Psychiatric Mental Health Nursing ,4th Edition by Frisch, Noreen Cavan, Frisch, Lawrence E. – Test Bank

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Psychiatric Mental Health Nursing ,4th Edition by Frisch, Noreen Cavan, Frisch, Lawrence E. – Test Bank

CHAPTER 2 PSYCHIATRIC NURSING

 

TRUE/FALSE

 

  1. In nursing schools in the late 19th century and early 20th century in this country, nurses for clients with medical problems and nurses for clients with mental problems were usually educated separately.

 

ANS:  T                    PTS:   1

 

  1. In the 19th century, nurses who were trained to work with people who were physically ill had nurses as teachers, while those nurses who were trained to work with people who were mentally ill had physicians as teachers.

 

ANS:  T                    PTS:   1

 

  1. Various societies at times throughout history have treated people who were mentally ill with reverence.

 

ANS:  T                    PTS:   1

 

  1. Mental illness has always been viewed as an illness or a disease.

 

ANS:  F                    PTS:   1

 

  1. The term lunatic came from the idea in the Middle Ages and Renaissance that the lunar body controlled people who are mentally ill.

 

ANS:  T                    PTS:   1

 

  1. People who were mentally ill in the Middle Ages and Renaissance period were treated with kindness.

 

ANS:  F                    PTS:   1

 

  1. Insulin shock for the treatment of mental illness was used only in Europe and not in the United States.

 

ANS:  F                    PTS:   1

 

  1. Advances in neuroscience most likely will eliminate the need for psychiatric nurses and their work with communities and individuals to assess dysfunction and assist clients in the area of improved coping skills.

 

ANS:  F                    PTS:   1

 

COMPLETION

 

  1. The theory that a source of infection causes insanity and that removal of the infection can cure the person is known as the ____________________ Theory.

 

ANS:  Septic Foci

 

PTS:   1

 

  1. The theory that persons are mentally ill by virtue of having bad character is known as the ____________________ Theory.

 

ANS:  Moral Degeneracy

 

PTS:   1

 

  1. The theory that dirt and putrefaction are the principal causes of ill health, and that justified removing people who were ill or insane from the rest of society, is known as the ____________________ Theory.

 

ANS:  Miasmic

 

PTS:   1

 

MULTIPLE CHOICE

 

  1. Hippocrates and the Greeks and Romans of his time believed that emotional stability was influenced by:
a. family interaction
b. sin, God, and the devil
c. blood, bile, and phlegm
d. sloth and wastefulness

 

 

ANS:  C

The Greek and Roman cultures developed the idea of “humors”: blood, black bile, yellow bile, and phlegm. Hippocrates believed that excesses of black bile caused melancholy. Through bloodletting, the excess could be removed. This was a primitive treatment of mental illness.

 

PTS:   1                    DIF:    Knowledge    REF:   Care of the Mentally Ill| Early Civilization

 

  1. In the Middle Ages and Renaissance, mental illness was viewed with:
a. fear
b. indifference
c. repulsion
d. reverence

 

 

ANS:  A

During the Middle Ages and Renaissance, mental illness was viewed with fear. Affected individuals were thought to be influenced by the moon.

 

PTS:   1                    DIF:    Knowledge

REF:   Care of the Mentally Ill| Middle Ages and Renaissance

 

  1. William Battie is recognized in the history of care for people who were mentally ill for the:
a. belief in the contamination theory of mental illness
b. idea that body “humors” influence emotional states
c. idea that attendants and nurses should be carefully trained
d. insistence on privatized care for people who are mentally ill

 

 

ANS:  C

William Battie recommended that those who worked as attendants and nurses to people who were mentally ill should be carefully selected and trained. He believed that demonstrating a caring attitude was an important aspect of treatment.

 

PTS:   1                    DIF:    Knowledge

REF:   Care of the Mentally Ill| Eighteenth and Early Nineteenth Centuries

 

  1. Which phrase provides the BEST definition of asylums?
a. areas for basic incarceration to segregate people who are insane
b. custodial care under the direction of physicians
c. private care facilities akin to sanatoriums
d. public institutions to provide humane, rational treatment

 

 

ANS:  D

Asylums were large public institutions that were to promote human and rational methods of treatment of people who were mentally ill. They were self-sufficient communities. Everything for daily living was available on the grounds of the institution. This included laundry services, cooking facilities, and so on.

 

PTS:   1                    DIF:    Knowledge

REF:   Care of the Mentally Ill| Eighteenth and Early Nineteenth Centuries

 

  1. In the 1800s, “inmates” (clients) in asylums for people who were mentally ill often never left once they were committed, due to a number of factors that included which of the following?
a. Life in the asylum was significantly better than living in society.
b. Asylums were designed as permanent residences for people who were mentally ill.
c. Inmates who were “good” workers were needed to maintain the asylum.
d. Inmates were unable to afford to pay an attorney to have their commitment overturned.

 

 

ANS:  C

Inmates were frequently not released from the asylums because they were good workers. While they were given time to read and relax, they provided the major workforce for the daily chores to be completed at the asylums.

 

PTS:   1                    DIF:    Comprehension

REF:   Care of the Mentally Ill| Nineteenth Century

 

  1. The individual credited as an advocate for mental health reform, humane treatment, and safe environments for people who are mentally ill is:
a. Lucille Brown
b. Dorothea Dix
c. Lavinia Dock
d. Isabel Hampton Robb

 

 

ANS:  B

Dorothea Dix believed that people who are mentally ill should be treated humanely. She also believed that people who are mentally ill should be treated in a safe environment. She fought to include activities such as dance for the inmates.

 

PTS:   1                    DIF:    Knowledge    REF:   Care of the Mentally Ill| Nineteenth Century

 

  1. A popular treatment of people who were mentally ill in asylums during the first half of the 20th century was:
a. baths of different temperatures and types
b. psychotropic medication
c. individual psychotherapy
d. family therapy

 

 

ANS:  A

People who were mentally ill during the first half of the 20th century were treated with baths of different temperatures and types. Hot baths were used for melancholy, and cold baths were used for mania.

 

PTS:   1                    DIF:    Knowledge

REF:   Nursing Education| Eighteenth and Nineteenth Centuries

 

  1. Which of the following publications presented the first theoretical framework for the practice of psychiatric care?
a. Interpersonal Relations in Nursing
b. Perspectives in Psychiatric Care
c. The Dynamic Nurse-Patient Relationship
d. The Future of Nursing

 

 

ANS:  A

Hildegard Peplau published Interpersonal Relations in Nursing. This book served as the first theoretical framework for the practice of psychiatric nursing. Peplau’s framework focused on the interaction between nurse and client. She identified three phases of the relationship: introductory, working, and termination phases.

 

PTS:   1                    DIF:    Knowledge

REF:   Nursing Education| The Role of Nursing Theory and Scholarship

 

  1. Which publication was the result of work to integrate mental health principles into basic nursing curricula?
a. Interpersonal Relations in Nursing
b. Perspectives in Psychiatric Care
c. The Dynamic Nurse-Patient Relationship
d. The Future of Nursing

 

 

ANS:  D

The Future of Nursing by Lucille Brown, director of the Department of Studies in the Professions at Russell Sage Foundation, was the result of work to integrate mental health principles into basic nursing curricula. Through the years, this document has come to be known as the Brown Report. Brown recommended that psychiatric hospitals should not conduct their own schools, but should develop affiliation agreements with nursing-established programs.

 

PTS:   1                    DIF:    Knowledge

REF:   Nursing Education| The Role of Nursing Theory and Scholarship

 

  1. Which statement reflects the current perspective of psychiatric nursing?
a. Psychiatric nurses don’t do real nursing.
b. Psychiatric nursing is a new area of interest.
c. Psychiatric nursing is a specialty within nursing.
d. Psychiatric nursing is the only area of nursing with standards of practice.

 

 

ANS:  C

The current perspective of psychiatric nursing is that it is a specialty within nursing. This specialty includes subspecialties for advance practice registered nurses. Subspecialties focus on such areas as mental health services for the child, adolescent, adult, elderly, and the patient who is chronically ill, to name a few.

 

PTS:   1                    DIF:    Comprehension

REF:   Nursing Education| The Role of Nursing Theory and Scholarship

 

  1. Under whose leadership was psychiatric nursing included in the training of general nurses in the 20th century?
a. Dorothea Dix
b. Effie Taylor
c. Edward Cowles
d. Hildegard Peplau

 

 

ANS:  B

Effie Taylor, the nursing director of the Phipps Clinic at Johns Hopkins was the first director to include psychiatric nursing practice into a nursing school’s curricula. All students were trained in the care of people who were mentally ill.

 

PTS:   1                    DIF:    Knowledge    REF:   Nursing Education| Twentieth Century

 

  1. In 1955, what organization first required that nursing programs include theory and clinical experiences in psychiatric nursing to receive national accreditation?
a. The Joint Commission, formerly known as the Joint Commission on Accreditation of Hospitals (JCAHO)
b. American Hospital Association
c. American Nurses Association
d. National League for Nursing

 

 

ANS:  D

The National League for Nursing mandated that theory and clinical experiences were a requirement for a school of nursing to be nationally accredited. This ruling ensured that graduates from accredited programs were educationally prepared to provide appropriate nursing care for persons who were mentally ill.

 

PTS:   1                    DIF:    Knowledge    REF:   Current Trends and Issues| Table 2-2

 

  1. The basic-level psychiatric mental health nurse is one who has demonstrated clinical skills within the specialty of psychiatric nursing, and whose education is at least at which of the following levels?
a. licensed practical nursing
b. associate degree
c. baccalaureate degree
d. master’s degree

 

 

ANS:  C

The education for the basic-level of psychiatric nursing is the baccalaureate degree. Graduates of this degree have both theoretical and practical knowledge in the treatment of people who are mentally ill.

 

PTS:   1                    DIF:    Comprehension                              REF:   Current Trends and Issues

 

  1. At the basic level of practice of psychiatric nursing, the nurse is qualified to:
a. diagnose mental disorders using the DSM-IV
b. assist clients to regain or improve coping
c. treat mental disorders
d. prescribe simple medications under supervision

 

 

ANS:  B

Nurses at the basic level of psychiatric nursing are qualified to assist clients who are mentally ill to regain or improve coping. These nurses work with individuals, families, communities, and groups to promote health. They are able to assess dysfunction while assisting the client to regain or improve coping and prevent further disability.

 

PTS:   1                    DIF:    Comprehension

REF:   Psychiatric Mental Health Nursing: Areas of Practice: Basic Level Functions

 

  1. At the advanced practice level of psychiatric nursing, the nurse has skills beyond basic nursing. The advanced practice nurse has skills in:
a. diagnosis and treatment
b. psychoanalysis
c. positron emission tomography (PET) scanning
d. psychological testing

 

 

ANS:  A

At the advanced practice level, the nurses may focus on the full range of activities from mental health promotion to illness care. Their additional education provides them with the skills needed for diagnosis and treatment of mental disorders. In many states, APRNs have prescriptive authority for drugs.

 

PTS:   1                    DIF:    Comprehension

REF:   Psychiatric Mental Health Nursing: Areas of Practice: Advanced Level Functions

 

  1. You notice in the chart that a nurse’s name is followed by the letters “APRN.” To qualify for these letters, the nurse must be certified at a national level and has to have at least which of the following levels of education?
a. associate degree
b. baccalaureate degree
c. master’s degree
d. doctoral degree

 

 

ANS:  C

An advanced practice registered nurse (APRN) is a licensed registered nurse with at least a master’s degree preparation. According to the American Nurses Association (ANA) Standards of Practice, APRNs must have psychiatric nursing training and be nationally certified as a clinical specialist in psychiatric mental health nursing. Some psychiatric APRNs are certified as nurse practitioners.

 

PTS:   1                    DIF:    Comprehension

REF:   Current Trends and Issues: Mental Health Advanced Practice Registered Nurse

 

  1. According to the American Nurses Association (ANA) Standards of Practice, the psychiatric mental health nurse focuses on the:
a. diagnosis of psychiatric disorders
b. diagnosis of human responses to mental problems
c. treatment of client social welfare problems
d. treatment of biochemical disorders

 

 

ANS:  B

According to the American Nurses Association (ANA) Standards of Practice, the psychiatric mental health nurse focuses on the diagnosis of human responses to mental illness. Their patients include individuals, families, groups, and communities. Issues related to all levels of prevention can be addressed by the psychiatric mental health nurse.

 

PTS:   1                    DIF:    Comprehension                              REF:   Current Trends and Issues

 

  1. Which of the following concerns is considered a major contemporary issue that requires the psychiatric mental health nurse to address both psychiatric mental health issues and larger social issues?
a. addictions
b. aging
c. chronic illness
d. schizophrenia

 

 

ANS:  A

Addiction is a major contemporary issue of concern to both psychiatric nursing and society. Other issues of major concern include domestic violence, homelessness, and poverty. Funding to address these issues has not been sufficient. These issues are among the priority issues to be addressed according to Healthy People 2010.

 

PTS:   1                    DIF:    Knowledge    REF:   Future Directions

 

  1. Case management for persons who are demented and live alone is one of the roles of which type of psychiatric nurse?
a. day-care center director
b. psychiatric unit nurse
c. home health psychiatric nurse
d. advanced practice nurse

 

 

ANS:  C

Home health psychiatric nurses are involved in case management for persons who are demented and live alone. Services provided by home health psychiatric nurses include primary prevention, secondary prevention, and tertiary prevention.

 

PTS:   1                    DIF:    Comprehension

REF:   Future Directions| Community-Based Roles in Psychiatric Nursing

 

  1. According to the American Nurses Association, “Behaviors and mental states that indicate the client is a danger to self or others or has severe disability” are considered to be:
a. something only advanced practice nurses can deal with
b. phenomena of concern for the psychiatric mental health nurse
c. outside the scope of the psychiatric mental health nurse
d. best treated by medication and restraints if needed

 

 

ANS:  B

A major phenomena of concern for the psychiatric mental health nurse is the assessment of behaviors and mental states that indicate the client is a danger to him- or herself, is a danger to others, or has severe disability. If one of these three situations exist, the client may be admitted on an involuntary admission in many states. The admission is focused on providing the individual with appropriate mental health care.

 

PTS:   1                    DIF:    Comprehension                              REF:   Future Directions

 

  1. The developing philosophy of managed care and cost containment is affecting current treatment of mental illness in which of the following ways?
a. Many persons with mental illness do not receive treatment.
b. Almost all persons treated for mental illness receive adequate care.
c. Persons discharged from short-term hospital stays receive appropriate follow-up care.
d. Limited hospitalization for stabilization on medication is the most cost-effective treatment.

 

 

ANS:  A

Many persons with mental illness do not receive treatment. The reasons include factors related to managed care and cost containment. Many persons are underdiagnosed and undertreated. Current data shows that barely half of the persons with depression receive treatment and that less than half of that treatment is judged to be adequate. In addition, length of stay in acute care settings has decreased as a direct result of reduction of funding for mental health treatment. However, recently legislation addressing mental health parity has been passed in some states.

 

PTS:   1                    DIF:    Comprehension                              REF:   Future Directions

 

  1. Delivery of mental health nursing care in the future will MOST likely:
a. be offered only as part of short-term, acute-care inpatient treatment programs
b. require advanced practice credentialing as the entry level
c. focus exclusively on prevention programs
d. occur in community-based settings that require nurses to perform a variety of roles

 

 

ANS:  D

In the future the majority of mental health care will occur in community-based settings. These settings include schools, homes, religious institutions, and halfway houses. A major focus will be on primary prevention of mental illness. Issues related to secondary and tertiary prevention will also be addressed.

 

PTS:   1                    DIF:    Comprehension                              REF:   Future Directions

 

  1. In 1963, which major piece of legislation regarding care of people who are mentally ill was passed?
a. The Brown Report
b. The National Mental Health Act
c. The Community Mental Health Centers Act
d. The Mental Health Parity Act

 

 

ANS:  C

In 1963, the Community Mental Health Centers Act was passed. The act was part of President John F. Kennedy’s New Frontier. The act supported the notion of the “least restrictive environment” for the treatment of mental illness. This was the beginning of deinstitutionalization.

 

PTS:   1                    DIF:    Knowledge    REF:   Nursing Education| Twentieth Century

 

  1. Ida Jean Orlando is noted for publishing which document in 1961?
a. Perspectives in Psychiatric Care c. Interpersonal Relationships in Nursing
b. The Dynamic Nurse-Patient Relationship d. Mental Health Services and Practice

 

 

ANS:  B

In 1961, Ida Jean Orlando published The Dynamic Nurse-Patient Relationship. It was the culmination of a 5-year project funded by the National Institute of Mental Health (NIMH). Factors that supported or impeded the integration of mental health principles into basic nursing curricula were identified.

 

PTS:   1                    DIF:    Knowledge

REF:   Nursing Education| The Role of Nursing Theory and Scholarship

 

 

CHAPTER 16 THE CLIENT WHO IS SUICIDAL

 

TRUE/FALSE

 

  1. Suicide attempts are more common in women than in men.

 

ANS:    T                           PTS:     1

 

  1. Women are more likely to successfully complete suicide than men are.

 

ANS:    F                           PTS:     1

 

  1. There is an increased risk of suicide in clients with a psychiatric diagnosis compared to clients without a psychiatric diagnosis.

 

ANS:    T                           PTS:     1

 

  1. In comparison to people who have not been diagnosed as schizophrenic, people with a diagnosis of schizophrenia are more likely to tell others of their intentions when they are suicidal.

 

ANS:    F                           PTS:     1

 

  1. People with depression often attempt suicide, but rarely complete suicide.

 

ANS:    F                           PTS:     1

 

  1. Adolescents who attempt suicide with drug ingestion typically do so in the presence of others.

 

ANS:    T                           PTS:     1

 

COMPLETION

 

  1. An act of killing or permitting a death for reasons of mercy is called ____________________.

 

ANS:    euthanasia

 

PTS:     1

 

  1. The age group in which suicide is the third leading cause of death is ages ____________________ to ____________________.

 

ANS:

15, 24

fifteen, twenty-four

 

PTS:     1

 

MULTIPLE CHOICE

 

  1. As a nurse working with a group of males over age 65, you would keep in mind factors that bring an increased risk of suicide. Which of the following factors would you associate with the highest risk of suicide in the male population over age 65?
a. occupation
b. divorce
c. marriage
d. income

 

 

ANS:    B

Divorce in males over age 65 was the major factor associated with the highest risk of suicide. The loss of a spouse through death or divorce can leave the client experiencing grief and loss, which in turn can cause depression.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics

 

  1. Suicidal deaths are probably underreported for which of the following reasons?
a. Many accidents are misclassified as nonsuicidal.
b. Suicide is a crime.
c. Insurance companies do not investigate accidents.
d. Families obscure the details about suicidal intent of the family member.

 

 

ANS:    A

Suicidal deaths are probably underreported because some deaths attributed to accidental causes are likely self-inflicted. One study found that nearly 15% of actual suicides were misclassified as nonsuicidal in official death reports. The World Health Organization (WHO) reports that suicide rates may be significantly underreported depending on the processes used by each reporting country.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Suicide or Accident

 

  1. Which of the following principles should the nurse consider when planning nursing care for a client who was admitted to the hospital after a suicide attempt?
a. Clients who attempt suicide and fail are likely to try again.
b. People who attempt suicide and fail do not really want to die.
c. People who talk about suicide are less likely to attempt it.
d. Once in the hospital, clients seldom commit suicide.

 

 

ANS:    A

Nurses caring for clients admitted after a suicide attempt would recognize that these clients are likely to try again. In short, a previous suicide attempt puts an individual at very significantly increased risk for subsequent completed suicides.

 

PTS:     1                           DIF:      Application       REF:     Planning/Intervention| Secondary Prevention

 

  1. Suicidal ideation is defined as:
a. thoughts about wanting to die
b. thoughts with at least one attempt
c. attempts that are unsuccessful
d. attempts using nonlethal methods

 

 

ANS:    A

Suicidal ideation is thoughts about wanting to die. Many individuals have thoughts or ideas of suicide but never attempt it.

 

PTS:     1                           DIF:      Knowledge

REF:     Prevalence of Suicide and Related Statistics| Suicidal Ideation

 

  1. Which of the following available suicide methods is the MOST lethal?
a. bottle of whiskey
b. shoelaces
c. full bottle of Prozac
d. loaded gun

 

 

ANS:    D

The most lethal method of suicide is the use of a loaded gun. Firearms are used by the majority of persons, particularly younger adults who successfully complete a suicide.

 

PTS:     1                           DIF:      Knowledge

REF:     Prevalence of Suicide and Related Statistics| Methods

 

  1. Suicide is associated with psychiatric illness in which of the following ways?
a. People who successfully commit suicide usually have a psychiatric diagnosis.
b. Clients with a psychiatric diagnosis are at increased risk for suicide.
c. People with depression are at lower risk for suicide.
d. Clients with a psychiatric diagnosis who attempt suicide are likely to be successful.

 

 

ANS:    B

Individuals with a psychiatric diagnosis are at increased risk for suicide. An early Swedish study found that 93% of persons who completed suicide had previously received some kind of psychiatric diagnosis. Most studies suggest that depression is commonly associated with both completed suicides and suicide attempts. Psychiatric conditions that have high incidence of suicide include depression (both uipolar and bipolar), schizophrenia, alcoholism, drug abuse, panic disorder, personality disorders, and obsessive-compulsive disorder.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Suicide and Psychiatric Illness

 

  1. Assessment for risk to attempt suicide includes assessing for evidence of psychiatric illness, degree of impulse control, and:
a. religious baptismal denomination
b. highest grade completed in formal education
c. frequency of interfaith dating and marriage
d. philosophical beliefs related to ending one’s own life

 

 

ANS:    D

Assessment for risk to attempt suicide includes assessing for evidence of psychiatric illness, the degree of impulse control, and the individual’s philosophical beliefs related to ending one’s own life. Some individuals believe that it is ethically acceptable to end an unsatisfactory life. They may view the self and life as empty, worthless, and hopeless. For some, suicide is thought to be an acceptable escape from the stressors encountered.

 

PTS:     1                           DIF:      Application

REF:     Prevalence of Suicide and Related Statistics| Suicide and Psychiatric Illness

 

  1. Recent studies suggest that clients with a diagnosis of bipolar illness, formerly called manic-depressive illness, will:
a. rarely contemplate the idea of suicide during their lifetime
b. think about suicide, but not carry out any of their suicidal ideas
c. attempt suicide sometime during their lives at a rate between 25% and 50%
d. have a lower rate of suicide than clients with any other psychiatric diagnosis

 

 

ANS:    C

Recent studies suggest that clients with a diagnosis of bipolar illness attempt suicide sometime during their lives at a rate between 25% and 50%. These rates tend to be higher for women than for men. A current report indicates that 1 in 100 persons with bipolar disorder will make a suicide attempt and 3 in 1,000 people with bipolar disorder will die through suicide annually, making their rate 20 times higher than that of the general population. Several studies suggest that persons with bipolar I disorder combined with hypomania are at higher risk for suicide attempt than are persons with bipolar I disorder.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Bipolar Disorder

 

  1. Suicide among persons with schizophrenia often occurs because they are:
a. undereducated
b. socially isolated
c. involuntarily confined
d. likely to tell others

 

 

ANS:    B

Suicide among persons with schizophrenia often occurs because they are socially isolated. Being socially isolated, the individual with schizophrenia is unable to develop health interpersonal relationships or an adequate support system. The isolation may create a sense of hopelessness and helplessness.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Schizophrenia

 

  1. Alcohol influences suicide risk by:
a. decreasing decision-making time
b. decreasing the lethality of the methods
c. increasing the number of attempts
d. increasing the inhibitions

 

 

ANS:    A

Alcohol influences suicide risk by decreasing decision-making time. Alcohol may be importantly involved in suicides that are impulsive and violent. One study in the 1980s found that 40% of persons attempting suicide acted within 5 minutes of considering self-harm. Such rapid decision making may be highly influenced by alcohol and other substances.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Alcohol and Substance Abuse

 

  1. Which of the following combinations is significantly associated with the frequency and severity of suicide attempts among adolescents?
a. schizophrenia, depression, and alcohol abuse
b. conduct disorder, depression, and substance abuse
c. schizophrenia, alcohol abuse, and school phobia
d. antisocial personality disorder, mania, and alcohol abuse

 

 

ANS:    B

Although conduct disorder may be one of the most common psychological findings among adolescent suicide victims, the not unusual combination of conduct disorder, depression, and substance abuse is significantly associated with the frequency and severity of suicide attempts. Completed suicide in this group was found to be associated with access to firearms.

 

PTS:     1                           DIF:      Analysis

REF:     Prevalence of Suicide and Related Statistics| Conduct Disorder

 

  1. Suicide is a high risk among clients with dual diagnoses. Which of these dual diagnoses, when linked with suicidal intention, is considered part of the “deadly triangle” in the elderly?
a. alcohol abuse and panic disorder
b. schizophrenia and drug abuse
c. depression and alcohol abuse
d. bipolar disorder and drug abuse

 

 

ANS:    C

Osgood described the combination of alcoholism, depression, and suicide as the “deadly triangle.” The combination of depression and alcohol abuse is particularly lethal among older individuals.

 

PTS:     1                           DIF:      Analysis

REF:     Prevalence of Suicide and Related Statistics| Mixed Diagnoses

 

  1. The best evidence supporting a link between suicide and the medical conditions of epilepsy, dementia, cerebrovascular disease, multiple sclerosis, head injury, and brain tumor is that these conditions:
a. involve diminished functioning
b. do not respond quickly or well to current treatment
c. involve brain centers that affect judgment and mood
d. are incurable diseases

 

 

ANS:    C

Suicidal ideations and risk for suicide is perhaps higher among persons with chronic medical conditions, especially those that result in pain, serious risk to life, or severe physical limitations. The best evidence supports a link between suicide and the following conditions: epilepsy, cerebrovascular disease, dementia, multiple sclerosis, head injury, and brain tumor. In all of these conditions brain centers affecting impulse, judgment, or affect might be involved. Two other conditions that appear to have increased suicide rates, lupus and Huntington’s disease, may likewise affect both mood and overall cerebral functioning.

 

PTS:     1                           DIF:      Analysis

REF:     Prevalence of Suicide and Related Statistics| Mixed Diagnoses| Medical Conditions and Suicide

 

  1. Emile Durkheim argued in his book Suicide that only social factors could explain suicide. In Durkheim’s view, suicide often occurs because society fails to either control individual impulses or:
a. provide an individual with a sense of individual identity in the crowd
b. allow individuals a sense of social connectedness and hope
c. give its members freedom to be autonomous and make individual choices
d. provide a safe haven for those who have nontraditional beliefs about death

 

 

ANS:    B

According to Durkheim, suicide often occurs because society fails to either control individual impulses or allow individuals a sense of social connectedness and hope. He suggests that stronger social controls result in lower suicide rates. However, he also postulates that too much or too little social integration can also result in risks for suicide.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Sociological Theory

 

  1. Edwin Schneidman wrote about three factors affecting suicidal ideation. These three factors included pain, perturbation, and which of the following factors?
a. press
b. distress
c. depression
d. biology

 

 

ANS:    A

According to Schneidman, pain, perturbation, and press affect suicidal ideation. Press is a concept describing the various stresses or pressures on an individual. Pain is viewed as a psychological phenomenon but is unlikely to exclude physical pain. Perturbation means the amount of emotional distress reflected in the presence or absence of impulse control.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Psychological Theory

 

  1. Schneidman’s term perturbation means the amount of:
a. stress or social pressures felt by an individual in society
b. disconnectedness or connectedness felt by an individual in his or her family of origin
c. turbulence in the mind compared to the turbulence occurring in the body
d. emotional distress reflected in the presence or absence of impulse control

 

 

ANS:    D

According to Schneidman, perturbation, pain, and press affect suicidal ideation. Schneidman’s term perturbation means the amount of emotional distress reflected in the presence or absence of impulse control. Pain is viewed as a psychological phenomenon but is unlikely to exclude physical pain. Press is a concept describing the various stresses or pressures on an individual.

 

PTS:     1                           DIF:      Knowledge      REF:     Theories of Suicide| Psychological Theory

 

  1. The Depression Paradox Theory of Suicide postulates that suicide results from a conflict between:
a. helplessness and responsibility
b. hopelessness and initiative
c. success and failure
d. perturbation and press

 

 

ANS:    A

The Depression Paradox Theory of Suicide postulates that suicide results from a conflict between helplessness and responsibility. The person may be caught between strong feelings of helplessness and equally strong feelings of responsibility. The bind generated by this conflict between feeling responsible and helpless may lead people to feel that only suicide gives them a way out of their troubles.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Psychological Theory

 

  1. A biological theory to explain suicide may emerge from the finding in several studies that those who successfully commit suicide have:
a. atrophy of the brain on postmortem
b. serotonin in their bloodstream
c. abnormal electroencephalogram (EEG) readings
d. low 5-hydroxyindoleacetic acid (5-HIAA) in body fluids

 

 

ANS:    D

A biological theory to explain suicide may emerge from findings in several studies that those who successfully commit suicide have low 5-hydroxyindoleacetic acid (5-HIAA) in body fluids. In general 5-HIAA levels in assayable body fluids are thought to reflect levels of brain serotonin, an important monoamine brain neurotransmitter. Serotonin is readily metabolized to 5-HIAA, which circulates in blood and cerebrospinal fluid. Multiple studies suggest that a subset of suicide attempters and completers, perhaps particularly those who use violent means of self-destruction, have very low 5-HIAA. This would support the possibility that there was a low level of serotonin in the brain.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Biological Explanations

 

  1. A client provides his family history, which includes that his mother has experienced suicidal ideation herself in the past. The nurse’s assessment is guided by the knowledge that the risk of suicide is even greater:
a. when a parent makes multiple overt threats of suicide without actually attempting suicide
b. if the child was adopted at birth by a parent who later attempts suicide
c. in families where relatives have completed suicide
d. for people who have a low frequency of the “SS” form of a serotonin transporter gene

 

 

ANS:    C

The nurse’s assessment is guided by the knowledge that the risk of suicide is greater in families where relatives have completed suicide. Studies of twins and adoptive versus biological children suggests a significant genetic influence related to suicide.

 

PTS:     1                           DIF:      Application       REF:     Theories of Suicide| Biological Explanations

 

  1. Using Hildegard Peplau’s theory of nursing, when the nurse intervenes with a client who has made a suicide attempt, the nurse MOST needs to:
a. give unconditional positive regard
b. form a significant interpersonal relationship
c. maintain the client’s level of self-esteem
d. work to get the client involved in activities

 

 

ANS:    B

There is strong evidence that one thing the nurse can do for the suicidal client is to form a significant interpersonal relationship. Early studies of persons who were hospitalized because of failed suicide attempts indicated that those clients felt isolated and ignored during their hospital stays and that their major needs were to be loved, to maintain a high level of self-esteem, to begin to have control over their lives, and to be supported.

 

PTS:     1                           DIF:      Application       REF:     Theories of Suicide| Nursing Theory

 

  1. Using Peplau’s theory, when a client has resolved his or her initial suicidal crisis, the nurse in an acute care setting will:
a. terminate the relationship, ensuring that the client has a support system
b. continue to be friends with the client as long as needed
c. provide ongoing social support until the client has a support system
d. explore an ongoing longitudinal study or extended relationship

 

 

ANS:    A

Using Peplau’s theory, when a client has resolved his or her initial suicidal crisis, the nurse in an acute care setting will terminate the relationship, ensuring that the client has a support system. The client should be able to identify when help is needed and from which resources (support system) from this help can be obtained. Because the nurse-client relationship is a professional relationship, the nurse ethically should not continue to be involved with the client in a nonprofessional manner.

 

PTS:     1                           DIF:      Application       REF:     Theories of Suicide| Nursing Theory

 

  1. Which of the following theorists provides a more comprehensive foundation and framework for all nursing care of the suicidal client?
a. Jean Watson
b. Helen Erickson
c. Rosemarie Parse
d. Hildegard Peplau

 

 

ANS:    D

Hildegard Peplau’s theory provides a foundation and framework for all nursing care of the suicidal client. Peplau’s theory focuses on the importance of the nurse-client relationship.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Nursing Theory

 

  1. Suicide attempts among adolescents MOST frequently occur in which of the following places?
a. school
b. friend’s house
c. home
d. hospital

 

 

ANS:    C

Suicide attempts among adolescents most frequently occur in the home. This is possibly because adolescent suicides frequently involve the overdose of medications or the use of guns. Both instruments are often found in the homes of these adolescents, making access easier.

 

PTS:     1                           DIF:      Comprehension

REF:     Special Populations| Adolescents and Young Adults

 

  1. A nurse who is leading a community discussion about adolescent suicide would report which of the following as the three leading causes of death among adolescents and young adults?
a. cancer, accidents, and suicide
b. heart disease, homicide, and accidents
c. homicide, accidents, and suicide
d. heart disease, cancer, and suicide

 

 

ANS:    C

A nurse leading a community discussion about adolescent suicide would report that the leading causes of death among adolescents and young adults include homicide, accidents, and suicide. Cancer and heart disease are leading causes of death for older adults.

 

PTS:     1                           DIF:      Application

REF:     Special Populations| Adolescents and Young Adults

 

  1. A nurse is working on a task force setting up a suicide prevention hotline. When gathering data to support projected numbers of calls and staffing levels, the nurse is guided by the knowledge that suicide rates of adolescents and young adults:
a. are inversely related to homicide rates
b. correspond to homicide rates
c. do not predictably relate to homicide rates
d. equal homicide rates of 3 months earlier

 

 

ANS:    A

In determining the projected numbers of calls and staffing levels for a suicide prevention hotline, the nurse is guided by the fact that suicide rates of adolescents and young adults are inversely related to homicide rates. Geographic regions with low suicide rates tend to have high homicide rates, and regions with high suicide rates tend to have lower homicide rates.

 

PTS:     1                           DIF:      Application

REF:     Special Populations| Adolescents and Young Adults

 

  1. An advanced practice nurse is working with a middle-aged client who attempted suicide in her teens by ingestion of drugs. The nurse’s periodic assessments of this client’s suicide risk are guided by the knowledge that research has shown which of the following?
a. The risk of completed suicide steadily decreases over 4 decades after the initial attempt.
b. Suicide attempts by ingestion of drugs rarely reflects true suicidal ideation.
c. This client carries a significant lifetime risk of completed suicide.
d. Suicide attempts by adolescents are not valid predictors of completed suicide in later life.

 

 

ANS:    C

Periodic assessments of a client who previously attempted suicide is guided by the knowledge that research has shown that these clients carry a significant lifetime risk of completed suicide. If the underlying reason for the attempt has not been addressed, the client may remain vulnerable and use the same ineffective coping strategies when faced with stressful situations in the future. The ultimate escape from the problem could result in a completed suicide.

 

PTS:     1                           DIF:      Application

REF:     Special Populations| Adolescents and Young Adults

 

  1. In a study by Chesley and Loring-McNulty (2003), the factor MOST mentioned by survivors of suicide attempts as preventing current suicidal behaviors was:
a. treatment by a health care professional
b. anger at having survived
c. belief that the suicide attempt was a sin
d. the stigma of having attempted suicide

 

 

ANS:    A

According to Chesley and McNulty (2003), the study participants mentioned most frequently treatment by a health care professional was the factor that prevented current suicidal behaviors and was also identified as a coping strategy. The participants also stated that they were grateful to have survived their suicidal attempts.

 

PTS:     1                           DIF:      Comprehension

REF:     Special Populations| Personality Traits and Suicide in Patients 50 Years and Older

 

  1. Isolation and loneliness are associated with increased risk for suicide among the elderly. Which of the following interventions has been shown by research to be effective in reducing loneliness?
a. 24-hour suicide hotlines
b. pet ownership and visitation
c. adult day-care centers
d. other residents in the nursing homes

 

 

ANS:    B

Pet ownership and visitation has proven to be effective in reducing loneliness in the elderly. There is a developing nursing role in activities that serve as preventive efforts for the elderly. These include increasing participation in adult day care and other socialization activities, increasing pet ownership and pet visitation programs, and actively seeking and treating depression in the elderly. These nursing strategies help reduce loneliness and increase socialization.

 

PTS:     1                           DIF:      Application

REF:     Special Populations| Personality Traits and Suicide in Patients 50 Years and Older

 

  1. The suicide rate for incarcerated persons compared to the general population has been found to be:
a. lower
b. about the same
c. somewhat higher
d. much higher

 

 

ANS:    D

The suicide rate for incarcerated persons is much higher than for the population as a whole. Suicide events are much more common in local jails and holding facilities than they are in prisons.

 

PTS:     1                           DIF:      Comprehension

REF:     Special Populations| The Incarcerated and Military Combatants

 

  1. As a nurse working in a local jail or a holding facility for prisoners, you would keep in mind that compared to suicide events in prisons, suicide events in this type of facility occur:
a. less often
b. at the same rate
c. slightly more often
d. much more often

 

 

ANS:    D

As a nurse working in a local jail or holding facility for prisoners, the nurse would recognize that suicides occur much more often in these facilities than in prisons. Suicide rates in federal and state prisons are generally not much different than those in the general population.

 

PTS:     1                           DIF:      Application

REF:     Special Populations| The Incarcerated and Military Combatants

 

  1. You are a nurse working in a local jail. One of the guards informs you that a recent admission is a middle-aged man accused of molesting a child and who has a psychiatric history. The guard suggests a psychiatric evaluation on this inmate. Which of the following actions would be of top priority on your part?
a. sorting out your feelings about child molestation before working with this client
b. asking this client if he has thought about killing himself
c. requesting the guard to keep an eye on the client until a psychiatrist comes to do the evaluation
d. complete routine work so you can spend a block of time doing a full assessment on this client

 

 

ANS:    B

The priority action for the nurse would be to ask the client if he has thought about killing himself. The nurse must first identify whether there are suicidal thoughts. If the client acknowledges having suicidal thoughts, the nurse’s next approach would be to determine if the individual has a plan and if he has the means to execute the plan. This information will help the nurse to determine lethality of a suicidal risk.

 

PTS:     1                           DIF:      Analysis

REF:     Special Populations| The Incarcerated and Military Combatants

 

  1. The population that has the lowest suicide rate is:
a. peace-time military personnel
b. general population
c. war-time military personnel
d. incarcerated persons

 

 

ANS:    A

Suicide risk among soldiers during peacetime is generally somewhat lower than that in the age and sex-matched general population. Incarcerated persons and war-time military personnel tend to have a higher suicide rate than the general population.

 

PTS:     1                           DIF:      Comprehension

REF:     Special Populations| The Incarcerated and Military Combatants

 

  1. In response to a critical incident of suicide on an inpatient unit, research identifies which response as MOST desired by psychiatric nurses?
a. informal discussion among themselves
b. formal debriefing and counseling
c. short-term medication
d. time off to individually process the event

 

 

ANS:    B

The research conducted by Joyce and Wallbridge (2003) revealed that psychiatric nurses expressed the need to use services such as debriefing and counseling when having experienced a critical incident of suicide on their unit. The researchers identified a need for training, availability, and flexibility of providing such services to nurses in psychiatric care.

 

PTS:     1                           DIF:      Application

REF:     Suicide Survivors| Antidepressants and Suicide| Research Highlights the Effect of Suicidal Behavior on a Psychiatric Unit Nursing Team| Implications

 

  1. A hospice client requests physician assistance to commit suicide. The hospice nurse’s assessment of the client’s mental status is guided by the knowledge that research data indicates that the client’s request is MOST likely an expression of:
a. clinical depression
b. feeling unworthy of living
c. retaining control over end-of-life
d. euphoric desire to “cross over”

 

 

ANS:    C

Hospice clients who requested assistance with suicide were most concerned with retaining control over the end of their lives. However, in 2001, the attorney general asserted that the use of controlled substances for assisting suicide was a violation of controlled substances regulations. With the Death with Dignity Act in question, assisted suicides remain illegal.

 

PTS:     1                           DIF:      Analysis             REF:     Suicide Survivors| A Discussion of Euthanasia

 

  1. You are giving a flu-prevention injection to a woman who shares with you that she lost her husband 2 years ago when, after discovering he had cancer, he committed suicide by carbon monoxide poisoning in their garage. This widow appears angry. She tells you that she still blames herself for not preventing her husband’s death by being home that day. Which of the following interventions would be the MOST helpful at this time?
a. Explain that she should be over the loss by this time.
b. Tell her that she was not to blame, because he would have committed suicide even if she were home.
c. Offer information about community resources and available groups for suicide survivors.
d. Let her express her anger, and reassure her that her angry feelings will go away.

 

 

ANS:    C

The most appropriate and helpful intervention would be for the nurse to offer information about community resources and available groups for suicide survivors. The groups will provide the wife with the opportunity to express her feelings regarding her husband’s suicide. Group meetings will also provide her an opportunity to address her own guilt feelings.

 

PTS:     1                           DIF:      Application       REF:     Suicide Survivors

 

  1. The nurse suspects that a client with depression and breast cancer has been hoarding her pain and sleeping medication. Which of these nursing actions is the BEST choice?
a. Confront the client with suspicions about the medication.
b. Withhold her medications, and discuss the situation with her provider tomorrow.
c. Allow this client the freedom to make choices regarding her own life.
d. While the client is at her radiation therapy, conduct a thorough search of her belongings.

 

 

ANS:    A

The most appropriate action for the nurse to take is to confront the client. Individuals with medical conditions are at risk for developing depression and contemplating suicide. The suicide rate of clients with cancer is probably elevated, particularly in the first year after diagnosis. The nurse would recognize this risk and use confrontation in an attempt to provide a safe environment for the client and prevent suicide attempts.

 

PTS:     1                           DIF:      Application

REF:     Prevalence of Suicide and Related Statistics| Medical Conditions and Suicide

 

  1. After several weeks of antidepressants, which of the following signs is MOST predictive of suicide in the client who was diagnosed with depression?
a. fatigue
b. insomnia
c. cheerful new energy
d. lack of social support

 

 

ANS:    C

After several weeks of antidepressant therapy, a cheerful new energy is most predictive of suicide in clients who have been diagnosed with depression. During depression, these individuals lacked the energy to commit suicide. However after treatment, they have the energy to complete a suicide. Warning signs include the giving away of personal items.

 

PTS:     1                           DIF:      Analysis             REF:     Nursing Care| Assessment

 

  1. The nurse is working with a hospitalized client who does not participate in her treatment plan. This client is asked to sit down to talk with the nurse. The client states, “I am all alone since my husband died. I cannot understand why he had to die. What reason is there to try to get well? I don’t want to see the hospital chaplain or the pastor. They keep bothering me. It doesn’t matter anyway. I’ve become empty and weak inside.” The nurse selects which nursing diagnosis?
a. Spiritual Distress
b. Powerlessness
c. Hopelessness
d. Helplessness

 

 

ANS:    A

The most appropriate diagnosis for clients who feel empty and weak inside and refusing to see a chaplain or pastor is Spiritual Distress. Spiritual distress is a disruption in the client’s belief system.

 

PTS:     1                           DIF:      Analysis             REF:     Nursing Diagnosis

 

  1. An elderly client returned home from the hospital after surgery in which he was diagnosed with liver cancer. After returning home, he became increasingly depressed. He was readmitted to the hospital when his wife found him unconscious after taking sleeping pills and alcohol. Which of the following client outcomes should the nurse establish for him as a priority? The client will:
a. remain safe while in the hospital
b. discuss his prognosis with the nurse
c. list reasons why he does not want to live
d. discuss his prognosis with his wife

 

 

ANS:    A

The priority outcome for a client after a suicidal attempt would be to remain safe while in the hospital. Client safety is always a priority.

 

PTS:     1                           DIF:      Analysis             REF:     Outcomes

 

  1. Which of the following nursing activities would BEST represent primary prevention of suicide?
a. discussion with clients who are suicidal about the impact of suicide on their families
b. getting clients with suicidal ideation to list reasons to live
c. educating persons with depression about suicide
d. educating the general public about suicide

 

 

ANS:    D

Educating the general public about suicide is an example of primary prevention. Primary prevention describes preventive activities applied to the whole population, regardless of demonstrable risk factors. The other options deal with situations where a disease has already occurred and are not considered examples of primary prevention.

 

PTS:     1                           DIF:      Application       REF:     Planning/Intervention| Primary Prevention

 

  1. Tertiary prevention in the area of suicide is BEST represented by:
a. reduced numbers of suicidal attempts in certain populations
b. increase in education about risk factors involved in suicide
c. increase in survival rates of persons attempting suicide
d. increased hospitalization of persons with suicidal ideation

 

 

ANS:    C

Tertiary prevention in the area of suicide is best represented by an increase in survival rates of persons attempting suicide. Tertiary prevention focuses on rehabilitation and restoration. Reduced numbers of suicidal attempts in certain populations and increase in education about risk factors involved in suicide focus on primary prevention. Increased hospitalization of persons with suicidal ideation focuses on secondary prevention.

 

PTS:     1                           DIF:      Comprehension

REF:     Planning/Intervention| Tertiary Prevention

 

  1. Which of the following actions would be the strongest primary prevention deterrent to the prevalence of suicide in the population as a whole?
a. reduced accessibility of guns
b. prohibition of the sale of poisons
c. reduced amount of carbon monoxide in household gas
d. blocking access to high mountains

 

 

ANS:    A

Reduced accessibility of guns would be the strongest primary prevention deterrent to the prevalence of suicide in the population as a whole. Guns are the most lethal form of suicide and account for a large number of suicide deaths. While poisons are sometimes used in suicides, the number of fatalities from this source is lower that the number of fatalities from gun shots. Also, falling from high mountains is not one of the major causes of suicidal deaths.

 

PTS:     1                           DIF:      Application       REF:     Planning/Intervention| Restricting Lethal Access

 

  1. When working with a suicidal client, the nurse can reduce the risk of suicide attempts by the client BEST through which of the following actions?
a. getting the client engaged in activities during all waking hours
b. having the client increase contact with his or her family
c. having the client sign a written no-suicide contract
d. providing numbers where the client can reach the nurse 24 hours a day

 

 

ANS:    C

The nurse can reduce the risk of suicide attempts by having the client sign a written no-suicide contract. Most therapists agree that when clients readily agree to not harm themselves during a prescribed period, risk is decreased. Often such contracts are written and signed, and the clients are assured they have someone to call if they cannot bear it alone.

 

PTS:     1                           DIF:      Application

REF:     Planning/Intervention| Primary Prevention| Establishing a “Suicide Contract” or Agreement

 

  1. Nurse Amy is receiving a change-of-shift report on an inpatient psychiatric unit and learns that nurse Barbara on the previous shift negotiated a no-suicide contract with a client and increased the client’s level of restriction to the unit. Nurse Amy’s plan of care for the client is based on the understanding that these interventions indicate which of the following?
a. The client has improved ability to control impulses.
b. There is increased likelihood that the client will attempt self-harm behaviors.
c. Eventual completed suicide by this client is inevitable.
d. The client is simulating discharge conditions on a trial basis.

 

 

ANS:    B

Drew (2001) studied the use of no-suicide contracts in psychiatric inpatients units and found that clients with no-suicide contracts in and with higher levels of ward restrictions on the unit had a higher likelihood of self-harm behaviors. This research indicates that in the inpatient setting, negotiations of a contract are probably a reflection of staff assessment that the client risk of self-harm was higher.

 

PTS:     1                           DIF:      Analysis

REF:     Planning/Intervention| Primary Prevention| Establishing a “Suicide Contract” or Agreement

 

  1. The nurse has been working with a client who was admitted to the hospital after a suicide attempt by overdose. After 10 days of treatment, the provider discharges the client. Which statement by the client will indicate to the nurse that this client is ready for discharge?
a. “The next time, I’ll be careful who I tell.”
b. “I enjoy living alone, and I don’t need to socialize.”
c. “I am cured. I will never get depressed again.”
d. “I have no thoughts of suicide or plans to harm myself.”

 

 

ANS:    D

The best indication to the nurse that the client is ready for discharge is the statement, “I have no thoughts of suicide or plans to harm myself.” Saying, “The next time, I’ll be careful who I tell,” indicates that the client is possibly still having suicidal thoughts. The client’s statement about living alone indicates that the client does not understand what factors might cause him to have feelings of isolation, hopelessness, or worthlessness. The statement, “I am cured. I will never get depressed again,”is incorrect because it demonstrates that the client does not realize there is no cure for depression.

 

PTS:     1                           DIF:      Analysis             REF:     Evaluation

 

  1. The nurse evaluating the success of interventions for clients who are suicidal will look at prevention of attempts or statements by the client indicating a lessening of time where ideation is present. Which of the following would also BEST measure success of interventions for clients who are suicidal?
a. verbalized increased comfort in being alone
b. shortness of the hospital stay compared to previous stays
c. verbalized hope for the future
d. medication compliance

 

 

ANS:    C

The client verbalizing hope for the future is the best indicator that nursing interventions for a suicidal client have been successful. Clients who are suicidal tend to demonstrate symptoms of depression such as hopelessness, helplessness, and worthlessness. The nurse’s evaluation should also include monitoring the client’s view of self and life situation to assess if the factors contributing to the client’s suicidal ideations have changed in any way.

 

PTS:     1                           DIF:      Analysis             REF:     Evaluation

 

  1. Medications that have been demonstrated to reduce suicide risk include all EXCEPT which of the following?
a. antidepressants
b. atypical antipsychotics
c. lithium
d. sedative-hypnotics

 

 

ANS:    D

Medications that have been demonstrated to reduce suicide risk include antidepressants, atypical antipsychotics, and lithium. Sedative-hypnotics do not reduce the risk of suicide. These medications are sometimes taken in overdose as a method for suicide.

 

PTS:     1                           DIF:      Comprehension

REF:     Prevalence of Suicide and Related Statistics| Bipolar Disorder

 

  1. The nurse caring for a client who is depressed and suicidal would recognize that the nurse’s primary responsibility is to:
a. encourage the client to interact with others on the unit
b. support the client while maintaining a safe environment
c. involve family members in the treatment plan immediately
d. administer antidepressant medications

 

 

ANS:    B

Supporting the client while maintaining a safe environment is the primary responsibility of the nurse caring for a client who is depressed and suicidal. Involving family members, encouraging socialization, and administering medications are also nursing strategies; however maintaining safety is the priority and the nurse’s primary responsibility.

 

PTS:     1                           DIF:      Application       REF:     Nursing Care

 

  1. In a study by Clarke and von Anerom, regarding how men and women who self-identify as depressed describe their experiences on Internet blogs, the data revealed which of the following?
a. For women, suicide was a frequent topic of discussion.
b. Men are more likely than women to describe their experiences in terms of self-harm.
c. Women are more likely than men to describe violence against self.
d. Women are more likely than men to contribute depression to situations outside of their relationships.

 

 

ANS:    B

Clarke and von Anerom found that men were more likely to describe their experiences in terms of self-harm and violence against self. Men were also more likely to contribute depression outside of their relationships and immediate experiences. Also, for men, suicide was a frequent topic of discussion.

 

PTS:     1                           DIF:      Comprehension

REF:     Theories of Suicide| Biological Explanations| Research Highlights

 

CHAPTER 32 COMPLEMENTARY AND SOMATIC THERAPIES

 

TRUE/FALSE

 

  1. Somatic therapies are interventions used in the management of psychiatric symptoms.

 

ANS:  T                    PTS:   1

 

  1. The interpretation of touch has little to do with culture and family.

 

ANS:  F                    PTS:   1

 

  1. The nurse can assume that all clients like to be touched.

 

ANS:  F                    PTS:   1

 

  1. When a client is placed in restraints, he or she should be left alone to ensure privacy.

 

ANS:  F                    PTS:   1

 

  1. Nurses assisting with electroconvulsive therapy (ECT) must pad the bed of the client so the client will not hurt him- or herself during seizures.

 

ANS:  F                    PTS:   1

 

COMPLETION

 

  1. During the relaxation response, the ____________________ wave is the dominant brain wave.

 

ANS:  alpha

 

PTS:   1

 

  1. The technique of alternately tensing and relaxing muscle groups throughout the body is known as ____________________ muscular relaxation.

 

ANS:  progressive

 

PTS:   1

 

  1. The technique that produces relaxation via the stimulation of skin and surrounding tissue is called ____________________.

 

ANS:  massage

 

PTS:   1

 

  1. The basic massage movement characterized by kneading motions is called ____________________.

 

ANS:  petrissage

 

PTS:   1

 

MULTIPLE CHOICE

 

  1. Which of the following BEST defines the term complementary modalities?
a. processes of providing compliments to clients, colleagues, and administrators
b. physical alternatives for managing symptoms and maintaining functioning
c. adjunctive practices to reduce stress, enhance functioning, and promote health
d. techniques to stimulate sympathetic responses of the psychophysiological state

 

 

ANS:  C

Complementary modalities are those modalities used as an adjunct to medical care and psychiatric treatment that are thought to have effects on stress, sleep disturbance, anxiety, or other emotions. Some of the complementary modalities include relaxation techniques, imagery, hypnosis, message, music therapy, and pet therapy.

 

PTS:   1                    DIF:    Comprehension                              REF:   Competencies

 

  1. Which of the following therapies can be considered a somatic therapy?
a. cognitive-behavioral therapy
b. light therapy
c. guided imagery
d. pet-assisted therapy

 

 

ANS:  B

Light therapy (or phototherapy) is a somatic therapy for treating individuals with seasonal affective disorder (SAD). Other somatic therapies include: seclusion and restraints.

 

PTS:   1                    DIF:    Comprehension

REF:   Nursing Role in Somatic Interventions| Light Therapy

 

  1. Relaxation is BEST described as a:
a. state of mind
b. psychophysiological state
c. body response to a brain impulse
d. paranormal experience

 

 

ANS:  B

Relaxation is defined as a psychophysiological state characterized by parasympathetic dominance involving multiple visceral and somatic symptoms. Relaxation can reduce physical, mental, and emotional tension.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Relaxation

 

  1. When the parasympathetic response is activated, the person feels:
a. excited
b. elated
c. angry
d. calm

 

 

ANS:  D

The parasympathetic responses promote rest and effective digestion. In general, the parasympathetic response has the opposite effect from the sympathetic response, which promotes a feeling of flight or fight. When the parasympathetic system is activated, the alpha brain wave state is a deepened state of relaxation. Assisting the individual to achieve a relaxation state helps the individual to access inner resources that may be absent during periods of anxiety.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Relaxation

 

  1. When researching complementary therapies, beginning practitioners would correctly learn which of the following?
a. All complementary therapies are ways to reward clients for positive attributes.
b. Empirical assessment of effectiveness is easily demonstrated.
c. Effectiveness is significantly affected by the practitioner’s skill and technique.
d. Complementary therapies are samples of therapy provided free of charge.

 

 

ANS:  C

Complementary therapies require skill and knowledge for effective use. Certain complementary therapies may require additional training and possible licensure or certification by the practitioner.

 

PTS:   1                    DIF:    Comprehension                              REF:   Complementary Modalities

 

  1. Many complementary therapies use sensory mechanisms to:
a. change the client’s thinking and beliefs about illness and disability
b. alter the client’s emotions or level of consciousness toward a more calm, relaxed state
c. increase the client’s unconditional positive regard toward others
d. energize the client to more aggressively fight the underlying disease or disability

 

 

ANS:  B

Complementary therapies involve stimulation of the parasympathetic nervous systems’ responses. The parasympathetic nervous system promotes rest and relaxation and promotes a calming effect on the client.

 

PTS:   1                    DIF:    Comprehension                              REF:   Complementary Modalities

 

  1. Before being incorporated into practice, many complementary therapies require the competent practitioner to:
a. become certified in performing the specific therapy
b. complete a bachelor of science in nursing (BSN) degree
c. become licensed as a registered nurse
d. undergo psychoanalysis for a minimum of 1 year

 

 

ANS:  A

Some complementary therapies require the therapist to be certified to demonstrate that the therapist possesses the appropriate skills and knowledge. Because of the training required, the possession of a BSN or RN licensure is not sufficient. Psychoanalysis is not a requirement to perform the complementary therapies.

 

PTS:   1                    DIF:    Comprehension                              REF:   Complementary Modalities

 

  1. The complementary modality that has been shown to decrease feelings of loneliness is:
a. energy therapy
b. hypnotherapy
c. music therapy
d. pet-assisted therapy

 

 

ANS:  D

Pet therapy has proven successful in the treatment of loneliness. The animals provide for companionship, affection, and comfort to the individual.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Pet-Assisted Therapy

 

  1. The distinction between therapeutic imagery and guided imagery is that in guided imagery the:
a. practitioner leads the subject
b. process has a positive outcome
c. subject directs the process
d. thoughts are not directed

 

 

ANS:  A

Imagery involves visualizing sights, sounds, taste, touch, and smells. When the imagery is guided, the practitioner is the guide. Other forms of imagery can be initiated and controlled by the individual at his or her own discretion.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Guided Imagery

 

  1. Which of the following said by the nurse would be MOST helpful in assisting the “special place” technique of guided imagery?
a. “There’s no place like home.”
b. “Focus on the here and now.”
c. “What negative feelings are you experiencing?”
d. “How does it look and smell?”

 

 

ANS:  D

Imagery involves visualizing sights, sounds, taste, touch, and smells. Depending on which of the five senses the practitioner wants to involve, the practitioner would ask a specific question. Asking, “How does it look or smell?” stimulates two of the senses.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Guided Imagery

 

  1. Studies have shown guided imagery to:
a. be useful with psychotic persons
b. work with persons who are sexually abused
c. have little effect in work with clients who have a diagnosis of Alzheimer’s disease
d. be useful with clients undergoing uncomfortable or scary medical procedures

 

 

ANS:  D

For individuals undergoing uncomfortable or scary medical procedures, imagery can be used to promote a sense of comfort and relaxation.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Guided Imagery

 

  1. Guided imagery has been found to be helpful in which of the following conditions?
a. panic disorder
b. schizophrenia
c. labor and childbirth
d. organic brain disorder

 

 

ANS:  C

Guided imagery has been found to be helpful with women going through labor and childbirth. It has been useful in helping women to relax and in the preparation for care and management. Guided imagery has also been found to be helpful when working with people with addictions and those undergoing chemotherapy and cancer treatment.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Guided Imagery

 

  1. Which of the following BEST defines hypnotherapy?
a. an unknown state
b. a sleep state
c. a physical state
d. an altered state

 

 

ANS:  D

Hypnotherapy involves hypnosis, which is assisting the client to an altered state of consciousness to create an awareness and a directed focus experience. The word hypnosis actually refers to the induction of sleep.

 

PTS:   1                    DIF:    Knowledge    REF:   Complementary Modalities| Hypnotherapy

 

  1. Which statement BEST articulates the role of the practitioner in hypnosis?
a. adaptive
b. directive
c. mutual
d. passive

 

 

ANS:  B

The practitioner’s role in hypnosis is directive. The practitioner is active in directing the client, and the client is suggestible and in a very relaxed state during hypnosis.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Hypnotherapy

 

  1. Many studies have examined the usefulness of hypnosis in the relief of which of the following health problems?
a. bronchial asthma
b. chronic dizziness
c. pain disorders
d. systemic dermatitis

 

 

ANS:  C

Studies have examined the usefulness of hypnosis in the relief of pain disorders. Hypnosis has been found to be effective in relieving the pain associated with reproductive health and in the management of migraine.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Hypnotherapy

 

  1. The nurse may practice hypnosis when:
a. licensure laws allow it as part of nursing practice
b. advanced academic education in psychology has been undertaken
c. she or he is an advanced practice psychiatric mental-health nurse
d. the client requests that it be one of the modalities

 

 

ANS:  A

In nursing practice the use of hypnosis is governed by licensure laws in each state. Nurses who practice hypnotherapy must have formal training in the use of the modality. Most often this training is accompanied by a graduate degree and always by a period of supervised work with a faculty member who is an advanced practitioner.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Hypnotherapy

 

  1. Research published by Hawkins and Polemikos in 2002 indicates that teaching children to use self-hypnosis to manage sleeping problems:
a. is ineffective due to children being unable to learn self-hypnosis
b. paradoxically causes a hyperalert state that increases insomnia
c. is both possible and effective
d. will result in altered sleep patterns and increased nightmares

 

 

ANS:  C

The research published by Hawkins and Polemikos in 2002 indicates that teaching children to use self-hypnosis to manage sleeping problems is both possible and effective. Children can use self-hypnosis to address such sleeping problems as difficulty initiating sleep and dealing with sleep terrors.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Hypnotherapy

 

  1. Research published by Garner et al. in 2008 on the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit, revealed that massage therapy:
a. effectively eliminates both migraine and nonmigraine headaches
b. increases a person’s perception of pain and anxiety
c. triggers episodes of migraine headache
d. has immediate beneficial effects on anxiety-related measures.

 

 

ANS:  D

Garner et al. in 2008 found that massage therapy had a positive effect on the treatment of stress, anxiety, and aggression in a young adult psychiatric inpatient unit. Data revealed that massage therapy had immediate beneficial effects on anxiety-related measures (anxiety, resting heart rate, and saliva cortisol levels). Findings also indicated that massage may be a useful deescalating tool for reducing stress and anxiety in hospitalized psychiatric patients.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Massage and Touch

 

  1. As a complementary modality, massage is primarily useful to facilitate relaxation and to stimulate:
a. breathing
b. circulation
c. growth
d. libido

 

 

ANS:  B

Massage is stimulation of the skin and underlying tissues for the purpose of increasing circulation and inducing a relaxation response. Massage and the use of touch have long been a part of nursing practice. Massage techniques include the back, a very traditional part of care, and is frequently given to clients on bedrest, confined to wheelchairs, and before the hours of sleep.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Massage and Touch

 

  1. Nurses are skilled in basic massage movements, including petrissage, which is BEST described as:
a. long, soothing strokes
b. kneading motions
c. simple touch
d. percussive motions

 

 

ANS:  B

Petrissage is best described as kneading motions, which are used during a massage and used for stimulation. Effleurage are the long, soothing strokes used to increase circulation. Tapotement is stimulating rapid percussive movements.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Massage and Touch

 

  1. Which of the following BEST describes therapeutic massage?
a. the stimulation of skin and underlying tissue to increase circulation
b. a psychophysiological state with parasympathetic responses to produce relaxation
c. an extension of massage involving deep tissue and advanced techniques
d. use of energy interventions to touch the person’s energy fields for calming

 

 

ANS:  C

Therapeutic massage is an extension of massage therapy techniques involving deep tissue and advanced massage techniques. Stimulating the skin and underlying tissue to increase circulation describes a regular massage, a psychophysiological state with parasympathetic responses to produce relaxation describes hypnosis, and the use of energy interventions to touch the person’s energy fields for calming describes therapeutic touch.

 

PTS:   1                    DIF:    Knowledge    REF:   Complementary Modalities| Massage and Touch

 

  1. For most clients, touch is a mechanism of communicating which of the following messages?
a. caring
b. direction
c. knowledge
d. practice

 

 

ANS:  A

Touch is one mechanism of communicating caring. It also communicates support and nurturing to clients who feel isolated and fearful. For example, reaching out to take a client’s hand is a way to communicate caring and support.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Massage and Touch

 

  1. Before touching a client, the nurse MOST needs to do which of the following things?
a. Read the chart.
b. Check with the primary nurse.
c. Assess the client’s needs and desires regarding touch.
d. Make a care plan for the particular client in regard to touch.

 

 

ANS:  C

Before touching a client, the nurse most needs to assess the client’s needs and desires regarding touch. Touch may mean different things to individuals of different cultures.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Massage and Touch

 

  1. Clients in which of the following age ranges would be likely to receive the least amount of touch?
a. 5 to 15
b. 20 to 35
c. 45 to 60
d. 70 to 85

 

 

ANS:  D

One study on the use of touch by health care personnel found that clients in the age range of 66 to 100 years received the least amount of touch when compared with younger patients. Clients in geriatric institutions may well place great importance and value on the smallest gesture of touch, as touch leads to a feeling of affinity and of belonging to community.

 

PTS:   1                    DIF:    Analysis         REF:   Complementary Modalities| Massage and Touch

 

  1. When compared to highly mobile counterparts, the least mobile elderly tended to respond to touch:
a. equally
b. less positively
c. more positively
d. not at all

 

 

ANS:  C

When compared to highly mobile counterparts, the least mobile elderly tend to respond to touch more positively. Being less mobile, these individuals often feel isolated from their community. They place great importance and value on the smallest gesture of touch because touch leads to a feeling of affinity and of belonging to community.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Massage and Touch

 

  1. The MOST widely accepted energy-based technique in nursing is:
a. craniosacral balancing
b. healing touch
c. therapeutic touch
d. polarity therapy

 

 

ANS:  C

The most widely accepted energy-based technique in nursing is therapeutic touch. Therapeutic touch is a five-step process of centering: assessing the client’s energy field, smoothing or unruffling the field, modulating or transferring energy, and knowing when to stop.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Energy-Based Modalities

 

  1. When using therapeutic touch, a specific technique developed by Dolores Krieger, which of the following steps would be performed first?
a. assessing
b. centering
c. modulating
d. smoothing

 

 

ANS:  B

The first step in therapeutic touch as developed by Dolores Krieger is centering. The other four steps used in her approach include assessing the client’s energy field, smoothing or unruffling the field, modulating or transferring energy, and knowing when to stop.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Therapeutic Touch

 

  1. In the five-step process of therapeutic touch, which step would be performed last?
a. assessing
b. centering
c. modulating
d. smoothing

 

 

ANS:  C

Modulating or transferring energy would be the last step. This is followed by knowing when to stop.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Therapeutic Touch

 

  1. Which step in therapeutic touch consists of consciously directing human energies to transfer energy to another part of the body?
a. assessing
b. centering
c. modulating
d. smoothing

 

 

ANS:  C

Modulating is consciously directing human energies to transfer to another part of the body. The other steps do not involve the process of energy transfer.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Therapeutic Touch

 

  1. Use of art and music is particularly useful with clients who:
a. are diagnosed with mania or depression
b. have difficulty communicating verbally
c. show special artistic talents before diagnosis
d. are extremely anxious or hypersensitive

 

 

ANS:  B

Art and music provide the nurse with an opportunity to work with clients in avenues that do not require verbal expression or the rational, cognitive processes. Many times a client is unable or unwilling to express emotion (particularly negative emotion) through words. Visual and expressive arts are a means of communication that circumvent the need for talk and permit the client and nurse to interact on emotional and intuitive levels.

 

PTS:   1                    DIF:    Application    REF:   Complementary Modalities| Music Therapy

 

  1. Soothing music is said to produce which of the following effects?
a. hypometabolic response
b. sympathetic stimulation
c. decreased immune response
d. maintain neuropeptides

 

 

ANS:  A

Soothing music is said to produce a hypometabolic response characteristic of relaxation. A variety of body systems, including the immune system, autonomic nervous system, and endocrine systems, react to the sound of soothing music. Research has documented that music reduces psychophysiological stress, pain, anxiety, and isolation.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Music Therapy

 

  1. Several types of music have consistently been shown to produce physiologic benefits. They include classical, new age, and:
a. jazz
b. Gregorian
c. carnival
d. baroque

 

 

ANS:  D

Baroque has also been shown to produce physiologic benefits consistently. These forms of music usually have a beat that is slower than the human heart rate.

 

PTS:   1                    DIF:    Knowledge    REF:   Complementary Modalities| Music Therapy

 

  1. One of the hypothesized reasons for the effectiveness of some music therapy to have positive physiologic benefits is that it:
a. has a beat slower than the heart
b. is preferred by many people
c. is perceived as distracting
d. reminds people of their childhood

 

 

ANS:  A

Certain music has a beat that is slower than the human heart rate. They include baroque, classical, and New Age music. These forms of music produce physiologic benefits in treatment.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Music Therapy

 

  1. Research on the effects of drumming as a complementary modality in addiction treatment indicates that drumming:
a. decreases awareness of preconscious dynamics
b. isolates the client, which reduces peer pressure to use drugs
c. enhances theta-wave production of brain-wave synchronization
d. induces brain-wave patterns indicative of an excited state

 

 

ANS:  C

Research reviews indicated that drumming enhances recovery through inducing relaxation and enhancing theta-wave production of brain-wave synchronization. Drumming was experienced as pleasurable and as a technique that enhanced awareness of preconscious dynamics. Drumming also created a sense of connectedness, alleviating self-centeredness and isolation.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Music Therapy| Research Highlight| Findings

 

  1. Studies in pet-assisted therapy that have MOST decreased the feelings of loneliness used which of the following pets?
a. bunnies
b. dogs
c. fish
d. parakeets

 

 

ANS:  B

Pets, particularly dogs, puppies, and cats, have been shown to decrease feelings of loneliness. One investigation suggests that volunteers and pets visiting a nursing home create “an aura of domesticity for residents who had been cut off from home and families by age and illness.”

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Pet-Assisted Therapy

 

  1. When considering elderly long-term care, nursing research has shown which of the following concerning facility residents MOST likely to participate in animal-assisted therapy (AAT)?
a. Those who elect to participate in AAT are less likely to have previously owned a pet.
b. Those who have previously owned a pet find AAT to be a traumatic reminder of their pets.
c. Prior life experiences with pets is a major factor influencing desire to participate in AAT.
d. Not having prior life experience with pets motivates the elderly to try something new.

 

 

ANS:  C

Prior life experiences with pets is a major factor influencing a client’s desire to participate in animal-assisted therapy (AAT). Individuals who have had previous pets may have experienced pleasure with interacting with their pets. Often pets and their owners form a bond that can be very strong. Pets are often used to reduce feelings of loneliness.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Music Therapy

 

  1. A middle-aged male is admitted to the psychiatric unit because of an incident where he damaged his bedroom in a fit of rage. He also threatened his brother. He is easily provoked and has little tolerance for other clients on the unit. You attend a team meeting where the staff reviews the use of anger-control assistance for working with this client. You realize that whenever dealing with this client, you need to do which of the following?
a. Have someone else with you for safety.
b. Let him know that you are in charge.
c. Remind him he might need to be secluded.
d. Use a calm, direct, reassuring manner.

 

 

ANS:  D

For the psychiatric nurse, anger control includes establishing a basic level of trust and rapport with the client. The nurse should also use a calm and reassuring manner. The nurse should use every means possible to learn from the client (or his family) what situations are likely to bring on anger.

 

PTS:   1                    DIF:    Analysis

REF:   Nursing Role in Somatic Interventions| Anger Control Assistance

 

  1. As part of anger control assistance, which of the following things would you MOST encourage a client to do?
a. Remind him- or herself that he or she can be restrained.
b. Openly express his or her feelings toward other clients.
c. Keep his or her feelings inside until you can talk.
d. Let you or other staff know when he or she is feeling tension rising.

 

 

ANS:  D

Encouraging the client to let the nurse and staff know when he or she feels tension rising would be part of anger control assistance. Once the client informs the staff of feelings that tension is rising, steps can be taken to reduce the tension. A client may need to express feelings regarding a situation, a person, or thoughts he or she may be having.

 

PTS:   1                    DIF:    Application

REF:   Nursing Role in Somatic Interventions| Anger Control Assistance

 

  1. For a client to get a better understanding of his or her own responses and feelings, you suggest the client use which of the following modalities?
a. a journal
b. music therapy
c. massage
d. meditation

 

 

ANS:  A

The use of anger journals can be a technique used in anger control. The anger control journal allows the individual to express feelings in a much more appropriate manner than acting on the feelings.

 

PTS:   1                    DIF:    Application

REF:   Nursing Role in Somatic Interventions| Anger Control Assistance

 

  1. Of the nursing interventions that can be used for a client who is out of control, which is least restrictive?
a. seclusion
b. restraints
c. drugs to sedate
d. armed guards

 

 

ANS:  A

Seclusion is one of the least restrictive interventions that can be used for a client who is out of control. Restraints, drugs to sedate, and armed guards are restrictive in nature. When seclusion is used, it is similar to a forced time-out. It provides the client a safe place to calm down, regain a sense of control, and then reenter the unit.

 

PTS:   1                    DIF:    Analysis         REF:   Nursing Role in Somatic Interventions| Seclusion

 

  1. ECT is least used or recommended for which age group?
a. infants and young children
b. adolescents
c. young and middle-aged adults
d. the elderly

 

 

ANS:  A

ECT is not recommended for infants and young children. It can, however, be effective in treatment of certain disorder of adolescence and adulthood. It is most often used for severe depression.

 

PTS:   1                    DIF:    Analysis

REF:   Collaborative Interventions in Psychiatric Somatic Treatment| Electroconvulsive Therapy

 

  1. The use of ECT is MOST effective in the treatment of which of the following diagnoses?
a. Alzheimer’s
b. depression
c. catatonia
d. schizophrenia

 

 

ANS:  B

ECT is most effective in the treatment of severe depression. ECT is highly effective in helping clients who are severely depressed and do not respond to medications. Many studies on ECT and depression produce response rates as high as 90%, in comparison to medications, tricyclic antidepressants, and MAO inhibitors.

 

PTS:   1                    DIF:    Application

REF:   Collaborative Interventions in Psychiatric Somatic Treatment| Electroconvulsive Therapy

 

  1. When applying restraints to a client who exhibits behavior that is dangerous to self and when other less-restrictive measures have not worked, the nurse must:
a. obtain a provider’s order
b. hold the client in time-out for at least an hour prior to applying restraints
c. seek permission from the hospital administrator
d. leave this work to the nurse assistants

 

 

ANS:  A

When a client is placed in restraints, a provider’s orders must be obtained. A client would only be placed in restraints if the client behavior is dangerous to self, others, or when other less-restrictive measures such as a time-out have not worked. Permission from the hospital administrator is not necessary when applying restraints.

 

PTS:   1                    DIF:    Application

REF:   Nursing Role in Somatic Interventions| Physical Restraints

 

  1. Which of the following statements would the nurse MOST likely issue to the client who is being put into restraints?
a. “This hurts us more than it hurts you, so realize we like you and don’t mean to harm you.”
b. “You have been threatening to hurt yourself and must suffer the consequences of your actions.”
c. “We are restraining you because you are not in control of yourself. You are restrained so you can gain control.”
d. “Your doctor ordered these restraints. If you don’t like them, you can take it up with him (or her).”

 

 

ANS:  C

The nurse would most likely tell the client who is being placed in restraints that the restraints are being used to help the client gain control over his or her feelings of anger. The nurse would never tell the client that restraints are being used to make the client suffer or because the doctor ordered them. The nurse would not tell the client that placing him or her in restraints hurts the nurse more. Honesty and a clear reason for the restraints must be used to ensure that the client understands the reasons for the nurse’s actions.

 

PTS:   1                    DIF:    Application

REF:   Nursing Role in Somatic Interventions| Physical Restraints

 

  1. If the client is placed in restraints and requires these restraints for longer than 2 hours, the nurse must carry out which of the following actions?
a. Remind the client why he or she is in restraints, and what the consequences are for what he or she did.
b. Remove the restraints for at least 5 minutes every 2 hours (one at a time), and check circulation.
c. Give the client a snack such as an apple.
d. Take off the restraints, and leave them off.

 

 

ANS:  B

Restraints must be removed for at least 5 minutes every 2 hours so that the nurse can check the client’s circulation in each limb. Restraints are removed and then replaced only one at a time. The nurse will not remove all restraints until the client’s condition no longer poses a threat to self or others. While a client may receive a snack while in restraints, there is no requirement that the snack is given at any particular time.

 

PTS:   1                    DIF:    Application

REF:   Nursing Role in Somatic Interventions| Physical Restraints

 

  1. Before a client receives ECT, the nurse must do which of the following things?
a. Remove hairpins, rings, and all metal items.
b. Hydrate the client.
c. Give all routine medication.
d. Apply dentures and hearing aids to client.

 

 

ANS:  A

Before a client receives ECT, the nurse must remove the client’s hairpins, rings, and all metal items. The same procedure is used that would be appropriate for preparing a client for surgery.

 

PTS:   1                    DIF:    Application

REF:   Collaborative Interventions in Psychiatric Somatic Treatment| Electroconvulsive Therapy| Nursing Care

 

  1. When a client receives ECT, which of the following medications or treatments is given to the client prior to the induction of the electrical seizure activity and until the effects of succinylcholine paralysis wear off?
a. meperidine (Demerol)
b. Narcan
c. 100% oxygen
d. nitrous oxide

 

 

ANS:  C

Mechanical ventilation with 100% oxygen is provided prior to inducing electrical seizure activity and until the effects of succinylcholine paralysis wear off and the client is able to breath on his or her own. This typically takes about 5 minutes. Meperidine (Demerol), Narcan, and nitrous oxide generally are not used for ECT.

 

PTS:   1                    DIF:    Analysis

REF:   Collaborative Interventions in Psychiatric Somatic Treatment| Electroconvulsive Therapy| Pharmacological Aspects of ECT

 

  1. The effectiveness of magnetic therapy in the treatment of affective disorders is supported by the finding that some clients with affective disorders:
a. have favorably responded to implantation of magnets in the deep recesses of the brain
b. show irreversible underlying brain activity after regional stimulation with pulsating fields
c. are able to replace antidepressant medication with transcutaneous magnetic therapy
d. improved in mood after certain kinds of magnetic imaging procedures (MRI spectroscopy)

 

 

ANS:  D

Some research has found that clients with affective disorders experience improved mood after certain kinds of magnetic imaging procedures. These include magnetic resonance imaging (MRI) and spectroscopy. These findings have led to preliminary investigations of a variety of externally applied magnetic fields that may prove useful in the management of clients with psychiatric disorders.

 

PTS:   1                    DIF:    Comprehension

REF:   Collaborative Interventions in Psychiatric Somatic Treatment| Magnet Therapy

 

  1. The use of physical restraints in emergency psychiatric services centers has been found to be all EXCEPT which of the following?
a. only for limited periods of time
b. appropriately conservative
c. rarely applied, even with persons presenting with acute psychosis
d. a first-line treatment

 

 

ANS:  B

A survey of more than 50 emergency psychiatric services found that restraints were used in less than 10% of clients presenting with acute psychosis, and that when applied these were used for a mean of 3.3 hours. These data suggest that many centers are appropriately conservative in their use of restraints, applying them rarely and for only limited periods of time.

 

PTS:   1                    DIF:    Comprehension

REF:   Nursing Role in Somatic Interventions| Physical Restraints

 

  1. Somatic therapies include all EXCEPT which of the following?
a. physical outlets for expressing anger
b. ECT
c. massage
d. seclusion

 

 

ANS:  C

Massage therapy is not a somatic therapy but one of the complementary modalities. Physical outlets for anger, ECT, and seclusion are all approaches to the more traditional somatic therapies.

 

PTS:   1                    DIF:    Comprehension

REF:   Complementary Modalities| Massage and Touch

 

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