Complete Test Bank With Answers
Sample Questions Posted Below
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Chapter 01: Me, Meds, Milieu
MULTIPLE CHOICE
- b.
The nurse primarily serves in a supportive role to other members of the team.
The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing.
Clearly differentiated nursing actions have been identified that distinguish nursing
from other professions.
Although professional role overlap exists, nursing offers unique contributions to
psychotherapeutic management.
ANS: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
application of psychotherapeutic management. Psychiatric social workers do not have
expertise in physical care. Ideally, all team members support each other.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 3
MSC: NCLEX: Safe, Effective Care Environment
The primary element required to match individual patient needs with appropriate services is
proper:
- b.
- d.
planning.
evaluation.
assessment.
implementation.
ANS: C
Proper assessment is critical for being able to determine the appropriate level of services that
will provide the patient with optimal care at the lowest cost. The decision tree for the
continuum of care establishes this fact.
Cognitive level: Understanding
TOP: Nursing process: Assessment
- 7
MSC: NCLEX: Safe, Effective Care Environment
An adult with paranoid schizophrenia is hospitalized. This patient has frequent auditory
hallucinations and walks about the unit, muttering. To use psychotherapeutic management
effectively, it is most important for the nurse to:
- b.
c.
d.
understand the disease process of schizophrenia.
minimize contact between this patient and other patients.
administer PRN medication before interacting with the patient.
use behavior modification to decrease the frequency of hallucinations.
ANS: A
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An understanding of psychopathology is the foundation on which the three components of
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
basis for understanding psychopharmacology and milieu management. Minimizing contact
between the patient and others and administering PRN medication indiscriminately are
nontherapeutic interventions. Using behavior modification to decrease the frequency of
hallucinations would need to be incorporated into the plan of care.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 1-2
MSC: NCLEX: Safe, Effective Care Environment
A depressed adult is hospitalized after a suicide attempt. The patient receives an
antidepressant medication, is closely supervised, attends a variety of group therapies and
activities, watches television during free time, and talks to visitors in the evening. Which
additional intervention is needed in the patient’s care?
- b.
c.
Milieu therapy
Adequate drug therapy
Increased contact with significant others
Meaningful communication with nursing staff
ANS: D
Two of the three elements of psychotherapeutic management are present:
psychopharmacology and milieu management. There is no evidence that the
psychotherapeutic nurse–patient relationship exists. Maintaining contact with significant
others is not considered an element of the psychotherapeutic management model.
Cognitive level: Applying
MSC: NCLEX: Psychosocial Integrity
REF:
- 1-2
TOP: Nursing process: Planning
A patient attends outpatient programs at a community mental health center and meets with the
primary nurse regularly. Last week, the patient’s haloperidol (Haldol) dose was reduced from
5 mg to 2 mg daily to decrease side effects. The nurse will need to monitor changes in:
- b.
c.
the activity schedule at the center.
the nature of the patient’s symptoms.
attention given to the patient by other staff.
balance among psychotherapeutic management elements.
ANS: B
It will be necessary for the nurse to assess for exacerbation of the patient’s symptoms of
psychosis as well as for an amelioration of side effects. Dosage decrease might lead to the
return or worsening of positive symptoms such as hallucinations and delusions, and negative
symptoms such as blunted affect, social withdrawal, and poor grooming.
Cognitive level: Applying
TOP: Nursing process: Assessment
- 2
MSC: NCLEX: Physiologic Integrity
Which guideline should a nurse use when applying the components of psychotherapeutic
management to the care of a patient with mental illness?
- b.
- d.
The nurse’s role in milieu management is secondary to that of social work.
Omitting any one component usually will result in less effective treatment.
The most important element of psychotherapeutic management is drug therapy.
A therapeutic nurse–patient relationship is the most important aspect of treatment.
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ANS: B
The three components listed as choices a, c, and d above work together to provide the best
treatment outcomes. When one element is missing, treatment is usually compromised. No
single element is more important than the others; however, patients’ needs govern the
application of the components and permit judicious use.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 1-2
TOP: Nursing process: Planning
Which statement most accurately describes a nurse’s role regarding psychopharmacology?
The psychiatric nurse:
- b.
c.
d.
frequently makes decisions regarding administration of PRN medications.
might adjust a medication dose if a patient is not responding positively.
administers medications but is not responsible for monitoring drug effectiveness.
should refer a patient’s questions about drug side and adverse effects to the
psychiatrist.
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as
patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
team member who makes this determination. Nurses are responsible for monitoring drug
effectiveness as well as administering medication. Nurses should assume responsibility for
teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
of medications unless they have prescriptive privileges.
Cognitive level: Understanding
TOP: Nursing process: Implementation
2
MSC: NCLEX: Safe, Effective Care Environment
A nurse considers environmental aspects of milieu management while planning care for a
newly admitted patient. Which element has the highest priority?
- b.
c.
Norms
Safety
Balance
Structure
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other
dimensions of the milieu.
REF:
MSC: NCLEX: Safe, Effective Care Environment
2
TOP: Nursing process: Planning
When the treatment team in an inpatient psychiatric unit institutes a new unit schedule that
provides for all patients to be involved in activities continuously throughout both the day and
early evening, which element of milieu management needs reflection and reconsideration?
- b.
- d.
Norms
Balance
Limit setting
Environmental modification
ANS: B
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The situation described suggests a milieu in which patients have no time for planned
therapeutic encounters with staff; hence, it is a milieu lacking balance. Environmental
modification is not a core element of milieu management. Data are insufficient to permit the
student to choose either the component of norms or limit setting.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2
TOP: Nursing process: Evaluation
During an interaction with a patient, a nurse encourages the patient to express feelings,
identify stressors, and review coping strategies. These nursing interventions relate most to the
use of:
- b.
c.
d.
risk assessment.
behavior modification.
therapeutic communication.
environmental manipulation.
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse–patient
relationship. Being therapeutic does not imply that the nurse is providing therapy, a formal,
structured process. Risk assessment has a different purpose related to provision of an
appropriate level of care. Environmental manipulation is more related to milieu management
than to therapeutic use of self.
Cognitive level: Understanding
TOP: Nursing process: Implementation
- 2
MSC: NCLEX: Psychosocial Integrity
- b.
- d.
make an initial assessment.
confirm the patient’s problem.
assess potential dangerousness to self or others.
determine the level of supervision needed for the patient.
ANS: C
Risk assessment involves looking at dangerousness to self or others, the degree of disability,
and whether or not the individual is acutely psychotic to determine the feasibility of
community-based care versus hospital-based care. Risk assessment usually follows the initial
assessment. Confirmation of the patient’s problem is not part of the risk assessment protocol.
Arranging entry into the mental health system will follow risk assessment if the patient is
assessed as needing service.
Cognitive level: Applying
TOP: Nursing process: Assessment
- 2-3
MSC: NCLEX: Safe, Effective Care Environment
Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic at
the moment; not a danger to self or others; lives in parents’ home. Which decision regarding
placement on the continuum of care is appropriate?
- b.
- d.
Hospitalize the patient.
Discharge the patient from the system.
Refer the patient to outpatient services.
Refer the patient to self-help resources in the community.
ANS: C
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Referral should be made to the least restrictive, most effective, and most cost-conscious
source of services. Because the patient is not a danger to self or others, hospitalization is not
needed. However, follow-up as an outpatient would be more appropriate than referral to a
self-help group, in which structure might be lacking, or discharge from the system.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2-3
TOP: Nursing process: Planning
A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take it
anymore. Do you?” The most effective reply that the nurse could make is based on the
psychotherapeutic management model component of:
- b.
c.
d.
psychopathology.
milieu management.
psychopharmacology.
therapeutic nurse–patient relationship.
ANS: C
Concerns about medication voiced by patients require the nurse to have knowledge about
psychotherapeutic drugs to make helpful responses. The nurse–patient relationship component
is based on use of self. Milieu management is concerned with the environment of care.
Psychopathology provides foundational knowledge of mental disorders but would be less
relevant in framing a response to the patient than knowledge of psychopharmacology.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 2
MSC: NCLEX: Physiologic Integrity
A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take it
anymore. Do you?” Select the nurse’s best response.
- b.
c.
“I wonder why you think that.”
“Tell me how it makes you feel.”
“One must never stop taking medication.”
“You need to discuss this with your psychiatrist.”
ANS: B
As part of the psychopharmacology component of psychotherapeutic management, the
responsibility of the nurse is to gather data about patients’ responses to medication and to be
alert for side and adverse effects of the medication. The other responses are tangential to the
real issue.
Cognitive level: Applying
TOP: Nursing process: Implementation
2
MSC: NCLEX: Physiologic Integrity
The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has a
permanent disorder and will have many hospitalizations in the future. I wonder how I will be
able to raise our children alone.” The nurse’s reply should be based on knowledge of:
- b.
c.
psychopathology.
milieu management.
psychopharmacology.
nursing relationship therapy.
ANS: A
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An understanding of psychopathology will enable the nurse to communicate reassurance to
the spouse regarding the treatment of panic attacks in an outpatient setting.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 2
MSC: NCLEX: Psychosocial Integrity
- b.
c.
d.
Breakfast is late being served.
A sink is leaking, leaving water on the bathroom floor.
The daily schedule has not been posted on the unit bulletin board.
A small group of patients is complaining that one patient turned down the TV
volume.
ANS: B
Safety is the component of therapeutic milieu management that takes priority over the other
components. A patient could be injured if he or she slipped and fell. The other problems do
not pose a threat to patient safety.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2
TOP: Nursing process: Planning
A community mental health nurse assesses a person with a psychiatric disorder on an initial
visit. The nurse should refer this person to services on the care continuum that:
- b.
c.
are the least costly.
are the least restrictive.
offer psychoeducation.
promote rapid symptom stabilization.
ANS: B
The concept of least restrictive treatment environment preserves individual rights to freedom.
Many patients are healthy enough to receive community-based treatment. Hospitalization is
reserved for short periods when patients are assessed as being a danger to self or others. Cost
is a consideration but is of lesser concern than safety. All facets of the continuum should offer
psychoeducation as needed by patients and families. Some aspects of the care continuum are
more concerned with a patient’s need for symptom stabilization than others (e.g., hospitals
versus psychiatric rehabilitation programs). The outcome of symptom stabilization is not a
need for some patients, so it is not a correct answer.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 2-3
MSC: NCLEX: Safe, Effective Care Environment
An acutely psychotic patient is restricted to an inpatient unit. Which milieu element has been
adapted?
- b.
- d.
Norms
Balance
Therapy
Psychopathology
ANS: B
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Balance refers to negotiating the line between dependence and independence. The more
psychotic the individual, the less independence he or she can usually handle safely. Unit
restriction with careful supervision by staff helps compensate for lack of patient judgment.
Norms refers to behavioral expectations for patients. Therapy is provided by
advanced-practice nurses or others with advanced education. Psychopathology is not
considered an environmental element.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 1-2
MSC: NCLEX: Safe, Effective Care Environment
When inpatient psychiatric care is not indicated, an individual with schizophrenia who has a
history of medication noncompliance should be referred to which service?
- b.
c.
d.
Primary care
Outpatient counseling
Apartment residential living
A group home with 24-hour supervision
ANS: D
Although inpatient hospitalization is unnecessary, the individual requires an environment in
which medication compliance can be fostered. In this case, the group home would provide the
best alternative. The other options do not provide adequate supervision.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2-3
TOP: Nursing process: Planning
A patient with bipolar disorder has stabilized and is being discharged from the hospital. The
patient will live independently at home but lacks social skills and transportation. Which
referral would be most appropriate?
- b.
c.
A group home
A self-help group
A day treatment program
Assertive community treatment (ACT)
ANS: D
Assertive community treatment (ACT) provides intensive supervision, which includes
assistance with medications and transportation that would support the goal of minimizing
future hospitalizations. A group home is unnecessary, because the patient will reside at home.
A day treatment program would provide a therapeutic program directed toward symptoms, but
the patient’s symptoms have stabilized so this service is not indicated. A self-help group
would not provide the intensity of service this patient needs.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 4
TOP: Nursing process: Planning
A patient with long-standing bipolar disorder comes to the mental health center. The patient
says, “I lost my job and home. Now, I eat in soup kitchens and sleep at a shelter. I am so
depressed that I thought about jumping from a railroad bridge into a river.” Which factor has
priority for the nurse who determines the appropriate level of care?
- b.
Long-standing bipolar disorder
Risk for suicide
Homelessness
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Lack of income
ANS: B
Risk assessment shows the patient to have suicidal thoughts, and a plan for the suicide that is
highly lethal, executable, and with low potential for rescue. The other factors do not have as
great an effect on the determination of the level of services needed.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2-3
TOP: Nursing process: Evaluation
When explaining risk assessment, the nurse would indicate that the highest priority for
admission to hospital-based care is:
- b.
c.
safety of self and others.
confusion and disorientation.
withdrawal from harmful substances.
medical illness complicating a psychiatric disorder.
ANS: A
The highest priority is safety. In the other situations, threats to safety might or might not exist.
Cognitive level: Analyzing
TOP: Nursing process: Implementation
- 2-3
MSC: NCLEX: Safe, Effective Care Environment
What explanation about the unit milieu would be most important for the nurse to give to a
newly admitted patient?
- b.
- d.
“Your behavior will be carefully monitored during your hospital stay.”
“Unit activities will help you cope with immediate needs and stressors.”
“You will be given enough medication to bring your symptoms under control.”
“I will be gathering information about you to plan your care and your discharge.”
ANS: B
This choice best reflects the purpose of milieu management in psychotherapeutic
management. Stating that behavior will be monitored creates suspicion. Discussing
medication administration is a psychopharmacology issue and is not pertinent to unit milieu.
Stating that assessment will take place is not directly related to milieu.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 1-3
MSC: NCLEX: Psychosocial Integrity
Referral to a psychiatric extended-care facility would be most appropriate for which of the
following patients?
- b.
- d.
An adult with generalized anxiety disorder
A severely depressed 70-year-old retiree
A patient with personality disorder who frequently self-mutilates
A severely ill person with schizophrenia who is regressed and withdrawn
ANS: D
Extended care often serves those with severe and persistent mental illness and those with a
combination of psychiatric and medical illnesses. Patients with anxiety disorders can be
referred to outpatient services. Severely depressed patients would need more intensive care, as
would a self-mutilating individual.
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REF:
MSC: NCLEX: Safe, Effective Care Environment
- 6
TOP: Nursing process: Analysis
MULTIPLE RESPONSE
What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder
to community-based care? Select all that apply.
- b.
c.
d.
Need for PRN medication
Severity of the patient’s illness
Need for structured formal therapy
Presence of suicidal or homicidal ideation
Amount of supervision required by the patient
ANS: B, D, E
The decision tree for the continuum of care calls for the assessment of severity of the illness,
the presence or absence of suicidal or homicidal ideation, whether or not the disability is so
great that the patient is unable to provide for his or her own basic needs, and the amount of
supervision required for patient safety. The frequency of need for PRN medication and the
need for structured formal therapy are not considerations mentioned in the decision tree.
REF:
MSC: NCLEX: Safe, Effective Care Environment
- 2
TOP: Nursing process: Evaluation
Which scenarios demonstrate that a nurse is functioning within the scope of psychotherapeutic
management? The nurse (select all that apply)
- b.
- d.
structures meaningful unit activities.
administers electroconvulsive therapy.
encourages a patient to express feelings.
interprets the results of psychological testing.
assesses a patient for medication side effects.
ANS: A, C, E
Electroconvulsive therapy is a medical treatment and, therefore, should be administered by a
physician. Psychological testing is interpreted by a psychologist. All other scenarios are
within the scope of practice of the nurse.
Cognitive level: Analyzing
TOP: Nursing process: Implementation
- 1-2
MSC: NCLEX: Safe, Effective Care Environment
Chapter 05: Cultural Issues
MULTIPLE CHOICE
- Culture is defined as a group’s shared:
- race and
- values, beliefs, and
- biologic variations and psychological
- patterned behavioral responses that developed over
ANS: B
Culture is the internal and external manifestation of a person’s, group’s, or community’s learned and shared values, beliefs, and norms that are used to help individuals function in life and understand and interpret life occurrences. None of the other responses provides an adequate explanation of culture, because all are too narrow in scope.
DIF: Cognitive level: Understanding REF: p. 50
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
- A nurse begins work at an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after:
- identifying culture-bound
- implementing scientifically proven
- correcting inferior health practices of the
- exploring commonly held beliefs and values of the
ANS: D
Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer.
DIF: Cognitive level: Applying REF: p. 50
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
- A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge?
- Knowledge is acquired through use of affective or feeling
- Knowledge is acquired according to proof of
- Knowledge develops by striving for transcendence of the mind and
- Knowledge evolves from an individual’s relationship with a supreme
ANS: B
The European-American perspective of acquiring knowledge evolves through acquiring proof that something exists using the personal senses. The distracters describe the beliefs of other cultural groups.
DIF: Cognitive level: Understanding REF: p. 51
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?
- Patients of different cultural groups may metabolize medications at different
- Metabolism of psychotropic medication is consistent among various cultural groups.
- Differences in hepatic enzymes will influence the rate of elimination of psychotropic
- It is important to provide patients with oral and written literature about their psychotropic
ANS: A
Cytochrome P-450 enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates. Information about medication is important but does not apply to pharmacokinetics.
DIF: Cognitive level: Understanding REF: p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine:
- if the patient’s immunizations are
- the patient’s religious
- the patient’s specific ethnic
- whether or not an interpreter is
ANS: D
The assessment depends on communication. The nurse should first determine whether or not an interpreter is needed. The other information can be subsequently assessed when communication is effective.
DIF: Cognitive level: Analyzing REF: p. 54
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore:
- divine relationships.
ANS: C
Patients who view illness as disequilibrium or lack of balance may seek alternative therapies to restore balance. Chi is an energy force. Meridians are lines in the body representing body functions. Divine relationships are an aspect of balance, but equilibrium is a broader concept.
DIF: Cognitive level: Understanding REF: p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after:
- ignoring the
- feeding the child warm
- looking deeply into the child’s
- a root doctor or native healer
ANS: D
Individuals who believe in culture-bound illnesses usually also believe that the cure for the illness is found in treatment by a native healer or roots doctor. The parent would not believe that any of the other options are effective.
DIF: Cognitive level: Applying REF: p. 53
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- A Hispanic parent says, “An old woman gave my baby the evil eye.” The health care provider determines that the infant is physically healthy. The most culturally competent intervention would be to:
- tell the parent that the baby is healthy and needs no
- explain that the evil eye is a superstition and not a cause of
- encourage the parent to immerse the baby in cool water baths
- bring a root doctor into the consultation to restore the baby’s lost
ANS: D
An individual who believes in mal ojo will also believe that Western medicine is ineffective to treat it. This person will believe that because the illness has an unnatural cause, treatment is best conducted by a native healer who can remove the spell. The parent would not view offering no treatment or casting doubt on evil eye as a superstition as helpful, making these options culturally insensitive. A cool water bath could destabilize an infant’s body temperature.
DIF: Cognitive level: Analyzing REF: p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
- A patient of Cuban descent is hospitalized with depression. Which factor is most applicable to care planning?
- The nurse should confer with the family’s oldest woman, who will serve as the primary decision
- With the patient’s permission, the nurse should consult with family and religious advisors to plan
- The plan of care should incorporate use of meditation and contemplation techniques.
- Western medical treatment will be readily accepted by the
ANS: B
Patients of Hispanic cultures often have relational worldviews. Individuals who have a relational worldview usually desire the involvement of family, religious advisors, and even friends during health care visits and the planning of interventions. The patient’s consent is required for this involvement. The other options reflect alternative worldviews.
DIF: Cognitive level: Applying REF: p. 53 TOP: Nursing process: Planning MSC: NCLEX: Psychosocial Integrity
- A clinic patient comes to an appointment carrying a baby. The nurse notes abrasions on the baby’s thighs and determines that skin scraping has been used. In an effort to use cultural negotiation, the nurse should:
- encourage using less pressure during scraping to prevent abrasions and
- show the parent how to use moxibustion rather than skin
- explain that skin scraping does not effectively treat
- caution that the scraped skin can become
ANS: A
Cultural negotiation is the nurse’s ability to work within a patient’s cultural belief system to develop culturally appropriate interventions. Only by suggesting a modification of the technique of skin scraping so as to perform it in a manner that will not cause injury or the potential for infection can the nurse reflect cultural negotiation.
DIF: Cognitive level: Applying REF: p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Physiologic Integrity
- A Hispanic patient says, “I have no energy and cannot eat. I want to sleep but can’t, because pain moves around different parts of my body.” A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing:
- lost soul (susto).
- spiritual
- a broken
ANS: A
Loss of one’s soul, a culture-bound illness occasionally seen among Hispanic individuals, produces vague symptoms such as those described. Western medicine regards these as depressive symptoms, but individuals with lost soul speak only of physical symptoms, rather than psychological or emotional disequilibrium. The other options are culture-bound disorders with symptoms different from what is described in this scenario.
DIF: Cognitive level: Understanding REF: p. 53 TOP: Nursing process: Analysis MSC: NCLEX: Psychosocial Integrity
- A Hispanic patient reports symptoms consistent with the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with:
- care from a traditional
- skin
ANS: A
The patient is probably experiencing lost soul, a culture-bound illness. Its symptoms are depressive in nature and might well respond to treatment with an antidepressant. However, because the individual sees the cause as loss of the soul, she will not have faith in medication as a cure. Using a traditional healer to return the lost soul will set the stage for medication to relieve symptoms. The other options are not culturally appropriate.
DIF: Cognitive level: Applying REF: p. 53 TOP: Nursing process: Planning
MSC: NCLEX: Psychosocial Integrity
- A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse’s most appropriate initial intervention?
- Ask if the parent has used
- Report the parent for suspected child
- Assess whether or not the parent desires to harm the
- Ask if the parent has taken the child to an
ANS: A
Recognition of the characteristic marks of coining or skin scraping can keep the nurse from making a culturally insensitive judgment that child abuse is occurring. Coining is used by Asian families to restore equilibrium for babies and small children. The other options would be inappropriate or ineffective.
DIF: Cognitive level: Applying REF: p. 53
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
- A parent said, “My child had mal ojo, so I did not give her the medicine for an ear infection.” The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse would analyze that the situation occurred because of:
- lack of knowledge of therapeutic
- differences in perceptions of how illness
- evidence of unconscious hostility toward the
- a misunderstanding about the communicability of
ANS: B
A parent who believes that his or her child’s illness is the result of a spell cast on him or her will not understand the need for giving the child medication on a regular basis for several days. Diagnosing noncompliance will not help resolve the problem. Cultural negotiation and repatterning will be necessary. The other options do not present viable explanations.
DIF: Cognitive level: Understanding REF: pp. 51, 53 Table MSC: NCLEX: Psychosocial Integrity
- A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools. Group sessions are short and concise. After the group session, the patients are most likely to believe that:
- the nurse was
- the session was
- the teaching was
- they were treated
ANS: A
Hispanic individuals usually have a relational worldview. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task. An individual with a relational worldview would be unlikely to hold any of the other views.
DIF: Cognitive level: Analyzing REF: pp. 51-52 TOP: Nursing process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which action should occur next?
- Verify understanding by asking the patient to restate the
- Ask if the patient is willing to follow directions for
- Reinforce cultural norms about eating hot and cold
- Provide the information in written form to the
ANS: A
Many Asians and Asian-Americans believe that questioning an authority figure (nurse) would be disrespectful, so they do not ask for clarification when they do not understand directions for their treatment. Individuals of this culture are usually willing to comply once they understand. Written information may be provided later. Although hot and cold foods might be used by Asian-Americans, there is no evidence that this patient is interested in this therapy.
DIF: Cognitive level: Analyzing REF: p. 51 TOP: Nursing process: Evaluation MSC: NCLEX: Psychosocial Integrity
- A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with these consumers?
- Silence is considered a social
- Touching is an accepted part of
- Important topics are always preceded by polite social
- Rules regarding roles and status are important and must be
ANS: D
Relationships are based on the idea that the Supreme Being is present in each person and that all persons must be valued and treated with dignity. This is particularly true of treatment received by tribal elders, healers, and others perceived to be in positions of importance. The other options are not consistent with the ecologic worldview.
DIF: Cognitive level: Applying REF: p. 52 TOP: Nursing process: Planning MSC: NCLEX: Psychosocial Integrity
- A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence?
- Serve the patient a cold beverage at the beginning of the
- Review Middle Eastern cultural values before the
- Avoid offering to shake hands with the
- Determine if a translator is
ANS: B
Brushing up on Middle Eastern culture would be a sensitive action that might result in a lowering of barriers between the nurse and patient. It would not be necessary to serve beverages during the interview. A translator would probably not be needed if the patient is a college professor. Shaking hands with Middle Easterners is acceptable.
DIF: Cognitive level: Applying REF: pp. 51-52
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
- An African-American patient tells a nurse with a European-American worldview, “There’s no sense talking. You wouldn’t understand because you live in a white world.” Select the nurse’s best response.
- “Nurses are educated to care for people from all cultures. It is a required component of nursing ”
- “It would be helpful if you described an example of something you think I would not understand.”
- “Your mental illness is causing you to view me with prejudice. We are all here to help you.”
- “Yes, I do understand. Everyone goes through the same ”
ANS: B
Having the patient speak in specifics rather than globally will help the nurse understand the patient’s perspective. This approach will help the nurse establish rapport with the patient. False reassurances will not facilitate communication with the patient.
DIF: Cognitive level: Analyzing REF: p. 51
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
- A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient’s self-esteem, but after 3 weeks the patient’s eye contact was unchanged. Select the accurate analysis of this
- The patient’s poor eye contact indicated anger and hostility that did not
- The nurse should have assessed the patient’s culture before formulating this diagnosis and
- Resolution of shame and guilt cannot be expected to occur in 3 weeks. The nurse should allow more
- The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye
ANS: B
The amount of eye contact a person engages in is often culturally determined. In some cultures eye contact is considered insolent, whereas in others eye contact is expected and valued. Korean-Americans often prefer not to engage in direct eye contact.
DIF: Cognitive level: Analyzing REF: p. 54 TOP: Nursing process: Evaluation MSC: NCLEX: Psychosocial Integrity
- When a Mexican-American woman and nurse interact, the patient often holds the nurse’s hand or links arms with the nurse. The nurse is uncomfortable with this behavior. Which analysis is most accurate?
- The patient is using touch to make the nurse uncomfortable and manipulate the relationship based on that
- An energy field disturbance has occurred. Touch rebalances the energy between the patient and
- The patient is afraid of being alone. When touching the nurse, the patient is reassured and
- The patient is accustomed to and comfortable with touch, as are members of many Hispanic
ANS: D
The most likely answer is that the patient’s behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are much less likely.
DIF: Cognitive level: Analyzing REF: pp. 51-52 TOP: Nursing process: Analysis MSC: NCLEX: Psychosocial Integrity
- At the time of discharge, a patient with a European-American worldview demands copies of all medical records. Which analysis most accurately explains the patient’s behavior? The patient:
- continues to experience mistrust of the team’s
- is probably planning to see an attorney about poor
- values the written evidence of illness and
- probably wants to edit the records for
ANS: C
Members of European-American cultures have analytic worldviews and value information that is written because it lends proof. The distracters offer more remote reasons for the behavior.
DIF: Cognitive level: Analyzing REF: pp. 51-52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
- Which questions should the nurse ask to determine an individual’s worldview? Select all that apply.
- “What is more important: the needs of an individual or the needs of a community?”
- “How would you describe an ideal relationship between individuals?”
- “How long have you lived at your present residence?”
- “Of what importance are possessions in your life?”
- “Do you speak any foreign languages?”
ANS: A, B, D
The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine whether the worldview of the individual is analytic, relational, community, or ecologic. Other follow-up questions would be needed to validate findings.
DIF: Cognitive level: Applying REF: pp. 51-52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
- A nurse cares for patients who recently immigrated to the United States. The nurse would expect patients from which countries to hold relational worldviews? Select all that
- Germany
- Panama
- Mexico
- Ghana
- France
ANS: B, C, D
Persons of Hispanic and African-American cultures often hold relational worldviews. Mexico and Panama are predominantly Hispanic cultures. Ghana is African. Immigrants from Germany and France (European countries) would more likely have analytic worldviews.
DIF: Cognitive level: Understanding REF: p. 52
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity
| REF: |
| DIF: |
| REF: |
| DIF: |
| DIF: |
Chapter 13: Antiparkinsonian Drugs
MULTIPLE CHOICE
A psychiatric nurse should base care of patients diagnosed with Parkinson’s disease and
patients demonstrating extrapyramidal side effects (EPSEs) caused by antipsychotic drug
therapy on the premise that symptoms:
- b.
c.
are the same for both problems.
result from deficits in dopamine synthesis.
result from acetylcholine and dopamine imbalance.
are produced by neurodegeneration of the substantia nigra.
ANS: C
In both problems, acetylcholine and dopamine are not in balance. In Parkinson’s disease, this
results from neurodegeneration of the substantia nigra, and in the case of EPSEs, the cause is
blockade of dopamine receptors in the basal ganglia. The other options are not valid premises.
Cognitive level: Understanding
MSC: NCLEX: Physiologic Integrity
REF:
- 130-131
TOP: Nursing process: Planning
A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when
watching television. The nurse should use which term to document these findings?
- b.
c.
Dystonia
Akathisia
Dyskinesia
Bradykinesia
ANS: B
A patient with akathisia describes feeling restless, jittery, and unable to sit, and has restless
legs that feel better only if the patient is moving. Dystonia refers to sustained, twisted muscle
contractions. Dyskinesia refers to jerky motions. Bradykinesia refers to slow movement.
Cognitive level: Understanding
TOP: Nursing process: Implementation
- 131
MSC: NCLEX: Physiologic Integrity
A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when
watching television. The patient says, “I couldn’t sleep last night because I needed to pace.”
The nurse’s communication to the health care provider would be to suggest:
- b.
- d.
prescribing an anticholinergic drug.
discontinuing the antipsychotic drug.
prescribing dopaminergic medication.
using an antihistamine at bedtime to promote sleep.
ANS: A
The patient’s motor symptoms can be assessed as akathisia. Anticholinergic medication
provides relief for some patients. The nurse should report the patient’s symptoms to the health
care provider and anticipate the order to begin anticholinergic therapy. The other options do
not provide acceptable alternatives.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 133
MSC: NCLEX: Physiologic Integrity
| Which symptom of Parkinson’s disease has the highest priority for nursing intervention? |
| DIF: |
| REF: |
| DIF: |
| REF: |
| DIF: |
A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The
nurse observes that the patient’s eyes are rolled upward in a fixed gaze. The nurse should
assess this finding as:
- b.
c.
d.
akathisia.
nystagmus.
tardive dyskinesia.
an oculogyric crisis.
ANS: D
Oculogyric crisis is a specific dystonia in which the eyes roll upward and remain in a fixed
position. It results from involuntary muscle spasms and occurs early in the course of
treatment. Akathisia refers to motor restlessness. Nystagmus refers to a different type of
abnormal eye movements. Tardive dyskinesia refers to abnormal movements primarily of the
face and mouth muscles.
Cognitive level: Understanding
TOP: Nursing process: Assessment
- 132
MSC: NCLEX: Physiologic Integrity
A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The
nurse observes that the patient’s eyes are rolled upward in a fixed gaze. The nurse should
administer which drug from the patient’s PRN list?
- b.
- d.
Vitamin E
Carbidopa (Sinemet)
Benztropine (Cogentin)
Amantadine (Symmetrel)
ANS: C
Benztropine is an anticholinergic that can be given orally or parenterally in case of an
emergency, such as oculogyric crisis or dystonic reaction. The other options would not relieve
the dystonia.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 133-134
MSC: NCLEX: Physiologic Integrity
A patient has taken perphenazine (Prolixin) for a year. The nurse observes lip smacking and
grinding teeth. Which tool should the nurse use to complete the assessment?
- b.
- d.
AIMS
EPSE
SAD PERSONS
CAGE questionnaire
ANS: A
AIMS is the Abnormal Involuntary Movement Scale. It was developed to screen for tardive
dyskinesia. EPSE refers to extrapyramidal side effects. The other tools are for assessing
alcohol abuse and suicidality.
Cognitive level: Understanding
MSC: NCLEX: Physiologic Integrity
REF:
- 132-133
TOP: Nursing process: Planning
Tremor
| REF: |
| DIF: |
| DIF: |
| REF: |
| DIF: |
- c.
Akathisia
Dysphagia
Tardive dyskinesia
ANS: C
Dysphagia is difficulty swallowing. Because dysphagia can lead to a compromised airway, it
is the priority symptom among those listed.
Cognitive level: Analyzing
TOP: Nursing process: Assessment
- 132
MSC: NCLEX: Physiologic Integrity
A patient diagnosed with Parkinson’s disease begins levodopa therapy. The nurse understands
that administration of levodopa will:
- b.
- d.
improve symptoms of Parkinson’s disease by increasing dopamine in the CNS.
improve symptoms of Parkinson’s disease by decreasing levels of GABA.
cause the patient to develop symptoms of depression and an unsteady gait.
lead to an increased risk of dysphagia.
ANS: A
Levodopa is converted to dopamine in the central nervous system (CNS), so its administration
will cause a reduction in the symptoms of Parkinson’s disease related to dopamine deficiency.
The other options are incorrect. Levodopa increases dopamine levels. Levodopa is not
associated with changes in -aminobutyric acid (GABA). Levodopa will improve the patient’s
swallowing ability and gait, and will reduce symptoms of depression.
Cognitive level: Applying
MSC: NCLEX: Physiologic Integrity
REF:
- 131
TOP: Nursing process: Evaluation
The nurse caring for a patient receiving a dopaminergic drug should assess the individual for
early symptoms of:
- b.
- d.
psychosis.
fluid imbalance.
tardive dyskinesia.
labile hypertension.
ANS: A
Dopamine excess is associated with schizophrenia. When dopaminergic drugs are given,
symptoms of psychosis might appear or be exacerbated. Tardive dyskinesia is associated with
dopamine deficiency. The other options are unrelated.
Cognitive level: Applying
TOP: Nursing process: Assessment
- 133-134
MSC: NCLEX: Physiologic Integrity
Which statement by the nurse should be included in the teaching plan for patients receiving
anticholinergic agents?
- b.
c.
d.
“Avoid eating foods high in tyramine.”
“Do not abruptly stop taking the drug.”
“Take oral medications on an empty stomach.”
“Take a multivitamin and mineral supplement daily.”
ANS: B
| DIF: |
| DIF: |
| REF: |
| DIF: |
Tapering off the drug over a 1-week period is advisable instead of abruptly stopping the drug.
This prevents uncomfortable withdrawal symptoms. Avoiding foods high in tyramine is
important teaching for patients taking monoamine oxidase inhibitors (MAOIs). The other
statements are not applicable.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 135-136
MSC: NCLEX: Physiologic Integrity
A patient began trihexyphenidyl (Artane) for treatment of drug-induced parkinsonism. Which
finding demonstrates a positive response to the medication?
- b.
- d.
Blood pressure returns to patient’s normal range.
Gait is steady with decreased rigidity.
Patient reports fewer feelings of depression.
Patient has tremors with voluntary movement.
ANS: B
Gait disturbance, tremor, bradykinesia, and rigidity are symptoms of drug-induced
parkinsonism. Reduction in these symptoms constitutes a positive outcome. The other options
are not expected outcomes.
Cognitive level: Understanding
MSC: NCLEX: Physiologic Integrity
REF:
- 134
TOP: Nursing process: Evaluation
When developing a teaching plan for a patient receiving benztropine (Cogentin), a priority
consideration for the nurse is:
- b.
- d.
anticholinergic drugs often cause blurred vision.
urinary frequency may impair the patient’s concentration.
akathisia produced by the drug will make concentration difficult.
increased peristalsis might cause gastrointestinal distress and impair concentration.
ANS: A
CNS effects include confusion, drowsiness, and decreased memory and learning. This might
affect the patient’s ability to learn. Anticholinergics do not cause urinary frequency, akathisia,
or increased peristalsis.
Cognitive level: Understanding
MSC: NCLEX: Physiologic Integrity
REF:
- 134
TOP: Nursing process: Planning
A patient who takes haloperidol (Haldol) for a diagnosis of schizophrenia has a dystonic
reaction. Benztropine (Cogentin) 2 mg is given intramuscularly and then continued orally
twice daily. Three days later, the patient has fever, disorientation, and tachycardia. Select the
best analysis of this scenario.
- b.
- d.
Tardive dyskinesia has emerged.
Benztropine toxicity has developed.
Extrapyramidal symptoms have returned.
Dopaminergic benztropine effects have exacerbated the psychosis.
ANS: B
CNS hyperstimulation from anticholinergics causes fever, disorientation, excitement,
agitation, delirium, and hallucinations as well as cardiovascular, urinary, and gastrointestinal
symptoms. Collectively, these findings indicate anticholinergic toxicity. The symptoms
described in the scenario do not accurately reflect any of the other options.
| REF: |
| DIF: |
| Which patient receiving fluphenazine (Prolixin) should be monitored most closely for EPSEs? |
| REF: |
| DIF: |
| Patient teaching for a patient beginning an anticholinergic drug should include: |
| REF: |
| DIF: |
| DIF: |
Cognitive level: Analyzing
MSC: NCLEX: Physiologic Integrity
REF:
- 135
TOP: Nursing process: Evaluation
An older adult patient who takes trihexyphenidyl (Artane) for drug-induced parkinsonism
begins taking diphenhydramine (Benadryl) for cold symptoms. The nurse should carefully
monitor this patient for:
- b.
c.
d.
polyuria.
tachycardia.
constipation.
hypothermia.
ANS: B
An anticholinergic effect on the vagus nerve causes tachycardia by removing the braking
effect on the sinoatrial node. The additive effects of trihexyphenidyl and diphenhydramine
would be likely to produce tachycardia, which could lead to cardiac decompensation in an
older adult. In terms of priority of problems, hyperthermia may occur later, after toxic levels
of anticholinergics had been ingested; constipation would be less life-threatening than cardiac
decompensation. Anticholinergics cause urinary retention, not polyuria.
Cognitive level: Understanding
TOP: Nursing process: Assessment
- 135-136
MSC: NCLEX: Physiologic Integrity
- b.
- d.
limiting fluid intake to 1000 ml/day.
limiting strenuous activity on hot days.
eating small, frequent meals to decrease nausea.
wearing adequate clothing to prevent hypothermia.
ANS: B
An anticholinergic side effect is decreased sweating. Sweating produces body cooling through
evaporation. Heat stroke is a greater possibility when the body cannot cool itself. The other
options have no particular relevance to anticholinergic therapy.
Cognitive level: Applying
TOP: Nursing process: Implementation
- 135
MSC: NCLEX: Physiologic Integrity
- b.
c.
35-year-old man
45-year-old woman
74-year-old woman
Patient with a 5-year history of schizophrenia
ANS: C
Women, older adults, patients with affective symptoms, and patients with first episodes of
schizophrenia have a higher risk for EPSEs.
Cognitive level: Analyzing
TOP: Nursing process: Assessment
- 133
MSC: NCLEX: Physiologic Integrity
| REF: |
| DIF: |
| REF: |
| DIF: |
| DIF: |
An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and
dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and
bradykinesia develop, so an anticholinergic is added to the drug regimen. Within 3 days the
patient displays a marked cognitive deficit. Which medication is the most likely cause of the
cognitive change?
- b.
- d.
Antihypertensive
Anticholinergic
Antipsychotic
Antidiabetic
ANS: B
Anticholinergic medications often produce cognitive changes in older adults. Although the
other medications listed might produce untoward effects, because the symptoms appeared
after the introduction of the anticholinergic, one would suspect this drug first.
Cognitive level: Analyzing
MSC: NCLEX: Physiologic Integrity
REF:
- 134
TOP: Nursing process: Evaluation
Of the patients the nurse will see at the mental health center, which one should be assessed
most carefully for EPSEs?
- d.
59-year-old man with severe mental illness for 20 years; takes olanzapine
(Zyprexa)
18-year-old woman with a first episode of schizophrenia; takes haloperidol
(Haldol)
26-year-old man with generalized anxiety disorder; takes lorazepam (Ativan)
30-year-old woman with depression; takes amitriptyline (Elavil)
ANS: B
Risk factors for EPSEs include female gender, first episode of schizophrenia, and use of a
traditional antipsychotic medication. The other patients are at lower or no risk because of
taking an atypical antipsychotic, a tricyclic antidepressant, and an antianxiety drug. Men are at
lower risk.
Cognitive level: Analyzing
TOP: Nursing process: Assessment
- 133
MSC: NCLEX: Physiologic Integrity
Which medication from a patient’s pharmacologic profile is most likely to precipitate
neuroleptic malignant syndrome (NMS)?
- b.
c.
Diphenhydramine (Benadryl)
Risperidone (Risperdal)
Haloperidol (Haldol)
Clozapine (Clozaril)
ANS: C
Haloperidol is a first-generation high-potency antipsychotic drug. It has a greater risk for
producing NMS than atypical antipsychotic drugs. Diphenhydramine is not an antipsychotic
drug.
Cognitive level: Understanding
TOP: Nursing process: Assessment
- 133
MSC: NCLEX: Physiologic Integrity
Which neurotransmitter is most affected by an anticholinergic drug?
| DIF: |
| REF: |
| DIF: |
- b.
- d.
Acetylcholine
Dopamine
Serotonin
GABA
ANS: A
Anticholinergic drugs inhibit acetylcholine, thereby preventing stimulation of the cholinergic
excitatory pathways. The other neurotransmitters are associated with the etiology of
schizophrenia, anxiety, and depression.
Cognitive level: Understanding
TOP: Nursing process: Assessment
- 133
MSC: NCLEX: Physiologic Integrity
MULTIPLE RESPONSE
When patients are treated with antipsychotic medications, a variety of side effects and adverse
reactions may occur. Sequence the following list in order of intervention priority, beginning
with the most urgent:
- b.
- d.
Akathisia
Dystonic reaction
NMS
Tardive dyskinesia
ANS: A, B, C, D
NMS is considered a medical emergency requiring immediate intervention to save the
patient’s life. A dystonic reaction is extremely uncomfortable and requires swift intervention
to restore patient comfort. Akathisia is uncomfortable but is not considered an emergency.
Tardive dyskinesia is a serious, possibly unremitting problem that might require discontinuing
the medication. It develops over weeks, months, or years.
Cognitive level: Analyzing
MSC: NCLEX: Physiologic Integrity
REF:
- 131-133
TOP: Nursing process: Planning
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