Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis – Test Bank


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Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis – Test Bank

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Varcarolis: Foundations of Psychiatric Mental Health Nursing: A

Clinical Approach, 5th Edition


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Chapter 2: Relevant Theories and Therapies for Nursing Practice




1)   At the well-child clinic the nurse notices that a 26-month-old boy is displaying negative behavior. His mother relates that he refuses to have anything to do with toilet training and often shouts “no!” when given direction. His mother asks what might be the matter with her son. On the basis of knowledge of growth and development, the nurse should reply

A. “He is behaving normally for his age. He is striving for independence.”
B. “He needs firmer control. He should be scolded when he tells you ‘no’ and is defiant.”
C. “I suspect he has a serious developmental problem because most children are toilet trained by the age of 2 years.”
D. “He seems to be developing some undesirable attitudes. A child psychologist might be able to help you develop a remedial plan.”




2)   A 26-month-old child often displays negative behavior, refuses to have anything to do with toilet training, and often shouts “no!” when given direction. By using Freud’s stages of psychosexual development, the nurse would assess the child’s behavior as being consistent with the stage of development termed

A. oral.
B. anal.
C. phallic.
D. genital.




3)   A 26-month-old child often displays negative behavior, refuses to have anything to do with toilet training, and often shouts “no!” when given direction. His mother asks the nurse what might be the matter with the child. The counseling the nurse gives the mother should be based on the premise that the child is engaged in the psychosocial crisis of

A. trust versus mistrust.
B. initiative versus guilt.
C. industry versus inferiority.
D. autonomy versus shame and doubt.




4)   A 4-year-old child seen at the well-child clinic is noted to grab toys from his sibling, saying, “I want that toy, now!” The sibling usually cries, and the child’s mother becomes upset with the behavior. By using Freudian theory the nurse can interpret this behavior to the mother as being as a product of impulses originating in the

A. id.
B. ego.
C. superego.
D. preconscious.




5)   The mother of a 4-year-old child rewards and praises the child for helping his younger brother and for being polite and using good manners. The nurse supports the use of praise because the qualities of politeness and helpfulness will likely be internalized and become part of the child’s

A. id.
B. ego.
C. superego.
D. preconscious.




6)   The nurse who supports parental praise of a child who is behaving in a helpful way can hypothesize that in adulthood, when the individual behaves with politeness and helpfulness, she will feel

A. guilt.
B. anxiety.
C. unsatisfied.
D. positive self-esteem.




7)   A client says, “I never know the answers” or “My opinion doesn’t count for much.” The nurse can correctly assess that, according to Erikson, the client has had difficulty resolving the crisis of

A. initiative versus guilt.
B. trust versus mistrust.
C. autonomy versus shame and doubt.
D. generativity versus self-absorption.




8)   Which client statement would lead the nurse to suspect that the developmental task of infancy was not successfully completed by the client?

A. “Andy and I are very warm and close friends.”
B. “I’m afraid to allow anyone to really get to know me.”
C. “I’m always absolutely right, so don’t bother saying more.”
D. “I’m so ashamed because I didn’t do it correctly in the first place.”




9)   The nurse caring for a client makes the assessment that the client is suspicious of others and frequently engages in manipulation of others. To plan care, the nurse should consider these traits as being related to Freud’s

A. oral stage.
B. anal stage.
C. phallic stage.
D. genital stage.



10)   The nurse notes that an assigned client expresses the wish to be taken care of and that the client often behaves in a helpless fashion. The client can be assessed as having needs related to the stage of psychosexual development termed the

A. latency stage.
B. phallic stage.
C. anal stage.
D. oral stage.




11)   A is a 55-year-old retiree who volunteers 5 days a week helping with Meals on Wheels, coaching teen sports, and doing church visitation. B is a 58-year-old retiree who laughs at A and says, “I’m too busy taking care of myself to volunteer. I don’t care much about doing good for others.” These behaviors can be assessed as showing the difference between

A. trust and mistrust.
B. industry and inferiority.
C. intimacy and isolation.
D. generativity and self-absorption.



12)   The student nurse notes that a client uses a number of behaviors designed to relieve anxiety. The student asks the coassigned staff nurse if ego defense mechanisms and security operations are identical. The nurse should explain that, although both are unconsciously determined and designed to relieve anxiety, the major difference is that

A. defense mechanisms are always intrapsychic and not observable.
B. defense mechanisms always lead to arrested personal development.
C. security operations are interpersonal relationship activities.
D. security operations are masterminded by the id and superego.




13)   A student nurse tells the clinical instructor, “I’ve found that I do not need to interact with my assigned clients. I learn what I need to know simply by observing them.” The instructor can best interpret the nursing implications of Sullivan’s theory to the student by responding

A. “Nurses cannot be isolated from the therapeutic situation. We need to interact with clients to provide opportunities for them to practice interpersonal skills.”
B. “Observing client interactions can provide sufficient data to formulate priority nursing diagnoses and appropriate interventions.”
C. “I wonder how accurate your assessment of the client’s needs hierarchy can be if you do not interact with the client.”
D. “It is important to note client behavioral changes because these signify changes in personality.”




14)   A psychiatric technician mentions that little of what takes place on the behavioral health unit seems to be theory based. The nurse can enlighten the technician by citing the fact that many of Sullivan’s theoretic constructs are used in

A. the ongoing use of restraint and seclusion as behavior management tools.
B. the structure of the therapeutic milieu of most behavioral health units.
C. assessment tools based on age-appropriate versus arrested behaviors.
D. the method nurses use to determine the best sequence for nursing actions.




15)   When the nurse uses Maslow’s hierarchy of needs to plan care for a client who is psychotic, which client problem below will receive priority?

A. Refusal to eat
B. Feelings of alienation from family
C. Reluctance to participate in unit social activities
D. Need to be taught about medication action and side effects




16)   Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would the nurse include in the treatment plan?

A. Spanking the child for silence
B. Having the child observe others talking
C. Giving the child a small candy for speaking
D. Teaching the child relaxation techniques, then coaxing speech




17)   The mother of a young adult client who has schizophrenia tearfully asks the nurse what she could have done differently to prevent her child’s illness. The most reassuring response for the nurse would be

A. “Although schizophrenia is caused by impaired interpersonal relationships between parents and the child, try not to feel guilty. No one can predict how a child will respond to parental guidance.”
B. “Most of the damage is done, but there is still hope. By changing your parenting style, you can help your child learn to cope more effectively with the environment.”
C. “Schizophrenia is a biological illness not unlike diabetes and heart disease. You are not to blame for your child’s illness.”
D. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.”



18)   A nurse using Peplau’s interpersonal therapy while working with an anxious, withdrawn client will plan interventions focusing on

A. changing the client’s cognitions about self.
B. improving the client’s interactional skills.
C. reinforcing specific behaviors.
D. liberally using medications to relieve anxiety.




19)   A client tells the nurse she had psychotherapy weekly for 3 years. The client states the therapist used the techniques of free association, dream analysis, and facilitation of awareness of transference feelings to help her understand unconscious processes and foster personality change. The nurse can determine that the client was treated with

A. short-term dynamic psychotherapy.
B. transactional analysis.
C. cognitive therapy.
D. psychoanalysis.




20)   The nurse states “The patient is a lesbian and is experiencing severe anxiety and depression as she anticipates a problem with acceptance by her family when she reveals her sexual orientation.” The nurse has formulated the client’s problem from the vantage point of a therapist who uses

A. cognitive therapy.
B. behavioral therapy.
C. interpersonal psychotherapy.
D. psychodynamic psychotherapy.



21)   The nurse psychotherapist is working with an anxious, dependent client. The therapeutic strategy most consistent with the framework of psychodynamic or psychoanalytic psychotherapy would be

A. emphasizing medication compliance.
B. identifying client strengths and assets.
C. using psychoeducational materials.
D. focusing on feelings developed by the client toward the nurse.




22)   A client tells the nurse, “I was the lone survivor in a small plane crash in which three of my business associates were killed. I got anxious and depressed and saw a counselor three times a week for 4 weeks. The therapist and I talked about my feelings about being a survivor. I’m OK now, back to being my old self.” The nurse can correctly conclude that the type of therapy the client underwent was

A. milieu therapy.
B. psychoanalysis.
C. behavior modification.
D. interpersonal psychotherapy.




23)   A cognitive strategy the nurse could use to help an excessively dependent client would be to have the client

A. reveal his or her dreams.
B. take prescribed medications.
C. examine his or her thoughts about being independent.
D. choose an applicable diagnostic label from the DSM-IV-TR.



24)   A 39-year-old businesswoman and single parent of three is experiencing many feelings of inadequacy in her job and family situation since her 16-year-old daughter ran away several weeks ago. She seeks the help of a therapist specializing in cognitive therapy. The nurse psychotherapist who uses cognitive therapy will treat the client by

A. focusing on unconscious mental processes.
B. negatively reinforcing an undesirable behavior.
C. discussing ego states.
D. helping her identify and change faulty thinking.




25)   A college student has been invited to be the best man at the wedding of a college friend who lives across the country. The wedding is in 6 weeks. He must travel by plane but is afraid of flying. A nurse suggests seeing a therapist. What type of therapy would the nurse be most likely to recommend?

A. Psychoanalysis
B. Milieu therapy
C. Systematic desensitization
D. Short-term dynamic therapy




26)   The advanced practice nurse concludes a client would profit from the type of therapy in which peers and interdisciplinary staff all have a voice in determining the level of client privileges. The nurse would arrange for

A. milieu therapy.
B. cognitive therapy.
C. short-term dynamic therapy.
D. systematic desensitization.




27)   A client expresses suicidal ideation and admits to having a plan for committing suicide. The advanced practice nurse assesses the client as being at risk for suicide. In arranging for the client’s admission to the inpatient unit, the nurse has used principles of

A. a practice beyond the scope of nursing licensure.
B. interpersonal relationship therapy.
C. short-term dynamic therapy.
D. milieu therapy.



28)   A nurse sees the nursing theory of Dorothea Orem as providing a suitable framework for practice. This nurse would plan care to

A. acknowledge the client’s suffering related to illness.
B. support client coping strategies to enhance adaptation.
C. assist the client to discover and use stress reduction strategies.
D. promote self-care activities of the seriously and persistently mentally ill client.




29)   The nurse providing cognitive therapy for a client who believes she is stupid would evaluate cognitive intervention as effective when the client states

A. “I’m disappointed in my lack of ability.”
B. “Sometimes I do stupid things.”
C. “Things always go wrong for me.”
D. “I always fail when I try new things.”






1)   Desired outcomes of a nurse assuming the role of participant observer during an interaction with a client would include (more than one answer may be correct)

  1. client anxiety level decreases
  2. nurse self-awareness is enhanced
  3. the nurse views the client as a unique individual
  4. the focus of the interaction remains client centered




2)   A client states “I’m going to be engaging in cognitive therapy. What can I expect from the sessions?” Which responses by the nurse would be appropriate? (More than one answer may be correct.)

  1. “The therapist will be active and questioning.”
  2. “You may be given homework assignments.”
  3. “The therapist will help you look at ideas and beliefs you have about yourself.”
  4. “The goal is to increase your subjectivity about the thoughts that govern your behavior.”

Varcarolis: Foundations of Psychiatric Mental Health Nursing: A

Clinical Approach, 5th Edition


Test Bank


Chapter 4: Psychiatric Mental Health Nursing and Managed Care Issues




1)   An advanced practice psychiatric mental health nurse practitioner has taken a new position at a managed behavioral health agency. The nursing activity that would best use the advanced practice nurse’s unique qualifications is

A. milieu management.
B. assisting clients with self-care.
C. monitoring biological treatments.
D. consultation-liaison activities.



2)   A nurse who has a bachelor’s of science in nursing degree and certification in psychiatric mental health nursing would be considered competent to

A. provide psychotherapy.
B. provide crisis intervention.
C. prescribe psychopharmacologic agents.
D. provide consultation regarding client treatment.




3)   A client has had the following problems identified: ineffective coping related to mastectomy for breast cancer, deficient knowledge of cancer treatment options, dysfunctional grieving related to perception of loss, and disturbed body image related to mastectomy. A psychiatric mental health liaison nurse has been called. The problem that the liaison nurse should suggest an oncology nurse address is

A. ineffective coping.
B. deficient knowledge.
C. dysfunctional grieving.
D. disturbed body image.




4)   A community mental health nurse visits a client who lives in a community residence. On two sequential visits, the client makes veiled references to receiving verbally abusive treatment at the hands of one of the residence aides. The action the nurse should take is to

A. understand that psychiatric clients often feel abused.
B. listen and wait to see if the client continues to report the abuse.
C. confront the residence aide with the client’s allegations.
D. report the client’s comments to the protection and advocacy agency.



5)   The nurse using the Forchuck model of case management will see the essential component of case management as

A. the one-on-one therapeutic relationship between nurse and client.
B. monitoring the cost-effect ratio of care provided by a managed care organization.
C. a melding of nursing roles to meet all manifest needs of a particular client.
D. advocacy for the client in the community in which he or she lives and works.



6)   A client states “I’m pretty fed up with my wife. I’m thinking I should just get a divorce, but I worry about how that will affect my kids. What do you think I should do?” The psychiatric mental health nurse responds “Tell me what is happening between you and your wife.” Which basic nursing intervention does this interchange characterize?

A. Advocacy
B. Counseling
C. Health teaching
D. Milieu management



7)   Approximately 45 minutes ago, the nurse administered a prn anxiolytic to a client who was feeling acutely anxious. The nurse, who has been sitting with the client, asks “On a scale of 1 to 10, how would you rate your anxiety at the moment?” Which basic nursing intervention does this interaction characterize?

A. Counseling
B. Milieu management
C. Culturally relevant health promotion
D. Administering and monitoring psychobiological interventions




8)   The nurse meets with a client and his wife and explains the biological basis of the client’s illness and the importance of taking neuroleptic medication daily to reduce symptoms. The nurse asks if either of them can foresee any reasons this might be difficult to do. Which basic intervention does this interaction characterize?

A. Counseling
B. Milieu therapy
C. Health teaching
D. Health promotion




9)   The nurse has instructed the client of the need to come to the mental health clinic each Tuesday at 10 AM. The client tells the nurse “I have no transportation.” The nurse calls and arranges to have a car from the medical transportation volunteer pool pick him up at 9:30 AM. This basic intervention is part of

A. advocacy.
B. health promotion.
C. case management.
D. assisting clients with self-care.


10)   The clinical nurse specialist meets with a client receiving lithium. The nurse tells the client that her lithium level is 0.6 mEq/L, a finding in the desirable range. The nurse reinforces the importance of continuing to take the lithium as directed and the need to drink adequate amounts of fluids. This action is part of the advanced practice intervention of

A. psychotherapy.
B. consultation.
C. prescriptive authority.
D. complementary interventions.



11)   The clinical nurse specialist meets with the interdisciplinary staff members planning care for a client with borderline personality disorder hospitalized on a surgical unit after a suicide attempt. The staff members are seeking ways to prevent the client from manipulating and splitting staff. The clinical specialist offers several suggestions for interventions. The clinical specialist is intervening by providing

A. basic-level client interventions.
B. complementary interventions.
C. liaison consultation.
D. expanded advocacy.



12)   The psychiatric mental health nurse in the mental health clinic sees a client whose auditory hallucinations have worsened since his landlord told him he was being evicted. The nurse explores possible alternative living arrangements with the client and offers a 36-hour hospitalization while arrangements are being made. The phenomena in which the nurse is intervening is

A. self-concept change.
B. difficulty relating to others.
C. problems related to loneliness.
D. environmental events affecting client well-being.




13)   Which task can the clinical nurse leader who is creating the work assignment give to either a basic level or an advanced level psychiatric mental health nurse?

A. Responding to “telehealth” calls
B. Providing psychotherapy for a new client
C. Performing clinical supervisory activities with a new nurse
D. Meeting with community leaders to expand advocacy for residents of a group home for persistently mentally ill clients



14)   The psychiatric mental health nurse engages in daily sessions with a client with bipolar disorder to teach about the desired effects of prescribed medications, their side effects, and ways to manage the side effects. The problem for which the nurse is intervening is

A. self-care limitation.
B. difficulties relating to others.
C. symptom management.
D. problems related to emotions.




15)   The phenomenon of highest priority to a psychiatric nurse caring for a client with the following nursing diagnoses would be

A. risk for suicide.
B. disturbed thought processes.
C. situational low self-esteem.
D. self-care deficit: grooming.




16)   A new nurse is concerned with identifying outcomes pertaining to client social interactions and client self-control. The nurse’s mentor should suggest

A. using the DSM-IV-TR.
B. daily discussions with the mentor.
C. referring to the Nursing Outcomes Classification reference.
D. searching the Internet for hints.




17)   The nurse planning care for a client should strive to select valid nursing interventions. The best way of achieving this outcome is to select relevant interventions

A. suggested by experienced unit nurses.
B. clients have reported to be helpful.
C. that are research derived.
D. that seem logical.




18)   Which of the statements made by a nurse applying for a position as a case manager suggests the nurse does not have the requisite attitude or skill and should not be given the position?

A. “I most enjoy taking care of clients who are dependent.”
B. “I am rewarded when I see a client functioning in the community.”
C. “I am able to identify a client’s changing needs and shift roles accordingly.”
D. “My interpersonal skills are excellent and I know the resources of the community.”



19)   The most important issue a nurse who wishes to become involved in political action on behalf of clients and families affected by mental illness could choose is

A. the need to do away with utilization review.
B. passing a national mental health parity law.
C. stopping computerization of medical records.
D. the need for accurate mental health information on the Internet.



20)   The situation in which the nurse’s primary role can be assessed as advocacy is

A. treating the self-inflicted injuries of psychiatric clients.
B. providing preventive counseling regarding violence.
C. providing care to the family of a suicide victim.
D. participating in consumer mental health groups to destigmatize mental illness.







1)   The managed behavioral health care organization nurse speaking to a group of employers concerned about health care costs should explain that new strategies designed to decrease the high cost of inpatient treatment include (more than one answer may be correct)

  1. milieu therapy.
  2. shortened in-patient stays.
  3. introduction of nurse practitioners.
  4. development of new levels of outpatient care.




2)   Regarding client use of psychotropic medication, the activities in which the basic level psychiatric mental health nurse can engage in include (more than one answer may be correct)

  1. listening to the client’s concerns about medication dose.
  2. noting and addressing medication side effects.
  3. adjusting medication dosage as symptoms change.
  4. providing understandable medication teaching.



3)   Which of the following trends should the psychiatric nurse consider when engaged in planning for future managed behavioral health organization services? (More than one answer may be correct.)

  1. Cost constraints will continue.
  2. Community-based care will evolve.
  3. Case management is a necessary skill.
  4. The prevalence of dementia is falling.
  5. Cultural diversity in the United States is decreasing.



4)   A mentoring nurse tells a new nurse that “Documentation is a critically important skill for you to develop.” The rationale for this advice is that documentation (more than one answer may be correct)

  1. ensures that clients receive necessary care.
  2. justifies payment for the client’s care.
  3. keeps evaluators from giving deficiencies.
  4. makes risk management more effective.




5)   Trends that have significant bearing on the skill set needed by psychiatric nurses over the next 5 years include (more than one answer may be correct)

  1. increasing cultural diversity.
  2. the decreasing age of the population.
  3. community-based care case management.
  4. increased funding prospects for psychiatric care.



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