Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice, 6th Edition by Mary C. Townsend – Test Bank A+

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Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice 6th Edition by Mary C. – Test Bank

Chapter 5: Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing

Multiple Choice

1. An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth’s choices?
2. Most African American homes are headed by strong, dominant father figures.
3. Most African Americans choose to remain within their own social organization.
4. Most African Americans are uncomfortable expressing emotions and seek out belonging.
5. Most African Americans have few religious beliefs, which contributes to criminal activity.

ANS: 2

Rationale: The nurse should identify that a tendency to remain within one’s own social organization may have played a role in the youth’s choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educated and future focused. Those who have not assimilated may be unemployed or have low-paying jobs and view their future as hopeless, given their previous encounters with racism and discrimination.

Cognitive Level: Application

Integrated Process: Assessment

1. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology?
2. Dissociative disorders
3. Alzheimer’s dementia
4. Stress-related disorders
5. Schizophrenia-spectrum disorders

ANS: 3

Rationale: The nurse should correlate many Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology may occur when individuals fail to meet the expectations of the culture.

Cognitive Level: Application

Integrated Process: Assessment

1. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care?
2. Northern European Americans
3. Native Americans
4. Latino Americans
5. African Americans

ANS: 1

Rationale: The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group’s educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices.

Cognitive Level: Application

Integrated Process: Planning

1. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture?
2. Extremes of emotional expression prevent accurate assessment of this culture.
3. Suspicion of Western civilization has understandably resulted in minimal participation in cultural research.
4. The small size of this subpopulation makes research virtually impossible.
5. The Asian American culture includes individuals from Japan, China, Vietnam, Korea, and other countries.

ANS: 4

Rationale: The nursing instructor’s best explanation is that the Asian American culture is difficult to classify globally because of the number of countries that identify with this culture. The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes.

Cognitive Level: Application

Integrated Process: Assessment

1. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to affect this client’s decision?
2. Future orientation causes the client to devalue assertiveness skills.
3. Decreased emotional expression makes it difficult to be assertive.
4. Assertiveness techniques may not be aligned with the client’s definition of the female role.
5. Religious prohibitions prevent the client’s participation in assertiveness training.

ANS: 3

Rationale: The nurse should identify that the Latin American woman’s refusal to participate in an assertiveness training group may be affected by the Latin American cultural definition of the female role. Latin Americans place a high value on the family, which is male dominated. The father usually possesses the ultimate authority.

Cognitive Level: Application

Integrated Process: Evaluation

1. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, “It’s the man’s job to keep his wife in line.” Which cultural belief should a nurse associate with this client’s behavior?
2. That families are male–dominated, with clear male-female role distinctions.
3. That religious tenets support the use of violence in a marital context.
4. That the nuclear family is female-dominated and the mother has ultimate authority.
5. That marriage dynamics are controlled by dominant females in the family.

ANS: 1

Rationale: The nurse should associate the cultural belief that families are male–dominated, with clear male-female role distinctions with the client’s abusive behavior. The father in the Latin American family usually has the ultimate authority.

Cognitive Level: Application

Integrated Process: Evaluation

1. When working with clients of a particular culture, which action should a nurse avoid?
2. Making direct eye contact
3. Assuming that all individuals who share a culture or ethnic group are similar
4. Supporting the client in participating in cultural and spiritual rituals
5. Using an interpreter to clarify communication

ANS: 2

Rationale: The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals.

Cognitive Level: Application

Integrated Process: Implementation

1. To effectively plan care for Asian American clients, a nurse should be aware of which cultural factor?
2. Obesity and alcoholism are common problems.
3. Older people maintain positions of authority within the culture.
4. “Tai” and “chi” are the fundamental concepts of Asian health practices.
5. Asian Americans are likely to seek psychiatric help.

ANS: 2

Rationale: To effectively care for Asian American clients, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of yin and yang is the fundamental concept of Asian health practices. Psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families.

Cognitive Level: Application

Integrated Process: Planning

1. A Native American client is admitted to an emergency department (ED) with an ulcerated toe, secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate?
2. Try to locate a shaman that will agree to come to the ED.
3. Explain to the client that “voodoo” medicine will not heal the ulcerated toe.
4. Ask the client to explain what the shaman can do that the physician cannot.
5. Inform the client that refusing treatment is a client’s right.

ANS: 1

Rationale: The most appropriate nursing intervention would be to try to locate a shaman that will agree to come to the ED. The nurse should understand that in the Native American culture, religion, and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients.

Cognitive Level: Application

Integrated Process: Implementation

1. When planning client care, which folk belief that may affect health-care practices should a nurse identify as characteristic of the Latino American culture?
2. The root doctor is often the first contact made when illness is encountered.
3. The yin and yang practitioner is often the first contact made when illness is encountered.
4. The shaman is often the first contact made when illness is encountered.
5. The curandero is often the first contact made when illness is encountered.

ANS: 4

Rationale: The nurse should understand that it is characteristic of Latin American culture for a client to contact a curandero when illness is initially encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs.

Cognitive Level: Application

Integrated Process: Planning

1. In what probable way should a nurse expect an Asian American client to view mental illness?
2. Mental illness relates to uncontrolled behaviors that bring shame to the family.
3. Mental illness is a curse from God related to immoral behaviors.
4. Mental illness is cured by home remedies based on superstitions.
5. Mental illness is cured by “hot and cold” herbal remedies.

ANS: 1

Rationale: The nurse should except that many Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. In addition, it is often more acceptable for mental distress to be expressed as physical ailments.

Cognitive Level: Application

Integrated Process: Assessment

1. Which cultural considerations should a nurse identify as reflective of Western European Americans?
2. They are present-time oriented and perceive the future as God’s will.
3. They value youth, and older adults are commonly placed in nursing homes.
4. They are at high risk for alcoholism, because of a genetic predisposition.
5. They are future oriented and practice preventive health care.

ANS: 1

Rationale: The nurse should identify that most Western European Americans are present oriented and perceive the future as God’s will. Older adults are held in positions of respect and are often cared for in the home instead of in nursing homes.

Cognitive Level: Application

Integrated Process: Assessment

1. A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group?
2. African Americans
3. Asian Americans
4. Native Americans
5. Jewish Americans

ANS: 3

Rationale: The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present.

Cognitive Level: Application

Integrated Process: Assessment

Multiple Response

1. When interviewing a client of a different culture, which of the following questions should a nurse consider? (Select all that apply.)
2. Would using perfume products be acceptable?
3. Who may be expected to be present during the client interview?
4. Should communication patterns be modified to accommodate this client?
5. How much eye contact should be made with the client?
6. Would hand shaking be acceptable?

ANS: 2, 3, 4, 5

Rationale: When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability. Given that cultural influences affect human behavior, its interpretation, and another person’s response, it is important for nurses to understand the effects of these cultural influences to work effectively with diverse populations.

Cognitive Level: Application

Integrated Process: Implementation

1. A female nurse is caring for an Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? (Select all that apply.)
2. Limited touch is acceptable only between members of the same sex.
3. Conversing individuals of this culture stand far apart and do not make eye contact.
4. Devout Muslim men may not shake hands with women.
5. The man is the head of the household, and women take on a subordinate role.
6. Men of this culture are responsible for the education of their children.

ANS: 1, 3, 4

Rationale: When planning effective care for this client, the nurse should be aware that limited touch in this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of children.

Cognitive Level: Application

Integrated Process: Planning

1. In which of the following cultural groups should a nurse expect to find assessment of mood and affect most challenging, owing to the characteristics of the groups? (Select all that apply.)
2. Arab Americans
3. Native Americans
4. Latino Americans
5. Western European Americans
6. Asian Americans

ANS: 2, 5

Rationale: The nurse should expect that both Native Americans and Asian Americans may be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested.

Cognitive Level: Application

Integrated Process: Assessment

1. A nursing instructor is developing a lesson plan to teach about the Northern European American culture. Which of the following information should be included? (Select all that apply.)
2. About half of first marriages end in divorce in this cultural group.
3. This cultural group does not use preventive medicine and primary health care.
4. Punctuality and efficiency are highly valued in this cultural group.
5. This cultural group tends to be future oriented.
6. A typical diet of this cultural group includes rice, vegetables, and fish.

ANS: 1, 3, 4

Rationale: With the advent of technology and widespread mobility, less emphasis has been placed on the cohesiveness of the family in the Northern European American culture. Data on marriage, divorce, and remarriage in the United States show that about half of first marriages end in divorce. Northern European Americans, particularly those who achieve middle-class socioeconomic status, value preventive medicine and primary health care. Punctuality and efficiency are highly valued in the culture that promoted the work ethic, and most within this cultural group tend to be future oriented. A typical diet for many Northern European Americans is high in fats and cholesterol and low in fiber.

Cognitive Level: Application

Integrated Process: Assessment

1. The United States, viewed as a “melting pot” of multiple worldwide ethnic groups, has its own unique culture that impacts the health and care of individuals. Which of the following are characteristics common to the U.S. culture? (Select all that apply.)
2. The culture values independence, self-reliance, and determining one’s life.
3. There is a strong emphasis on achievement in jobs, sports, and physical beauty.
4. Constructive criticism is considered personally offensive.
5. The culture favors structured and formal behaviors, speech, and relationships with others.
6. Overconsumption of food in this culture leads to increased obesity and decreased health.

ANS: 1, 2, 5

Rationale: Independence, self reliance, and determining one’s life describes the characteristic of individuality. Strong emphasis on achievement in jobs, sports, and physical beauty describes the characteristic of perfectionism. Constructive criticism is considered helpful for others in the U.S. culture. General behaviors, speech, and relationships with others are informal. There is common use of first names when addressing others. The overconsumption of food, leading to increased obesity and decreased health relates to the characteristic of consumerism.

Cognitive Level: Application

Integrated Process: Assessment

Fill-in-the-Blank

1. ___________________ exists within each individual, regardless of belief system, and serves as a force for interconnectedness between the self and others, the environment, and a higher power.

ANS: Spirituality

Rationale: Spirituality exists within each individual, regardless of belief system, and serves as a force for interconnectedness between the self and others, the environment, and a higher power. Spirituality is the human quality that gives meaning and sense of purpose to an individual’s existence.

Cognitive Level: Application

Integrated Process: Assessment

Chapter 19: Trauma and Stressor-Related Disorders

Multiple Choice

1. A nursing instructor is teaching about trauma and stressor-related disorders. Which student statement indicates that further instruction is needed?
2. “The trauma that women experience is more likely to be sexual assault and child sexual abuse.”
3. “The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury.”
4. “After exposure to a traumatic event, only 10 percent of victims develop post-traumatic stress disorder (PTSD).”
5. “Research shows that PTSD is more common in men than in women.”

ANS: 4

Rationale: Research shows that PTSD is more common in women than in men. This student statement indicates a need for further instruction.

Cognitive Level: Application

Integrated Process: Evaluation

1. Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?
2. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
3. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to “normal” daily events.
4. Depressive symptoms occur in PTSD and not in AD.
5. Depressive symptoms occur in AD and not in PTSD.

ANS: 1

Rationale: PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events, such as divorce, failure, or rejection. Depressive symptoms can occur in both PTSD and AD.

Cognitive Level: Analysis

Integrated Process: Assessment

1. Which client would a nurse recognize as being at highest risk for the development of an AD?
2. A young married woman
3. An elderly unmarried man
4. A young unmarried woman
5. A young unmarried man

ANS: 3

Rationale: Adjustment disorders are more common in women, unmarried persons, and younger people. Although more common in the young, it can occur at any age.

Cognitive Level: Application

Integrated Process: Assessment

1. A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that learning has occurred?
2. “How clients perceive events and view the world affect their response to trauma.”
3. “The psychic numbing in PTSD is a result of negative reinforcement.”
4. “The individual becomes addicted to the trauma owing to an endogenous opioid response.”
5. “Believing that the world is meaningful and controllable can protect an individual from PTSD.”

ANS: 2

Rationale: Learning theorists view negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior. Psychic numbing decreases or protects an individual from emotional pain and, therefore, the learned response is the repetition of this behavior.

Cognitive Level: Application

Integrated Process: Evaluation

1. As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client’s symptom?
2. Anxiety
3. Altered thought processes
4. Complicated grieving
5. Altered sensory perception

ANS: 3

Rationale: The client’s survivor guilt is disrupting the normal process of grieving. Although the client may also experience anxiety, the symptom presented in the question is extreme guilt. There is no evidence presented in the question to indicate altered thought or altered sensory perception.

Cognitive Level: Analysis

Integrated Process: Diagnosis

1. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ?
2. Encourage the journaling of feelings.
3. Assess for the stage of grief in which the client is fixed.
4. Provide community resources to address the client’s concerns.
5. Encourage attending a grief therapy group.

ANS: 2

Rationale: Prior to implementing all other nursing interventions presented, the nurse must assess the stage of grief in which the client is fixed. Appropriate nursing interventions are always based on accurate assessments.

Cognitive Level: Application

Integrated Process: Implementation

1. Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?
2. Anxiety, feelings of hopelessness, and worry
3. Truancy, vandalism, and fighting
4. Nervousness, worry, and jitteriness
5. Depressed mood, tearfulness, and hopelessness

ANS: 4

Rationale: AD with depressed mood is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depression. The symptoms, such as depressed mood, tearfulness, and feelings of hopelessness, exceed what is an expected or normative response to an identified stressor.

Cognitive Level: Analysis

Integrated Process: Assessment

1. Both situational and intrapersonal factors most likely contribute to an individual’s stress response. Which factor would a nurse categorize as intrapersonal?
2. Occupational opportunities
3. Economic conditions
4. Degree of flexibility
5. Availability of social supports

ANS: 3

Rationale: Intrapersonal factors that might influence an individual’s ability to adjust to a painful life change include social skills, coping strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence.

Cognitive Level: Application

Integrated Process: Assessment

1. A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client’s problem?
2. Rates anxiety as 4 out of 10 by discharge.
3. States anxiety level has decreased by day one.
4. Accomplishes activities of daily living independently.
5. Demonstrates ability for adequate social functioning by day three.

ANS: 1

Rationale: An outcome statement must be client-centered, specific, measurable, and contain a time frame, so that it can be evaluated effectively. A “decrease” in anxiety is vague rather than specific, and expecting an anxiety decrease by day one may also be unrealistic. Accomplishing activities of daily living independently and demonstrating the ability for adequate social functioning do not address the anxiety nursing diagnosis.

Cognitive Level: Application

Integrated Process: Planning

1. Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?
2. Adjustment disorder
3. Generalized anxiety disorder
4. Panic disorder
5. Post-traumatic stress disorder

ANS: 4

Rationale: EMDR has been used for depression, adjustment disorder, phobias, addictions, generalized anxiety disorder, and panic disorder. However, at present, EMDR has only been empirically validated for trauma-related disorders such as PTSD and acute stress disorder.

Cognitive Level: Application

Integrated Process: Evaluation

1. After a teaching session about grief, a client says to the nurse, “I seem to be stuck in the anger stage of grieving over the loss of my son.” How would the nurse assess this statement, and in what phase of the nursing process would this occur?
2. Assessment phase; nursing actions have been successful in achieving the objectives of care.
3. Evaluation phase; nursing actions have been successful in achieving the objectives of care.
4. Implementation phase; nursing actions have been successful in achieving the objectives of care.
5. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

ANS: 2

Rationale: In the evaluation phase of the nursing process, reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care. The implementation of client teaching has enabled the client to verbalize an understanding of the grief process and his or her position in the process. Therefore, the nurse’s actions can be evaluated as successful.

Cognitive Level: Analysis

Integrated Process: Evaluation

1. By which biological mechanism does EMDR achieve its therapeutic effect?
2. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
3. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness.
4. EMDR achieves its therapeutic effect by causing an increase in memory access.
5. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

ANS: 1

Rationale: Some studies have indicated that eye movements cause a decrease in imagery vividness and distress, as well as an increase in memory access. EMDR is thought to relieve anxiety associated with the traumatic event. However, the exact biological mechanisms by which EMDR achieves its therapeutic effects are unknown.

Cognitive Level: Application

Integrated Process: Evaluation

1. A client receiving EMDR therapy says, “After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life.” Which of the following nursing responses is most appropriate?
2. “I am thrilled that you have responded so rapidly to EMDR.”
3. “To achieve lasting results, all eight phases of EMDR must be completed.”
4. “If I were you, I would complete the EMDR and comply with doctor’s orders.”
5. “How do you feel about continuing the therapy?”

ANS: 2

Rationale: Clients often feel relief quite rapidly with EMDR. However, to achieve lasting results, it is important that each of the eight phases be completed. The nurse’s most appropriate response should be to give information to correct the client’s misconceptions about the therapy. In answer 3 the nurse is subjectively giving advice rather than providing objective information.

Cognitive Level: Application

Integrated Process: Implementation

1. A nurse would recognize which treatment as most commonly used for AD and its appropriate rationale?
2. Psychotherapy; to examine the stressor and confront unresolved issues
3. Fluoxetine (Prozac); to stabilize mood and resolve symptoms
4. Eye movement desensitization therapy; to reprocess traumatic events
5. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

ANS: 1

Rationale: Psychotherapy is the most common treatment used for AD. AD is not commonly treated with medications. Anxiolytic and antidepressant medications may be prescribed as adjuncts to psychotherapy but should not be given as the first line of treatment. Eye movement desensitization and reprocessing therapy is not used to treat adjustment disorders.

Cognitive Level: Application

Integrated Process: Implementation

1. A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client’s plan of care?
2. The client will have no flashbacks.
3. The client will be able to feel a full range of emotions by discharge.
4. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
5. The client will refrain from discussing the traumatic event.

ANS: 3

Rationale: Obtaining adequate sleep without zolpidem by discharge is a goal that should be included in the client’s plan of care. Having no flashbacks and experiencing a full range of emotions by discharge are unrealistic goals. Clients are encouraged, not discouraged, to discuss the traumatic event.

Cognitive Level: Application

Integrated Process: Planning

1. A client diagnosed with PTSD is receiving paliperidone (Invega). Which symptoms should a nurse identify that would warrant the need for this medication?
2. Flat affect and anhedonia
3. Persistent anorexia and 10 lb weight loss in 3 weeks
4. Flashbacks of killing the enemy
5. Distant and guarded in relationships

ANS: 3

Rationale: The nurse should identify that a client who has flashbacks of killing the enemy may need paliperidone. Paliperidone is an antipsychotic medication that will address the symptoms of psychosis.

Cognitive Level: Application

Integrated Process: Assessment

1. A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis?
2. The client worries continually and appears nervous and jittery.
3. The client complains of a depressed mood, is tearful, and feels hopeless.
4. The client is belligerent, violates others’ rights, and defaults on legal responsibilities.
5. The client complains of many physical ailments, refuses to socialize, and quits her job.

ANS: 4

Rationale: The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, social withdrawal, or work or academic inhibition, without significant depressed or anxious mood.

Cognitive Level: Application

Integrated Process: Assessment

1. A client has been extremely nervous ever since a person died as a result of the client’s drunk driving. When assessing for the diagnosis of AD, within what time frame should the nurse expect the client to exhibit symptoms?
2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within one year of the accident.
3. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within three months of the accident.
4. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within six months of the accident.
5. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within nine months of the accident.

ANS: 2

Rationale: According to the DSM-5 diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within three months of the onset of the stressor.

Cognitive Level: Application

Integrated Process: Assessment

1. A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder?
2. The 60-year-old, because of memory deficits.
3. The 60-year-old, because of decreased cognitive processing ability.
4. The 20-year-old, because of limited cognitive experiences.
5. The 20-year-old, because of lack of developmental maturity.

ANS: 4

Rationale: Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity. By comparison, the 20-year-old does not have the developmental maturity, life experiences, and coping mechanisms that the 60-year-old might possess.

Cognitive Level: Analysis

Integrated Process: Evaluation

Multiple Responses

1. A client diagnosed with an adjustment disorder says to the nurse, “Tell me about medications that will cure this problem.” Which of the following are appropriate nursing responses? (Select all that apply.)
2. “Medications can interfere with your ability to find a more permanent problem solution.”
3. “Medications may mask the real problem at the root of this diagnosis.”
4. “Adjustment disorders are not commonly treated with medications.”
5. “Psychoactive drugs carry the potential for physiological and psychological dependence.”
6. “Psychoactive drugs will be prescribed only if your problems persist for more than three months.”

ANS: 1, 2, 3, 4

Rationale: Adjustment disorders are not commonly treated with medications because of temporary effects, masking the real problem, interfering with finding a permanent solution, and the potential for addiction.

Cognitive Level: Application

Integrated Process: Implementation

1. A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess? (Select all that apply.)
2. Feelings of guilt that precipitate social isolation
3. Aggressive behavior that affects job performance
4. Relationship problems
5. High levels of anxiety
6. Escalating symptoms lasting less than one month

ANS: 1, 2, 3, 4

Rationale: Characteristic symptoms of PTSD include re-experiencing the traumatic event, a sustained high level of anxiety or arousal, general numbing of responsiveness, nightmares, inability to remember certain aspects of the traumatic event, depression, guilt feelings, substance abuse, anger, and aggressive behaviors. The full-symptom picture must present for more than one month and cause significant interference with social, occupational, and other areas of functioning.

Cognitive Level: Application

Integrated Process: Assessment

1. A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer? (Select all that apply.)
2. An individual’s religious affiliation can affect response to trauma.
3. Responses are affected by how an individual handled previous trauma.
4. Protectiveness of family and friends can help an individual deal with trauma.
5. Control over the possibility of recurrence can affect the response to trauma.
6. The time in which the trauma occurred can affect the individual’s response.

ANS: 2, 3, 4, 5

Rationale: Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of (1) the traumatic experience, (2) the individual, and (3) the recovery environment. All information presented falls under one of these groups. Spiritual beliefs, which can be considered a cultural influence, can affect the individual’s response, however, an individual’s specific religious affiliation should have no bearing or influence.

Cognitive Level: Application

Integrated Process: Assessment

1. A nurse would recognize which of the following as the best predictors of PTSD in Vietnam veterans? (Select all that apply.)
2. The severity of the stressor
3. The degree of ego strength
4. The degree of psychosocial isolation in the recovery environment
5. The attitudes of society regarding the experience
6. The presence of preexisting psychopathology

ANS: 1, 3

Rationale: In research with Vietnam veterans, it was shown that the best predictors of PTSD were the severity of the stressor and the degree of psychosocial isolation in the recovery environment.

Cognitive Level: Analysis

Integrated Process: Assessment

1. A client diagnosed with PTSD states, “Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?” Which of the following are the most appropriate nursing responses? (Select all that apply.)
2. “I’m not sure, because antianxiety drugs have been approved by the FDA for PTSD.”
3. “Antidepressants are now considered first-line treatment choice for PTSD.”
4. “Many people have adverse reactions to antianxiety drugs.”
5. “Because of their addictive properties, antianxiety drugs are less desirable.”
6. “There have been no controlled studies on the effect of antianxiety drugs on PTSD.”

ANS: 2, 4, 5

Rationale: Antidepressants are now considered the first-line treatment of choice for PTSD. There has been an absence of controlled studies demonstrating the efficacy of benzodiazepines for the treatment of PTSD. Their addictive properties make them less desirable than other medications used in the treatment of PTSD. Paroxetine and sertraline (antidepressant drugs), not antianxiety drugs, have been approved by the FDA for the treatment of PTSD. Adverse reactions can occur with the use of anxiolytic drugs, but these reactions are not common.

Cognitive Level: Application

Integrated Process: Implementation

Ordering

1. Order the eight-phase process of eye movement desensitization and reprocessing (EMDR).

________ Instillation

________ Body scan

________ Closure

________ Reevaluation

________ Preparation

________ History and treatment planning

________ Desensitization

________ Assessment

ANS: The correct order is 5, 6, 7, 8, 2, 1, 4, 3

Rationale: EMDR is an integrative psychotherapy approach with a theoretical model that emphasizes the brain’s information processing system and memories of disturbing experiences as the basis of pathology. EMDR has been shown to be an effective therapy for PTSD and other trauma-related disorders.

1. History and Treatment Planning
2. Preparation
3. Assessment
4. Desensitization
5. Instillation
6. Body scan
7. Closure
8. Reevaluation

Cognitive Level: Analysis

Integrated Process: Assessment

Fill-in-the-Blank

1. An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called _________________.

ANS: trauma

Rationale: An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called trauma. PTSD can occur following exposure to an identifiable stressor or to an extreme traumatic event.

Cognitive Level: Application

Integrated Process: Assessment

Chapter 27: Community Mental Health Nursing

Multiple Choice

1. A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act?
2. Many perspective clients did not meet criteria for mental illness diagnostic-related groups.
3. Zoning laws discouraged the development of community mental health centers.
4. States could not match federal funds to establish community mental health centers.
5. There was not a sufficient employment pool to staff community mental health centers.

ANS: 3

Rationale: A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals.

Cognitive Level: Application

Integrated Process: Evaluation

1. A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care?
2. Teaching an adolescent about pregnancy prevention
3. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication
4. Teaching a client to cook meals, make a grocery list, and establish a budget
5. Teaching a client about his or her new diagnosis of bipolar disorder

ANS: 3

Rationale: The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

Cognitive Level: Application

Integrated Process: Implementation

1. A nursing instructor is teaching about case management. What student statement indicates that learning has occurred?
2. “Case management is a method used to achieve independent client care.”
3. “Case management provides coordination of services required to meet client needs.”
4. “Case management exists mainly to facilitate client admission to needed inpatient services.”
5. “Case management is a method to facilitate physician reimbursement.”

ANS: 2

Rationale: The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames.

Cognitive Level: Application

Integrated Process: Evaluation

1. A client at the mental health clinic tells the case manager, “I can’t think about living another day, but don’t tell anyone about the way I feel. I know you are obligated to protect my confidentiality.” Which case manager response is most appropriate?
2. “The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care.”
3. “Let’s discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk.”
4. “You seem to be preoccupied with self. You should concentrate on hope for the future.”
5. “This information is secure with me because of client confidentiality.”

ANS: 1

Rationale: The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the client’s care. This case manager’s priority is to ensure client safety and to inform others on the treatment team of the client’s suicidal ideation.

Cognitive Level: Application

Integrated Process: Implementation

1. When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention?
2. Teaching assertiveness skills in order to meet assessed needs
3. Supplying the couple with guidelines related to marital seminar leadership
4. Teaching the couple about various methods of birth control
5. Counseling the couple related to open and honest communication skills

ANS: 4

Rationale: Counseling the couple related to open and honest communication skills is a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

Cognitive Level: Application

Integrated Process: Implementation

1. A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of preventive care?
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
5. Primary intervention

ANS: 1

Rationale: Providing nursing education on drug abuse to a high school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population.

Cognitive Level: Application

Integrated Process: Implementation

1. A newly admitted homeless client diagnosed with schizophrenia states, “I have been living in a cardboard box for two weeks. Why did the government let me down?” Which is an appropriate nursing response?
2. “Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless.”
3. “Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia.”
4. “Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success.”
5. “Your discharge from the state hospital was based on presumed family support, and this was not forthcoming.”

ANS: 3

Rationale: The most accurate nursing response is to explain to the client that the resources were not available to make transitioning out of a state hospital a success. There are several factors that are thought to contribute to homelessness among the mentally ill: deinstitutionalization, poverty, lack of affordable housing, lack of affordable health care, domestic violence, and addiction disorders.

Cognitive Level: Application

Integrated Process: Implementation

1. An instructor is teaching nursing students about the difference between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization?
2. Partial hospitalization does not provide medication administration and monitoring.
3. Partial hospitalization does not use an interdisciplinary team.
4. Partial hospitalization does not offer a comprehensive treatment plan.
5. Partial hospitalization does not provide supervision 24 hours a day.

ANS: 4

Rationale: The instructor should explain that partial hospitalization does not provide supervision 24 hours a day. Partial hospitalization programs generally offer a comprehensive treatment plan formulated by an interdisciplinary team. They have proved to be an effective method of preventing hospitalization.

Cognitive Level: Application

Integrated Process: Evaluation

1. When a home health nurse administers an outpatient’s injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing?
2. Primary prevention level of care
3. Secondary prevention level of care
4. Tertiary prevention level of care
5. Case management level of care

ANS: 3

Rationale: When administering medication in an outpatient setting, the nurse is providing a tertiary prevention level of care. Tertiary prevention services are aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

Cognitive Level: Application

Integrated Process: Implementation

1. A client diagnosed with schizophrenia is hospitalized owing to an exacerbation of psychosis related to non-adherence with antipsychotic medications. Which level of care does the client’s hospitalization reflect?
2. Primary prevention level of care
3. Secondary prevention level of care
4. Tertiary prevention level of care
5. Case management level of care

ANS: 2

Rationale: The client’s hospitalization reflects the secondary prevention level of care. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

Cognitive Level: Application

Integrated Process: Implementation

1. When attempting to provide health-care services to the homeless, what should be a realistic concern for a nurse?
2. Most individuals that are homeless reject help.
3. Most individuals that are homeless are suspicious of anyone who offers help.
4. Most individuals that are homeless are proud and will often refuse charity.
5. Most individuals that are homeless relocate frequently.

ANS: 4

Rationale: A realistic concern in the provision of health-care services to the homeless is that individuals who are homeless relocate frequently. Frequent relocation confounds service delivery and interferes with providers’ efforts to ensure appropriate care.

Cognitive Level: Application

Integrated Process: Planning

1. A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect?
2. Meningitis
3. Tuberculosis
4. Encephalopathy
5. Mononucleosis

ANS: 2

Rationale: The nurse should suspect that the homeless client has contracted tuberculosis. Tuberculosis is a growing problem among individuals who are homeless, owing to being in crowded shelters, which are ideal conditions for the spread of respiratory tuberculosis. Prevalence of alcoholism, drug addiction, HIV infection, and poor nutrition also impact the increase of contracted cases of tuberculosis.

Cognitive Level: Analysis

Integrated Process: Assessment

Multiple Response

1. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.)
2. An acutely suicidal teenager
3. A chronically mentally ill woman who has a history of medication non-adherence
4. A socially isolated older individual
5. A depressed individual who is able to contract for safety
6. A client who is hearing voices that tell the client to harm others

ANS: 2, 4

Rationale: The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication non-adherence and for a depressed individual who is able to contract for safety. Day programs (also called partial hospitalizations) are designed to prevent institutionalization or to ease the transition from inpatient hospitalization to community living.

Cognitive Level: Application

Integrated Process: Implementation

1. Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.)
2. PACT offers nationally based treatment to people with serious and persistent mental illnesses.
3. PACT is a type of case-management program.
4. The PACT team provides services 24 hours a day, 7 days a week, 365 days a year.
5. The PACT team provides highly individualized services directly to consumers.
6. PACT is a multidisciplinary team approach.

ANS: 2, 3, 4, 5

Rationale: NAMI defines PACT as a service-delivery model that provides comprehensive, locally, not nationally, based treatment to people with serious and persistent mental illnesses. PACT is a type of case-management program that provides highly individualized services directly to consumers. It is a team approach and includes members from psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. The PACT team provides these services 24 hours a day, 7 days a week, 365 days a year.

Cognitive Level: Application

Integrated Process: Assessment

1. Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.)
2. Schizophrenia
3. Body dysmorphic disorder
4. Antisocial personality disorder
5. Neurocognitive disorder
6. Conversion disorder

ANS: 1, 3, 4

Rationale: A number of studies have been conducted, primarily in large, urban areas, which have addressed the most common types of mental illness identified among homeless individuals. Schizophrenia is frequently described as the most common diagnosis. Other prevalent disorders include bipolar disorder, substance abuse and dependence, depression, personality disorders, and neurocognitive disorders.

Cognitive Level: Application

Integrated Process: Assessment

Ordered Response

1. Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan.

________ Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness

________ Services aimed at reducing the residual defects that are associated with severe and persistent mental illness

________ Services aimed at reducing the incidence of mental disorders within the population

ANS: The correct order is 2, 3, 1

Rationale: The premise of the model of public health is based largely on the concepts set forth by Gerald Caplan (1964) during the initial community mental health movement. They include primary prevention, secondary prevention, and tertiary prevention.

1. Primary prevention is aimed at reducing the incidence of mental disorders within the population.
2. Secondary prevention is aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness.
3. Tertiary prevention is aimed at providing services that reduce the residual defects that are associated with severe and persistent mental illness.

Cognitive Level: Analysis

Integrated Process: Planning

Fill-in-the-Blank

1. The ________________________ movement closed state mental hospitals and caused the discharge of individuals with mental illness.

ANS: deinstitutionalization

Rationale: The deinstitutionalization movement closed state mental hospitals and caused the discharge of individuals with mental illness. Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act (often called the Community Mental Health Centers Act) in 1963. This act called for the construction of comprehensive community health centers, the cost of which would be shared by federal and state governments. Unfortunately, many state governments did not have the capability to match the federal funds required for the establishment of these mental health centers.

Cognitive Level: Application

Integrated Process: Assessment