide the child with an anatomically correct doll to act
   out a story.
   d. Allow the child to tell a story.

Answer 20

a. Engage the child in a specific therapeutic game.
b. Ask the child to draw a picture.
c. Provide the child with an anatomically correct doll to act
out a story.
d. Allow the child to tell a story.

Question 21

2. Which are the purposes of a thorough mental health nursing assessment? Select all that apply.
   a. Establish a rapport between the nurse and patient.
   b. Assess for risk factors affecting the safety of the patient or others.
   c. Allow the nurse the chance to provide counselling to the
   patient.
   d. Identify the nurse’s goals for treatment.
   e. Formulate a plan of care.

Answer 21

a. Establish a rapport between the nurse and patient.
b. Assess for risk factors affecting the safety of the patient or others.
e. Formulate a plan of care.

Question 22

3. The nurse is performing a spiritual assessment on a patient.
   Which patient statement would indicate to the nurse that
   there is an experiential concern in the patient’s spiritual life?
   a. “I really believe that my spouse loves me.”
   b. “My sister will never forgive me for what I did.”
   c. “I try to find time every day to pray, even though it’s not
   easy.”
   d. “I am happy with my life choices, even if my mother is
   not.”

Answer 22

b. “My sister will never forgive me for what I did.”

Question 23

4. The nurse is caring for a patient who states that he has
   “given up on life.” His wife left him, he was fired from his
   job, and he is four payments behind on his mortgage, meaning
   he will soon lose his house. Which nursing diagnosis is
   appropriate?
   a. Anxiety related to multiple losses
   b. Defensive coping related to multiple losses
   c. Ineffective denial related to multiple losses
   d. Hopelessness related to multiple losses

Answer 23

d. Hopelessness related to multiple losses

Question 24

5. The nurse is documenting. Which statement is appropriate
   to include in the patient’s chart?
   a. “Patient states, ‘I am going to kill myself.’”
   b. “Patient is in good spirits today.”
   c. “Patient has been nasty to the nursing staff this
   afternoon.”
   d. “Patient is demanding and uncooperative.”

Answer 24

a. “Patient states, ‘I am going to kill myself.’”

Question 25

1. A patient with depression presents with her family in the emergency department. The family feels she should be admitted because “she might hurt herself.” An assessment indicates moderate depression with no risk factors for suicide other than the depressed mood itself, and the patient denies any intent or thoughts of self-harm. The family agrees that the patient has not done or said anything to suggest that she might be a danger to herself. Which of the following responses is consistent with the concept of “least restrictive alternative” doctrine? a. Admit the patient as a temporary inpatient admission. b. Persuade the patient to agree to a voluntary inpatient admission. c. Admit the patient involuntarily to an inpatient mental health treatment unit. d. Arrange for an emergency outpatient counselling appointment the next day.

Answer 25

d. Arrange for an emergency outpatient counselling appointment the next day.

Question 26

2. An advanced-practice nurse wishes to initiate treatment with an antipsychotic medication that, although very likely to benefit the patient, in a small percentage of patients may cause a dangerous adverse effect. The nurse explains the purpose, expected benefits, and possible risks of the medication. The patient readily signs a form accepting the medication, stating, “These pills will poison the demons inside of me.” Although he has been informed of the risk for adverse effects, he is unable to state what these are and simply reports, “I won’t have side effects because I am iron and cannot be killed.” Which of the following responses would be most appropriate under these circumstances? a. Begin administration of the medications based on his signed permission because he has legally consented to treatment. b. Petition the court to appoint a guardian for the patient because he is unable to comprehend the proposed treatment. c. Administer the medications even though consent is unclear because the patient is clearly psychotic and in need of the medications. d. Withhold the medication until the patient is able to identify the benefits and risks of both consenting and refusing consent to the medications.

Answer 26

b. Petition the court to appoint a guardian for the patient because he is unable to comprehend the proposed treatment.

Question 27

3. A patient incidentally shares with you that he has difficulty controlling his anger when around children because their play irritates him, leading to resentment and fantasies about attacking them. He has a history of impulsiveness and assault, escalates easily on the unit, and has a poor tolerance for frustration. This weekend he has an overnight pass, which he will use to see his sister and her family. As you meet with the patient and his sister just prior to his getting the pass, the sister mentions that she has missed her brother because he usually helps her watch the children, and she has to work this weekend and needs him to babysit. The patient becomes visibly apprehensive upon hearing this. Which of the following responses would best reflect appropriate nursing practice relative to the conflict this situation presents between safety and the patient’s right to confidentiality? a. Cancel the pass without explanation to the sister, and reschedule it for a time when babysitting would not be required of the patient. b. Suggest that the sister make other arrangements for child care, but withhold the information the patient shared regarding his concerns about harming children. c. Speak with the patient about the safety risk involved in babysitting, seeking his permission to share this information and advising against the pass if he declines to share the information. d. Meet with the patient’s sister, sharing with her the patient’s disclosure about his anger toward children and the resultant risk that his babysitting would present.

Answer 27

d. Meet with the patient’s sister, sharing with her the patient’s disclosure about his anger toward children and the resultant risk that his babysitting would present.

Question 28

4. Mrs. Fujiwara was admitted for treatment of depression with suicidal ideation triggered by marital discord. She has spoken with staff about her fears that the marriage will end, has indicated that she does not know how she could cope if her marriage ended, and has a history of suicide attempts when the marriage seemed threatened in the past. Her spouse visits one night and informs Mrs. Fujiwara that he has decided to file for divorce. Staff members, though aware of the visit and the husband’s intentions regarding divorce, take no action, feeling that the 15-minute suicide checks Mrs. Fujiwara is already on are sufficient. Thirty minutes after the visit ends, staff make rounds and discover that Mrs. Fujiwara has hanged herself in her bathroom using hospital pyjamas she had tied together into a rope. Which of the following statements best describes this situation? Select all that apply. a. The nurses have created liability for themselves and their employer by failing in their duty to protect Mrs. Fujiwara. b. The nurses have breached their duty to reassess Mrs. Fujiwara for increased suicide risk after her husband’s visit. c. Given Mrs. Fujiwara’s history, the nurses should have expected an increased risk for suicide after the husband’s announcement. d. The nurses correctly reasoned that suicides cannot always be prevented and did their best to keep Mrs. Fujiwara safe via the 15-minute checks. e. The nurses are subject to a tort of professional negligence for failing to increase the suicide precautions in response to Mrs. Fujiwara’s increased risk. f. Had the nurses restricted Mrs. Fujiwara’s movements or increased their checks on her, they would have been liable for false imprisonment and invasion of privacy, respectively.

Answer 28

a. The nurses have created liability for themselves and their employer by failing in their duty to protect Mrs. Fujiwara. b. The nurses have breached their duty to reassess Mrs. Fujiwara for increased suicide risk after her husband’s visit. c. Given Mrs. Fujiwara’s history, the nurses should have expected an increased risk for suicide after the husband’s announcement. e. The nurses are subject to a tort of professional negligence for failing to increase the suicide precautions in response to Mrs. Fujiwara’s increased risk.

Question 29

1. Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? a. The nurse assesses the patient at regular intervals. b. The nurse administers psychotropic medications. c. The nurse spends time sitting with a withdrawn patient. d. The nurse participates in team meetings with other professionals.

Answer 29

c. The nurse spends time sitting with a withdrawn patient.

Question 30

2. A male patient frequently inquires about the female student nurse’s boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behaviour? a. The student requests assignment to a patient of the same gender as the student. b. The student points out to the patient that he is making social inquiries and explores this behaviour. c. The student tells the patient that she cannot talk about her personal life and returns the focus to his issues. d. The student explains that if the patient persists in focusing on her, she cannot work with him.

Answer 30

b. The student points out to the patient that he is making social inquiries and explores this behaviour.

Question 31

3. Mary, a patient in the psychiatric unit, had a very rejecting and abusive father and a difficult childhood, but from age 10 on was raised by a very warm and supportive grandmother who recently passed away. Mary frequently comments on how hard her nurse, Jessa, works and on how other staff do not seem to care as much about their patients as Jessa does. Jessa finds herself agreeing with Mary and appreciating her insightfulness, recalling to herself that except for her former head nurse, other staff do not seem to appreciate how hard she works and seem to take her for granted. Jessa enjoys the time she spends with Mary and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jessa would most benefit her and the patient? a. Mary is experiencing transference; Jessa should help Mary to understand that she is emphasizing in Jessa those qualities that were missing in her father. b. Jessa is idealizing Mary, seeing in her strengths and abilities that Mary does not really possess; Jessa should temporarily distance herself somewhat from Mary. c. Mary is overidentifying with Jessa, seeing similarities that do not in reality exist; Jessa should label and explore this phenomenon in her interactions with Mary. d. Jessa is experiencing counter-transference in response to Mary’s meeting Jessa’s needs for greater appreciation; Jessa should seek clinical supervision to explore these dynamics.

Answer 31

d. Jessa is experiencing counter-transference in response to Mary’s meeting Jessa’s needs for greater appreciation; Jessa should seek clinical supervision to explore these dynamics.

Question 32

4. Which of the following statements would be appropriate during the orientation phase of the nurse–patient relationship? Select all that apply. a. “My name is Sarah, and I am a student nurse here to learn about mental health.” b. “I will be here each Thursday from 8 a.m. until noon if you would like to talk.” c. “Tell me about what you think would best help you to cope with the loss of your wife.” d. “Let’s talk today about how our plan for improving your sleep has been working.” e. “We will meet weekly for 1 hour, during which we will discuss how to meet your goals.” f. “Being home alone while your wife was hospitalized must have been very difficult for you.”

Answer 32

a. “My name is Sarah, and I am a student nurse here to learn about mental health.” b. “I will be here each Thursday from 8 a.m. until noon if you would like to talk.” e. “We will meet weekly for 1 hour, during which we will discuss how to meet your goals.” f. “Being home alone while your wife was hospitalized must have been very difficult for you.”

Question 33

5. A student nurse exhibits the following behaviours or actions while interacting with her patient. Which of these is appropriate as part of a therapeutic relationship? a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. b. Offering the patient advice on how he or she could cope more effectively with stress. c. Controlling the pace of the relationship by selecting topics for each interaction. d. Limiting the discussion of termination issues so as not to sadden the patient unduly.

Answer 33

a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak.

Question 34

1. You have been working closely with a patient for the past month. Today, he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. “A new psychiatrist is a chance to start fresh. I’m sure it will go well for you.” b. “You say you look forward to the meeting, but you appear anxious or unhappy.” c. “I notice that you frowned and avoided eye contact just now—don’t you feel well?” d. “I get the impression you don’t really want to see your psychiatrist—can you tell me why?”

Answer 34

b. “You say you look forward to the meeting, but you appear anxious or unhappy.”

Question 35

2. Which behaviour is consistent with therapeutic communication? a. Offering your opinion when asked in order to convey support b. Summarizing the essence of the patient’s comments in your own words c. Interrupting periods of silence before they become awkward for the patient d. Telling the patient he did well when you approve of his statements or actions

Answer 35

b. Summarizing the essence of the patient’s comments in your own words

Question 36

3. Which statement about nonverbal behaviour is accurate? a. A calm expression means that the patient is experiencing low levels of anxiety. b. Patients respond more consistently to therapeutic touch than to verbal interventions. c. The meaning of nonverbal behaviours varies with cultural and individual differences. d. Eye contact is a reliable measure of the patient’s degree of attentiveness and engagement.

Answer 36

c. The meaning of nonverbal behaviours varies with cultural and individual differences.

Question 37

4. A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response would most enhance the chances of achieving a therapeutic interaction? a. Apologize for the differential in height and proceed while standing to avoid delay. b. If permitted, raise the head of the bed and, with the patient’s permission, sit on the bed. c. If permitted, raise the head of the bed to approximate the nurse’s height while standing. d. Sit in whatever chair is available in the room to convey informality and increase comfort

Answer 37

c. If permitted, raise the head of the bed to approximate the nurse’s height while standing.

Question 38

5. A patient with schizophrenia approaches staff arriving for the day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic? a. “There are no such things as demons; what you saw were hallucinations.” b. “It is not possible for anyone to enter your room at night; you are safe here.” c. “You seem very upset; please tell me more about what you experienced last night.” d. “That must have been very frightening, but we’ll check on you at night, and you’ll be safe.

Answer 38

c. “You seem very upset; please tell me more about what you experienced last night.”

Question 39

1. The nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? a. Constricted pupils b. Dry mouth c. Decrease in heart rate d. Sudden drop in blood pressure

Answer 39

b. Dry mouth

Question 40

2. If it is determined that a patient will benefit from guided imagery, what teaching should the nurse provide? a. Focus on a visual object or sound. b. Become acutely aware of your breathing pattern. c. Envision an image of a place that is peaceful. d. Develop deep abdominal breathing.

Answer 40

c. Envision an image of a place that is peaceful.

Question 41

A patient is going to undergo biofeedback. Which patient statement requires further teaching by the nurse? a. “This will measure my muscle activity, heart rate, and blood pressure.” b. “It will help me recognize how my body responds to stress.” c. “I will feel a small shock of electricity if I tell a lie.” d. “The instruments will know if my skin temperature changes.”

Answer 41

c. “I will feel a small shock of electricity if I tell a lie.”

Question 42

4. A patient has told the nurse that she knows she is going to lose her job, which scares her because she needs to work to pay her bills. Which nursing response reflects the positive stress response of problem solving? a. “What are your plans to find a new job?” b. “Can you call your parents to support you during this time?” c. “Is it possible that this job loss is an opportunity to find a better-paying job?” d. “I’m sure everything will turn out just fine.”

Answer 42

a. “What are your plans to find a new job?”

Question 43

5. The nurse is caring for four patients. Which patient would be at highest risk for psychosocial compromise? The patient who has experienced: a. The death of a friend b. A divorce c. A recent job layoff d. The death of a spouse

Answer 43

d. The death of a spouse

Question 44

1. Mr. Yeung, a recent immigrant from China, has been admitted to the observation unit for investigation of unspecified physical malaise. His family tells the nurse that Mr. Yeung began to exhibit certain behaviours when his import business declined and his creditors demanded money. He has subsequently made vague physical complaints for the past 6 weeks. Which patient behaviour would alert the nurse to the potential for somatization? a. The patient states, “I am so sad that I don’t know what to do.” b. The patient shows the nurse bottles of medication used to treat anxiety. c. The patient presents with concerns involving back pain, dizziness, and fatigue. d. The patient states, “My doctor diagnosed me with bipolar disorder.”

Answer 44

c. The patient presents with concerns involving back pain, dizziness, and fatigue.

Question 45

Mr. Oliva has been admitted to the psychiatric ward for depression and substance abuse, mainly of alcohol and recreational drugs. As you are explaining his diagnoses and the potential treatment plan to him, his wife and he state that the problem is “ghost sickness,” which came about when his mother died. What is the most therapeutic nursing response? a. “I have no idea what ‘ghost sickness’ is.” b. “Please explain what you mean by ‘ghost sickness.’” c. “There is not a disorder known as ‘ghost sickness.’” d. “Why do you believe in evil spirits?”

Answer 45

b. “Please explain what you mean by ‘ghost sickness.’”

Question 46

You are a nurse in an outpatient well-baby clinic. You are planning care for a young Cree mother and her infant. The young mother has been identified as at risk for postpartum depression. Which intervention is most appropriate? a. Assess whether the patient follows traditional Cree beliefs. b. Contact an elder from Indigenous Services. c. Discuss the medicine wheel concept of healing with the patient. d. Contact a “singer” to provide a healing ritual within 3 days of admission.

Answer 46

a. Assess whether the patient follows traditional Cree beliefs.

Question 47

You are a nurse on a busy medical unit with a multicultural clientele. In your orientation to the unit, you learn that individualism is a concept closely aligned with North American values. When caring for clients with diverse cultural backgrounds, which general nursing action would be most appropriate? a. Maintain eye contact at all times. b. Assume that personal space is significantly closer than the nurse’s personal space. c. State, “You can beat this diagnosis; you are in control of yourself.” d. Ask if the family should be included in the decision-making process.

Answer 47

d. Ask if the family should be included in the decision-making process.

Question 48

You are a flight nurse who is bringing a young Inuit man from Nunavut for psychiatric assessment in a Winnipeg hospital. You assess the client as acutely suicidal. Which goal is appropriate? a. Patient will visit with a cultural leader from the Inuit community. b. Patient will experience rebalance of yin–yang by discharge. c. Patient will identify sources that increase “cold wind” within 24 hours of admission. d. Patient will be put on suicidal observation and assessment.

Answer 48

d. Patient will be put on suicidal observation and assessment.

Question 49

. Jack had a psychotic episode when he was 15 years old. He did not respond well to treatments available at the time and continued to have a significant number of residual symptoms. At the age of 42, he began taking olanzapine (Zyprexa), which significantly reduced his remaining symptoms, allowing him to leave his group home and live independently for the first time. However, once his mental health became more stable and he was living in his own apartment, he was unsure of what to do with his time, how to go about getting a job, and how to meet his sexual and companionship needs appropriately. What type of crisis situation is represented by this case? a. Maturational crisis b. Situational crisis c. Adventitious crisis d. Phase 4 crisis

Answer 49

a. Maturational crisis

Question 50

Rashid witnessed a car suddenly careen out of control and onto the sidewalk where he and his best friend were walking. Rashid’s friend pushed him out of the way at the last second but was struck and killed instantly. Rashid was treated for minor injuries and released but was referred for mental health evaluation because he was very distraught over the death of his friend. Which response should be used first during your assessment of Rashid? a. “Tell me about what happened that day.” b. “What would you like to accomplish during your treatment?” c. “Do you think you are coping well with this very tragic event?” d. “Tell me what has been going through your mind since the accident.”

Answer 50

d. “Tell me what has been going through your mind since the accident.”

Question 51

Rashid confides that he feels so guilty that his friend died while pushing him to safety that he has found himself having overwhelming impulses to kill himself by crashing his car, which he almost did yesterday. Which intervention would be most therapeutic? a. Admit Rashid to an inpatient mental health unit to ensure his safety until his condition can improve. b. Work with Rashid’s family to ensure that he does not have access to a car, and set up emergency counselling sessions. c. Persuade Rashid to agree to remain safe pending counselling, as admitting him would only further traumatize him. d. Consult with a psychiatrist or prescribing physician so that Rashid can be started immediately on antianxiety and antidepressant medications.

Answer 51

a. Admit Rashid to an inpatient mental health unit to ensure his safety until his condition can improve.

Question 52

Justine Lee, a mother of two teenagers and a nurse with 15 years of experience in the crisis centre, fails to show up for work several days in a row not long after providing crisis intervention to area high school students following a shooting at their school. Co-workers complain that she is not taking her share of crisis calls. As Justine’s manager, you attempt to address the issue, but she responds irritably and denies that anything is wrong. Justine most likely: a. Is becoming burned out on crisis work b. Is experiencing vicarious traumatization c. Has developed a hidden substance abuse problem d. Has lost her objectivity, owing to having children of her own

Answer 52

b. Is experiencing vicarious traumatization

Question 53

Suzanne experiences a crisis after witnessing the brutal assault of her friend during a robbery in their office tower parkade. Which outcome is the most appropriate for Suzanne? a. Suzanne reports greater satisfaction with her life within 2 months. b. Suzanne attends all treatment sessions specified in her treatment plan. c. Within 3 weeks, Suzanne reports that she no longer feels distressed. d. Suzanne returns to her pre-crisis level of functioning within 2 weeks.

Answer 53

d. Suzanne returns to her pre-crisis level of functioning within 2 weeks.

Question 54

1. Which assessment statements would be appropriate for a patient who may be suicidal? Select all that apply. a. Do you ever think about suicide? b. Are you thinking of hurting yourself? c. Do you sometimes wish you were dead? d. Has it ever seemed like life is not worth living? e. If you were to kill yourself, how would you do it? f. Does it seem as though others might be better off if you were dead?

Answer 54

a. Do you ever think about suicide? b. Are you thinking of hurting yourself? c. Do you sometimes wish you were dead? d. Has it ever seemed like life is not worth living? e. If you were to kill yourself, how would you do it? f. Does it seem as though others might be better off if you were dead?

Question 55

Jon, 15 years old, asks the community health nurse what the greatest health risk for his age group is. How should the nurse respond? a. Suicide b. Substance abuse c. Eating disorders d. Unintentional injuries

Answer 55

d. Unintentional injuries

Question 56

Ms. Rallyea, 58 years old, is admitted with severe clinical depression and started on antidepressant medications. Her mood has remained low and she has not initiated conversation. On her fifteenth day of hospitalization, she informs the nurse that she is feeling great and energetic. What should the nurse do? a. Notify the social worker of the improvement to schedule a discharge planning conference. b. Invite Ms. Rallyea to talk and ask her if she is thinking of hurting herself. c. Report to the team that the antidepressant medication is effective. d. Chart the mood change and share the observation at the team meeting the next day.

Answer 56

b. Invite Ms. Rallyea to talk and ask her if she is thinking of hurting herself.

Question 57

A nurse has great difficulty distancing herself from the care of a client when she leaves work. What should the nurse do? a. Recognize that she is too compassionate. b. Request that the client be assigned to another nurse. c. Share her concern with the patient. d. Confide in a colleague she trusts.

Answer 57

d. Confide in a colleague she trusts.

Question 58

The nurse is caring for a patient in the emergency department who was sexually assaulted just hours earlier. Which behaviours should the nurse expect if the patient was exhibiting controlled-style reactions? a. Shock, numbness b. Volatility, anger c. Crying, sobbing d. Smiling, laughing

Answer 58

a. Shock, numbness

Question 59

. The nurse is caring for a patient who has just been sexually assaulted. Which is the appropriate initial nursing response? a. “I will get you the number for the crisis intervention specialist.” b. “May I get your consent to test you for pregnancy and HIV?” c. “You are safe here.” d. “I need to look at your bruises and cuts.”

Answer 59

c. “You are safe here.”

Question 60

A patient who has been sexually assaulted has chosen to accept pregnancy prophylaxis medication but states that she does not believe in abortion. What information can you, as a nurse, give that will help with her decision? a. “Emergency contraception is not an abortion pill and will not work if you are already pregnant. That is the reason we perform a pregnancy test.” b. “Just take a few days to consider your options.” c. “Here is the number to your local sexual health clinic. They can explain it to you.” d. “I won’t give you the pregnancy prophylaxis medication then.”

Answer 60

a. “Emergency contraception is not an abortion pill and will not work if you are already pregnant. That is the reason we perform a pregnancy test.”

Question 61

The nurse is working at a telephone hotline centre when a sexual assault survivor calls. If the sexual assault survivor states that she is fearful of going to the hospital, what is the appropriate nursing response? a. “You don’t need to go to the hospital if you don’t want to.” b. “I’m here to listen to you, and we can talk about your feelings.” c. “Did you do something to make the other person attack you?” d. “Why are you afraid to seek medical attention?”

Answer 61

b. “I’m here to listen to you, and we can talk about your feelings.”

Question 62

The nurse is caring for a patient who is in the long-term reorganization phase of rape-trauma syndrome. Which symptoms should the nurse anticipate? Select all that apply. a. Development of fear of locations that resemble the rape location b. Emergence of acceptance of the rape c. Dreams with violent content d. A shift from anxiety to calm e. Onset of phobia of being alone

Answer 62

a. Development of fear of locations that resemble the rape location c. Dreams with violent content e. Onset of phobia of being alone