Essentials of Psychiatric Mental Health Nursing 3rd Edition by Varcarolis

: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis) 2

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 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 oncoming 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? 

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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 incorpo 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, 

: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis) 4

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 

immig 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

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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.