Table of Contents Unit I: Essential Theoretical Concepts for Practice 1. Practicing the Science and the Art of Psychiatric Nursing 2. Mental Health and Mental Illness 3. Theories and Therapies 4. Biological Basis for Understanding Psychopharmacology 5. Settings for Psychiatric Care 6. Legal and Ethical Basis for Practice Unit II: Tools for Practice of the Art 7. Nursing Process and QSEN: The Foundation for Safe and Effective Care 8. Skills: Medium for All Nursing Practice 9. Therapeutic Relationships and the Clinical Interview Unit III: Caring for Patients with Psychobiological Disorders 10. Stress and Stress-Related Disorders 11. Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders 12. Somatic Symptom Disorders and Related Disorders 13. Personality Disorders 14. Eating Disorders 15. Mood Disorders: Depression 16. Bipolar Spectrum Disorders 17. Schizophrenia Spectrum Disorders and Other Psychotic Disorders 18. Neurocognitive Disorders 19. Substance-Related and Addictive Disorders Unit IV: Caring for Patients Experiencing Psychiatric Emergencies 20. Crisis and Mass Disaster 21. Child, Partner, and Elder Violence 22. Sexual Violence 23. Suicidal Thoughts and Behaviors 24. Anger, Aggression, and Violence 25. Care for the Dying and Those Who Grieve Unit V: Age-Related Mental Health Disorders 26. Children and Adolescents 27. Adults 28. Older Adults
Test Bank for Psychiatric Mental Health Nursing, 8th Edition Wanda Mohr
Chapter 01- Introduction to Psychiatric-Mental Health Nursing
- A nurse is giving a presentation about preventing mental illness to college freshmen. A student asks, “What does it mean to be mentally healthy?” Which of the following potential responses by the nurse is best?
A) “Mental health is difficult to define and depends on cultural norms.” B) “Mental health is marked by productivity, fulfilling relationships, and adaptability.” C) “Mental health is characterized by the absence of mental illness.” D) “Mental health is the performance of behavior that is accepted as normal.”
- A 48-year-old independent, successful woman is recovering from a modified radical mastectomy. She states she was grateful that during the first few weeks after surgery her mother stayed with her and did “everything” for her. Which element of mental health does this reflect?
A) Reality orientation B) Mastery of the environment C) Self-governance D) Tolerance of the unknown
- Why is the document Mental Health: A Report of the Surgeon General (1999) most significant?
A) Because it states clearly that there are effective treatments for mental illness B) Because it allocates research money to psychiatric facilities C) Because it sets new guidelines for use of restraints D) Because it establishes reimbursement guidelines for third-party payers
- While a nurse is performing an admission assessment for a mental health client, the client states that all of his problems have been caused by his parents. The nurse knows that psychological factors that can influence mental health include which of the following?
A) Neuroanatomy B) Emotional developmental level C) Values and beliefs D) Religion
- What is the primary purpose of the five-axis system used in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision(DSM-IV-TR)?
A) To separate the various mental disorders into five related categories B) To give a comprehensive picture of client functioning C) To improve prognostic ability D) To provide a decision-making algorithm for pharmacologic treatment
- One limitation of the DSM relates to diagnostic labels given to children. The most problematic issue caused by applying adult categories to children is which of the following?
A) It prevents the proper treatment of childhood disorders. B) The criteria for diagnosis of a disorder are flexible for an adult, but not for children. C) Categories are based on manifestations of adult disorders, not research in children. D) The DSM
was written before childhood psychological conditions were recognized.
- Which of the following represents a problem complicating the treatment of people with mental illness?
A) Insurers' reimbursement decisions B) Increased responsibility for care by state mental hospitals C) Overuse of the well-coordinated mental health care system D) Lack of effective treatments
- Julie, a 47-year-old woman, missed 1 week of work when she was hospitalized with bipolar disorder. She was placed on medication and was able to return to work. When asked about her absence, Julie informed coworkers that she was suffering from influenza. What is the most likely reason Julie lied about her illness?
A) This is a sign that the medication is not effectively treating her illness. B) Fear of rejection, isolation, and discrimination based on her mental health diagnosis
C) Due to workplace policies that encourage the firing of those with mental illnesses D) To avoid eliciting sympathy among her coworkers
- A 22-year-old man with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client attended a prestigious art school and enjoyed many social and leisure activities. Of the following long-term goals for this client, which is consistent with an overarching recovery goal for all clients with mental disorders?
A) The client will not injure himself. B) The client's symptoms will be reduced. C) The client will show interest in social and leisure activities. D) The client will resume pre-illness functioning.
- Which of the following approaches to care best reflects cultural competence?
A) Always assign nurses of a specific ethnic background to clients with the same ethnic background. B) Learn the behaviors and values associated with people of specific ethnic backgrounds. C) Assess the culturally mediated beliefs of each client. D) Believe that people are more alike than they are different. Chapter 02- Neuroscience-Biology and Behavior
- The basic units of structure and function in the nervous system are called which of the following?
A) Glial cells B) Neurons C) Axons D) Dendrites
- The structure and function of a neuron form the basis for the overall function of the nervous system. What are the components of a neuron?
A) A glial cell, nucleus, organelles, dendrites, and axons B) A glial cell, nucleus, dendrites, and synapses C) A cell body, nucleus, organelles, dendrites, and axons D) A cell body, nucleus, axon, and synapses
- A patient has researched the role of neurotransmitters in her mental illness. What is the role of neurotransmitters?
A) Excite the receptor cell located inside the synaptic cleft. B) Inhibit the receptor cell found inside of glial cells. C) Communicate information within the receptor cell. D) Communicate information from one cell or cell group to another.
- Because neurotransmitters are responsible for immediately transmitting impulses between nerve cells, they are known as which of the following?
A) First messengers B) Second messengers C) Receptors D) Synapses
- A nurse is caring for a patient who is addicted to alcohol and drugs and is discussing the pathway of the brain responsible for this behavior. The nurse should know that the pathway of the brain thought to be involved in pleasurable sensations and the euphoria resulting from use of drugs is called the:
A) Tuberinfundibular dopamine pathway B) Nigrostriatal dopamine pathway C) Mesocortical dopamine pathway D) Mesolimbic dopamine pathway
- A client lives with acquired deficits in emotional control, memory, and learning. What part of this client's brain is most likely affected?
A) Basal ganglia B) Brainstem C) Limbic system D) Cerebellum
- You are caring for a mental health client who has developed difficulty with balance and muscle tone after a car accident that involved a head injury. Based on this information, what area of the brain was most likely injured in the accident?
A) Diencephalon B) Brainstem C) Cerebellum D) Pons
- A client who experiences dysfunction in the hypothalamus is most likely to have
A) Maintaining homeostasis B) Processing sensory input
C) Secreting melatonin D) Integrating motor activities
- Sensory deprivation in infancy and childhood has adversely affected a boy's brain development. Which characteristic of the brain was most directly involved in this process?
A) Neuroplasticity B) Reactive plasticity C) Adaptive plasticity D) Synaptic plasticity
- Rather than being 100%, concordance rates for schizophrenia in monozygotic twins are only 50%. Which of the following statements best explains this phenomenon?
A) Genetic predisposition to disease is frequently overstated. B) One twin is inherently more vulnerable in every case. C) Environmental experiences affect gene expression. D) The genetic pathway responsible for vulnerability is unrelated to being a twin. Chapter 03- Conceptual Frameworks and Theories
- A psychiatric–mental health nurse is aware of the importance of theories in the development and delivery of care. Which of the following is the best definition of a theory?
A) A group of related concepts or ideas B) A person's or group's beliefs about how something happens or works C) A prediction about two or more concepts D) A researchable question related to health care
- Which of the following explains why theories are important to psychiatric–mental health nursing?
A) Theories provide more treatment options for clients. B) Theories add professionalism to health care. C) Theories simplify treatment decisions for most clients. D) Theories lead to the expansion of knowledge.
- A client has been told by a psychologist that memories in his unconscious are contributing to his depression. This reasoning implies that the psychologist ascribes to what theory?
A) Psychoanalytic theory B) Behavior theory C) Cognitive–behavioral theory
D) The humanistic perspective
- A client's current plan of care includes interventions that are rooted in the concepts of reinforcement. Which theory of human behavior is being prioritized during this client's care?
A) Humanistic theory B) Sociocultural theory C) Behavioral theory D) Psychoanalytic theory
- A client and her therapist have been discussing the notion that her psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. This discussion is congruent with what theory?
A) Humanistic theory B) Interpersonal theory C) Biophysiological theory D) Sociocultural theory
- During marital counseling, a man complains that his wife often “bombards” him with problems as soon as he settles down at home after work, which results in a prolonged argument. The wife admits that she does this but states she feels neglected and that her husband does not take the family problems seriously. She doesn't want her marriage to turn out like her parents' marriage. The wife admits that she sometimes provokes an argument in order to gain her husband's attention. How would a behaviorist most likely explain the wife's actions?
A) She has repressed painful memories about her emotionally distant father and is working out her anger at the parent in the marital relationship. B) Her thoughts about her parents' unhappy marriage are a justification for her behavior. C) She has an underlying anxiety disorder. D) The long argument in which she and her husband participate positively reinforces her behavior.
- An adult man recalls that he was teased as a child about his inability to participate in sports. He began to avoid situations in which others might evaluate his behavior. He seeks treatment now because he is an accomplished musician but cannot perform for an audience. According to behavioral theory, his behavior is an example of which of the following concepts?
A) Discrimination B) Modeling C) Generalization D) Shaping
- The nurse is working with a client who admits to having low self-esteem. The care team has determined that cognitive restructuring will likely enhance the client's self-esteem. Which of the following best describes the goals of this intervention?
A) Avoid negative self-talk B) Replace negative self-talk with positive statements C) Change distorted thinking and the subsequent behaviors D) Use adaptive defense mechanisms
- A 55-year-old woman is being treated for narcissistic personality disorder. The therapist demonstrates caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory?
A) Shaping B) Discrimination C) Modeling D) Conditioning
- In a group therapy session, group members confront a 35-year-old woman about her abuse of prescription pain medications. The woman states that, because a physician has prescribed her medication, she is not a drug addict. The nurse identifies this as an example of which of the following defense mechanisms?
A) Regression B) Projection C) Denial D) Sublimation Chapter 04- Evidence-Based Practice
- The nurse demonstrates a commitment to the health, safety, and welfare of people by providing evidence-based practice. What does the term “evidence-based practice” mean?
A) Care that integrates research and clinical expertise with the client's characteristics, culture, and preferences B) Care that bases decision making on established clinical protocols C) Care based on prior outcomes from the nurse's practice D) Care based on outcomes and research conducted by the practitioner
- Many pseudoscientific practitioners function openly and market themselves as mainstream
“therapists.” Why does the public often respond favorably to unconventional therapies? A) Pseudoscientific therapies are frequently more effective than conventional therapies. B) Further advancements can be made in effective pseudoscientific treatments with continued practice. C) Malpractice is minimized because pseudoscientific treatments are not empirically supported.
D) Some clients and families are disenchanted with the outcomes of professionally approved treatments.
- Nursing is both an art and a science. Which statement best represents how evidence-based practice encompasses these two aspects of nursing?
A) The art of nursing has been replaced by evidence-based practice. B) Multiple theoretical perspectives no longer guide evidence-based nursing care. C) The art of nursing is demonstrated through carrying out the science of nursing in a skillful, knowledgeable, intelligent, and ethical manner. D) The artful side of nursing is of less value to positive patient outcomes than is the science of nursing.
- Evidence-based practice is based on the scientific method and empirical evidence. Which of the following is a principle of empirical evidence?
A) Scientific observations are subjective inferences made by the knowledgeable nurse researcher. B) Empirical studies may be designed to report the physical and mental effects of subjective experiences. C) Empirical evidence is not appropriate in the field of mental health because cognitions and emotions are subjective and unpredictable. D) Empirical knowledge is verifiable only with valid and reliable measurement instruments.
- The nurse is part of team conducting a research study that involves controlled observations. Controlled observations involve which of the following activities?
A) Putting information together to form a new understanding B) Watching something carefully and noting events C) Testing a hypothesis or prediction D) Determining whether data are reliable and supportive
- Two patients with schizophrenia have consented to be involved in clinical trials to determine the efficacy of a new antipsychotic medication. The researcher administers the new drug to one subject and a sugar pill to another subject. The patient who received the sugar pill received a treatment that is considered which of the following?
A) Sham treatment B) Unethical treatment C) Placebo D) Supplemental therapy
- A research team has been formed to study a new medication and its effects on depression. The researcher wants to use a design where neither the clients nor the research staff will know who is receiving the medication or the placebo. What type of study is this group conducting?
A) An empirical study B) An evidence-based study C) A case-control study
D) A double-blind study
- A researcher is determining whether data that were obtained in a psychiatric nursing study are reliable and whether the data support the study hypothesis. In what part of the scientific process is the researcher functioning?
A) Experimentation B) Analysis C) Synthesis D) Prediction
- The nurse is working with a 42-year-old female patient who is mildly overweight. The patient expresses a desire to “tone up” before summer and is interested in trying an over-the-counter weight loss remedy. The nurse should perform health education related to what subject?
A) To be wary of any product that claims rapid or effortless results without exercise B) The relatively low risk of using natural remedies C) The small amount of active ingredient in most over-the-counter treatments D) To choose a product that reports data indicating a high degree of effectiveness
- Many people get health care information from the Internet. Hence, evidence-based health care can be threatened by the proliferation of pseudoscientific information available to the public. Which measure is currently being taken to prevent the misinformation of the healthcare consumer?
A) Evidence-based knowledge is currently only disseminated in professional journals and publications. B) The Food and Drug Administration (FDA) has been denied the jurisdiction to prosecute unscrupulous internet marketers. C) Public education is being performed by the Federal Trade Commission (FTC) through a campaign called Operation Cure All. D) Websites publicizing misinformation on the Internet are being screened and blocked. Chapter 05- Legal and Ethical Aspects
- A psychiatric–mental health nurse has been consistently aware of the need to adhere to standards of practice during interactions with clients and their families. What is a standard of nursing practice?
A) The body of text in the state nurse practice act B) A document outlining minimum expectations for safe nursing practice C) Unwritten but traditional practices that constitute safe nursing care
D) Part of the federal nurse practice act
- Nursing students are reviewing the nurse practice act in the state where they reside. A state's nurse practice act has which of the following functions?
A) Makes recommendations for how nurses should practice B) Defines the scope and limit of nursing practice C) Defines specific situations that constitute malpractice D) Follows federal laws about nursing practice
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Chapter 01: Community Health Nursing
Stanhope: Community Health Nursing in Canada, 3rd Canadian Edition
1. Which of the following best
describes community health nursing
|a.||Giving care with a focus on the aggregate’s needs|
|b.||Giving care with a focus on the group’s needs|
|c.||Focusing on the health care of individual clients in the community|
|d.||Working with an approach of unique client care|
ANS: C By definition, community health nursing is the health care of individual clients in the community. DIF: Cognitive Level: Knowledge/Remember REF: p. 3 OBJ: 1.6 TOP: Client Need: Safe and Effective Care Environment - Management of Care 2. Which of the following best
describes primary health care
|a.||A comprehensive way to address issues of social justice|
|b.||Giving the care to manage acute or chronic conditions|
|c.||Giving direct care to ill individuals within their family setting|
|d.||Having the goal of health promotion and disease prevention|
ANS: A By definition, primary health care is comprehensive and addresses issues of social justice and equity. Social justice in the context of health refers to ensuring fairness and equality in health services so that vulnerable individuals in society have easy access to health care. DIF: Cognitive Level: Knowledge/Remember REF: p. 10 OBJ: 1.4 TOP: Client Need: Health Promotion and Maintenance 3. The health of which of the following is the primary focus of public health nurses (PHNs)?
ANS: D PHNs use knowledge of nursing, social sciences, and public health sciences for the promotion and protection of health and for the prevention of disease among populations. DIF: Cognitive Level: Knowledge/Remember REF: p. 13, Table 1-4 | p. 20 OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance 4. Which change is the primary explanation for life expectancy increasing so notably since the early 1900s?
|a.||An increase in findings from medical laboratory research|
|b.||Incredible advances in surgical techniques and procedures|
|c.||Improved sanitation and other public health activities|
|d.||Increased use of antibiotics to fight infections|
ANS: C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy since the early 1900s. DIF: Cognitive Level: Knowledge/Remember REF: pp. 12-13 OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance 5. Which community health nursing practice area receives funding from the private sector?
|d.||Street or outreach nurses|
ANS: C The nurse entrepreneur receives private funding, whereas all of the other community health nurse (CHN) roles are with provincially or federally funded positions. DIF: Cognitive Level: Knowledge/Remember REF: p. 22, Table 1-4 Examples OBJ: 1.6 TOP: Client Need: Safe and Effective Care Environment - Management of Care 6. A PHN strives to prevent disease and disability, often in partnership with other community groups. Which statement is an appropriate summary of the PHN’s role?
|a.||The PHN asks the political leaders what interventions should be chosen.|
|b.||The PHN assesses the community and decides on appropriate interventions.|
|c.||The PHN uses data from the main health care institutions in the community to determine needed health services.|
|d.||The PHN works with community members to carry out public health functions.|
ANS: D It is crucial that the PHN work with
members of the community to carry out core public health functions. DIF: Cognitive Level: Application/Apply REF: p. 13, How To box OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance 7. Which of the following is used as a measurement of population health?
|a.||Health status indicators|
|b.||The levels of prevention|
|c.||The number of memberships at the local fitness centre|
|d.||Reported provincial alcohol and tobacco sales in any given month|
ANS: A Population health refers to the health outcomes of a population as measured by determinants of health and health outcomes. DIF: Cognitive Level: Knowledge/Remember REF: p. 16 OBJ: 1.2 TOP: Client Need: Health Promotion and Maintenance 8. A registered nurse (RN), has just been employed as a CHN. Which question would be most relevant to her practice as she begins her position?
|a.||“Which community groups are at greatest risk for problems?”|
|b.||“Which patients should I see first as I begin my day?”|
|c.||“With which physicians will I be collaborating most closely?”|
|d.||“Who is the nursing assistant to whom I can refer patients?”|
ANS: A CHNs apply the nursing process to the entire community; asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses focus on particular individuals. DIF: Cognitive Level: Application/Apply REF: p. 15 OBJ: 1.6 TOP: Client Need: Health Promotion and Maintenance 9. The CHN working with women at the senior citizens’ centre reminds them that the only way the centre will be able to afford a driver and a van service for those who cannot drive themselves is to continue to write letters to their local city council representatives, requesting funding for such a service. What is the CHN doing?
|a.||Ensuring that the women do not expect the CHN herself to do anything about their problem|
|b.||Demonstrating that she understands the women’s concerns and needs|
|c.||Expressing empathy, support, and concern|
|d.||Helping the women engage in political action locally|
ANS: D CHNs have an imperative to work with
the members of the community to carry out public health functions such as political action. DIF: Cognitive Level: Application/Apply REF: p. 13, How To box OBJ: 1.5 | 1.6 TOP: Client Need: Safe and Effective Care Environment - Management of Care 10. Which activity is an example of the “advocate” role of the CHN?
|a.||Organizing home care support for a newly discharged older adult client|
|b.||Acting as a member of a community action group for provision of accessible transit choices|
|c.||Doing prenatal assessments|
|d.||Facilitating a self-help group for smoking cessation|
ANS: B An advocate provides a voice to client concerns when acting as a member of a community action group for provision of accessible transit choices. DIF: Cognitive Level: Application/Apply REF: p. 19, Table 1-3 OBJ: 1.6 TOP: Client Need: Safe and Effective Care Environment - Management of Care 11. In which scenario is the PHN most comprehensively fulfilling collaborative practice responsibilities?
|a.||The PHN meets with several groups about community recreation issues.|
|b.||The PHN spends the day attending meetings at various health agencies.|
|c.||The PHN talks to several people about their particular health concerns.|
|d.||The PHN watches television, including a telecast of a city council meeting on the local cable station.|
ANS: B Any of these might represent a PHN communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the PHN who spends the day attending meetings at various health agencies is most comprehensively fulfilling requirements effectively, since health is broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is only one-way communication. DIF: Cognitive Level: Synthesis/Synthesize REF: pp. 15-16 OBJ: 1.5 TOP: Client Need: Safe and Effective Care Environment - Management of Care 12. A CHN often has to make resource allocation decisions. In such cases, which approach will most help the CHN to arrive at the decision?
|a.||Choosing a moral or ethical principle|
|b.||Choosing the cheapest, most economical approach|
|c.||Choosing the most rational outcome|
|d.||Choosing the needs of the aggregate, rather than the needs of a few individuals|
ANS: D Although all of the answers represent components of the CHN’s decision-making process, the predominant needs of the population outweigh the expressed needs of one person or a few people. DIF: Cognitive Level: Application/Apply REF: pp. 7-8 OBJ: 1.3 TOP: Client Need: Safe and Effective Care Environment - Management of Care 13. Which situation most closely represents the focus of public health nursing?
|a.||Assessing the services and effectiveness of the school health clinic|
|b.||Caring for patients after their outpatient surgeries|
|c.||Giving care to schoolchildren at the school clinic and to the children’s families|
|d.||Treating paediatric patients at an outpatient clinic|
ANS: A A public health or population-focused approach would consider the entire group of children receiving care, to see if services are effective in achieving the goal of improving the health of the school population. DIF: Cognitive Level: Application/Apply REF: p. 13, How To box OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance 14. Which public health service best represents primary
|a.||Developing a health education program about the dangers of smoking|
|b.||Providing a diabetes clinic for adults in low-income neighbourhoods|
|c.||Providing an influenza vaccination program in a community retirement village|
|d.||Teaching school-aged children about the positive effects of exercise|
ANS: C Although all the services listed are appropriate and valuable, providing influenza vaccines to healthy adults represents the primary level of health prevention. DIF: Cognitive Level: Application/Apply REF: p. 14 OBJ: 1.5 TOP: Client Need: Health Promotion and Maintenance 15. What term is used interchangeably with the term subpopulations
ANS: B Generally, subpopulations
are referred to as aggregates within the larger community population. DIF: Cognitive Level: Knowledge/Remember REF: p. 16 OBJ: 1.2 TOP: Client Need: Health Promotion and Maintenance
Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition Chapter 02: Family, Social, Cultural, and Religious Influences on Child Health Promotion MULTIPLE CHOICE 1. A nurse is selecting a family theory to assess a patient’s family dynamics. Which family theory best describes a series of tasks for the family throughout its life span?
ANS: D Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. Interactional theory and structural-functional theory are not family theories. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. DIF:Cognitive Level: UnderstandREF:p. 17 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 2.Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events?
|b.||Developmental systems theory|
|d.||Duvall’s developmental theory|
ANS: C Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. DIF:Cognitive Level: UnderstandREF:p. 16 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 3.Which is the term for a family in which the paternal grandmother, the parents, and two minor children live together?
|b.||Developmental systems theory|
|c.||Family stress theory|
|d.||Duvall’s developmental theory|
ANS: D An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. DIF:Cognitive Level: RememberREF:p. 18 TOP:Integrated Process: Nursing Process: Planning MSC:Area of Client Needs: Health Promotion and Maintenance 4.A nurse is assessing a family’s structure. Which describes a family in which a mother, her children, and a stepfather live together?
ANS: A A blended family contains at least one stepparent, step-sibling, or half-sibling. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. DIF:Cognitive Level: UnderstandREF:p. 18 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 5.Parents of a firstborn child are asking whether it is normal for their child to be extremely competitive. The nurse should respond to the parents that studies about the ordinal position of children suggest that firstborn children tend to:
ANS: B Firstborn children, like only children, tend to be more achievement oriented. Being praised less often, being more popular with the peer group, and identifying with peer groups more than parents are characteristics of later-born children. DIF:Cognitive Level: ApplyREF:p. 29 TOP:Integrated Process: Nursing Process: Implementation MSC:Area of Client Needs: Health Promotion and Maintenance 6.The nurse is teaching a group of new parents about the experience of role transition. Which statement by a parent would indicate a correct understanding of the teaching?
|a.||be praised less often.|
|b.||be more achievement oriented.|
|c.||be more popular with the peer group.|
|d.||identify with peer group more than parents.|
ANS: A If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect. Infants with special care needs can be a significant source of added stress. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development. DIF:Cognitive Level: UnderstandREF:p. 17 TOP:Integrated Process: Nursing Process: Evaluation MSC:Area of Client Needs: Health Promotion and Maintenance 7.When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called?
|a.||“My marital relationship can have a positive or negative effect on the role transition.”|
|b.||“If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.”|
|c.||“Young parents can adjust to the new role easier than older parents.”|
|d.||“A parent’s previous experience with children makes the role transition more difficult.”|
ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child’s individual nature. DIF:Cognitive Level: RememberREF:p. 20 TOP:Integrated Process: Nursing Process: Diagnosis MSC:Area of Client Needs: Health Promotion and Maintenance 8.When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction?
ANS: B For effective discipline, parents must be consistent and must follow through with agreed-on actions. Realistic goals should be set for this age group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child. Withdrawal of love and approval is never appropriate or effective. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. DIF:Cognitive Level: ApplyREF:p. 20 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 9.Which is most characteristic of the physical punishment of children, such as spanking?
|a.||Children as young as 4 years old rarely need to be punished.|
|b.||Parental control should be consistent.|
|c.||Withdrawal of love and approval is effective at this age.|
|d.||One should expect rules to be followed rigidly and unquestioningly.|
ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment. Spanking can cause severe physical and psychological injury and interfere with effective parent-child interaction. Children do become accustomed to spanking, requiring more severe corporal punishment each time. The use of corporal punishment may interfere with the child’s development of moral reasoning. DIF:Cognitive Level: UnderstandREF:p. 20 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 10.A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guidelines concerning adoption should the nurse use in planning a response?
|a.||Psychological impact is usually minimal.|
|b.||Children rarely become accustomed to spanking.|
|c.||Children’s development of reasoning increases.|
|d.||Misbehavior is likely to occur when parents are not present.|
ANS: A It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity. DIF:Cognitive Level: UnderstandREF:p. 22 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 11.A parent of a school-age child is going through a divorce. The parent tells the school nurse the child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which implication?
|a.||Telling the child is an important aspect of their parental responsibilities.|
|b.||The best time to tell the child is between ages 7 and 10 years.|
|c.||It is not necessary to tell the child who was adopted so young.|
|d.||It is best to wait until the child asks about it.|
ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an indication of maladjustment, suggestive of lack of adequate parenting, or an unusual response that indicates need for referral in school-age children after parental divorce. DIF:Cognitive Level: ApplyREF:p. 24 TOP:Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity 12.A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which statement?
|a.||Indication of maladjustment|
|b.||Common reaction to divorce|
|c.||Lack of adequate parenting|
|d.||Unusual response that indicates need for referral|
ANS: D Let’s talk about the child care options that will be best for Eric is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. I’m sure he’ll be fine if you get a good babysitter, You will need to stay home until Eric starts school, and You should go back to work so Eric will get used to being with others are directive statements. They do not address the effect of her working on Eric. DIF:Cognitive Level: ApplyREF:p. 27 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 13.Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior?
|a.||“I’m sure he’ll be fine if you get a good babysitter.”|
|b.||“You will need to stay home until Eric starts school.”|
|c.||“You should go back to work so Eric will get used to being with others.”|
|d.||“Let’s talk about the child care options that will be best for Eric.”|
ANS: B Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perceptions and judgments. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize it as a distinct human type. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of systems of roles carried out in groups. Examples of primary social groups include the family and peer groups. DIF:Cognitive Level: RememberREF:p. 29 TOP:Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 14.Which term best describes the emotional attitude that one’s own ethnic group is superior to others?
ANS: D Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serves as a frame of reference for individual perception and judgments. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or quality of being superior; it does not include ethnicity. DIF:Cognitive Level: UnderstandREF:p. 30 TOP:Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1.Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.)
ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. DIF:Cognitive Level: UnderstandREF:p. 19 TOP:Integrated Process: Nursing Process: Diagnosis MSC:Area of Client Needs: Health Promotion and Maintenance 2.A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.)
|a.||Ability to stay connected without spending time together|
|b.||Clear set of family values, rules, and beliefs|
|c.||Adoption of one coping strategy that always promotes positive functioning in dealing with life events|
|d.||Sense of commitment toward growth of individual family members as opposed to that of the family unit|
|e.||Ability to engage in problem-solving activities|
|f.||Sense of balance between the use of internal and external family resources|
ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room. DIF:Cognitive Level: ApplyREF:p. 21 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 3.Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which types of behaviors? (Select all that apply.)
|a.||Time-out as a discipline measure cannot be used when in a public place.|
|b.||A rule for the length of time-out is 1 minute per year.|
|c.||When the child misbehaves, one warning should be given.|
|d.||The area for time-out can be in the family room where the child can see the television.|
|e.||When the child is quiet for the specified time, he or she can leave the room.|
ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. He or she would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent. DIF:Cognitive Level: ApplyREF:p. 24 TOP:Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning COMPLETION
|a.||Displaying fears of abandonment|
|b.||Verbalizing that he or she “is the reason for the divorce”|
|c.||Displaying fear regarding the future|
|d.||Ability to disengage from the divorce proceedings|
|e.||Engaging in fantasy to understand the divorce|
CHAPTER 1 SM NOT EXISTENT Chapter 2 Descriptive Statistics Case Problem: Heavenly Chocolates Website Traffic
- Descriptive statistics for the time spent on the website, number of pages viewed, and amount spent are shown below.
The mean time a shopper is on the Heavenly Chocolates website is 12.8 minutes, with a minimum time of 4.3 minutes and a maximum time of 32.9 minutes. The following histogram demonstrates that the data are skewed to the right. The meannumber of pages viewed during a visit is 4.8 pages with a minimun of 2 pages and a maximum of 10 pages A histogram of the number of pages viewed indicates that the data are slightly skewed to the right. The mean amount spent for an on-line shopper is $68.13 with a minimum amount spent of $17.84 and a maximum amount spent of $158.51. The following histogram indicates that the data are skewed to the right.
|Time (min)||Pages Viewed||Amount Spent ($)|
- Summary by Day of Week
The above summary shows that Monday and Friday are the best days in terms of both the total amount spent and the averge amount spent per transaction. Friday had the most purchases (11) and the highest value for total amount spent ($945.43). Monday, with nine transactions, had the highest average amount spent per transaction ($90.38). Sunday was the worst sales day of the week in terms of number of transactions (5), total amount spent ($218.15), and average amount spent per transaction ($43.63). However, the sample size for each day of the week are very small, with only Friday having more than ten transactions. We would suggest a larger sample size be taken before recommending any specific stratgegy based on the day of week statistics.
|Day of Week||Frequency||Total Amount Spent ($)||Average Amount Spent ($)|
- Summary by Type of Browser
Chrome was used by 27 of the 50 shoppers (54%).But, the average amount spent spent bycustomers who used Chrome ($61.36)is less than the average amount spent by customers who used Firefox ($76.76) or some other type of browser ($74.48). This result would suggest targeting special promotion offers to Firefox users or users of other types of browsers. But, before recommending any specific strategies based upon the type of browser, we would suggest taking a larger smaple size.
|Browser||Frequency||Total Amount Spent ($)||Average Amount Spent ($)|
- A scatter diagram showing the relationship between time spent on the website and the amount spent follows: