,Table of Content
Chapter 01: Science and the Therapeutic Use of Self in Psychiatric Mental Health Nursing ................................................... 3
Chapter 02: Mental Health and Mental Illness ........................................................................................................................ 10
Chapter 03: Theories and Therapies ........................................................................................................................................ 17
Chapter 04: Biological Basis for Understanding Psychopharmacology Varcarolis: Essentials of Psychiatric Mental Health
Nursing: A Communication Approach to Evidence-Based Care, 5e....................................................................................... 27
Chapter 05: Settings for Psychiatric Care ................................................................................................................................ 37
Chapter 06: Legal and Ethical Basis for Practice .................................................................................................................... 45
Chapter 07: The Nursing Process in Psychiatric-Mental Health Nursing Varcarolis: Essentials of Psychiatric Mental Health
Nursing: A Communication Approach to Evidence-Based Care, 5e....................................................................................... 55
Chapter 08: Communication Skills: Medium for All Nursing Practice Varcarolis: Essentials of Psychiatric Mental Health
Nursing: A Communication Approach to Evidence-Based Care, 5e....................................................................................... 65
Chapter 09: Therapeutic Relationships and the Clinical Interview ......................................................................................... 73
Chapter 10: Trauma and Stress-Related Disorders and Dissociative Disorders Varcarolis: Essentials of Psychiatric Mental
Health Nursing: A Communication Approach to Evidence-Based Care, 5e ........................................................................... 84
Chapter 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive and Related Disorders ............................................... 92
Chapter 12: Somatic Symptom Disorders ............................................................................................................................. 106
Chapter 13: Personality Disorders ......................................................................................................................................... 117
Chapter 14: Eating Disorders................................................................................................................................................. 128
Chapter 15: Mood Disorders: Depression ............................................................................................................................. 138
Chapter 16: Bipolar Spectrum Disorders ............................................................................................................................... 150
Chapter 17: Schizophrenia Spectrum Disorders and Other Psychotic Disorders Varcarolis: Essentials of Psychiatric Mental
Health Nursing: A Communication Approach to Evidence-Based Care, 5e .......................................................................... 162
Chapter 18: Neurocognitive Disorders ................................................................................................................................... 176
Chapter 19: Substance-Related and Addictive Disorders ...................................................................................................... 187
Chapter 20: Crisis and Mass Disaster .................................................................................................................................... 202
Chapter 21: Child, Partner, and Elder Violence .................................................................................................................... 212
Chapter 22: Sexual Violence ................................................................................................................................................. 222
Chapter 23: Suicidal Thoughts and Behaviors ...................................................................................................................... 231
Chapter 24: Anger, Aggression, and Violence ...................................................................................................................... 242
Chapter 25: Care for the Dying and Those Who Grieve ....................................................................................................... 253
Chapter 26: Children and Adolescents ................................................................................................................................... 264
Chapter 27: Adults ................................................................................................................................................................. 274
Chapter 28: Older Adults ....................................................................................................................................................... 286
,Chapter 01: Science and the Therapeutic Use of Self in Psychiatric Mental Health
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 demonstrate what behavior?
a. Denying suicidal ideation
b. Reporting a sense of well-being
c. Taking medications as prescribed
d. Attending 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)
TOP: Nursing Process: Outcomes Identification
MSC: NCLEX: Health Promotion and Maintenance
2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a
divorce. Select the nurse’s most caring comment.
a. “Let’s discuss healthy means of coping when you have suicidal feelings.”
b. “I understand why you’re 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 nurse’s 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 for therapeutic interventions.
DIF: Cognitive Level: Application (Applying)
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
3. In the shift-change report, an off-going nurse criticizes a patient who wears extremely heavy
makeup. Which comment by the nurse who receives the report best demonstrates advocacy?
a.“This is a psychiatric hospital, so we expect our patients to behave bizarrely.”
b.“Let’s 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)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment
4. 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 is not 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. “I’d like to sit with you for a while, so you may feel more comfortable talking with
me.”
ANS: D
Attending is a technique that demonstrates the nurse’s 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 nontherapeutic.
DIF: Cognitive Level: Application (Applying)
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 website’s 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) 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
nurse’s 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 flowcharts 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) 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 and
nurse-to-patient ratios are better because of the nature of patients’ problems.”
b. “Psychiatric nurses use complex communication skills, as well as critical thinking,
to solve multidimensional problems. I’m 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)
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:
,
, 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) 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 another’s cause, particularly when the other person lacks the
ability to do that for him 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)
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 patient’s 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 I’m 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) 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 patient’s 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) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe, Effective Care Environment
12. A team of nurses wants to integrate evidence-based practice into a facility’s clinical pathways.
Which step should the team implement first?
a.Acquire findings from published literature.
b.Apply the research findings to clinical practice.
c.Assess the outcomes of using new research findings.
d.Ask questions to identify clinical problems that should be changed.
ANS: D
Integrating evidence-based practice is a multistep process rather than a single change event.
The first step is to identify clinical problems that should be changed. Each step must proceed
in order when integrated into a clinical environment.
DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment
13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients.
Which reaction reported by a patient indicates this nurse is most effective?
a.Feeling less distrustful of others
b.Sensing a connection with others
c.Experiencing only minimal uneasiness about the future
d.Being somewhat encouraged with efforts to improve
ANS: B
A patient is likely to respond most to caring with a sense of connectedness with others. The
absence of caring can make patients feel some degree of distrustful, disconnection, unease,
and discouragement.
DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity
,MULTIPLE RESPONSE
1. An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you
will instantly know how to take care of psychotic patients.” What is the new graduate’s 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 nurse’s 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) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe, Effective Care Environment
2. Which patient statements identify qualities of nursing practice with high therapeutic value?
“My nurse: (Select all that apply.)
a.“The nurses talk in language I can understand.”
b.“The nursing staff helps me keep track of my medications.”
c.“My nurse is willing to go to social activities with me.”
d.“The staff lets me do whatever I choose without interfering.”
e.“My nurses look 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)
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
, Chapter 02: Mental Health and Mental Illness
Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication
Approach to Evidence-Based Care, 5e
MULTIPLE CHOICE
1. An 86 year old, previously healthy and independent, falls after an episode of vertigo. Which
statement made by this patient best demonstrates resilience?
a. “I knew this would happen eventually.”
b. “Attending my weekly water aerobics class is too risky.”
c. “I don’t need that silly walker to get around by myself.”
d. “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: Analysis (Analyzing)
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2. Which basic intervention should a psychiatric mental health nurse plan to provide for a patient
diagnosed with a mood disorder?
a. Sharing clinical expertise to enhance patient treatment
b. Performing individual or group psychotherapy for the patient
c. Using appropriate diagnostic tests to monitor patient condition
d. Conducting stress reduction and health maintenance classes
ANS: D
Conducting stress reduction and health maintenance classes is the basic intervention that
should be performed by a psychiatric mental health nurse. These classes will provide
individualized guidance to patients to prevent or reduce mental illness and improve mental
health. Community screenings and stress management classes are examples of health
maintenance classes. Consulting nurses from other disciplines to share clinical expertise and
enhance patient treatment is an advanced practice psychiatric mental health nursing
intervention. Performing individual and group psychotherapy and performing diagnostic tests
like blood pressure, etc., are also advanced practice psychiatric mental health nursing
interventions.
DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
3. 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.
