Chapter 23: Clients with Psychosocial and Mental Health Concerns Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 23: Clients with Psychosocial and Mental Health Concerns

MULTIPLE CHOICE

1. The nurse explains that although uncomfortable, mild anxiety under normal circumstances usually

a.

interferes with problem solving.

b.

is short-lived.

c.

is repressed and forgotten.

d.

spirals into panic.

ANS: B

Under normal circumstances, mild anxiety is short-lived and stimulates problem solving, so repression and panic need not occur.

DIF: Comprehension/Understanding REF: p. 421 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

2. The client begins to cry as she speaks of her several miscarriages during the last 2 years. The nurse assesses the crying as a(n)

a.

emotion-focused coping mechanism.

b.

inappropriate coping mechanism.

c.

lack of coping mechanism.

d.

problem-focused coping mechanism.

ANS: A

Emotion-focused coping mechanisms include crying and sharing feelings.

DIF: Application/Applying REF: p. 421 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

3. The newly diagnosed diabetic client asks the nurse many questions about management of diet and insulin protocols. The nurse assesses that the client is using

a.

cause-and-effect coping mechanisms.

b.

defense mechanisms.

c.

delaying mechanisms.

d.

problem-focused coping mechanisms.

ANS: D

Clients using problem-focused coping mechanisms seek information about the problem or make a plan to overcome the problem.

DIF: Application/Applying REF: p. 421 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

4. The client repeatedly asks the nurse about the medical protocol for his pancreatitis. Because of the focus on this one concern, the nurse assesses

a.

mild anxiety.

b.

moderate anxiety.

c.

no anxiety at all.

d.

severe anxiety.

ANS: B

Focusing on only one concern is a manifestation of moderate anxiety. In mild anxiety a person is alert and able to learn or to solve problems. In severe anxiety, a person has decreased sensory perception, can focus only on details, and is unable to learn new information.

DIF: Application/Applying REF: p. 421 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

5. The nurse attempting to develop a plan of care that addresses a clients spirituality should incorporate measures to address

a.

broad concepts related to values, meaning, and purpose.

b.

only those individual aspects of the self that the client has shared with the nurse.

c.

the clients religion and the specific degree of participation in the church.

d.

the personal relationship between God and the client.

ANS: A

Spirituality is a broad concept encompassing values and beliefs about meaning and purpose in life and may or may not include a specific religion.

DIF: Application REF: p. 420 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Religious and Spiritual Influences on Health

6. A clients scheduled discharge home has been postponed because his mother was unable to come until tomorrow. After hearing the news, the client says his doctor is a fool and the care in the facility is very poor. The nurse assesses the clients behavior as

a.

displacement.

b.

intellectualization.

c.

rationalization.

d.

regression.

ANS: A

Displacement is the transfer of feelings from a threatening topic or person to another, more neutral topic or person.

DIF: Application/Applying REF: p. 422 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

7. The nonverbal behavior of the nurse that is likely to increase anxiety in a client is

a.

speaking slowly in a clear, firm voice.

b.

maintaining a brisk, business-like approach.

c.

listening with full attention.

d.

decreasing noise levels and bright light.

ANS: B

Nonverbal interventions to decrease anxiety include (a) listening with full attention; (b) looking at the client with unbroken eye contact; (c) maintaining a calm, unhurried approach; (d) speaking slowly in a clear, firm voice (not loud); (e) offering or using touch; and (f) decreasing noise and bright light, if possible.

DIF: Knowledge/Remembering REF: p. 422 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Therapeutic Environment

8. A nurse on the general medical floor of a hospital has assessed a client as having severe manifestations of a psychiatric disorder. The most beneficial action by the nurse would be to

a.

arrange a consultation with a mental health specialist.

b.

document the findings and leave a note for the physician.

c.

encourage the client to continue taking prescribed medications.

d.

not discuss the problem in order to avoid upsetting the client.

ANS: A

An important concept to remember when caring for clients with mental health problems, especially those who are seeking care for other reasons, is that if manifestations are severe or risk factors are significant, additional evaluation by a specialist is needed. Documenting the findings is appropriate, but the physician should be notified in a timely manner. Always encourage clients to take prescribed medications. Ignoring the problem to avoid upsetting the client is not beneficial. The best response by the nurse, who is acting as an advocate for the client, is to ensure appropriate referrals get made.

DIF: Application/Applying REF: p. 424 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Referrals

9. A client has continued to seek medical attention over the last 8 months regarding his health status, despite physical examination findings being consistently negative. The nurse concludes that this clients behavior is consistent with

a.

compulsive disorder.

b.

generalized anxiety disorder.

c.

panic disorder.

d.

post-traumatic stress disorder.

ANS: B

The client with generalized anxiety disorder (GAD) has excessive anxiety for 6 months or more that is uncontrollable and often focused on health or financial concerns.

DIF: Application REF: p. 424 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

10. A nurse questions a client with panic disorder about whether a parent or sibling also has a panic disorder. This nurse is using a

a.

behavioral approach.

b.

biologic approach.

c.

psychoanalytic approach.

d.

psychodynamic approach.

ANS: B

From the biologic viewpoint, some evidence supports a genetic influence for GAD, panic disorder, and phobias. First-degree relatives (parents, siblings, children) of clients with these disorders have an increased risk of the same manifestations compared with normal control subjects. Psychoanalytic theory proposes that anxiety results from inability to control painful impulses, thoughts, or memories. Behavioral theory explains abnormal behavior as a learned response to specific reinforcement in the environment. Both are included in the psychological etiology of mental disorders.

DIF: Application/Applying REF: p. 424 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

11. A client has been taking thioridazine (Mellaril) for acute schizophrenia for a month when she comes to the hospital with a broken leg. The nurse notices that the client is slurring her words, keeps wiping her mouth with tissues to control the drooling, and has trouble holding a glass of water. The nurse documents the clients assessment and notifies the physician that the nurse suspects

a.

alcohol abuse.

b.

drug abuse.

c.

extrapyramidal symptoms.

d.

tardive dyskinesia.

ANS: C

Antipsychotic medications affect dopamine receptors, and muscular side effects known as extrapyramidal symptoms (EPS) are common. Manifestations are tremor in the arms and legs, drooling, and spasms of the tongue, neck, or face.

DIF: Application/Applying REF: p. 426 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

12. A mental health nurse assessing a client with schizophrenia finds that the client exhibits positive manifestations of the disorder after noting

a.

avoidance of social contact.

b.

blunted affect.

c.

delusions.

d.

lack of attention to hygiene.

ANS: C

Positive manifestations of schizophrenia include the most obvious manifestation of psychosis: auditory or visual hallucinations, delusions, and disorganized thinking and speech. Avoiding social contact would be a negative manifestation. Blunted affect and lack of personal hygiene are probably related to depression, although flat affect may be seen in schizophrenia also. However, the major manifestations are related to thinking and communication skills.

DIF: Application/Applying REF: p. 426 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

13. A client admitted for an asthma attack is also receiving psychiatric treatment for chronic schizophrenia. During the interview the client stops responding and says, Why are you asking me all these questions? Why do you want to know? Are you recording this for the others? The nurses best response is

a.

I am asking these questions as part of your hospital admission for asthma.

b.

We cannot admit you without getting this information into our computers.

c.

We will stop for now, but Im going to report your behavior to your doctor.

d.

Why are you asking me questions? This is part of the admission procedure.

ANS: A

No attempt should be made to challenge the reality of the clients remarks. Responses should be respectfully recorded and the nurse should respond calmly.

DIF: Application/Applying REF: p. 427 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Therapeutic Interactions

14. A client being admitted for surgery has a concurrent history of bipolar disorder. The nurse would assess this client for manifestations of mania that include

a.

crying spells.

b.

decreased energy level.

c.

excessive, rapid speech.

d.

sad mood.

ANS: C

Manifestations of mania include elated mood that is not attributable to a real event, denial of having an emotional problem, impulsive acts that may be dangerous or socially inappropriate, increased energy level, increased socialization to the point of intrusiveness, excessive rapid speech, increased or decreased appetite, decreased need for sleep, and increased libido.

DIF: Application/Applying REF: p. 427 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

15. A client with depression says to the nurse, I have been on this antidepressant for 5 days and I still feel awful. The nurse can be most supportive by responding

a.

Depression is a horrible feeling. I am sure that you will be getting results from your medication in a few days.

b.

Depressive feelings make you feel hopeless. I will call your doctor and see if I can get an order for something to make you feel better.

c.

Its tough to wait for relief. Many drugs take several weeks to manage symptoms.

d.

You mustnt feel so down. Everyone reacts to medications in a slightly different way.

ANS: C

Antidepressants do not produce effects immediately; depressed clients often must wait 3 to 6 weeks before recognizing any relief from the antidepressant.

DIF: Application/Applying REF: p. 428 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

16. A home health nurse is visiting a client living with his parents who has severe depression and is considered at risk of suicide. When the client refuses to sign a no harm contract, the most appropriate action by the nurse is to

a.

call 911, explaining that there is a psychiatric emergency.

b.

instruct family members to keep a close watch on the client.

c.

schedule another visit for the following day.

d.

telephone the physician for a referral to a psychiatric nurse.

ANS: D

After instructing the family that a psychiatric emergency exists, the nurse should call 911 and report a psychiatric concern. TJC requires that its organizations identify safety risks for its client population and this requirement includes identifying clients at risk for suicide. Safety of the client is paramount.

DIF: Application/Applying REF: p. 429 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

MULTIPLE RESPONSE

1. The nurse caring for a client with schizophrenia would assess for manifestations of this disorder, including (Select all that apply)

a.

disorganized speech and behavior.

b.

excessive and rapid speech.

c.

flat or inappropriate affect.

d.

sad moods and crying spells.

ANS: A, C

Disorganized speech and behavior and flat or inappropriate affect are two manifestations of schizophrenia. Excess, rapid speech reveals the mania of bipolar disorder, while sad moods and crying spells signal depression or the depressive phase of bipolar disorder.

Cognitive Level: Application/Applying

DIF: Application/Applying REF: p. 427 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

2. A nurse observes that an older client is laughing forcefully when describing the strain of caring for the spouse, who has Alzheimers disease. The client states that neither one of them goes to church or participates in any social events any longer. Other than caring for the person with Alzheimers disease, the spouse spends much free time sleeping. The nurse would need to assess this client more for (Select all that apply)

a.

changes in appetite.

b.

decreased ability to concentrate.

c.

excessive spending sprees.

d.

feeling guilt or hopelessness.

e.

suicidal thoughts.

ANS: A, B, D, E

All the correct options point to depression, which the nurse suspected when the client related a decrease in usual activities and socialization, and increased sleeping. Excessive spending sprees might be seen in someone with bipolar disorder during the manic phase.

DIF: Application/Applying REF: p. 427 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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