| Content | Test Bank For Foundations for Population Health in Community Public Health Nursing 5th Edition Stanhope
Chapter 01: Community- and Prevention-Oriented Practice to Improve Population
Health
Stanhope: Foundations for Population Health in Community/Public Health Nursing,5th Edition
MULTIPLE CHOICE
1. Which of the following best describes community-based nursing?
a. A practice in which care is provided for individuals and families
b. Providing care with a focus on the group’s needs
c. Giving care with a focus on the aggregate’s needs
d. A value system in which all clients receive optimal care
ANS: A
By definition, community-based nursing is a setting-specific practice in which care is
provided for “sick” individuals and families where they live, work, and attend school. The
emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and
continuous care. These nurses may be generalists or specialists in maternal–infant, pediatric,
adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and
chronic care to individuals and families, rather than focusing on groups, aggregates, or
systems.
2. Which of the following best describes community-oriented nursing?
a. Focusing on the provision of care to individuals and families
b. Providing 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: D
By definition, community-oriented nursing has the goal of preserving, protecting, or
maintaining health and preventing disease to promote the quality of life. All nurses may focus
on individuals and families, give direct care to ill persons within their family setting, and help
manage acute or chronic conditions. These definitions are not specific to community-oriented
nursing.
3. Which of the following is the primary focus of public health nursing?
a. Families and groups
b. Illness-oriented care
c. Individuals within the family unit
d. Health care of communities and populations
ANS: D
In public health nursing the primary focus is on the health care of communities and
populations rather than on individuals, groups, and families. The goal is to prevent disease and
preserve, promote, restore, and protect health for the community and the population within it.
Community-based nurses deal primarily with illness-oriented care of individuals and families
acorss the life span. The aim is to amanage acute and chronic health conditions in the
community, and the focus of practice is on individual or family-centered illness care.
Foundations for Population Health in Community Public Health Nursing 5th Edition Stanhope
4. Which of the following is responsible for the dramatic increase in life expectancy during the
20th century?
a. Technology increases in the field of medical laboratory research
b. Advances in surgical techniques and procedures
c. Sanitation and other population-based prevention programs
d. Use of antibiotics to fight infections
ANS: C
Improvements in control of infectious diseases through immunizations, sanitation, and other
population-based prevention programs led to the increase in life expectancy from less than 50
years in 1900 to more than 78 years in 2013. Although people are excited when a new drug is
discovered that cures a disease or when a new way to transplant organs is perfected, it is
important to know about the significant gains in the health of populations that have come
largely from public health accomplishments.
5. A nurse is developing a plan to decrease the number of premature deaths in the community.
Which of the following interventions would most likely be implemented by the nurse?
a. Increase the community’s knowledge about hospice care.
b. Promote healthy lifestyle behavior choices among the community members.
c. Encourage employers to have wellness centers at each industrial site.
d. Ensure timely and effective medical intervention and treatment for community
members.
ANS: B
Public health approaches could help prevent premature deaths by influencing the way people
eat, drink, drive, engage in exercise, and treat the environment. Increasing knowledge of
hospice care, encouraging on-site wellness centers, and ensuring timely treatment of medical
conditions do not address the focus of improving overall health through health promotion
strategies. This is the major method that is suggested to decrease the incidence of premature
death.
6. Which of the following is a basic assumption of public health efforts?
a. Health disparities among any groups are morally and legally wrong.
b. Health care is the most important priority in government planning and funding.
c. The health of individuals cannot be separated from the health of the community.
d. The government is responsible for lengthening the life span of Americans.
ANS: C
Public health practice focuses on the community as a whole, and the effect of the
community’s health status (resources) on the health of individuals, families, and groups. The
goal is to prevent disease and disability and promote and protect the health of the community
as a whole. Public health can be described as what society collectively does to ensure that
conditions exist in which people can be healthy. The basic assumptions of public health do not
judge the morality of health disparities. The focus is on prevention of illness not on spending
more on illness care. Additionally, individual responsibility for making healthy choices is the
directive for lengthening life span not the role of the government.
7. Which of the following actions would most likely be performed by a public health nurse?
a. Asking community leaders what interventions should be chosen
b. Assessing the community and deciding on appropriate interventions
c. Using data from the main health care institutions in the community to determine
Foundations for Population Health in Community Public Health Nursing 5th Edition Stanhope needed health services
d. Working with community groups to create policies to improve the environment
ANS: D
Although the public health nurse might engage in any of the tasks listed, he or she works
primarily with members of the community to carry out core public health functions, including
assessment of the population as a whole and engaging in promoting health and improving the
environment. The interventions of asking community leaders which interventions should be
chosen, asessing the community and deciding on appropriate interventions, and using data
from health care institutions do not demonstrate the engagement of the community when
making decisions about what the community actually wants and needs.
8. Which of the following public health nurses most clearly fulfills the responsibilities of this
role?
a. The nurse who met with several groups to discuss community recreation issues
b. The nurse who spent the day attending meetings of various health agencies
c. The nurse who talked to several people about their particular health concerns
d. The nurse who watched the city council meeting on local cable television
ANS: B
Any of these descriptions might represent a nurse communicating, cooperating, or
collaborating with community residents or groups about health concerns. However, the nurse
who spent the day attending meetings of various health agencies is the most representative,
because in public health, concerns are addressed from a broader perspective. In public health,
broad concerns of the community should be addressed. Concerns are broader than recreation,
individual concerns are not as important as aggregate priorities, and watching television (a
one-way form of communication) is less effective than interacting with others.
9. Which of the following best defines aggregate?
a. A large group of persons
b. A collection of individuals and families
c. A collection of people who share one or more characteristics
d. Another name for demographic group
ANS: C
An aggregate is defined a collection of people who share one or more personal or
environmental characteristics. Members of a community can be defined in terms of either
geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children
attending a particular school). These members make up a population. The term population
may be used interchangeably with the term aggregate. A large group of persons, a collection
of individuals and families, and another name for demograhpic group are not accurate
definitions of the term aggregate.
10. A registered nurse was just employed as a public health nurse. Which question would be the
most relevant for the nurse to ask?
a. “Which groups are at the greatest risk for problems?”
b. “Which patients should I see first as I begin my day?”
c. “With which physicians will I be most closely collaborating?”
d. “With which nursing assistants will I partner the most?”
ANS: A
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Foundations for Population Health in Community Public Health Nursing 5th Edition Stanhope
Asking which groups are at greatest risk reflects a community-oriented perspective. The
incorrect responses reflect a focus on individuals rather than a community-oriented
perspective.
11. Making sure that essential community-oriented health services are available defines which of
the core public health functions?
a. Policy development
b. Assessment
c. Assurance
d. Scientific knowledge-based care
ANS: C
Assurance includes making sure that essential community-oriented health services are
available in the community. The definition does not fit the terms assessment, policy
development. Scientific knowledge-based care is not a core function of public health.
Assessment is systematic data collection on the population, monitoring the population’s health
status, and making information available about the health of the community. Policy
development refers to efforts to develop policies that support the health of the population,
including using a scientific knowledge base to make policy decisions.
12. When talking to a women’s group at the senior citizens’ center, the nurse reminded them that
the only way the center would be able to afford to provide transportation services for them
would be for them to continue to write letters to their local city council representatives
requesting funding for such a service. What was the nurse trying to accomplish through this
action?
a. Ensure that the women did not expect the nurse to solve their problem.
b. Demonstrate that the nurse understood the women’s concerns and needs.
c. Express empathy, support, and concern.
d. Help the women engage in political action.
ANS: D
Public health nurses engage themselves and others in policy development and encourage and
assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond merely understanding the women’s concern, and instead mobilizes them to take action. This action does not
demonstrate the nurse showing empathy rather the nurse is empowering these women. |
Chapter 01: Community Health Nursing
Stanhope: Community Health Nursing in Canada, 3rd Canadian Edition
MULTIPLE CHOICE
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)?
| a. |
Families |
| b. |
Groups |
| c. |
Individuals |
| d. |
Populations |
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?
| a. |
Telenurses |
| b. |
Corrections nurses |
| c. |
Nurse entrepreneurs |
| 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 prevention?
| 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?
| a. |
Groups |
| b. |
Aggregates |
| c. |
Clients |
| d. |
Communities |
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
|
Table of Content
Table of Contents
Chapter 1. Healthy Lifestyles Chapter
2. Culture Chapter
3. The Family Chapter
4. Communication Chapter
5. Theories of Growth and Development Chapter
6. Prenatal Period to 1 Year Chapter
7. Toddlerhood Chapter
8. Preschool Chapter
9. School Age Chapter
10. Puberty and Adolescence Chapter
11. Early Adulthood Chapter
12. Middle Adulthood Chapter
13. Late Adulthood Chapter
14. Death and Dying |
Chapter 05: Comfort and Sedation
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1.Nociceptors differ from other nerve receptors in the body in that they:
| a. |
adapt very little to continual pain response. |
| b. |
inhibit the infiltration of neutrophils and eosinophils. |
| c. |
play no role in the inflammatory response. |
| d. |
transmit only the thermal stimuli. |
ANS: A
Nociceptors are stimulated by mechanical, chemical, or thermal stimuli. Nociceptors differ from other nerve receptors in the body in that they adapt very little to the pain response. The body continues to experience pain until the stimulus is discontinued or therapy is initiated. This is a protective mechanism so that the body tissues being damaged will be removed from harm. Nociceptors usually initiate inflammatory responses near injured capillaries. As such, the response promotes infiltration of injured tissues with neutrophils and eosinophils.
DIF: Cognitive Level: Remember/Knowledge REF: p. 54
OBJ:Discuss the physiology of pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
2.A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating the ventilator well and has not required any sedation. On assessment, the nurse notes the patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min. The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The patient responds appropriately to the nurse’s commands. The nurse should:
| a. |
assess the patient’s level of pain. |
| b. |
decrease the ventilator rate. |
| c. |
provide sedation as ordered. |
| d. |
suction the patient again. |
ANS: A
Pulse, respirations, and blood pressure frequently result from activation of the sympathetic nervous system by the pain stimulus. Because the patient is postoperative, the patient should be assessed for the presence of pain and need for pain medication. Decreasing the ventilator rate will not help in this situation. Providing sedation may calm the patient but will not solve the problem if the physiological changes are from pain. The patient has just been suctioned and the airway is clear. There is no need to suction again.
DIF: Cognitive Level: Analyze/Analysis REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
3.The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse’s first priority is to
| a. |
administer antianxiety medications as ordered. |
| b. |
administer pain medication as ordered. |
| c. |
identify and treat the underlying cause. |
| d. |
reassess the patient hourly to determine whether symptoms resolve on their own. |
ANS: C
When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or withdrawal from alcohol and drugs. Treatment is not initiated until assessment is completed. Medication may not be needed if the underlying cause can be resolved.
DIF: Cognitive Level: Apply/Application REF: p. 70 | Table 5-11
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
4.Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they
| a. |
can be used only on heavily sedated patients. |
| b. |
can be used only on pediatric patients. |
| c. |
provide raw EEG data and a numeric value. |
| d. |
require only five leads. |
ANS: C
The BIS and PSI have very simple steps for application, and results are displayed as raw EEG data and the numeric value. A single electrode is placed across the patient’s forehead and is attached to a monitor. These monitors can be used in both children and adults and in patients with varying levels of sedation.
DIF: Cognitive Level: Understand/Comprehension REF: p. 60
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5.The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that neuromuscular blocking agents provide:
| a. |
antianxiety effects. |
| b. |
complete analgesia. |
| c. |
high levels of sedation. |
| d. |
no sedation or analgesia. |
ANS: D
Neuromuscular blocking (NMB) agents do not possess any sedative or analgesic properties. Patients who receive NMBs must also receive sedatives and pain medication.
DIF: Cognitive Level: Remember/Knowledge REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
6.The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis?
| a. |
Glasgow Coma Scale score of 3 |
| b. |
Train-of-four yields two twitches |
| c. |
Bispectral index of 60 |
| d. |
CAM-ICU positive |
ANS: B
A train-of-four response of two twitches (out of four) using a peripheral nerve stimulator indicates adequate paralysis. The Glasgow Coma Scale does not assess paralysis; it is an indicator of consciousness. The bispectral index provides an assessment of sedation. The CAM-ICU is a tool to assess delirium.
DIF: Cognitive Level: Remember/Knowledge REF: p. 73
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7.The nurse is concerned that the patient will pull out the endotracheal tube. As part of the nursing management, the nurse obtains an order for
| a. |
arm binders or splints. |
| b. |
a higher dosage of lorazepam. |
| c. |
propofol. |
| d. |
soft wrist restraints. |
ANS: D
The priority in caring for agitated patients is safety. The least restrictive methods of keeping the patient safe are appropriate. If possible, the tube or device causing irritation should be removed, but if that is not possible, the nurse must prevent the patient from pulling it out. Restraints are associated with an increased incidence of agitation and delirium. Therefore, restraints should not be used unless as a last resort for combative patients. The least amount of sedation is also recommended; therefore, neither increasing the dosage of lorazepam nor adding propofol is indicated and would be likely to prolong mechanical ventilation.
DIF: Cognitive Level: Apply/Application REF: p. 61
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
8.The primary mode of action for neuromuscular blocking agents used in the management of some ventilated patients is
| a. |
analgesia. |
| b. |
anticonvulsant therapy. |
| c. |
paralysis. |
| d. |
sedation. |
ANS: C
These agents cause respiratory muscle paralysis. They do not provide analgesia or sedation. They do not have anticonvulsant properties.
DIF: Cognitive Level: Remember/Knowledge REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
9.The most important nursing intervention for patients who receive neuromuscular blocking agents is to
| a. |
administer sedatives in conjunction with the neuromuscular blocking agents. |
| b. |
assess neurological status every 30 minutes. |
| c. |
avoid interaction with the patient, because he or she won’t be able to hear. |
| d. |
restrain the patient to avoid self-extubation. |
ANS: A
Neuromuscular blocking agents cause paralysis only; they do not cause sedation. Therefore, concomitant administration of sedatives is essential. Neurological status is monitored according to unit protocol. Nurses should communicate with all critically ill patients, regardless of their status. If the patient is paralyzed, restraining devices may not be needed.
DIF: Cognitive Level: Apply/Application REF: p. 72
OBJ: Discuss assessment and management challenges in subsets of critically ill patients.
TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
10.The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the:
| a. |
Confusion Assessment Method (CAM-ICU). |
| b. |
FACES assessment tool. |
| c. |
Glasgow Coma Scale. |
| d. |
Richmond Agitation Sedation Scale. |
ANS: D
Various sedation scales are available to assist the nurse in monitoring the level of sedation and assessing response to treatment. The Richmond Agitation Sedation Scale is a commonly used tool that has been validated. The CAM-ICU assesses for delirium. The FACES scale assesses pain. The Glasgow Coma Scale assesses neurological status.
DIF: Cognitive Level: Remember/Knowledge REF: p. 59 | Table 5-5
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
11.The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen?
| a. |
Creatinine: 3.1 mg/dL |
| b. |
Platelet count 350,000 billion/L |
| c. |
White blood count 13, 550 mm3 |
| d. |
ALT 25 U/L |
ANS: A
Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level. Thrombocytopenia (low platelet count) is another possible side effect. This platelet count is elevated. An elevated white blood count indicates infection. Although ibuprofen is cleared primarily by the kidneys, it is also important to assess liver function, which would show elevated liver enzymes, not low values such as shown here.
DIF: Cognitive Level: Analyze/Analysis REF: p. 71
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
12.The nurse is assessing pain levels in a critically ill patient using the Behavioral Pain Scale. The nurse recognizes __________ as indicating the greatest level of pain.
| a. |
brow lowering |
| b. |
eyelid closing |
| c. |
grimacing |
| d. |
relaxed facial expression |
ANS: C
The Behavioral Pain Scale issues the most points, indicating the greatest amount of pain, to assessment of facial grimacing.
DIF: Cognitive Level: Understand/Comprehension REF: p. 58 | Table 5-3
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
13.The nurse wishes to assess the quality of a patient’s pain. Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response?
| a. |
“Is the pain constant or intermittent?” |
| b. |
“Is the pain sharp, dull, or crushing?” |
| c. |
“What makes the pain better? Worse?” |
| d. |
“When did the pain start?” |
ANS: B
If the patient can describe the pain, the nurse can assess quality, such as sharp, dull, or crushing. The other responses relate to continuous or intermittent presence, what provides relief, and duration.
DIF: Cognitive Level: Understand/Comprehension REF: p. 56
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
14.The nurse is assessing the patient’s pain using the Critical Care Pain Observation Tool. Which of the following assessments would indicate the greatest likelihood of pain and need for nursing intervention?
| a. |
Absence of vocal sounds |
| b. |
Fighting the ventilator |
| c. |
Moving legs in bed |
| d. |
Relaxed muscles in upper extremities |
ANS: B
Fighting the ventilator is rated with the greatest number of points for compliance with the ventilator, and could indicate pain or anxiety. Absence of vocal sounds (e.g., no crying) and relaxed muscles do not indicate pain and are not given a point value. The patient may be moving the legs as a method of range of motion, not necessarily in response to pain. The patient needs to be assessed for restlessness if the movement is excessive.
DIF: Cognitive Level: Apply/Application REF: p. 59 | Table 5-4
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
15.The nurse is caring for four patients on the progressive care unit. Which patient is at greatest risk for developing delirium?
| a. |
36-year-old recovering from a motor vehicle crash; being treated with an evidence-based alcohol withdrawal protocol. |
| b. |
54-year-old postoperative aortic aneurysm resection with a 40 pack-year history of smoking |
| c. |
86-year-old from nursing home with dementia, postoperative from colon resection, still being mechanically ventilated |
| d. |
95-year-old with community-acquired pneumonia; family has brought in eyeglasses and hearing aid |
ANS: C
From this list, the 86-year-old postoperative nursing home resident is at greatest risk due to advanced age, cognitive impairment, and some degree of respiratory failure. The 96-year-old has been provided eyeglasses and a hearing aid, which will decrease the risk of delirium. Smoking is a possible risk for delirium. The 36-year-old is receiving medications as part of an alcohol withdrawal protocol, which should decrease the risk for delirium.
DIF: Cognitive Level: Analyze/Analysis REF: p. 61 | Table 5-8
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
16.The nurse is caring for a patient with hyperactive delirium. The nurse focuses interventions toward keeping the patient:
| a. |
comfortable. |
| b. |
nourished. |
| c. |
safe. |
| d. |
sedated. |
ANS: C
The greatest priority in managing delirium is to keep the patient safe. Sedation may contribute to the development of delirium. Comfort and nutrition are important, but they are not priorities.
DIF: Cognitive Level: Understand/Comprehension REF: p. 61
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
17.The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period. Which of the following nursing interventions would improve the patient’s well-being and reduce anxiety the most?
| a. |
Arrange for the patient’s dog to be brought into the unit (per protocol). |
| b. |
Provide aromatherapy with scents such as lavender that are known to help anxiety. |
| c. |
Secure the harpist to come and play soothing music for an hour every afternoon. |
| d. |
Wheel the patient out near the unit aquarium to observe the tropical fish. |
ANS: A
Nonpharmacological approaches are helpful in reducing stress and anxiety, and each of these activities has the potential for improving the patient’s well-being. The patient is likely to benefit most from the presence of his or her own dog rather than the other activities, however; if unit protocol does not allow the patient’s own dog, the nurse should investigate the use of therapy animals or the other options.
DIF: Cognitive Level: Apply/Application REF: p. 64
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Psychological Integrity
18.The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)?
| a. |
Patient with a C4 fracture and quadriplegia |
| b. |
Patient with a femur fracture and closed head injury |
| c. |
Postoperative patient who had elective bariatric surgery |
| d. |
Postoperative cardiac surgery patient with mild dementia |
ANS: C
The patient undergoing bariatric surgery (an elective procedure) is the best candidate for PCA as this patient should be awake, cognitively intact, and will have the acute pain related to the surgical procedure. The quadriplegic would be unable to operate the PCA pump. The cardiac surgery patient with mild dementia may not understand how to operate the pump. Likewise, the patient with the closed head injury may not be cognitively intact.
DIF: Cognitive Level: Analyze/Analysis REF: p. 71 | Box 5-6
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
19.The nurse is caring for a patient receiving a benzodiazepine intermittently. The nurse understands that the best way to administer such drugs is to:
| a. |
administer around the clock, rather than as needed, to ensure constant sedation. |
| b. |
administer the medications through the feeding tube to prevent complications. |
| c. |
give the highest allowable dose for the greatest effect. |
| d. |
titrate to a predefined endpoint using a standard sedation scale. |
ANS: D
The best approach for administering benzodiazepines (and all sedatives) is to administer and titrate to a desired endpoint using a standard sedation scale. Administering around the clock as well as giving the highest allowable dose without basing it on an assessment target may result in excessive sedation. For greatest effect, most benzodiazepines are given intravenously.
DIF: Cognitive Level: Apply/Application REF: p. 72
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
20.The nurse is concerned about the risk of alcohol withdrawal syndrome in a postoperative patient. Which statement by the nurse indicates understanding of management of this patient?
| a. |
“Alcohol withdrawal is common; we see it all of the time in the trauma unit.” |
| b. |
“There is no way to assess for alcohol withdrawal.” |
| c. |
“This patient will require less pain medication.” |
| d. |
“We have initiated the alcohol withdrawal protocol.” |
ANS: D
The most important treatment of alcohol withdrawal syndrome is prevention. Many units have protocols that are initiated early to prevent the syndrome. Alcohol withdrawal syndrome is common; however, this statement does not indicate knowledge of management. The patient experiencing alcohol withdrawal may exhibit a variety of symptoms, such as disorientation, agitation, and tachycardia. Patients with substance abuse require increased dosages of pain medications.
DIF: Cognitive Level: Understand/Comprehension REF: p. 74
OBJ: Identify nonpharmacological and pharmacological strategies to promote comfort, reduce anxiety, and prevent delirium. TOP: Nursing Process Step: Intervention
MSC: NCLEX Client Needs Category: Physiological Integrity
MULTIPLE RESPONSE
1.Nonpharmacological approaches to pain and/or anxiety that may best meet the needs of critically ill patients include: (Select all that apply.)
| a. |
anaerobic exercise. |
| b. |
art therapy. |
| c. |
guided imagery. |
| d. |
music therapy. |
| e. |
animal therapy. |
ANS: C, D, E
Guided imagery is a powerful technique for controlling pain and anxiety, especially that associated with painful procedures. Similar to guided imagery, a music therapy program offers patients a diversionary technique for pain and anxiety relief. Likewise animal therapy has many benefits for the critically ill patient. Anaerobic exercise is not a nonpharmacological approach for managing pain and anxiety. Most critically ill patients are not able to participate in art therapy.
DIF: Cognitive Level: Remember/Knowledge REF: pp. 62-64
OBJ:Identify nonpharmacological and pharmacological strategies to promote comfort and reduce anxiety.TOP:Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
2.Which of the following statements regarding pain and anxiety are true? (Select all that apply.)
| a. |
Anxiety is a state marked by apprehension, agitation, autonomic arousal, and/or fearful withdrawal. |
| b. |
Critically ill patients often experience anxiety, but they rarely experience pain. |
| c. |
Pain and anxiety are often interrelated and may be difficult to differentiate because their physiological and behavioral manifestations are similar. |
| d. |
Pain is defined by each patient; it is whatever the person experiencing the pain says it is. |
| e. |
While anxiety is unpleasant, it does not contribute to mortality or morbidity of the critically ill patient. |
ANS: A, C, D
Pain is defined by each patient, anxiety is associated with marked apprehension, and pain and anxiety are often interrelated. Critically ill patients commonly have both pain and anxiety. Anxiety does increase both morbidity and mortality in critically ill patients, especially those with cardiovascular disease.
DIF: Cognitive Level: Understand/Comprehension REF: p. 53
OBJ: Define pain and anxiety. TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
3.Which of the following factors predispose the critically ill patient to pain and anxiety? (Select all that apply.)
| a. |
Inability to communicate |
| b. |
Invasive procedures |
| c. |
Monitoring devices |
| d. |
Nursing care |
| e. |
Preexisting conditions |
ANS: A, B, C, D, E
All of these factors predispose the patient to pain or anxiety.
DIF: Cognitive Level: Remember/Knowledge REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
4.Choose the items that are common to both pain and anxiety. (Select all that apply.)
| a. |
Cyclical exacerbation of one another |
| b. |
Require good nursing assessment for proper treatment |
| c. |
Response only to real phenomena |
| d. |
Subjective in nature |
| e. |
Perception may be influenced by prior experience |
ANS: A, B, D, E
Both pain and anxiety are subjective in nature. One can exacerbate the other in a vicious cycle that often requires good nursing assessment to manage the precipitating problem and break the cycle. Anxiety is a response to a real or perceived fear. Pain is a response to real or “phantom” phenomenon but always involves transmission of nerve impulses. Both relate to the patient’s perceptions of pain and fear. Previous experiences of both pain and/or anxiety can influence the patient’s perception of both. Anxiety is a response to real or perceived fear, and pain is a response to a real or “phantom” phenomenon.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5.Anxiety differs from pain in that: (Select all that apply.)
| a. |
it is confined to neurological processes in the brain. |
| b. |
it is linked to reward and punishment centers in the limbic system. |
| c. |
it is subjective. |
| d. |
there is no actual tissue injury. |
| e. |
it can be increased by noise and light. |
ANS: A, B, D, E
Unlike pain, anxiety is linked to the reward and punishment centers in the limbic system of the brain. It is totally neurological and does not involve tissue injury. Like pain, it is a subjective phenomenon. Noise, light, and other stimuli can increase the intensity of anxiety. Both anxiety and pain are subjective in nature.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-55
OBJ:Discuss the physiology of pain and anxiety.
TOP: Nursing Process Step: Assessment
6.Factors in the critical care unit that may predispose the client to increased pain and anxiety include: (Select all that apply.)
| a. |
an endotracheal tube. |
| b. |
frequent vital signs. |
| c. |
monitor alarms. |
| d. |
room temperature. |
| e. |
hostile environment. |
ANS: A, B, C, D, E
Anxiety is likely to result from loss of control, the inability to communicate, continuous noise and lighting, excessive stimulation (including repeated vital sign measurements), lack of mobility, and uncomfortable room temperatures. Increased anxiety levels often lead to increased pain perception. Environments that are perceived as hostile also contribute.
DIF: Cognitive Level: Understand/Comprehension REF: pp. 53-54
OBJ: Identify factors that place the critically ill patient at risk for developing pain and anxiety.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7.In the healthy individual, pain and anxiety: (Select all that apply.)
| a. |
activate the sympathetic nervous system (SNS). |
| b. |
decrease stress levels. |
| c. |
help remove one from harm. |
| d. |
increase performance levels. |
| e. |
limit sympathetic nervous system activity. |
ANS: A, C, D
In the healthy person, pain and anxiety are adaptive mechanisms used to increase performance levels or to remove one from potential harm. The “fight or flight” response occurs in response to pain and/or anxiety and involves the activation of the sympathetic nervous system. Pain and anxiety, however, can induce significant stress. The SNS is activated, not limited, by pain and/or anxiety.
DIF: Cognitive Level: Remember/Knowledge REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
TOP:Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
8.The nurse is caring for a patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is responsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nurse to use when assessing the patient’s pain level? (Select all that apply.)
| a. |
The FACES scale |
| b. |
Pain Intensity Scale |
| c. |
The PQRST method |
| d. |
The Visual Analogue Scale |
| e. |
The CAM tool |
ANS: A, D |
CHAPTER 1: Delivering Value: The Global Challenge in Health Care Management
MULTIPLE CHOICE
- What is one issue that health care organizations must address in order to create and deliver value?
| a. |
To create appropriate barriers to health care for equity |
| b. |
To improve access to health care |
| c. |
To increase cost acceleration |
| d. |
To decrease the overall quality of care |
ANS: B
| |
Feedback |
| A |
Incorrect: Improving access to health care must be addressed to create and deliver value. |
| B |
Correct: Improving access to health care must be addressed to create and deliver value. |
| C |
Incorrect: Improving access to health care must be addressed to create and deliver value. |
| D |
Incorrect: Improving access to health care must be addressed to create and deliver value. |
PTS: 1
- Health care concerns shared by the United States, China, and India include concerns over ____.
| a. |
the consolidated financial mechanism |
| b. |
lack of spending at the local level |
| c. |
the low number of specialists |
| d. |
lifestyle issues and behaviors |
ANS: D
| |
Feedback |
| A |
Incorrect: Health care concerns shared by the United States, China, and India include concerns over lifestyle issues and behaviors. |
| B |
Incorrect: Health care concerns shared by the United States, China, and India include concerns over lifestyle issues and behaviors. |
| C |
Incorrect: Health care concerns shared by the United States, China, and India include concerns over lifestyle issues and behaviors. |
| D |
Correct: Health care concerns shared by the United States, China, and India include concerns over lifestyle issues and behaviors. |
PTS: 1
- The Premier Hospital Quality Incentive Demonstration (PHQID) was launched to determine if economic incentives are effective at improving ____.
| a. |
the cost of inpatient care |
c. |
the cost of outpatient care |
| b. |
the quality of inpatient care |
d. |
the quality of outpatient care |
ANS: B
| |
Feedback |
| A |
Incorrect: The Premier Hospital Quality Incentive Demonstration (PHQID) was launched to determine if economic incentives are effective at improving the quality of inpatient care. |
| B |
Correct: The Premier Hospital Quality Incentive Demonstration (PHQID) was launched to determine if economic incentives are effective at improving the quality of inpatient care. |
| C |
Incorrect: The Premier Hospital Quality Incentive Demonstration (PHQID) was launched to determine if economic incentives are effective at improving the quality of inpatient care. |
| D |
Incorrect: The Premier Hospital Quality Incentive Demonstration (PHQID) was launched to determine if economic incentives are effective at improving the quality of inpatient care. |
PTS: 1
- Investor-owned facilities comprise about ____ percent of the hospital sector.
| a. |
15–20 |
c. |
55–60 |
| b. |
30–35 |
d. |
75–80 |
ANS: A
| |
Feedback |
| A |
Correct: Investor-owned facilities comprise about 15–20 percent of the hospital sector. |
| B |
Incorrect: Investor-owned facilities comprise about 15–20 percent of the hospital sector. |
| C |
Incorrect: Investor-owned facilities comprise about 15–20 percent of the hospital sector. |
| D |
Incorrect: Investor-owned facilities comprise about 15–20 percent of the hospital sector. |
PTS: 1
- Organizations within the health care industry have increasingly consolidated into ____ over the past two decades with the stated objective of being more efficient, but may not operate as such.
| a. |
community care centers |
c. |
systems |
| b. |
corporations |
d. |
foundations |
ANS: C
| |
Feedback |
| A |
Incorrect: Organizations within the health care industry have increasingly consolidated into systems over the past two decades with the stated objective of being more efficient, but may not operate as such. |
| B |
Incorrect: Organizations within the health care industry have increasingly consolidated into systems over the past two decades with the stated objective of being more efficient, but may not operate as such. |
| C |
Correct: Organizations within the health care industry have increasingly consolidated into systems over the past two decades with the stated objective of being more efficient, but may not operate as such. |
| D |
Incorrect: Organizations within the health care industry have increasingly consolidated into systems over the past two decades with the stated objective of being more efficient, but may not operate as such. |
PTS: 1
- The Human Relations School ascertains that in order to improve productivity, management must ____.
| a. |
implement the top-down control of work |
| b. |
minimize the input of workers |
| c. |
offer monetary incentives |
| d. |
understand the informal organization of workers |
ANS: D | 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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