,Chapter 01: Practicing the Science and the Art of Psychiatric Nursing
MULTIPLE CHOICE
1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the
community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
ANS: B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The
goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in
life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model
rather than recovery.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Outcomes Identification MSC:
NCLEX: Health Promotion and Maintenance
2. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the
nurse who receives the report best demonstrates advocacy?
a. This is a psychiatric hospital. Craziness is what we are all about.
b. Lets all show acceptance of this patient by wearing lots of makeup too.
c. Your comments are inconsiderate and inappropriate. Keep the report objective.
d. Our patients need our help to learn behaviors that will help them get along in society.
ANS: D
Accepting patients needs for self-expression and seeking to teach skills that will contribute to their well-being
demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that
others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift report but not at the
expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show
compassion for each other.
DIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
3. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an
example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.
ANS: D
Attending is a technique that demonstrates the nurses commitment to the relationship and reduces feelings of
isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false
reassurances are non-therapeutic.
DIF: Cognitive Level: Application (Applying) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses
most caring comment.
a. Lets discuss some means of coping other than suicide when you have these feelings.
b. I understand why youre so depressed. When I got divorced, I was devastated too.
c. You should forget about your marriage and move on with your life.
d. How did you get so depressed that hospitalization was necessary?
,ANS: A
The nurses communication should evidence caring and a commitment to work with the patient. This commitment lets
the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web
sites address most alerts the nurse that the site may have biased and prejudiced information?
a. Address ends in .org.
b. Address ends in .com.
c. Address ends in .gov.
d. Address ends in .net.
ANS: B
Financial influences on a site are a clue that the information may be biased. .com at the end of the address indicates that
the site is a commercial one. .gov indicates that the site is maintained by a government entity.
.org indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit
from its activities. .net can have multiple meanings.
DIF: Cognitive Level: Comprehension (Understanding) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, I read a
descriptive research study that says that this approach does not work. I plan to stop calling patients by name. Which
statement is the best appraisal of this nurses comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse specialists.
c. New research findings should be incorporated into clinical algorithms before using them in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
ANS: A
Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before
practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical
algorithms use flow charts to manage problems and do not specify one response to a clinical problem. Classic tenets of
practice should change as research findings provide evidence for change.
DIF: Cognitive Level: Analysis (Analyzing) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
7. Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The
other student asks, Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.
Select the best response by the student interested in psychiatric nursing.
a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better
because of the nature of patients problems.
b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional
problems. Im challenged by those situations.
c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to
continue them after I graduate.
d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. That
appeals to me.
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical surgical nursing, although substantial
overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting
the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have
increased, similar to other specialties. Psychiatric nursing involves clinical practice,
,not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
8. Which research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
ANS: B
Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is
Level A and provides the strongest evidence for changing practice. Expert committee recommendations and
descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates
research findings after they have been analyzed.
DIF: Cognitive Level: Comprehension (Understanding) REF: 3
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment
9. A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A
group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the
nurses fulfilled?
a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
ANS: A
An advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do that for
himself or herself. Examples of individual advocacy include helping patients understand their rights or make
decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the
interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on
behalf of patients who are unable to articulate their own needs.
DIF: Cognitive Level: Comprehension (Understanding) REF: 8
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
10. An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a
patients perception that his or her nurse is caring?
a. My nurse always asks me which type of juice I want to help me swallow my medication.
b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better.
c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon.
d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone.
ANS: D
Caring evidences empathic understanding, as well as competency. It helps change pain and suffering into a shared
experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of
statements that demonstrate advocacy or giving advice.
DIF: Cognitive Level: Application (Applying) REF: 3
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The
patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the
treatment team consult for information on more effective medications for this patient?
a. Clinical algorithm
b. Clinical pathway
c. Clinical practice guideline
,d. International Statistical Classification of Diseases and Related Health Problems (ICD)
ANS: A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of
information. These guidelines help the treatment team make decisions cognizant of an individual patients needs, such
as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific
disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies
diseases.
DIF: Cognitive Level: Application (Applying) REF: 5
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment
12. Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric
nursing?
a. Abraham Maslow
b. Hildegard Peplau
c. Kris Martinsen
d. Harriet Bailey
ANS: B
Although all these leaders included science as an important component of practice, Hildegard Peplau most
influenced its development in psychiatric nursing. Maslow was not a nurse, but his theories influence how nurses
prioritize problems and care. Bailey wrote a textbook in the 1930s on psychiatric nursing interventions. Kris
Martinsen emphasized the importance of caring in nursing practice.
DIF: Cognitive Level: Knowledge (Remembering) REF: 4
TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity
13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which
reaction by a patient indicates this nurse is effective? A patient reports feeling:
a. distrustful of others.
b. connected with others.
c. uneasy about the future.
d. discouraged with efforts to improve.
ANS: B
A patient is likely to respond to caring with a sense of connectedness with others. The absence of caring can make
patients feel distrustful, disconnected, uneasy, and discouraged.
DIF: Cognitive Level: Comprehension (Understanding) REF: 7
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you will instantly know
how to take care of psychotic patients. What is the new graduates best analysis of this comment? Select all that
apply.
a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of
practice.
b. New research findings must be continually integrated into a nurses practice to provide the most effective care.
c. Experience provides mental health nurses with the tools and skills needed for effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error.
e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients needs.
ANS: A, B
Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is
continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains
,respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and
error are unsystematic approaches to care.
DIF: Cognitive Level: Application (Applying) REF: 2
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment
2. Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all that
apply.) My nurse:
a. talks in language I can understand.
b. helps me keep track of my medications.
c. is willing to go to social activities with me.
d. lets me do whatever I choose without interfering.
e. looks at me as a whole person with different needs.
ANS: A, B, E
Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level
understandable to the patient, using holistic principles to guide care, and providing medication supervision. The
incorrect options suggest a laissez-faire attitude on the part of the nurse, when the nurse should instead provide
thoughtful feedback and help patients test alternative solutions or violate boundaries.
DIF: Cognitive Level: Application (Applying) REF: 6
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
,Chapter 02: Mental Health and Mental Illness
MULTIPLE CHOICE
1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this
patient best demonstrates resilience? The patient:
a. says, I knew this would happen eventually.
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, I dont need that silly thing.
d. says, Maybe some physical therapy will help me with my balance.
ANS: D
Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the
patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying I knew this would happen
eventually and discontinuing healthy activities suggest a hopeless perspective on the health change.
Refusing to use a walker indicates denial.
DIF: Cognitive Level: Comprehension (Understanding) REF: 14
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2. A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a
mental illness? The patient:
a. describes coping and relaxation strategies used when feeling anxious.
b. describes mood as consistently sad, discouraged, and hopeless.
c. can perform tasks attempted within the limits of own abilities.
d. reports occasional problems with insomnia.
ANS: B
A patient who reports having a consistently negative mood is describing a mood alteration. The incorrect options
describe mentally healthy behaviors and common problems that do not indicate mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care?
Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
ANS: C
The patients ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an
increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the
patient toward adaptation. The remaining options are maladaptive behaviors.
DIF: Cognitive Level: Analysis (Analyzing) REF: 14
TOP: Nursing Process: Outcomes Identification MSC:
NCLEX: Psychosocial Integrity
4. Which organization actively seeks to reduce the stigma associated with mental illness through public
presentations such as In Our Own Voice (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS)
d. North American Nursing Diagnosis Association International (NANDA-I)
ANS: B
Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to
,dispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses. The APA publishes the
DSM 5. The USDHHS regulates and administers health policies.
DIF: Cognitive Level: Knowledge (Remembering) REF: 19
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment
5. A nurse must assess several new patients at a community mental health center. Conclusions concerning
current functioning should be made on the basis of:
a. the degree of conformity of the individual to societys norms.
b. the degree to which an individual is logical and rational.
c. a continuum from mentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
ANS: C
Because mental health and mental illness are relative concepts, assessment of functioning is made by using a
continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to societys
norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional
growth is not the most useful criterion to assess mental health or mental illness.
DIF: Cognitive Level: Application (Applying) REF: 11 TOP:
Nursing Process: Diagnosis| Nursing Process: Analysis MSC:
NCLEX: Psychosocial Integrity
6. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patients insurance form. Which
resource should the nurse consult to discern the criteria used to establish this diagnosis?
a. A psychiatric nursing textbook
b. NANDA International (NANDA-I )
c. A behavioral health reference manual
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
ANS: D
The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on nursing diagnoses.
A psychiatric nursing textbook or behavioral health reference manual may not contain diagnostic criteria.
DIF: Cognitive Level: Application (Applying) REF: 12 TOP:
Nursing Process: Analysis| Nursing Process: Diagnosis MSC:
NCLEX: Safe, Effective Care Environment
7. A 40-year-old adult living with parents states, Im happy but I dont socialize much. My work is routine. When
new things come up, my boss explains them a few times to make sure I understand. At home, my parent make
decisions for me, and I go along with them. A nurse should identify interventions to improve this patients:
a. self-concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
ANS: A
The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows
both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Although the patient
reports being happy, the subsequent comments refute that self-appraisal. The patients comments do not indicate that
he/she is out of touch with reality. The patients needs are broader than control over own behavior.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
8. A patient tells a nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one of
,my friends or relatives has these problems. Select the nurses best response.
a. Comparing yourself with others has no real advantages.
b. Why do you blame yourself for having a psychiatric illness?
c. Mental illness affects 50% of the adult population in any given year.
d. It sounds like you are concerned that others dont experience the same challenges as you.
ANS: D
Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the
challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic
communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking
patients if they blame themselves is an example of probing.
DIF: Cognitive Level: Application (Applying) REF: 11
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses best
response.
a. No functional difference exists between the two diagnoses. Both serve to identify a human deviance.
b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.
c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and
present responses to actual mental health problems.
d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify
interventions for problems a patient has or may experience.
ANS: D
The medical diagnosis, defined according to the DSM-5, is concerned with the patients disease state, causes, and
cures, whereas the nursing diagnosis focuses on the patients response to stress and possible caring interventions.
Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems.
DIF: Cognitive Level: Application (Applying) REF: 16
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
10. The spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood experiences have
anything to do with this disabling illness. Select the nurses response that will best help the spouse understand
this condition.
a. Psychological stress is actually at the root of most mental disorders.
b. We now know that all mental illnesses are the result of genetic factors.
c. It must be frustrating for you that your spouse is sick so much of the time.
d. Although this disorder more likely has a biological rather than psychological origin, the support and
involvement of caregivers is very important.
ANS: D
Many of the most prevalent and disabling mental disorders have been found to have strong biological influences.
Helping the spouse understand the importance of his or her role as a caregiver is also important. Empathy is
important but does not increase the spouses level of knowledge about the cause of the patients condition. Not all
mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.
DIF: Cognitive Level: Application (Applying) REF: 14
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
11. Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care
planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are constant from culture to culture.
d. Some symptoms of mental disorders may reflect a persons cultural patterns.
, ANS: D
A nurse who understands that a patients symptoms are influenced by culture will be able to advocate for the patient
to a greater degree than a nurse who believes that culture is of little relevance. All mental illnesses are not culturally
determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little
relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.
DIF: Cognitive Level: Application (Applying) REF: 18
TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment
12. A patients history shows intense and unstable relationships with others. The patient initially idealizes an
individual and then devalues the person when the patients needs are not met. Which aspect of mental health is a
problem?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANS: D
The information provided centers on relationships with others, which are described as intense and unstable. The
relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to
describe work effectiveness, communication skills, or activities.
DIF: Cognitive Level: Application (Applying) REF: 12
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
13. In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled
mentally ill?
a. Person who is usually pessimistic but strives to meet personal goals
b. Wealthy person who gives $20 bills to needy individuals in the community
c. Person with an optimistic viewpoint about life and getting his or her own needs met
d. Person who attends a charismatic church and describes hearing Gods voice
ANS: D
Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the
voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it more difficult to
make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as
mentally ill.
DIF: Cognitive Level: Application (Applying) REF: 17
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
14. A participant at a community education conference asks, What is the most prevalent type of mental
disorder in the United States? Select the nurses best response.
a. Why do you ask?
b. Schizophrenia
c. Affective disorders
d. Anxiety disorders
ANS: D
The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression,
dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.
DIF: Cognitive Level: Comprehension (Understanding) REF: 15
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which
resource should the nurse consult?
