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Download Basic Concepts of Psychiatric Mental Health Nursing 8th Edition Shives Test Bank all chapters
Download Basic Concepts of Psychiatric Mental Health Nursing 8th Edition Shives Test Bank all chapters
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1. Select the most appropriate psychosocial nursing diagnosis based on the following client
information: A client has a 20-year history of alcoholism, liver failure, and marital
problems. His chief complaints include tremors, fatigue, drowsiness, nausea, insomnia,
crying spells, and anxiety.
A) Cirrhotic liver disease related to alcoholism
B) Inadequate nutrition, as evidenced by nausea and anorexia
C) Sleep disturbance as evidenced by insomnia, fatigue, and daytime drowsiness
D) Depression related to alcoholism
Ans: C
Feedback:
The correct answer reflects the client's difficulty, along with the data that support this
assessment.
2. The following outcome would be expected if the nursing intervention were to provide
reality orientation to a patient:
A) The patient writes examples of positive thoughts about self.
B) The patient reports feelings of calmness after therapy.
C) The patient identifies the day of the week/month/season of year.
D) The patient accepts reality as stated by the nurse.
Ans: C
Feedback:
The correct answer is the only option that reflects that the patient is oriented to reality
and can demonstrate this orientation by an action or behavior.
3. When evaluating care plans as a part of peer review, the nurse knows that the best
nursing diagnoses are written in terms of what?
A) Cues, inferences, and goals
B) Judgments and advice
C) Client and nursing needs
D) Validated data and suspected problems
Ans: D
Feedback:
Diagnoses are written using validated data and are a mechanism for conveying to the
care team what the suspected problems will be or are.
Page 1
4. When designing written plans of care, the nurse is aware that the administrative
purposes include what?
A) Providing a blueprint for charting
B) Communicating information and appropriate client interventions to all caregivers
C) Providing criteria for reviewing quality of care
D) Providing continuity of care 24 hours a day
Ans: C
Feedback:
Administrative purposes of the care plan include those that assist in the overall
management of the care environment. Providing criteria to review quality of care
delivered is an administrative function and purpose for the nursing care plan.
5. The psychiatric nurse is working with a male client who has refused to take his
medications. Which of the following would be a nursing intervention within the
psychological dimension?
A) Establish a relationship in order to solve problem around noncompliance with
medication regimen.
B) Encourage the client's attendance at a discharge group.
C) Administer antidepressant agents as ordered.
D) Observe for therapeutic effects and side effects of the medication.
Ans: A
Feedback:
The only intervention that deals with the psychological dimension of care is the correct
answer. The others have to do with behavior and physiological dimensions of care.
Page 2
7. Which of the following is most important when writing a plan of care?
A) Prioritizing and individualizing the plan according to the nursing diagnosis
B) Using the correct medical-surgical terminology to convey understanding of
concepts
C) Stating generalized nursing actions such as comfort measures
D) Including only long-term goals to reflect desired future results
Ans: A
Feedback:
The most important element of the care plan is prioritization and individualization of the
client's care. Using correct terminology is also important but not the most important
element. It is appropriate neither to state generalized nursing actions nor to include only
long-term goals.
9. One of the mental health nurse's roles in caring for a psychiatric client is maintaining a
therapeutic environment (milieu). This would be categorized in which step of the
nursing process?
A) Planning
B) Nursing diagnosis
C) Implementation
D) Evaluation
Ans: C
Feedback:
During implementation, the nurse uses various skills to put a plan of care into action,
such as maintaining the therapeutic environment. Planning involves a plan of care that
individualizes and identifies priorities of care and proposed effective interventions.
Nursing diagnosis is a statement of an existing problem or a potential health problem
that a nurse is both competent and licensed to treat. Evaluation focuses on the client's
status, progress toward goal achievement, and ongoing reevaluation of the care plan.
Page 3
10. A mental health nurse is developing a plan of care for a client with anxiety disorder and
a gastric ulcer. The diagnosis of gastric ulcer would be placed on which of the following
axes of the DSM-IV-TR?
A) I
B) II
C) III
D) IV
Ans: C
Feedback:
Axis III is general medication conditions, such as gastric ulcer. Axis IV is categorized as
psychosocial and environmental problems. Axis II is personality disorders and mental
retardation. Axis I contains clinical disorders and other conditions that may be a focus
of clinical attention.
11. During the admission assessment of a new client, the nurse has collected and
documented a set of vital signs to serve as baselines for future assessment. The client's
vital signs would be considered to be what?
A) Judgments
B) Nursing diagnoses
C) Cues
D) Inferences
Ans: C
Feedback:
Objective data such as vital signs and laboratory results are cues that can be used as the
basis for subsequent steps in the nursing process.
12. Mrs. Yamada has been admitted to the psychiatric unit because of her worsening
diagnosis of major depression that has not responded appreciably to treatment. In light
of Mrs. Yamada's statement that “everything would be better if I was just dead and
gone,” the nurse would be justified in identifying what type of nursing diagnosis related
to suicide?
A) Risk nursing diagnosis
B) Wellness nursing diagnosis
C) Actual nursing diagnosis
D) Syndrome nursing diagnosis
Ans: A
Feedback:
This client's psychiatric diagnosis coupled with her statement that refers to suicide
would justify a risk nursing diagnosis of “risk for suicide related to depression.”
Page 4
13. John is a 26-year-old patient who is receiving inpatient care for the treatment of
schizophrenia. John believes himself to be a police informant who is under threat from
organized crime members, and he rarely sleeps, paces frequently, and has tremulous
hands and pressured speech. What actual nursing diagnosis should the nurse identify
when planning John's care?
A) Delusions
B) Schizophrenia
C) Persecution
D) Anxiety
Ans: D
Feedback:
Anxiety is a NANDA-approved nursing diagnosis and one that is strongly supported by
John's behavior and condition. Delusions, schizophrenia, and persecution are not
nursing diagnoses.
14. A client's frequent night awakenings, early morning rising, and daytime drowsiness
have prompted the nurse to add a diagnosis of “disturbed sleep pattern” to the client's
plan of care. What information should immediately follow this diagnosis?
A) Previous attempts at alleviating the diagnosis
B) The DSM-IV-TR diagnosis that corresponds to the nursing diagnosis
C) The evidence supporting the diagnosis
D) The client's preferred intervention for the diagnosis
Ans: C
Feedback:
A nursing diagnosis should be followed by the cues and judgments that underlie the
diagnosis. This is normally accomplished by following the diagnosis with statements
such as “evidenced by,” “related to,” and “demonstrated by.”
15. A client's nursing diagnosis of “risk for self-directed violence” has been identified
because of her recent history of cutting and self-mutilation. Which of the following
expected outcomes is most appropriate for this client's plan of care during inpatient
treatment?
A) “The client will demonstrate resolution of her psychiatric diagnosis.”
B) “The client will demonstrate better coping skills.”
C) “Staff will observe the client for signs of self-mutilation.”
D) “The client will refrain from cutting or self-mutilation.”
Ans: D
Feedback:
An expected outcome is a measurable, client-oriented goal, such as the goal of
abstaining from self-harm. “Resolution of her psychiatric diagnosis” and “better coping
skills” do not meet these criteria of attainability and measurability. An expected
outcome should not be framed in terms of the care providers' actions or interventions.
Page 5
16. In planning the care of a patient who has been admitted to the hospital after a suicide
attempt, an expected outcome should relate directly to what?
A) The patient's coping skills
B) The patient's mood and affect
C) The patient's refraining from suicide attempts
D) The patient's compliance with therapy
Ans: C
Feedback:
The outcome statement should be directly related to the nursing diagnosis. In the case of
patient who has attempted suicide, an expected outcome should be the absence of
further attempts.
17. A 33-year-old female client with a diagnosis of bipolar I disorder has a history of having
reckless, frequent, and anonymous sexual encounters during manic periods. As a result,
she has recently tested positive for a chlamydial infection. What is the most appropriate
outcome for this client?
A) The client will demonstrate three positive coping strategies when feeling the
impulse to seek new sexual encounters.
B) The client will comply with antibiotic therapy for the treatment of chlamydial
infection.
C) The client will learn to control mood and behavior in a more effective manner
during manic episodes.
D) The client will exhibit better self-control and more responsible behavior.
Ans: A
Feedback:
Outcome must be measurable and specific in order to be clinically useful. The
demonstration of coping skills meets these criteria. Complying with treatment may be
necessary but does not address the core diagnosis. Showing “better self-control” and
controlling mood are less measurable outcomes.
18. Because of his fear of poisoning, a client with a diagnosis of schizophrenia has severely
limited his food intake over the past several months, leading a weight loss of nearly 40
pounds. What consideration would be the priority in the planning of this client's care?
A) The client's compliance with psychotherapy
B) The client's mood and affect
C) The client's coping skills
D) The client's nutritional status
Ans: D
Feedback:
Because of their urgency, physiologic needs such as the stabilization of a comorbid
medical condition take precedence over needs that are higher on Maslow's hierarchy.
Page 6
19. The nurse educator on a psychiatric unit is leading an initiative to increase the
awareness and application of evidence-based practice on the unit. The nurses on the unit
would recognize that such practice integrates which of the following components?
(Select all that apply.)
A) Patient preferences
B) Best research evidence
C) Nurses' expertise
D) Insurers' priorities
E) Quality-assurance indicators
Ans: A, B, C
Feedback:
Evidence-based nursing practice is a term used to describe the process by which nurses
make clinical decisions (eg, choose nursing interventions) using the best available
research evidence, their clinical expertise, and client preferences.
20. A 22-year-old client who has been diagnosed with paranoid personality disorder has
been receiving treatment. The final stage of the nursing process in the care of this client
should focus on what?
A) Encouraging the client to develop coping skills and life skills
B) Evaluating the effectiveness of the treatment
C) Selecting specific interventions
D) Engaging the client's friends and family
Ans: B
Feedback:
The evaluation phase is the final phase of the nursing process, and it focuses on the
client's status, progress toward goal achievement, and ongoing reevaluation of the care
plan.
Page 7
Another random document with
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tubercles as younger stages of the larger scars characteristic of the
genus Ulodendron. Williamson’s contributions to our knowledge of
Halonia are of primary importance; he supplied further proof of the
Lepidodendroid nature of these branches and advanced our
knowledge of their anatomy. In an early paper[315] he expressed the
view that the differences on which Halonia and Ulodendron are
separated are such as result from a difference in age and are not of
generic importance. In the last memoir, of which he was sole author,
published by the Royal Society[316], Williamson brought forward
further evidence in support of this well-founded opinion.
That the fossils known as Halonia are branches of a
lepidodendroid plant is at least certain, and it is probable that the
lateral branches which they bore were fertile, though satisfactory
proof of this is lacking. We know also that Halonia branches are
characterised by the Lepidophloios form of leaf-cushion; there is,
however, no sufficient reason to assume that such branches were
never attached to stems with the cushions of the Lepidodendron
form. The further question, namely whether Williamson was correct
in his contention as to the absence of any essential distinction
between Ulodendron and Halonia, does not admit of an
unchallenged answer. In 1903 Weiss[317] described the anatomy of a
specimen of a biseriate Halonia branch of Lepidophloios. The form of
the leaf-cushions is unfortunately not very well preserved, but Weiss
figures other specimens with two rows of tubercles on which the leaf-
cushions are sufficiently distinct to justify a comparison with those of
Lepidophloios. He believes with Williamson that it is the presence of
tubercles in place of scars which distinguishes Halonia from
Ulodendron, and that the arrangement of the tubercles or scars is a
matter of little importance. He expresses the opinion justified by the
evidence available that the absence or presence of tubercles is
merely due to accidents of preservation or, one may add, to
difference in age. Kidston[318] dissents from Weiss’s description of his
specimen as a biseriate Halonia; he regards it as a Ulodendron
branch of Sigillaria discophora (König). Until specimens with more
clearly preserved external features are forthcoming it is impossible to
settle the point in dispute, but on the facts before us there would
seem to be a prima facie case in favour of Weiss’s contention.
The designation Halonia may be retained as a descriptive term for
Lepidodendroid shoots characterised by spirally disposed scars or
tubercles and bearing leaf-cushions of the Lepidophloios type. In the
case of specimens showing prominent tubercles, the superficial
tissues are usually absent and, as in the fossil represented in fig.
161, the name Halonia does not necessarily imply the presence of
leaf-cushions of a particular type.