Chapter 56: Psychiatric Disorders Nursing School Test Banks

Chapter 56: Psychiatric Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A patient is given anxiolytic medications for a mental disorder. What type of approach is this considered?
a. Analytical
b. Interpersonal
c. Biologic
d. Psychoanalytic
ANS: C
The biologic approach attempts to manage the physiologic effects of mental illness using medications.

DIF: Cognitive Level: Comprehension REF: p. 1283 OBJ: 2
TOP: Psychiatric Disorders KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

2. A patient states that he feels angry at work for no reason and often yells at his coworkers. The therapist asks the patient to describe events and then tells the patient to try different strategies to cope with these angry outbursts. What type of approach is this considered?
a. Biologic
b. Analytical
c. Cognitive or behavioral
d. Interpersonal
ANS: D
The interpersonal approach helps the patient develop new coping skills.

DIF: Cognitive Level: Comprehension REF: p. 1284 OBJ: 2
TOP: Psychiatric Disorders KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. What is the best action for the nurse to implement to effectively listen therapeutically to a patient?
a. Concentrate on the patient and not think of responses to the patient while he or she is speaking.
b. Determine the cause of the patients problem while the patient is speaking.
c. Ask the patient why he thinks he feels the way he does.
d. Tell the patient that you have had similar experiences.
ANS: A
To listen therapeutically, the nurse needs to concentrate on the patient and refrain from making up responses to the patient while he is speaking.

DIF: Cognitive Level: Application REF: p. 1284 OBJ: 1
TOP: Establishing Therapeutic Relationships
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. A nurse speaking to a patient who is depressed says, So what you are saying is that you are feeling very sad today. What is this considered?
a. Listening
b. Sharing observations
c. Clarifying
d. Being available
ANS: C
By reflecting the meaning of the patients statement, the nurse is using clarification. This technique validates that the therapist understands what the patient is saying, and it provides validation for the patient.

DIF: Cognitive Level: Comprehension REF: p. 1284 OBJ: 2
TOP: Establishing Therapeutic Relationships
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

5. When performing a mental status examination, a nurse notes that the patient keeps repeating, I didnt do it. I didnt do it. I didnt do it. This response would be an example of which one of the components of the mental status examination?
a. Appearance
b. Mood and affect
c. Thought content
d. Memory and attention
ANS: C
Repetitive statements and thoughts are considered to be obsessive. This would be an element of the thought content component of the mental status examination.

DIF: Cognitive Level: Comprehension REF: p. 1285 OBJ: 3
TOP: Mental Status Examination KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

6. A patient says, I just dont think I can keep going on. I just want it all to end. The nurse assesses that this patient has suicidal ideation. What is the nurses best response?
a. Do you have any thoughts of harming yourself?
b. Have you felt like this before?
c. You are just depressed. When you feel better, you wont think that way.
d. We will keep you safe here.
ANS: A
The best response to a patient who may have suicidal ideation is to ask a simple direct question to determine the patients true intent. Having done that, this should be reported at once. All suicidal threats, even mild ones, should be reported and taken seriously.

DIF: Cognitive Level: Application REF: p. 1286 OBJ: 3
TOP: Mental Status Examination KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. What should a nurse suspect a patient diagnosis might be when the patient states, I often feel restless, have a tight sensation in my chest, and have an increased heart rate at times?
a. Anxiety disorder
b. Panic disorder
c. Agoraphobia
d. Obsessive-compulsive disorder
ANS: A
The patient is reporting symptoms that reflect signs of an anxiety disorder.

DIF: Cognitive Level: Comprehension REF: p. 1287 OBJ: 6
TOP: Anxiety Disorders KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

8. A group of nursing students are taking their first major examination. What should the nursing instructor expect the students might experience?
a. Posttraumatic stress disorder
b. Panic disorder
c. Mild anxiety
d. Moderate anxiety
ANS: C
The students are usually experiencing mild anxiety, which can be beneficial as a motivator.

DIF: Cognitive Level: Comprehension REF: p. 1287 OBJ: 6
TOP: Anxiety Disorders KEY: Nursing Process Step: N/A
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

9. A patient is admitted with posttraumatic stress disorder (PTSD) says he had a very stressful experience when in high school and has never really recovered. What is the most appropriate nursing action?
a. Encourage the patient to talk about what caused the traumatic event.
b. Guide the patient in relaxation techniques to distract him when flashbacks occur.
c. Provide sleeping medication so that he can sleep at night.
d. Allow the patient to talk about his condition as often as he likes.
ANS: B
Patients with PTSD should not be encouraged to talk about the traumatic event. The patient should learn relaxation techniques to distract themselves when anxiety symptoms begin. Sedation does not address the problem of anxiety.

DIF: Cognitive Level: Application REF: p. 1289 OBJ: 6
TOP: Posttraumatic Stress Disorder KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

10. A patient admitted with a conversion disorder after an automobile accident insists he is paralyzed, although no physical cause for his paraplegia can be found. What is the best nursing response when the patient asks the nurse to push him to his room?
a. There is nothing wrong with your arms. Roll yourself to your room.
b. I will help you to walk to your room. I know you can walk.
c. Let me lift the foot rests so you can move your chair with your feet.
d. OK. I am going that way myself.
ANS: D
The patient is experiencing dysfunction without a discernible cause, but this dysfunction is very real to him. The less attention brought to his coping mechanism, the better.

DIF: Cognitive Level: Application REF: p. 1289 | p. 1291
OBJ: 6 TOP: Somatoform Disorders
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

11. Which combination of medications could be used to treat an anxiety disorder?
a. Librium and Xanax
b. Effexor and Ativan
c. Effexor and Haldol
d. Klonopin and Valium
ANS: B
A combination of an antidepressant and anxiolytic medication is recommended as the appropriate drug therapy for the patient with an anxiety disorder. Xanax, Librium, Ativan, Valium, and Klonopin are all anxiolytic medications. Haldol is a neuroleptic medication, and Effexor is an antidepressant.

DIF: Cognitive Level: Knowledge REF: p. 1290 OBJ: 4
TOP: Drug-Related Responses KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. Which nursing diagnosis is appropriate for all patients with an anxiety, a somatoform, or a dissociative disorder?
a. Altered nutrition, less than body requirements
b. Disturbed body image
c. Ineffective denial
d. Ineffective coping
ANS: D
Ineffective coping is appropriate for all three disorders. Ineffective coping is the underlying psychopathologic process of these anxiety disorders.

DIF: Cognitive Level: Comprehension REF: p. 1291 OBJ: 7
TOP: Nursing Care of the Patient with an Anxiety Disorder
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

13. A patient who went away to college in September returns in October, thinking that he is a drummer in a popular rock band. What is this most likely a manifestation of?
a. Dissociative disorder
b. Conversion disorder
c. Schizophrenia
d. Amnesia
ANS: C
Schizophrenia occurs in adolescence or early adulthood. The patient experiences delusions that are characteristic of schizophrenia in a classic stress situation, which may have been the precipitating event that caused the thought disorder.

DIF: Cognitive Level: Comprehension REF: p. 1291 OBJ: 6
TOP: Schizophrenia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity

14. A patient is receiving large doses of chlorpromazine (Thorazine) and begins to exhibit extrapyramidal signs of involuntary muscle movement. Which classification of drugs should the nurse anticipate will be added to the patients protocol?
a. Antiparkinsonian
b. Antihypertensive
c. Anticonvulsant
d. Antiemetic
ANS: A
Antiparkinsonian drugs will control the muscle movement and drooling that are the major signs of neuroleptic toxicity.

DIF: Cognitive Level: Comprehension REF: p. 1292 OBJ: 7
TOP: Neuroleptic Medications KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. A long-time patient with schizophrenia in the inpatient unit has developed involuntary movements of his tongue. What has this patient developed?
a. Acute dystonic reaction
b. Tardive dyskinesia
c. Neuroleptic malignant syndrome
d. Laryngospasm
ANS: B
Tardive dyskinesia is a side effect of continued use of neuroleptic medications to control schizophrenia.

DIF: Cognitive Level: Knowledge REF: p. 1292 OBJ: 4
TOP: Schizophrenia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. Which is not considered as a probable cause of mood disorders?
a. Loss of significant others
b. Learned helplessness
c. Neurotransmitter dysregulation
d. Traumatic event in childhood
ANS: D
A traumatic event in childhood could, most likely, cause PTSD. All other options are causes of mood disorders.

DIF: Cognitive Level: Knowledge REF: p. 1295 OBJ: 5
TOP: Mood Disorders KEY: Nursing Process Step: N/A
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

17. A patient with bipolar disorder is being treated with tricyclic medications. What should the nurse inform the patient to expect when teaching information concerning side effects?
a. Orthostatic hypotension
b. Hypercholesterolemia
c. Fatigue
d. Blurred vision
ANS: A
Orthostatic hypotension and urinary retention are side effects of tricyclic antidepressants. These drugs are commonly used to treat the depressant effects of bipolar disorders.

DIF: Cognitive Level: Comprehension REF: p. 1295 OBJ: 7
TOP: Drug Treatment KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

18. A patient with schizophrenia has undergone eight electroconvulsive therapy treatments (ECTs) in the past 2 weeks. The daughter is upset that her parent is lethargic, confused, and does not recognize her. What knowledge should the nurse consider when preparing to respond?
a. The combination of ECTs and neuroleptic medications can make a patient drowsy.
b. These reactions indicate a drug overdose.
c. Many patients with schizophrenia punish their families by pretending not to know them.
d. A temporary memory loss is common after several ECTs.
ANS: D
When a patient has had several ECTs, an expected brief period of confusion and temporary memory loss may result. This effect dissipates in a short period.

DIF: Cognitive Level: Comprehension REF: p. 1298 OBJ: 6
TOP: Electroconvulsive Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. A patient is hyperactive with mania and has a nursing diagnosis of Nutrition, altered, less than body requirements, related to hyperactivity, What implementation is most appropriate when considering this diagnosis?
a. Offer nutritious finger foods and high-protein milk shakes to eat on the go.
b. Spoon-feed the patient while the patient is seated at the table.
c. Arrange for one large meal at noon to be eaten in the company of others.
d. Limit fluid intake to make the patient hungry at mealtime.
ANS: A
Patients with mania are on the go. Nutritious foods that can be eaten while the patient is moving around will meet their dietary needs. The patients short attention span prevents him or her from sitting long enough to eat or to be fed by spoon. Limiting fluids is contraindicated for the patient who is hyperactive.

DIF: Cognitive Level: Application REF: p. 1300 OBJ: 6
TOP: Manic Behavior KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. A patient is brought in from the emergency department after telling the physician that he is a relative of the president of the United States. He says that he should not be detained because he has important business to attend to that involves national security. He is dressed in a bright coat with plaid pants and gets very angry when you try to question him. What is this patient is experiencing?
a. Panic attack
b. Hyperactive episode
c. Extrapyramidal effect
d. Manic episode
ANS: D
Inappropriate dress, self-aggrandizement, hyperactivity, and frustration are elements of a manic episode.

DIF: Cognitive Level: Comprehension REF: p. 1288 OBJ: 6
TOP: Nursing Care of the Patient with Bipolar Disorder with Manic Episodes
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

21. While in the dayroom, one of the patients becomes very agitated and begins to threaten to harm the other patients and is directing violence at the other patients and staff. What is the most appropriate nursing implementation?
a. Decrease the stimuli and use restraints if all other measures fail.
b. Offer to call the physician and ask another staff member to call security.
c. Remove harmful objects and try to perform relaxation exercises with the patient.
d. Restrain the patient and do not allow him or her to eat or drink anything by mouth.
ANS: A
Because the patient is threatening to harm others, decreasing stimuli will be helpful to decrease the behavior and, if everything else fails, restraints will be needed. Restraints should be applied according to current policy. Patients who are being restrained need to have frequent checks and their nutritional and elimination needs monitored.

DIF: Cognitive Level: Application REF: p. 1300 OBJ: 7
TOP: Nursing Implementations for Manic Episodes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

22. Since the summer weather began, a patient taking lithium for manic episodes has been walking daily. What important instruction should the nurse provide to this patient?
a. Stay in the shade when walking.
b. Stop walking.
c. Maintain hydration.
d. Wear sunscreen.
ANS: C
Lithium toxicity can occur if the patient becomes dehydrated. The therapeutic range of lithium is narrow; consequently, toxicity to this drug is common.

DIF: Cognitive Level: Application REF: p. 1297 OBJ: 7
TOP: Medications for Manic Episodes KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

23. A patient who has a history of episodes of road rage thinks that she is a very good driver and does not understand why she keeps being told she is a poor driver. She is losing her license now, and she tells the nurse that she is feeling very unhappy and abandoned. She feels like she might hurt herself. The nurse realizes that the patient is exhibiting which personality disorder?
a. Narcissistic
b. Paranoid
c. Schizoid
d. Borderline
ANS: D
Difficulty controlling anger and an unstable sense of self are elements of a borderline personality disorder.

DIF: Cognitive Level: Comprehension REF: p. 1301 OBJ: 6
TOP: Personality Disorders KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity

24. A coworker is noted to be very organized. However, you see that he is always making lists and citing the rules of the organization. He wants all his projects to be perfect and gets very upset when things happen that make him miss his deadlines. The coworker is exhibiting signs of which personality disorder?
a. Avoidant
b. Obsessive-compulsive
c. Histrionic
d. Dependent
ANS: B
Patients who have a preoccupation with perfectionism, orderliness, and control have an obsessive-compulsive personality disorder. These patients may be anxious and attempt to maintain the perfectionism. The patient data in this question demonstrate the elements of obsessive-compulsive disorder.

DIF: Cognitive Level: Comprehension REF: p. 1286 | p. 1301
OBJ: 5 TOP: Personality Disorders
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

25. What is a common cause of delirium?
a. Overuse of steroids
b. Liver abnormalities
c. Parkinson disease
d. Neoplasms
ANS: D
Neoplasms and Alzheimer disease are two causes of delirium. All of the other options are causes of dementia.

DIF: Cognitive Level: Knowledge REF: p. 1300 OBJ: 6
TOP: Cognitive Disorders KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

26. A nurse is assessing a patient with an acute stress disorder. What characteristics of this disorder should the nurse assess? (Select all that apply.)
a. Diminished awareness of surroundings
b. Derealization
c. Depersonalization
d. Amnesia
e. Irritability
ANS: A, B, C, D
Individuals who have been overcome by an acute stress disorder exhibit diminished orientation, reality testing, and personal awareness, and they frequently experience amnesia. Irritability is not part of the syndrome.

DIF: Cognitive Level: Comprehension REF: p. 1289 OBJ: 4
TOP: Acute Stress Disorder KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

27. A nursing instructor is explaining the difference between illusion and hallucination. Which examples provided by students in the class indicate an illusion? (Select all that apply.)
a. A car backfiring being perceived as gunfire
b. The television news being perceived as someone talking to you
c. Hearing Gods voice directing you to drive your car off the road
d. Seeing your dead spouse smile at you from a flower
e. A spot on the wall being perceived as a spider
ANS: A, B, E
An illusion has an external stimulus that causes an erroneous translation. Anyone, even a person with intact sensorium, can have an illusion. An example of an illusion is seeing water on the highway, which is really only heat waves. A hallucination has no external stimulus. An example of a hallucination is a person with alcoholism seeing spiders crawling on the ceiling.

DIF: Cognitive Level: Comprehension REF: p. 1286 OBJ: 6
TOP: Hallucinations versus Illusions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

COMPLETION

28. When a patient asks a nurse to touch him, the nurse asks why he needs this. The patient replies, I just need to know that I am real. The nurse assesses that response as a primary sign of _____.

ANS:
derealization
Derealization causes patients to feel that they have lost touch with themselves and feel that they are not real. Physical touch helps them reorient.

DIF: Cognitive Level: Comprehension REF: p. 1289 OBJ: 4
TOP: Derealization KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

29. When a nurse asks questions like, What day is today? or What time is it now? the nurse is testing the patients _____.

ANS:
sensorium orientation
The sensorium is also referred to as orientation. The sensorium orients the person to person, place, and time.

DIF: Cognitive Level: Comprehension REF: p. 1287 OBJ: 6
TOP: Sensorium KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity

Leave a Reply