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Question 1

01 A nurse asks a patient, “If you had fever and vomiting for 3 days, what would you do?” Which aspect of the mental status examination is the nurse assessing?

a. Behavior
b. Cognition
c. Affect and mood
d. Perceptual disturbances

Answer 1

ANS:B

Assessing cognition involves determining a patient’s judgment and decision making. In this case, the nurse would expect a response of “Call my doctor” if the patient’s cognition and judgment are intact. If the patient responds, “I would stop eating” or “I would just wait and see what happened,” the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.

PTS:1
DIF:Cognitive Level: Apply (Application)
REF:Page 121 (Box 7-4)
TOP:Nursing Process: Assessment
MSC:Client Needs: Psychosocial Integrity

Question 2

02 During the first interview with a parent whose child died in a car accident, the psychiatric advanced practice nurse feels sorry for the patient and reaches out to take the parent’s hand. Select the correct analysis of the psychiatric advanced practice nurse’s behavior:

A. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.

B. The parent will perceive the gesture as intrusive and overstepping boundaries.

C. It shows empathy and compassion. It will encourage the parent to continue to express feelings.

D. The action is inappropriate. “No touch” rules are important in all psychiatric interactions.

Answer 2

The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.

Question 3

03 Alvin is a 55-year-old retiree who volunteers 5 days a week helping with Meals on Wheels, coaching teen sports, and doing church visitation. Bob is a 58-year-old retiree who laughs at Alvin and says, “I’m too busy taking care of myself to volunteer. I don’t care much about doing good for others.” These behaviors can be assessed as showing the difference between:

A. Generativity and self-absorption

B. Industry and inferiority

c. intimacy and isolation

d. trust and mistrust

Answer 3

Altruism and self-interest. “Generativity and Self-Absorption”

Altruism is the principle or practice of concern for the welfare of others. It’s a traditional virtue in many cultures and a core aspect of various religious traditions and secular worldviews. Altruistic individuals derive satisfaction from helping others without expecting anything in return. Alvin’s behavior of volunteering for Meals on Wheels, coaching teen sports, and doing church visitation is a clear demonstration of altruism. He is dedicating his time and energy to help others without any apparent personal gain.

On the other hand, self-interest refers to actions that elicit personal benefit. Bob’s behavior of focusing on taking care of himself and expressing indifference towards doing good for others is a clear demonstration of self-interest. He prioritizes his own needs and wants over those of others.

In summary, Alvin and Bob’s behaviors show the difference between altruism and self-interest. Alvin’s actions are driven by a desire to help others (altruism), while Bob’s actions are driven by a focus on his own needs and wants (self-interest).

Coursehero says “Generativity and Self-Absorption.”

Question 4

04 Which nursing documentation best meets the requirement for problem-oriented charting?

A: “Pacing and muttering to self. Sensory perceptual alteration related to internal auditory stimulation. Given fluphenazine 2.5 mg PO at 0900 and went to room to lie down. Calmer by 0930. Returned to lounge to watch TV.”

B: “Agitated behavior. Patient muttering to self as though answering an unseen person. Given haloperidol 2 mg PO and went to room to lie down. Patient calmer within 30 minutes. Returned to lounge to watch TV.”

C: “Pacing hall and muttering to self as though answering an unseen person. Haloperidol 2 mg PO administered at 0900, with calming effect in 30 minutes. Stated ‘I’m no longer bothered by the voices.’”

D: “S: States ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg PO. I: Haloperidol 2 mg PO given at 0900. E: Returned to lounge at 0930 and quietly watched TV.”

Answer 4

D - “S: States ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg PO. I: Haloperidol 2 mg PO given at 0900. E: Returned to lounge at 0930 and quietly watched TV.”

Question 5

06 A psychiatric advanced practice nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient. Considering the need to focus on social interactions, interventions should focus on:

a.
rewarding desired behaviors.

b.
use of assertive communication.

c.
changing the patient’s self-concept.

d.
administering medications to relieve anxiety.

Answer 5

Enhancing the pt’s interactions with others. / Use of assertive communication.

Question 6

07 The purpose of a professional organization’s scope and standards of practice is to:

a. Define the role and actions for that particular profession.

b. Define the differences between professions.

c. Establish the legal authority to practice for the profession

d. Define the legal statutes that are governing a profession.

Answer 6

a. Define the role and actions for that particular profession.

Question 6

09 In a biopsychosocial assessment, which of the following questions might be used to assess the social domain?

A. Did any medical conditions precipitate the psychiatric symptoms?
B. Did the patient have any childhood attentional problems or school phobia?
C. Has the patient ever attempted suicide or harmed himself?
D. Have the symptoms affected the patient’s social and work functioning?

Answer 6

D. Have the symptoms affected the patient’s social and work functioning?

Question 6

08 Open-ended questions are.

A. Are useful in obtaining direct responses
B. Define the focus of interest
C. Are useful in the beginning of an interview
D. Define the boundaries of the therapeutic alliance

Answer 6

C. Are useful in the beginning of an interview

Question 7

10 What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:
a. great sense of independence.
b. rapport and trust with the nurse.
c. self-responsibility and autonomy.
d. resolution of feelings of transference.

Answer 7

b. rapport and trust with the nurse.

Question 8

11 Validation is a communication strategy used to

A. Let the patient know that his or her feelings are reasonable.
B. Evaluate change in symptoms or behaviors.
C. Prompt the patient to continue talking.
D. Elicit more information about a response.

Answer 8

A. Let the patient know that his or her feelings are reasonable.

Question 9

12 Which comments by an elderly person best indicate successful completion of the developmental task? Select all that apply.

a. “I am proud of my children’s successes in life.”
b. “I should have given to community charities more often.”
c. “My relationship with my father made life more difficult for me.”
d. “My experiences in the war helped me appreciate the meaning of life.”
e. “I often wonder what would have happened if I had chosen a different career.”

Answer 9

A and D

Question 10

13 On evaluation, the patient appears to be having difficulty with working memory, planning, and insight into his problems. The psychiatric advanced practice nurse recognizes that these symptoms are associated with problems with the:

a) Frontal lobe

b) Temporal lobe

c) Parietal lobe

d) Occipital lobe

Answer 10

a. Frontal lobe

Question 11

14 On the basis of recent scores taken from The Holmes and Rahe Stress Scale, which patient could the psychiatric advanced practice nurse expect to have greater difficulty adjusting to life changes that have occurred over the past year?

a. Dan, a 67-year-old retired man who lost his home in a hurricane.

b. Bob, a 40-year-old man who has received a promotion and undertaken a weight loss program.

c. Catherine, a 45-year-old woman whose daughter left home to attend college and whose ill mother is moving in.

d. Angela, a 32-year-old woman who is pregnant, divorcing her husband, and changing residence.

Answer 11

Angela, a 32-year-old woman who is pregnant, divorcing her husband, and changing residence.

Question 12

15 Which documentation of DSM-IV-TR diagnoses is correct?

a. Axis I: Acute renal failure
Axis II: 75
Axis III: Bipolar disorder I, mixed
Axis IV: Loss of disability benefits 2 months ago
Axis V: None

b. Axis I: Schizophrenia, paranoid type
Axis II: Death of spouse last year
Axis III: 60
Axis IV: None
Axis V: Diabetes, type 2

c. Axis I: Polysubstance dependence
Axis II: Narcissistic Personality Disorder
Axis III: 90
Axis IV: Hyperlipidemia
Axis V: Charges pending for assault

d. Axis I: Major Depression
Axis II: Avoidant Personality Disorder
Axis III: Hypertension
Axis IV: Home destroyed by hurricane last year
Axis V: 65

Answer 12

D.

Axis I: Major Depression
Axis II: Avoidant Personality Disorder
Axis III: Hypertension
Axis IV: Home destroyed by hurricane last year
Axis V: 65

Question 13

16 The purposes of the psychiatric interview include all except

A. Gaining an understanding of the patient’s illness
B. Obtaining information efficiently
C. Providing education about psychiatric disorders
D. Establishing a therapeutic alliance

Answer 13

C

Question 14

17 A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship?

a. Begin at the orientation phase.
b. Resume the working relationship.
c. Initially establish a social relationship.
d. Return to the emotional catharsis phase.

Answer 14

ANS: A

a. Begin at the orientation phase.

After termination of a long-term relationship, the patient and new nurse usually have to begin at ground zero, the orientation phase, to build a new relationship. If termination is successfully completed, the orientation phase sometimes progresses quickly to the working phase. Other times, even after successful termination, the orientation phase may be prolonged.

Question 15

18 A patient tells the psychiatric advanced practice nurse she had outpatient therapy weekly for 3 years. The patient states the therapist used the techniques of free association, dream analysis, and facilitation of awareness of transference feelings to help her understand unconscious processes and foster personality change. The psychiatric advanced practice nurse can determine that the patient was treated with:

a. milieu therapy

b. behavioral therapy

c. psychoanalysis

d. cognitive therapy

Answer 15

c. psychoanalysis

Question 16

19 During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?

a. Preorientation
b. Orientation
c. Working
d. Termination

Answer 16

c. Working

Question 17

20 Patients’ perceptual difficulties may have an adverse effect on the therapeutic alliance. Which of the following is likely to have the greatest negative effect?

A. The patient perceives the office seating arrangement as belittling.
B. The patient perceives the clinician as being part of her delusional system.
C. The patient perceives the sound in the hall as messages for the patient.
D. The patient perceives the clinician’s glancing at his watch as nonvalidating.

Answer 17

B. The patient perceives the clinician as being part of her delusional system.

Question 18

21 To encourage the patient to talk freely during the interview, the clinician

A. Uses direct questioning
B. Explains behavior/brain interaction theory
C. Takes notes conscientiously
D. Provides empathetic response.

Answer 18

D. Provides empathetic response.

Question 19

22 During an initial assessment, the relevant features of communication are its ability to

A. Promote a therapeutic alliance and increase understanding.
B. Prompt a disclosure of past successes and failures.
C. Bring about changes in behavior.
D. Educate the patient about what is important to disclose.

Answer 19

A. Promote a therapeutic alliance and increase understanding.

Question 19

23 Which documentation of a patient’s behavior best demonstrates a nurse’s observations?

A. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
B. Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking.
C. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others.
D. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”

Answer 19

D. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”

Question 20

24 What is the process by which the PMHNP identifies signs and symptoms of mental illness and develops an appropriate treatment plan?

a. psychiatric interview

b. physical examination

c. interdisciplinary treatment planning

d. neurological examination

Answer 20

a. psychiatric interview

Question 21

25 Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship?

a. “I don’t have any problems.”
b. “It is so difficult for me to talk about problems.”
c. “I don’t know how it will help to talk to you about my problems.”
d. “I want to find a way to deal with my anger without becoming violent.”

Answer 21

d. “I want to find a way to deal with my anger without becoming violent.”

ANS: D
Thinking about a more constructive approach to dealing with anger indicates a readiness to make a behavioral change. Behavioral change is associated with the working phase of the relationship. Denial is often seen in the orientation phase. It is common early in the relationship, before rapport and trust are firmly established, for a patient to express difficulty in talking about problems. Stating skepticism about the effectiveness of the nurse-patient relationship is more typically a reaction during the orientation phase.

Question 22

26 A patient says, “I can’t do anything by myself,” and “I always need help.” The psychiatric advanced practice nurse correctly assesses that this patient had difficulty resolving which psychosocial crisis?

a. autonomy vs shame and doubt

b. initiative vs guilt

c. trust vs mistrust

d. generativity vs self-absorption

Answer 22

ANS: A

a. autonomy vs shame and doubt

These statements show severe self-doubt, indicating that the crisis of gaining control over the environment is not being successfully met. Unsuccessful resolution of the crisis of Initiative versus Guilt results in feelings of guilt. Unsuccessful resolution of the crisis of Trust versus Mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results in self-absorption that limits the ability to grow as a person.

DIF: Cognitive Level: Application REF: Pages: 28-30

Question 23

27 As compared to the previous DSM-IV-TR, the DSM-5 personality disorders are now categorized according to which of the following:

a. axis II

b. axis III

c. axis IV

d. In the primary psychiatric disorder

Answer 23

d. In the primary psychiatric disorder

Question 24

28 Which of the lobes of the brain is primarily involved in auditory hallucinations?

a. frontal lobe

b. occipital lobe

c. parietal lobe

d. temporal lobe

Answer 24

d. temporal lobe

Question 25

29 A nurse assessing a new patient asks, “What is meant by the old saying, ‘You can’t judge a book by looking at the cover’?” Which aspect of cognition is the nurse assessing?

a. memory

b. orientation

c. attention

d. abstraction

Answer 25

d. abstraction

Question 26

30 After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?

a. The patient’s reactions toward the nurse seem realistic and appropriate.
b. The patient states, “Talking to you feels like talking to my parents.”
c. The nurse feels unusually happy when the patient’s mood begins to lift.
d. The nurse develops a trusting relationship with the patient.

Answer 26

c. The nurse feels unusually happy when the patient’s mood begins to lift.

ANS: C
Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable.

Question 27

31 A PMHNP is contracted to a student health clinic to work with incoming freshman and transfer students for several weeks. The PMHNP encounters a student who describes himself as shy and uncomfortable in social situations. He reports having few friends in high school and has realized that he needs a few drinks to loosen up before going out to party. Upon further questioning, it is revealed he consistently drinks two to three beers on the weekend to enhance his socialization. According to the DSM-5, does this student have a mental illness?

a. Yes, mild alcohol use disorder

b. No, the student does not meet criteria for a mental illness

c. Yes, adjustment disorder with mixed features

d. Yes, social anxiety disorder

Answer 27

b. No, the student does not meet criteria for a mental illness

Question 28

32 During the first interview, a nurse notices that the patient does not make eye contact. The nurse can correctly analyze that:

a. the patient is not truthful.
b. the patient is feeling sad.
c. the patient has a poor self-concept.
d. more information is needed to draw a conclusion.

Answer 28

d. more information is needed to draw a conclusion.

ANS:D
The data are insufficient to draw a conclusion. The nurse must continue to assess.

Question 29

33 On mental status examination, the patient’s thoughts reveal lack of directedness, excessive details, and difficulty with closure. This pattern is called:

a. concrete thinking

b. circumstantiality

c. perseveration

d. thought blocking

Answer 29

b. circumstantiality

Question 30

34 Closed-ended questions:

A. Are used to gather specific information
B. Allow the patient to talk without interruption
C. Are characterized by the use of reflection
D. Are used to obtain difficult or emotionally laden material

Answer 30

A. Are used to gather specific information

Question 31

35 A patient asks the psychiatric advanced practice nurse, “I read an article online about psychosocial factors that influence depression. What are psychosocial factors?” Examples a nurse could cite to support the premise that a patient’s depression may be influenced by psychosocial factors include: (Select all that apply)

a. having a hostile and overinvolved family

b. getting removed from a social club due to negative behavior

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. all of the above

Answer 31

e. all of the above

Question 32

36 The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The psychiatric advanced practice nurse supports the use of praise related to these behaviors. According to Freud’s personality theory, these qualities will likely be internalized and become part of the child’s:

a. id

b. ego

c. superego

d. preconscious

Answer 32

c. superego

Question 33

37 A person tells a nurse, “I was the only survivor in a small plane crash, but three business associates died. I got anxious and depressed and saw a counselor three times a week for a month. We talked about my feelings related to being a survivor, and now I’m fine, back to my old self.” Which type of therapy was used?

a. Milieu therapy

b. Psychoanalysis

c. Behavior modification

d. Interpersonal therapy

Answer 33

d. Interpersonal therapy

Question 34

38 A new antidepressant is prescribed for an elderly patient with major depression by your collaborating psychiatrist, but the dose is much more than the usual geriatric dose. Before reordering the medication, the psychiatric advanced practice nurse should:

a. consult a drug reference

b. teach the patient about possible side effects and adverse effects

c. confer with the psychiatrist regarding the dosing

d. encourage the patient to increase oral fluids to reduce drug concentration

Answer 34

c. confer with the psychiatrist regarding the dosing

Question 35

39 The PMHNP is aware that the essentials of the therapeutic alliance include all of the following except:

a. Formulating differential diagnoses

b. genuineness

c. acceptance

d. authenticity

Answer 35

a. Formulating differential diagnoses

Question 36

40 Why should a psychiatric advanced practice nurse introduce the matter of a contract during the first session with a new patient? Contracts:

a. specify what the nurse will do for the patient

b. are indicative of the feeling tone established between the participants

c. are binding and prevent either party from prematurely ending the relationship

d. spell out participation and responsibilities of both parties

Answer 36

d. spell out participation and responsibilities of both parties

Question 37

41 During the initial assessment of a patient with schizophrenia, in response to the question “What brought you to the clinic today?” A patient’s response of “the van” is an example of:

a. poverty of speech

b. oppositional behavior

c. tangentiality

d. concrete thinking

Answer 37

d. concrete thinking

Question 38

42 At what point in the nurse-patient relationship should a psychiatric advanced practice nurse first address termination?

a. pre-orientation

b. orientation

c. working

d. termination

Answer 38

b. orientation

Question 39

No 43

Answer 39

-

Question 40

No 05

Answer 40

-

Question 41

44 A psychiatric advanced practice nurse ends a relationship with a patient. Considering the magnitude and scope of the support provided, which action(s) by the nurse should not be included in the termination phase?

a. summarize goals and objectives

b. evaluate outcome attainment

c. review new medication options with client

d. reinforce identified client strengths

*Need to verify these answers.

Answer 41

A and C

Question 42

45 In using the communication technique of reflection, the psychiatric advanced practice nurse:

a. interprets the difference between a patient’s thoughts and his or her behaviors

b. repeats something that the patient has said to encourage the patient to give more information

c. provides prompts such as “tell me more”

d. seeks more information in order to have a more clear understanding

Answer 42

b. repeats something that the patient has said to encourage the patient to give more information

Question 43

46 The scope of practice for a psychiatric advanced practice nurse adds which interventions beyond the basic level?

a. perform initial psychiatric examinations

b. prescribe psychotropic medication

c. psychotherapy

d. consultation with other clinicians

e. all of the above

Answer 43

e. all of the above

Question 44

47 At what point in an assessment interview would a nurse ask, “How does your faith help you in stressful situations?” During the assessment of:

a. childhood growth and development
b. substance use and abuse
c. educational background
d. coping strategies

Answer 44

ANS: D
When discussing coping strategies, the nurse might ask what the patient does when upset, what usually relieves stress, and to whom the patient goes to talk about problems. The question regarding whether the patient’s faith helps deal with stress fits well here. It would be out of place if introduced during exploration of the other topics.

Question 45

48 Which behavior shows that a nurse values autonomy? The nurse:

a. suggests one-on-one supervision for a patient who has suicidal thoughts.
b. informs a patient that the spouse will not be in during visiting hours.
c. discusses options and helps the patient weigh the consequences.
d. sets limits on a patient’s romantic overtures toward the nurse.

Answer 45

ANS: C
A high level of valuing is acting on one’s belief. Autonomy is supported when the nurse helps a patient weigh alternatives and their consequences before the patient makes a decision. Autonomy or self-determination is not the issue in any of the other behaviors.

Question 46

49 For a patient who is over-inclusive or rambling, the clinician

A. Asks the patient to tell his story
B. Uses direction and redirection
C. Increases the amount of eye contact
D. Interviews the person accompanying the patient

Answer 46

B. Uses direction and redirection

Question 47

50 APRN practice is regulated by the:

a. The state nurse practice act

b. medicare regulations

c. collaborating physicians

d. the institution in which they practice

Answer 47

a. The state nurse practice act