Essentials of Psychiatric Mental Health Nursing 8th Edition Concepts of Care in Evidence Based Practice 8th Edition Morgan Townsend
PSYCHIATRIC MENTAL HEALTH NURSING, 10TH EDITION, KARYN I. MORGAN, MARY C. TOWNSEND, ISBN-13: 9780803699670
PSYCHIATRIC MENTAL HEALTH NURSING, 10TH EDITION, KARYN I. MORGAN, MARY
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Test Bank For Essentials of Psychiatric Mental Health Nursing
8th Edition Concepts of Care in Evidence Based Practice 8th
Edition Morgan Townsend | 9780803676787 | Chapter 1-32 |
All Chapters with Answers and Rationals
1. Which behavior best demonstrates aggression?
a. Stomping away from the nurses' station, going to the day room, and grabbing a pool cue from a
patient standing by the pool table.
b. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and
sobbing.
c. Telling the primary nurse, "I felt angry when you said I could not have a second helping at lunch."
d. Telling the medication nurse, "I am not going to take that or any other medication you try to give
me." - ANSWER: ANS: A
Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical
or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do
not feature violation of another's rights.
2. Which scenario predicts the highest risk for directing violent behavior toward others?
a. Major depression with delusions of worthlessness
b. Obsessive-compulsive disorder; performing many rituals
c. Paranoid delusions of being followed by alien monsters
d. Completing alcohol withdrawal and beginning a rehabilitation program - ANSWER: ANS: C
The correct answer illustrates the greatest disruption of ability to perceive reality accurately. People
who feel persecuted may strike out against those believed to be persecutors. The patients identified
in the distracters have better reality-testing ability.
3. A patient is hospitalized after an arrest for breaking windows in the home of a former domestic
partner. The history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest
for disorderly conduct. Which nursing diagnosis has priority?
a. Risk for injury
b. Posttrauma response
c. Disturbed thought processes
d. Risk for other-directed violence - ANSWER: ANS: D
The defining characteristics for Risk for other-directed violence include a history of being abused as a
child, having committed other violent acts, and demonstrating poor impulse control. The defining
characteristics for the other diagnoses are not present in this scenario.
4. A confused older adult patient in a skilled care facility is in bed sleeping. The nurse enters the room
quietly and touches the bed to see if it is wet. The patient awakens and hits the nurse in the face.
Which statement best explains the patient's action?
a. Older adult patients often demonstrate exaggerations of behaviors used earlier in life.
b. Crowding in skilled care facilities increases individual tendencies toward violence.
c. The patient interpreted the health care worker's behavior as potentially harmful.
d. This patient learned violent behavior by watching other patients act out. - ANSWER: ANS: C
Confused patients are not always able to evaluate accurately the actions of others. This patient
behaved as though provoked by the intrusive actions of the staff member.
5. A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial
intervention for the nurse would be to address the patient by name and say:
a. "Hey, what's going on?"
b. "Please quiet down immediately."
c. "I'd like to talk with you about how you're feeling right now."
,d. "You must go to your room and try to get control of yourself." - ANSWER: ANS: C
Intervention should begin with an analysis of the patient and situation. With this response, the nurse
is attempting to hear the patient's feelings and concerns, which leads to the next step of planning an
intervention.
6. A patient was responding to auditory hallucinations earlier in the morning. The patient approaches
the nurse, shaking a fist and shouting, "Back off!" and then goes into the day room. As the nurse
follows the patient into the day room, the nurse should:
a. make sure adequate physical space exists between the nurse and the patient.
b. move into a position that allows the patient to be close to the door.
c. maintain one arm's length distance from the patient.
d. sit down in a chair near the patient. - ANSWER: ANS: A
Making sure space is present between the nurse and the patient avoids invading the patient's
personal space. Personal space needs increase when a patient feels anxious and threatened. Allowing
the patient to block the nurse's exit from the room is not wise. Closeness may be threatening to the
patient and provoke aggression. Sitting is inadvisable until further assessment suggests the patient's
aggression is abating. One arm's length is inadequate space.
7. An intramuscular dose of antipsychotic medication needs to be given to a patient who is becoming
increasingly more aggressive. The patient is in the day room. The nurse should enter the day room:
a. and say, "Would you like to come to your room and take some medication your doctor prescribed
for you?"
b. accompanied by three staff members and say, "Please come to your room so I can give you some
medication that will help you feel more comfortable."
c. and place the patient in a basket-hold and then say, "I am going to take you to your room to give
you an injection of medication to calm you."
d. accompanied by a male nursing assistant and tell the patient, "You can come to your room willingly
so I can give you this medication, or the aide and I will take you there." - ANSWER: ANS: B
A patient gains feelings of security if he or she sees that others are present to help with control. The
nurse gives a simple direction, honestly states what is going to happen, and reassures the patient that
the intervention will be helpful. This positive approach assumes that the patient can act responsibly
and will maintain control. Physical control measures should be used only as a last resort.
8. After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with
the incident. The nurse says, "I dread facing potentially violent patients." Which response would be
the most urgent reason for this nurse to seek supervision?
a. Startle reactions
b. Difficulty sleeping
c. Wish for revenge
d. Preoccupation with the incident - ANSWER: ANS: C
The desire for revenge signals an urgent need for professional supervision to work through anger and
counter the aggressive feelings. The distracters are normal in a person who has been assaulted.
Nurses are usually relieved with crisis intervention and follow-up designed to give support, help the
individual regain a sense of control, and make sense of the event.
9. The staff development coordinator plans to teach the use of physical management techniques
when patients become assaultive. Which topic should be emphasized?
a. Practice and teamwork
b. Spontaneity and surprise
c. Caution and superior size
d. Diversion and physical outlets - ANSWER: ANS: A
Intervention techniques are learned behaviors that must be practiced to be used in a smooth,
organized fashion. Every member of the intervention team should be assigned a specific task to carry
out before beginning the intervention. The other options are useless if the staff does not know how to
use physical techniques and how to apply them in an organized fashion.
,10. An adult patient assaults another patient and is restrained. One hour later, which statement by
this restrained patient necessitates the nurse's immediate attention?
a. "I hate all of you!"
b. "My fingers are tingly."
c. "You wait until I tell my lawyer."
d. "It was not my fault. The other patient started it." - ANSWER: ANS: B
The correct response indicates impaired circulation and necessitates the nurse's immediate attention.
The incorrect responses indicate that the patient has continued aggressiveness and agitation.
11. Which is an effective nursing intervention to assist an angry patient to learn to manage anger
without violence?
a. Help the patient identify a thought that increases anger, find proof for or against the belief, and
substitute reality-based thinking.
b. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts,
whether or not violence is present.
c. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry
feelings.
d. Administer an antipsychotic or antianxiety medication. - ANSWER: ANS: A
Anger has a strong cognitive component; therefore using cognition to manage anger is logical. The
incorrect options do nothing to help the patient learn anger management.
12. Which assessment finding presents the greatest risk for violent behavior? A patient who:
a. is severely agoraphobic.
b. has a history of spousal abuse.
c. demonstrates bizarre somatic delusions.
d. verbalizes hopelessness and powerlessness. - ANSWER: ANS: B
A history of prior aggression or violence is the best predictor of patients who may become violent.
Patients with anxiety disorders are not particularly prone to violence unless panic occurs. Patients
experiencing hopelessness and powerlessness may have co-existing anger, but violence is not often
demonstrated. Patients with paranoid delusions are at greater risk for violence than those with
bizarre somatic delusions.
13. A patient being admitted suddenly pulls a knife from a coat pocket and threatens, "I will kill
anyone who tries to get near me." An emergency code is called. The patient is safely disarmed and
placed in seclusion. Justification for the use of seclusion is that the patient:
a. evidences a thought disorder, rendering rational discussion ineffective.
b. presents a clear and present danger to others.
c. presents a clear escape risk.
d. is psychotic. - ANSWER: ANS: B
The patient's threat to kill self or others with the knife he possesses constitutes a clear and present
danger to self and others. The distracters are not sufficient reasons for seclusion.
14. A patient sits in silence for 20 minutes after a therapy appointment, appearing tense and vigilant.
The patient abruptly stands and paces back and forth, clenching and unclenching fists, and then stops
and stares in the face of a staff member. The patient is:
a. demonstrating withdrawal.
b. working through angry feelings.
c. attempting to use relaxation strategies.
d. exhibiting clues to potential aggression. - ANSWER: ANS: D
The description of the patient's behavior shows the classic signs of someone whose potential for
aggression is increasing.
15. A cognitively impaired patient has been a widow for 30 years. This patient is frantically trying to
leave the unit, saying, "I have to go home to cook dinner before my husband arrives from work." To
intervene with validation therapy, the nurse should say:
a. "You must come away from the door."
b. "You have been a widow for many years."
, c. "You want to go home to prepare your husband's dinner?"
d. "Was your husband angry if you did not have dinner ready on time?" - ANSWER: ANS: C
Validation therapy meets the patient "where she or he is at the moment" and acknowledges the
patient's wishes. Validation does not seek to redirect, reorient, or probe. The other options do not
validate patient feelings.
16. A patient with a history of anger and impulsivity is hospitalized after an accident resulting in
injuries. When in pain, the patient loudly scolds the nursing staff for "not knowing enough to give me
pain medicine when I need it." Which nursing intervention would best address this problem?
a. Tell the patient to notify nursing staff 30 minutes before the pain returns so the medication can be
prepared.
b. Urge the health care provider to change the prescription for pain medication from as needed to a
regular schedule.
c. Tell the patient that verbal assaults on nurses will not shorten the wait for pain medication.
d. Have the clinical nurse leader request a psychiatric consultation. - ANSWER: ANS: B
Scheduling the medication at specific intervals will help the patient anticipate when the medication
can be given. Receiving the medication promptly on schedule, rather than expecting nurses to
anticipate the pain level, should reduce anxiety and anger. The patient cannot predict the onset of
pain before it occurs.
17. A patient has a history of impulsively acting out anger by striking others. Which would be an
appropriate plan for avoiding such incidents?
a. Explain that restraint and seclusion will be used if violence occurs.
b. Help the patient identify incidents that trigger impulsive acting out.
c. Offer one-on-one supervision to help the patient maintain control.
d. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety. - ANSWER: ANS: B
Identifying trigger incidents allows the patient and nurse to plan interventions to reduce irritation and
frustration that lead to acting out anger and to put more adaptive coping strategies eventually into
practice.
18. A patient with severe injuries is irritable, angry, and belittles the nurses. As a nurse changes a
dressing, the patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which
intervention uses a cognitive technique to help the patient?
a. Wordlessly discontinue the dressing change, and then leave the room.
b. Stop the dressing change, saying, "Perhaps you would like to change your own dressing."
c. Continue the dressing change, saying, "Do you know this dressing change is needed so your wound
will not get infected?"
d. Continue the dressing change, saying, "Unfortunately, you have no choice in this because your
doctor ordered this dressing change." - ANSWER: ANS: C
Anger is cognitively driven. The correct answer helps the patient test his cognitions and may help
lower his anger. The incorrect options will escalate the patient's anger by belittling or escalating the
patient's sense of powerlessness.
19. Which medication should a nurse administer to provide immediate intervention for a psychotic
patient whose aggressive behavior continues to escalate despite verbal intervention?
a. lithium (Eskalith)
b. trazodone (Desyrel)
c. olanzapine (Zyprexa)
d. valproic acid (Depakene) - ANSWER: ANS: C
Olanzapine is a short-acting antipsychotic drug that is useful in calming angry, aggressive patients
regardless of their diagnosis. The other drugs listed require long-term use to reduce anger. Lithium is
for patients with bipolar disorder. Trazodone is for patients with depression, insomnia, or chronic
pain. Valproic acid is for patients with bipolar disorder or for those who are borderline bipolar.
20. An emergency department nurse realizes that the spouse of a patient is becoming increasingly
irritable while waiting. Which intervention should the nurse use to prevent escalation of anger?
a. Explain that the patient's condition is not life threatening.
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