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Psychiatric Nursing Biological & Behavioral Concepts 2nd Edition By Deborah Antai-Otong -Test Bank
CHAPTER 2—CONCEPTS OF PSYCHIATRIC CARE: THERAPEUTIC MODELS
- A psychoanalytically oriented colleague tells you that the behavior of a client you are assigned to work with is driven by a strong thanatos. This client is most likely exhibiting which of the following behaviors?
The psychoanalytic theory assumes that humans have two primary drives or forces: eros, or the drive toward life, and thanatos, which is the drive toward death. Thanatos is expressed as aggression or hate.
- A client is informed by his family that they could not go on vacation because the cost of his mental health care prevented the family from having enough money for a vacation. Which of the following responses by the client would be the best example of the superego at work?
|a.||refusing further care||c.||getting angry at the family|
|b.||having feelings of guilt||d.||ignoring this statement|
The superego is the conscience that rewards moral behavior and punishes actions that are not acceptable by creating guilt. An overly strict superego may lead to extremes of guilt and anxiety.
- A client is thinking about suing the hospital and the doctor, even though he begins to admit to the nurse that his failure to comply with the treatment regimen may have caused his problems. He begins to share that he feels guilty about these thoughts of suing although he believes the hospital and doctor will settle out of court and he needs the money. The nurse understands that according to psychoanalytic theory, two parts of the client’s personality or two drives are warring. What drive or part of the client’s mind will mediate if the client is to come to a healthy decision?
The superego is the part of the client that is feeling guilty. It is the conscience. The id is the aggressive and sexual drive, which operates on the pleasure principle to reduce tension. The ego mediates between the drives, forces, or conflicts of the id and the superego.
- The mother of a teenager asks the nurse at what age a child’s personality is completely formed. A nurse applying psychoanalytic theory to this question would answer that the personality is almost completely formed by what age?
According to psychoanalytic theory, the personality is almost completely formed by 5 years of age.
- The nurse is working with a young adult client who has been in an automobile accident and is fully conscious but seems to have little recall of the event. The client’s spouse asks the nurse why the client is not able to recall the event. The best answer by the nurse would be that the client is:
|a.||in a state of denial||c.||repressing details of the event|
|b.||suffering from a concussion||d.||suppressing details of the event|
Repression is an unconscious process whereby unwanted, unacceptable, and/or painful memories are filed in the unconscious part of the mind. Repression is the first line of defense against such memories.
- You determine that one of your assigned clients is using defense mechanisms, some of which are sublimation and projection. You realize that these defense mechanisms, sublimation and projection, are allowing the client to:
|a.||use other people in a way that is not healthy for them or for the client|
|b.||postpone dealing with problems in an unhealthy way for a long period of time|
|c.||keep unpleasant thoughts in the preconscious mind instead of the conscious mind|
|d.||discharge some of the energy needed to keep unwanted thoughts out of awareness|
It takes energy to keep unwanted thoughts out of the conscious mind. Energy cannot be contained indefinitely. Some defense mechanisms such as reaction formation, projection, and sublimation allow for the energy to be discharged.
- The nurse assesses an adult client who admits to being a nail-biter when the nurse observes extreme shortness and unevenness of the client’s nails. The nurse recalls that people who bite their nails are said to be fixated at which of the following stages in Freud’s stages of psychosexual growth and development?
The development of orally focused habits such as smoking and nail-biting are associated with fixation at the oral stage of development in Freud’s theories of the stages of psychosexual growth and development.
- The nursing instructor advises students who are learning how to communicate with clients with mental health problems not to ask questions beginning with “Why did you…” for which of the following reasons?
|a.||It is an approach of authority.|
|b.||It hurts the trusting relationship.|
|c.||Often a person cannot identify unconscious motivation.|
|d.||The question makes the person feel like a child being parented.|
Often the person cannot identify the motivation for his behavior because it is unconscious. There are more acceptable techniques to foster communication.
- When you are working with a client who is very anxious and is using a defense mechanism, which of the following approaches would be best?
|a.||Advise the client to stop using the defense mechanism.|
|b.||Discuss the defense mechanism and whether it is helpful or not.|
|c.||Help the client identify some ways to reduce anxiety before other interventions.|
|d.||Have the client weigh the advantages and disadvantages of the defense mechanism.|
Anxiety needs to be reduced before the defenses can be disengaged. Do not take away defense mechanisms until there are other ways to deal with anxiety.
- One of your colleagues is basing his work with clients on the theories of Erikson. When explaining personality development, your colleague would say that personality is:
|a.||almost totally inherited|
|b.||developed over the life span|
|c.||completely developed by age 5|
|d.||a result of experiences before age 18|
Erik Erikson identified 8 stages of psychosocial development and believed that personality development continues over the life span.
- Erikson saw the major task of life as:
According to Erik Erikson, the task of identity is seen as the major task of life. All previous tasks are fundamental to self-discovery, and all adult tasks are predicated on comfortable resolution of identity.
- A young adult on the psychiatric ward asks a nurse for a date. Although the nurse realizes this is inappropriate and declines, the nurse will also:
|a.||make certain the client suffers some appropriate consequences for this action|
|b.||report this client’s behavior to the administrator and refuse to work with the client|
|c.||tell the client that this behavior is inappropriate with a professional nurse|
|d.||recognize age-appropriate behavior and advise the client of the professional nature of the relationship|
The young adult is seeking a life mate and dealing with the task of intimacy versus isolation. Although it is inappropriate for the nurse in a professional relationship to develop an intimate relationship, the nurse needs to recognize the client’s age-appropriate behavior.
- A client is discussing some insights gained in therapy in the past and mentions archetypes of anima and animus. The nurse listening to this client realizes that this client received therapy based on the theories of:
|a.||Albert Ellis||c.||Carl Jung|
|b.||Eric Berne||d.||Sigmund Freud|
Carl Jung discovered repeated common images he called archetypes. Two of the most popular were those of the anima, or feminine archetype in men, and the animus, the masculine archetype in women.
- Closely following the beliefs of Harry Stack Sullivan, a psychiatric nurse working with clients would look closely at what Sullivan referred to as the persona, which is best described as the:
|b.||“I” or “me”||d.||best friend|
The persona is what one is talking about when referring to “I” or “me.” It could also be called self-concept and begins developing in infancy with the idea of “good me” and “bad me.”
- The main focus of Sullivan’s work was on:
|a.||insight through gestalt||c.||interpersonal relationships|
|b.||learned helplessness||d.||identifying a purpose in life|
Harry Stack Sullivan focused on interpersonal relationships. He looked at the development of the self-system, which he called personification. Personification includes all related attitudes, feelings, and concepts about self and another.
- You are assigned to work with a client who describes a life of feeling isolated and helpless with many fears about dangers in the world. The client frequently demonstrates aggressive behavior or is verbally aggressive. Using Horney’s theories, you would view this aggressive behavior as:
|a.||a failure to develop a healthy personality|
|b.||incongruent with feeling helpless and isolated|
|c.||a means to protect what little security they have|
|d.||stemming from experiences with an aggressive mother|
Karen Horney believed that insecure, anxious children develop personality patterns to help them cope with feelings of isolation and helplessness. They may become aggressive as a means of protecting what little security they have.
- Applying interpersonal theories in the nurse-client relationship, the most important goal for the nurse and client to set for therapy sessions would be for the client to:
|a.||identify the causes of failed relationships in the past|
|b.||gain insight into how early relationships shape behavior|
|c.||deal with repressed anger against self and against significant others in his life|
|d.||verbalize a realistic and hopeful perspective of self in relationships with others|
In the nurse-client relationship where interpersonal theories are utilized, the client learns to separate past learning from present and to gain a realistic and hopeful perspective of self in relationships with others and society.
- The nurse is caring for a young child in the hospital. As the child’s visiting parent prepares to leave, the child appears anxious and begins to cry and cling to the parent. Using Bowlby’s stages of separation anxiety to explain the child’s behavior, the child can be said to be in a stage called:
John Bowlby described separation anxiety as a predictable process involving the stages of protest, despair, and detachment. Examples of protest behaviors include increasing anxiety, crying, clinging, throwing one’s self down, and searching.
- A couple is concerned about the amount of time they must spend away from their infant. Looking at the findings of Bowlby in his work on attachment, you would most help the clients by setting and meeting which one of the following goals?
|a.||Improve the quality of time and interactions.|
|b.||Leave the child when the child is distracted.|
|c.||Decrease the period of time between separations.|
|d.||Increase the amount of overall time with the child.|
John Bowlby found that the amount of time spent with early caregivers is less significant than the quality of time and interactions between the child and caregivers. The nurse should focus on helping the clients to learn to use behaviors that reinforce the child-parent attachment.
- When a child is in the final stages of separation anxiety as described by Bowlby and the primary caregiver returns to the child, the nurse should most likely expect the child to exhibit which of the following behaviors?
|a.||acting very excited||c.||clinging to caregiver|
|b.||engaging in a tantrum||d.||withdrawing from caregiver|
The final stage of separation anxiety is detachment in which the child appears listless, apathetic, and socially isolates and withdraws from the caregiver even when the caregiver returns.
- When the primary caregivers of a hospitalized infant cannot stay in the hospital with the infant, which of the following diagnoses would the nurse most likely include in the care plan?
|a.||caregiver role strain|
|b.||interrupted family processes|
|c.||risk for impaired parent-infant attachment|
|d.||ineffective therapeutic regimen management|
An infant who is hospitalized and left alone by primary caregivers is likely to be at risk of developing attachment disturbances.
- The systematic study of infant-caregiver attachment behaviors using the Strange Situation protocol was the work of which of the following persons?
|a.||Mary Ainsworth||c.||Karen Horney|
|b.||John Bowlby||d.||Bruno Bettelheim|
Mary Ainsworth systematically studied infant-caregiver attachments by means of the Strange Situation protocol. This protocol has provided an empirical template for delineating and measuring John Bowlby’s attachment theory and has spurred a plethora of clinical and scholarly contributions that transformed researchers and clinicians’ perceptions of early child-parent interactions.
- In his theories, Skinner identified two types of behavior which he referred to as:
|a.||angelic and demonic||c.||good boy and bad boy|
|b.||respondent and operant||d.||past oriented and future oriented|
- F. Skinner identified respondent behavior as occurring when a known and specific stimulus elicits a response and operant behaviors as those that obtain a response or reinforcement from another person or the environment.
- A client comes to the psychiatric nurse for help with social situations. The client is not comfortable meeting with others. The nurse utilizes the theories of Bandura and Walters. Which of the following interventions by the nurse would most reflect application of Bandura and Walter’s theories and techniques?
|a.||Ask the client to do the opposite of the expected or desired behavior.|
|b.||Use a gradually increasing schedule of social contact to desensitize the client.|
|c.||Verbally reinforce the client for any attempt to increase socialization behavior.|
|d.||Have the client study a person who is successful at socializing and imitate them.|
Albert Bandura and Richard Walters placed emphasis on the role of modeling in learning behaviors. The model can be a person, film, or cartoon. A person can take on new social behaviors quickly when imitating a role model.
- When working with clients diagnosed with schizophrenia who have been hospitalized several times in the last year after failing to fill their prescriptions, the nurse applies the self-efficacy model. What is the nurse’s primary goal in this case?
|a.||Making certain a staff member supervises the clients’ taking the medication.|
|b.||Reminding the clients daily through a phone call that the medication is due.|
|c.||Finding a source that will pay for, pick up, and deliver the medication to the clients.|
|d.||Convincing the clients they have the capacity to find a way to get the prescriptions filled.|
The primary goal of self-efficacy is to encourage or persuade the clients that they have the capacity to make adaptive behavioral changes in an identified problem area.
- When trying to reinforce a behavior using behavior modification techniques, the most effective schedule of reinforcement is:
A fixed-ratio schedule is used in industry when a worker’s pay depends upon the number of units produced or sold. For interval schedules, the reward is based upon the passage of time and not on the amount of behavior change.
- Beck is best known for his theories about which of the following:
|a.||behavior modification||c.||cognitive patterns|
|b.||interpersonal theories||d.||childhood development|
Aaron Beck is one of the best known proponents of cognitive psychology because of his writings on cognitive distortions or thinking errors.
- You are working with a client who is upset because he believes one of his college classmates does not like him. If you were to apply the theories of Ellis, you would most likely respond:
|a.||“Describe the feelings that you have toward this classmate.”|
|b.||“Tell me what you have done to cause this classmate not to like you.”|
|c.||“Let’s examine this irrational thought that everyone should like you.”|
|d.||“This is really something that is wrong with her and not with you at all.”|
Albert Ellis developed what he referred to as rational emotive therapy. He believed that irrational thoughts cause maladaptive behavior and emotional distress. He identified the thinking that everyone should like you as an irrational thought.
- When working with the mother of a young child who is in the later part of Piaget’s sensorimotor stage of development, you would teach the mother to do which of the following things to help the child move out of this stage?
|a.||play classical music frequently|
|b.||play peek-a-boo and hide and seek|
|c.||read the same book to the child every day|
|d.||reward the child for attempts to use the potty|
In the first stage or sensorimotor stage of development from birth to about 2 years of age, the young child appears to think that only objects that can be seen are those that exist. As the child grows in experience, the child develops object permanence. Peek-a-boo and hide-and-seek prepare the child for realizing that things and people are still there even when they cannot be seen.
- When you administer the atypical antipsychotic agents ordered by the psychiatrist to a client who has schizophrenia, you realize that this medication is most likely to do which of the following things?
|a.||increase the activity of dopamine|
|b.||decrease the activity of dopamine|
|c.||increase the reuptake of serotonin|
|d.||have no effect on dopamine activity|
In schizophrenia and mania, there is hyperactivity of dopaminergic systems that must be tempered or reduced. In Parkinson’s disease and depression, it is believed that the dopamine systems are hypoactive and, therefore, medications in those conditions increase dopamine availability to the body.
- When giving antipsychotic medication and atypical antipsychotics to clients with a diagnosis of schizophrenia, because of the effect of the medication on a specific neurotransmitter, you would most need to be frequently assessing these clients for:
|a.||weight loss||c.||ringing in the ears|
|b.||nausea and vomiting||d.||fine motor tremors|
Dopamine is primarily responsible for fine motor movement, sensory integration, and emotional behavior. These medications reduce dopamine so the client is apt to lose some of the fine motor movement and demonstrate tremors.
- A client who is experiencing low levels of GABA or fewer GABA receptors is most vulnerable to which of the following disorders?
|a.||panic disorder||c.||conversion disorder|
|b.||bipolar disorder||d.||antisocial personality disorder|
A person with low levels of GABA or fewer GABA receptors is more vulnerable to anxiety disorders or panic symptoms/disorders.
- The latest and most popular theory of mental disorders is that the cause is most likely:
|a.||a combination of factors|
|b.||genetically and chemically based|
|c.||structural differences in the brain|
|d.||a result of disturbed interpersonal interactions|
At the current time, researchers believe that mental disorders are most likely caused by a variety of factors. Some of the factors include structural differences in the brain and disturbed interpersonal interactions. Additionally, genetic propensity and chemical imbalance can be causative factors.
- You are working with a client who has been playing tennis and has developed tendonitis. Which of the following remarks by the client would indicate function in an integrated way as identified by the theories of Dunn?
|a.||“What other sport would be less injurious?”|
|b.||“I will use heat on my elbow after playing tennis.”|
|c.||“I will avoid activity and rest my elbow until it is healed.”|
|d.||“An elbow brace will be a help in preventing further damage.”|
Integrating involves using energy efficiently, such as taking measures to conserve energy so the physical resources needed to reduce swelling and pain are accessible.
- Your client has shared a primary appraisal of a wedding he attended. Based on how he describes his experiences at the wedding, the appraisal could fall into any one of the three types of primary appraisal described by Lazarus. Which of the following statements by the client would place it into the benign positive type of appraisal?
|a.||“It was all right I guess.”|
|b.||“It was very tastefully done.”|
|c.||“I felt real happy even if I felt guilty not taking a present.”|
|d.||“It was a challenge to get there on time, but I did manage it.”|
Benign appraisals are events with a genuinely positive appraisal. These events generate feelings of pleasure, joy, and happiness, but the feelings may also be accompanied by guilt or anxiety.
- When working with clients using Orem’s nursing theories, you would be most interested in helping the clients to maximize their:
|a.||level of mental health||c.||spiritual dimension|
|b.||interactions with others||d.||ability to care for self|
Orem’s model is a self-care model. Clients are assessed in terms of their self-care agencies. Nursing interventions are planned to maximize the client’s ability to care for self. Specific nursing actions include actions to provide assistance to client’s unable to meet their health-related self-care needs.
- A basic assumption of Freud’s psychoanalytic theory is that all behavior:
|a.||is learned||c.||is unconscious|
|b.||has meaning||d.||is sexually oriented|
According to Freud, everything a person does has meaning.
- A nurse who follows the therapeutic approach of Rogers, would most likely be using an approach focused on:
|a.||reality therapy||c.||client-centered therapy|
|b.||directive therapy||d.||psychoanalytic therapy|
Carl Rogers focused primarily on empathy, warmth, and genuineness in relating. His form of therapy was coined “client-centered therapy.”
- A common form of treatment on psychiatric inpatient units which focuses on the patient’s environment is known as:
|a.||milieu therapy||c.||encounter therapy|
|b.||reality therapy||d.||client-centered therapy|
Milieu therapy is the treatment modality that uses the total physical and social environment to provide psychosocial rehabilitation. The term is sometimes used interchangeably with therapeutic milieu.
- You are caring for a group of mental health patients, and you base your nursing practice on the belief that your clients should play a major role in their own self-care. These practices stem from the work of:
|a.||Martha Rogers||c.||Dorothea Orem|
|b.||Hildegard Peplau||d.||Ida Jean Orlando|
According to Dorothea Orem, people have the ability to perform self-care activities they initiate and perform independently to maintain life, health, and well-being. She coined the term describing the ability to care for one’s self, self-care agency.
- Dialectical behavior therapy (DBT) was introduced by:
|a.||B. F. Skinner||c.||Albert Bandura|
|b.||Sigmund Freud||d.||Marsha Linehan|
In 1987, Marsha Linehan introduced dialectical behavior therapy (DBT). This form of therapy is used to challenge distorted cognitions or schematas that produce enormous anxiety and stress in clients with borderline personality disorder.
- One of your clients constantly complains of feeling nervous even though his medicines have been administered as prescribed. The doctor orders one sugar tablet between doses of regularly scheduled medications. After taking the sugar tablet, the client states “That pill really worked. I feel much better now.” This is known as the:
|a.||halo effect||c.||placebo effect|
|b.||Skinner effect||d.||behavioral effect|
The placebo effect is an attitude of optimistic concern and belief in the efficacy of an intervention. It is one of the best reinforcements nurses can use.
- Alterations in the seretonergic system or serotonin (5-hydroglyryptamine, 5HT) function along with NE have been implicated in the pathogenesis of:
|b.||eating disorders||d.||personality disorders|
Alterations in the serotonerginic system function along with NE have been implicated in the pathogenesis of depressive syndrome.
- The nurse providing care to an alcoholic client administers Antabuse. The administration of Antabuse would be considered which form of behavioral therapy?
|a.||classic conditioning||c.||medical conditioning|
|b.||operant conditioning||d.||cognitive conditioning|
Operant conditioning includes use of aversion techniques. One form of aversion therapy includes the use of Antabuse for the treatment of alcohol. Clients who ingest alcohol while on Antabuse will experience several very uncomfortable symptoms.
- A nurse researcher is conducting a study to determine his client’s capacity to recover or adjust to stressful or life-threatening situations. This ability is known as:
Resilience is the capacity to recover or adjust to stressful or life-threatening situations.
- Which of the following are essential features of DBT? Select all that apply.
|a.||daily individual psychotherapy|
|b.||weekly skills training|
|c.||encouraging and coaching via telephone|
|d.||consultation with client|
|e.||short-term inpatient hospitalization|
|f.||electroconvulsive therapy (ECT)|
ANS: B, C
Dialectical Behavior Therapy (DBT) has five essential features which include weekly individual psychotherapy, weekly skills training group, encouragement and coaching via telephone interactions between sessions, consultation with the client, and the development of a treatment environment by the DBT directors and case managers. ECT is not an essential feature of DBT.
- When interviewing a client, which of the following statements would indicate that the client has distorted cognition? Select all that apply.
|a.||“I’m having a difficult time concentrating on my course work.”|
|b.||“All of my teachers think I’m hopeless because I did poorly on the last exam.”|
|c.||“School is going well. I received an A on the last exam.”|
|d.||“I’d like to apply for graduate school when I complete the undergraduate program.”|
|e.||“My classmates don’t want to study with me.”|
|f.||“I’m going to try my best in school this semester.”|
ANS: A, B, E
Cognitive distortions are characterized by statements
- A nurse caring for a 9-year-old client would plan care based on the knowledge that according to Sullivan’s theory, clients between the ages of 8 and 11 are in the concrete operational stage. Because of this information, the nurse’s assessment would most likely reveal a client who can do which of the following? Select all that apply.
|c.||Demonstrate mature cognitive structures|
|d.||Solve complex verbal problems|
|e.||Solve conservation problems|
|f.||Demonstrate egocentric thought and language|
ANS: B, E
Children in the concrete operational stage can solve conservation problems and reversibility is retained. Egocentric thought and language are characteristic of the preoperational period (2 to 7 years). It is not until the stage of formal operations period (11 years to adulthood) that the cognitive structures are mature and the individual is able to think scientifically and solve complex verbal problems.
CHAPTER 20—THE CLIENT EXHIBITING AGGRESSION, HOSTILITY, AND VIOLENCE
- According to Fernandez (1999), which group of health care workers is at greatest risk for physical assault?
|b.||female nurses||d.||male nurses and doctors|
According to Fernandez, male nurses and doctors are at the greatest risk for physical assault. Receptionists are at lowest risk.
- Aggressive and violent behaviors are more common among clients experiencing:
|a.||anxiety disorders||c.||personality disorders|
|b.||psychotic disorders||d.||substance abuse disorders|
Aggressive and violent behaviors are more common in clients experiencing psychotic disorders. These individuals are out of touch with reality and may be responding to auditory hallucinations. Clients who are paranoid may have delusions that others are out to harm them, and they may respond to nursing staff based on the belief that they are protecting themselves.
- A nurse who practices with the belief that a client’s aggressive behavior is a result of role modeling would most likely follow which psychodynamic theories?
|a.||biochemical theories||c.||psychodynamic theories|
|b.||social learning theories||d.||neuroendocrine theories|
Social learning theory views aggression as a learned response that is based on the assumption that role modeling, identification, and human interactions shape learning and behavior. Aggression is believed to be learned through observation and imitation.
- Contemporary neurophysiologic studies suggest which areas of the brain are linked to aggressive and violent behaviors?
|a.||frontal lobe||c.||occipital lobe|
|b.||temporal lobe||d.||parietal lobe|
Contemporary neurophysiologic studies suggest that the temporal lobes of the brain are linked to aggressive and violent behaviors. EEGs of the brains of violent criminals have revealed left hemispheric (temporal lobe) abnormalities.
- The prevalence and nature of a client’s aggression and violence in health care:
|a.||is a recent occurrence|
|b.||has decreased in the past 10 years|
|c.||has long been minimized and neglected|
|d.||has been a major topic of research since the early 20th century|
The prevalence and nature of a client’s aggression and violence in health care has long been minimized and neglected. Client aggression occurs more often than client violence with a substantial number of psychiatric nurses being threatened. Today, more concern is placed on client aggression and violence perhaps because of the serious morbidity for clients and staff.
- Which of the following statements is correct?
|a.||The incidence of client aggression and violence is equal.|
|b.||Client aggression occurs more often than client violence.|
|c.||Client violence occurs more often than client aggression.|
|d.||Clients very seldom demonstrate aggression and violence.|
Client aggression occurs more often than client violence. Aggressive behaviors are those that are marked by combativeness readiness, driving forceful energy, or initiative. Violence is the act of kicking, spitting, beating, grabbing, choking, pushing, forcing sex, or using a weapon.
- According to a 1999 study of health care workers in a Vancouver ED, respondents reported a 1-year prevalence rate of:
|a.||52% for physical assault and 57% for physical threat|
|b.||61% for physical assault and 79% for physical threat|
|c.||75% for physical assault and 80% for physical threat|
|d.||92% for physical assault and 97% for physical threat|
According to the study, respondents reported a 1-year prevalence rate of 92% for physical assault and a 97% for physical threat. Additionally, 66% of the respondents reported verbal abuse at least once per shift.
- Which is the priority when caring for potentially hostile, aggressive, or violent clients?
|a.||providing a safe environment for self, clients, and others|
|b.||administering a prescribed medication to address the client’s behavior|
|c.||exploring with the client reasons for the hostility, aggression, or violence|
|d.||assisting the client to develop alternative methods for expressing feelings|
The priority nursing intervention with a client who is potentially hostile, aggressive, or violent is to provide a safe environment for client, self, and others. The other interventions are all important and will be initiated, but safety is always the priority.
- You have been caring for a client who previously was described by other nurses as being extremely hostile. If your client is moving towards recovery and recognizes the hostility, your assessment would most likely reveal which of the following?
|a.||Hostility will probably increase.|
|b.||Hostility will probably decrease.|
|c.||Hostility will remain unchanged.|
|d.||Hostility will progress to violence.|
Assessment of a client who is moving toward recovery and recognizes the hostility would most likely reveal that the hostility is decreased.
- The nurse on a psychiatric unit assessing a newly admitted client for potential violent behavior knows that when comparing violence among men and women with psychiatric disorders, research suggests that:
|a.||women are violent more often than men|
|b.||men are violent more often than women|
|c.||there is no gender difference in terms of violence|
|d.||women use more physical aggression than men|
The research suggests that there is no gender difference in terms of violence between men and women with psychiatric disorders. Most researchers suggest that there is an overlap in the expression of violence and in the factors that contribute to its emergence in men and women, specifically psychosis and behavioral disturbances.
- You are caring for a client who is very angry. The client’s mental and motor activity have increased. Your assessment would reveal that the client is most likely experiencing which of the following?
The client is most likely experiencing agitation. Agitation is a state of increased mental and motor activity. Clients exhibiting agitated states are often verbally and physically threatening and can become abruptly violent.
- A nurse whose care is based on a belief that aggression is a basic drive (like thirst) would be following whose theories?
|a.||Erik Erikson||c.||Sigmund Freud|
|b.||Dorothea Orem||d.||Abraham Maslow|
According to Freud, aggression is a basic drive (like thirst). From birth to death the person possesses two conflicting instincts. One instinct is a life instinct (eros) that encourages a person to grow and survive. The second instinct is a death instinct (thanatos) that drives the person to redirect the death instinct or self-destructiveness from self to others.
- The psychiatric nurse planning care for clients is aware that violent behaviors occur:
|a.||across all age groups|
|b.||most often with adolescents with juvenile records|
|c.||less often with elderly clients experiencing dementia|
|d.||most often with children who have developmental disorders|
Violent behavior can occur across all age groups. Research has documented acts of violence on pediatric units, adolescent units, adult units, and in geriatric settings.
- Workplace violence occurs:
|a.||anywhere||c.||in any outpatient clinic|
|b.||in the emergency room||d.||on the inpatient psychiatric unit|
Workplace violence can occur anywhere. Incidents have been documented on psychiatric units, emergency rooms, and basically any area of the hospital or clinic. Violence may be initiated by a client, family member, friend, or staff member.
- A client becomes very agitated and begins to use profane language in a very loud tone of voice. The best response by the nurse is to:
|a.||ignore the client|
|b.||yell back at the client|
|c.||speak calmly and softly|
|d.||tell the client the behavior is childish|
If a client becomes angry and begins to use profane language in a very loud tone, the nurse’s best response is to speak calmly and softly to the client. Ignoring the client, yelling at the client, or telling the client his behavior is childish will only escalate the situation.
- You walk into an examination room only to realize that the client is holding a weapon. What should you do first?
|a.||Take the weapon away from the client.|
|b.||Have security take the weapon away from the client.|
|c.||Ask the client to place the weapon on a desk or on the floor.|
|d.||Ignore the fact that the client has a weapon and continue to provide care.|
If you walk into an examination room and see a client with a weapon, you should ask the client to place the weapon on a desk or on the floor. You should never ignore the weapon. Neither you nor any other staff member should approach the client in an attempt to take the weapon.
- An employer’s major responsibility is to:
|a.||provide a safe working environment|
|b.||screen any client seeking service from the facility|
|c.||install metal detectors at the entrance of the hospital|
|d.||hire twice the number of security guards to assure safety|
The major responsibility of an employer is to provide a safe working environment for the employees. This can be accomplished by providing security to escort staff to parking lots at night. Employers should also provide training to all staff on the proper procedures to use during situations of aggression, hostility, and violence.
- The nurse manager over an emergency department is conducting an in-service program on workplace violence. The nurse manager would evaluate the employees as understanding the causes of workplace violence if they identify which of the following? Select all that apply.
|a.||loud noises||d.||helpful and pleasant staff|
|b.||long waiting periods||e.||poor environmental design|
|c.||ignoring a client’s request||f.||speaking calmly and softly|
ANS: A, B, C, E
Research has shown that common causes of workplace violence include loud noises, long waiting periods, ignoring a client’s request, poor environmental design, crowdedness, and access to firearms. Other contributing factors are inadequately or inappropriately trained security or staff and lack of administrative support for zero tolerance of violence in the workplace. Speaking calmly and softly to a client and staff who are helpful and pleasant may reduce the potential for violence.
- Hostile clients may demonstrate which of the following behaviors? Select all that apply.
ANS: A, B, D, E, F
Hostile clients may demonstrate rudeness, sarcasm, faultfinding, physical violence, or verbal threats. Hostile clients do not exhibit kindness.
- You are the charge nurse on a psychiatric unit. One of the new clients is very angry and agitated. The client rushes into the nurses’ station where you are standing and begins to yell and curse at you. What interventions would be appropriate to de-escalate the situation? Select all that apply.
|a.||Use common sense.|
|b.||Use active listening.|
|c.||Give suggestions, not orders.|
|d.||Be concerned about personal safety.|
|e.||Avoid using threatening body language.|
|f.||Remain calm and convey being in control.|
ANS: A, B, C, D, E, F
All of the above are correct interventions to implement in an attempt to de-escalate a potentially violent situation.
- Data from several studies exploring the risk of violence in inpatient psychiatric facilities found that violence most likely occurs during which periods? Select all that apply.
|b.||visiting hours||e.||client transport|
|c.||bathing hours||f.||during change of shifts|
ANS: A, C, E
Data from several studies exploring risk for violence in inpatient psychiatric facilities have found violence occurred during high activity and interaction with clients such as mealtimes, client transport, and bathing hours. During periods of visiting hours, nursing reports, or change of shifts there is less interaction between staff members and clients and a reduced possibility of violence.
- Which of the following are true about hostility? Select all that apply.
|a.||It is a response to a threat.|
|b.||It never results in violence.|
|c.||It is always an inappropriate act.|
|d.||It is a response to invasion of privacy.|
|e.||It demonstrates a basic character flaw.|
|f.||It is an attempt to avoid facing situations of helplessness.|
ANS: A, D, F
Hostility is a response to a threat or invasion of privacy. It may also be the individual’s attempt to avoid facing situations of helplessness. Sometimes the act of hostility is appropriate and other times it is inappropriate. Hostility does not indicate a basic character flaw. Sometimes hostility results in violence.
- Assessment of a violent client would most likely reveal which of the following? Select all that apply.
|a.||withdrawn behavior||d.||frequent mood swings|
|b.||openness to others||e.||poor interpersonal skills|
|c.||a history of violence||f.||respect for authority figures|
ANS: A, C, D, E
Violent clients tend to demonstrate withdrawn behavior. They may have frequent mood swings and a history of violence. Most hostile clients have poor interpersonal skills. Openness to others is not a characteristic of violent clients.
- A nurse manager is charged with planning for staff safety in the new Emergency Department. His plans should include which of the following? Select all that apply.
|a.||training only nursing personnel on safety measures|
|b.||providing security escorts to the parking lot at night|
|c.||reducing the size of waiting areas to discourage the potential of loitering|
|d.||developing waiting areas to accommodate and assist visitors and clients|
|e.||designing the triage area, emergency rooms, and other public areas to reduce the risk of assault|
|f.||establishing a call system that alerts teams to assist staff involved in potential and actual violent situations|
ANS: B, D, E, F
In planning for the new Emergency Department, the nurse manager should do all of the above except for reducing the size of the waiting room. This would cause crowding and create the potential for clients and visitors to become agitated. Also, all personnel should be trained on safety measures.
- Nurses working on psychiatric units should be prepared to de-escalate or diffuse potentially violent situations. To prepare for these situations, nurses can do a self-assessment. Questions that may be asked in the self-assessment include which of the following? Select all that apply.
|a.||“How am I reacting?”||d.||“How is my tone of voice?”|
|b.||“How’s my body language?”||e.||“Do I like the client as a person?”|
|c.||“What are my “gut” feelings?”||f.||“Am I wearing anything attractive?”|
ANS: A, B, C, D
A self-assessment would include questions related to the nurse’s reactions, body language, “gut” feelings, and tone of voice. Questions regarding clothing should focus on whether the nurse is wearing clothing or other items which can put the nurse in danger of a violent act. Whether the nurse likes or dislikes a client has nothing to do with being prepared to de-escalate or diffuse a potentially volatile situation.
CHAPTER 36—PSYCHIATRIC NURSING RESEARCH
- The degree of positiveness of psychiatric nurses toward research has been described in the literature in which of the following ways?
|b.||about the same as in other fields of nursing|
|c.||paralleling the amount of education possessed by the nurse|
|d.||above the degree of positiveness of nurses in other specialties|
In 1992, Poster, Betz, and Randell reported that psychiatric nursing has long trained other nursing specialties in conducting research. They also reported that positive attitudes toward research among psychiatric nurses parallel the level of education that a nurse possesses.
- How will research most help nurses?
|a.||It will identify the right way and the best way to provide care for clients.|
|b.||Doing research will help nurses learn to be better at mathematics and statistics.|
|c.||It will assist nurses to define and promote their roles in various health care settings.|
|d.||Doing research will make nurses and nursing more like other professionals and professions.|
Nurses, like other health care providers, must define and promote their roles in various health care settings and research will help them accomplish this. Through evidence-based research, the nurse will be able to provide care that has been proven to be effective in the promotion of client health. Also, to be considered a profession, nursing must continue to develop its own body of knowledge.
- Which of the following tools was developed as a result of research into stress in children and how children deal with stress?
|a.||the Holmes and Rahe Child Stress Scale|
|b.||the Schoolagers Coping Strategy Inventory|
|c.||the Wechsler Intelligence Scale for Children|
|d.||the Draw a Person Test for Children|
The Schoolagers Coping Strategy Inventory was developed as a result of research into the type, frequency, and effectiveness of children’s coping behaviors. The Holmes and Rahe Child Stress Scale only measures stress levels. The Wechsler Intelligence Scale for Children measures intelligence. One version of the Draw a Person Test for Children screens for emotional or behavioral disorders. The other version of the test measures nonverbal intelligence.
- When deciding to do a research project, the first step of the scientific research process involves which of the following activities?
|a.||writing the hypothesis|
|b.||surveying the literature|
|c.||identifying the problem to be studied|
|d.||operationally defining the study terms|
The first step of the scientific research process is identifying the problem to be studied. The hypotheses, literature review, and operationally defining study terms occur after the problem has been clearly identified.
- A first time nurse researcher asks, “Why do I have to do a review of the literature prior to doing research?” In addition to informing this novice researcher that the review helps determine the study design and may reveal some existing instruments to use, which of the following reasons would be accurate?
|a.||This will help you determine if you would really like to research this area or not.|
|b.||To discover what other experts in the field think so you can quote them in your study.|
|c.||This is a required part of the research design and must be done whether helpful or not.|
|d.||To find out if research has already been done on the area you are interested in studying.|
A literature review is conducted to determine whether any research has already been conducted in the area proposed for study. The literature review provides the nurse researcher an opportunity to examine the relevance of previous studies, compare various studies, and determine what additional research is needed.
- Which of the following statements best represents the goal of research?
|a.||to build a scientific knowledge base|
|b.||to find a better way to do something|
|c.||to find a way to make or save money|
|d.||to discover something new and exciting|
The goal of research is to build a scientific knowledge base. Previously, nursing knowledge has been obtained through tradition, trial and error, authority, personal experiences, intuition, reasoning, or borrowing from other fields. As a profession, nursing is able to expand scientific knowledge regarding nursing through research. Research is scientific inquiry, the highest level of obtaining knowledge. Nursing research can thus be used to create, test, and refine theories regarding nursing education and nursing practice.
- When doing research, you will have a large group of interest from which you will select a subset to study. The large group of interest is referred to by which of the following terms?
The term population is used to represents the larger group of interest from which a subset has been selected. The subset is most often called the sample. The research project will be conducted with the sample. If the sample is randomly chosen from the larger population, generalizability of the results will be possible.
- The facts or the pieces of information that you will collect in a research study are called by which of the following terms?
|a.||fact set||c.||knowledge sets|
|b.||the data||d.||informational items|
The data are the pieces of information that you collect in a research study. Data can be obtained by a variety of methods which include results of standardized research tools, observations, interviews, and case studies.
- Which of the following statements is true about the analysis step of research?
|a.||If a nurse is not good at statistics, the nurse cannot do acceptable research work.|
|b.||Data analysis has become quite simple due to the computer and the aid of statisticians.|
|c.||Nurses need to employ a statistician to assist them with the data after the data is collected.|
|d.||The analysis step is the hardest and most time-consuming step of the research project.|
Data analysis has become simpler due to the use of computers for data analysis and the aid of statisticians. Many quantitative research studies that involve large quantities of numerical data would be almost impossible to analyze without the use of a computer. The aid of the statistician is frequently needed because his expertise is related to the analysis of numerical data.
- After the nurse researcher has analyzed the findings of a study, the nurse must try to interpret the findings. The results of the study are compared to which of the following things?
|a.||the hypothesis||c.||current beliefs|
|b.||earlier studies||d.||the literature review|
The hypothesis is a statement about the relationship between variables. The results of the study are compared to the researcher’s expectations that were stated in the hypothesis.
- Which of the following statements is true about the role(s) of the generalist psychiatric mental health nurse in research?
|a.||Few, if any, roles exist in research for this level of nurse.|
|b.||This type of nurse is unqualified to be involved in research.|
|c.||The generalist nurse has no responsibility for being involved in research.|
|d.||This nurse uses research data to guide practice and is a consumer of research.|
There are a number of roles that the psychiatric mental health generalist nurse can fulfill in research. The psychiatric mental health generalist nurse has a responsibility to be involved in research in various ways such as reading research reports and using research data to guide practice and provide evidence-based care.
- The nurse who is the principal investigator in a relatively large research project finds that he cannot collect all the data that is required in a study due to time constraints. Which of the following would probably be the best course of action for this nurse investigator?
|a.||abandon the research project|
|b.||train some additional data collectors|
|c.||redesign the study with a smaller group of subjects|
|d.||redesign the study to accommodate a different time frame|
Many studies would never be completed without the assistance of additional data collectors. It is difficult for the principal investigator to do all the data collection that is required in a large study. Other individuals are trained on the appropriate techniques and the expectations of their role.
- In the role of the client advocate, the nurse who is the principal investigator of a research project must most do which one of the following things during a research study?
|a.||ensure that clients are happy during the research study and do not leave the study|
|b.||negotiate for the client to assure that the client is well compensated for participating|
|c.||make certain that the rights of all prospective and active subjects are adequately protected|
|d.||remove weaker clients from any medication or treatment groups and place them in the control group|
In the role of client advocate, the nurse must ensure that the rights of all prospective and actual subjects are adequately protected. The Nuremberg Code and the Declaration of Helsinki were pivotal pieces of legislation which formed the foundation upon which current statements regarding the rights of research subjects are based.
- Most research by psychiatric mental health nurses has been conducted on which of the following age groups?
Most research in psychiatric-mental health nursing has been conducted on adults. This is the largest group of clients seen by psychiatric nurses. With the increased focus on the mental health issues of infants, children, and adolescents, the number of evidence-based research studies has increased. In addition, federal funding for these groups of individuals has been made much more available.
- When a nurse researcher wants to interview a group of adult clients on the inpatient unit where he works, he most needs to secure permission from which of the following persons or groups before proceeding with the studies?
|b.||the ethical committee|
|c.||the institutional review board|
|d.||the nursing peer review committee|
Unless the client has a guardian, the mentally competent client can give permission without the family’s consent. Ethics committees and nursing peer review committees do not normally get involved in issues of permission related to research. It is the institutional review board that will review the research proposal and determine whether the research project may proceed. A nursing peer review committee might review the research proposal for possible funding or the results of a research project for possible publication in a nursing journal.
- Qualitative research focuses on which of the following?
|b.||use of parametric statistical tests|
|c.||the meanings of experiences to people|
|d.||generalizations across groups of people|
Qualitative research focuses on the meanings of experiences to people. Quantitative research focuses on numerical data, using parametric and nonparametric tests. Qualitative research also is used to make generalizations.
- Historically, psychiatric nurses have been instrumental in:
|a.||research drug trials|
|b.||experimental studies exploring brain patterns in lab animals|
|c.||studies exploring the lived experiences of psychiatric patients|
|d.||research which focused on outcomes of services provided to mental health clients|
Historically, psychiatric nurses have been instrumental in research drug trials. Currently, nurses are involved in all aspects of research, including experimental and nonexperimental research. Many nurses are now the primary researchers on both quantitative and qualitative research projects.
- Which of the following statements is true regarding the framework of a research study?
|a.||It is never used with quantitative research design.|
|b.||It is synonymous with the review of the literature.|
|c.||It is developed by the target population of the study.|
|d.||It provides a knowledge base into which the study results are placed.|
The study framework consists of the concepts and constructs that form the study. It provides a knowledge base into which the study results are placed.
- A study conducted by Ahijevych & Bernard found that assessment instruments used to appraise health promoting behaviors:
|a.||suggested a middle-class bias|
|b.||were found to lack appropriate rigor|
|c.||documented the importance of stress and coping on mental health|
|d.||demonstrated a correlation between African American and Hispanic females|
Ahijevych & Bernard found that assessment instruments used to appraise health-promoting behaviors suggested a middle-class bias. The tools were insensitive to diverse populations such as the economically disadvantaged. Other assessment instruments sensitive to every segment of the society should be developed.
- Which of the following statements is true regarding research design?
|a.||identifies the concepts and constructs to be analyzed in the project|
|b.||determines what, if any, research has already been conducted on the particular problem|
|c.||provides an analysis of the results of the data obtained and communicates the study findings|
|d.||integrates and guides methodological decisions and defines the direction that the research adopts|
The research design integrates and guides methodological decisions and defines the direction that the research adopts. The nurse researcher will determine whether a qualitative or quantitative design is appropriate for the study. The literature review will determine what, if any, research has already been conducted on the particular problem. Concepts and constructs are identified in the study framework. Data is analyzed in the analysis of data section of the research project. Findings are communicated through publications and presentation of results at seminars and conferences.
- Which of the following was developed in response to the call of psychiatric mental health nurse leaders to establish a cadre of researchers with PhDs and expand the number of psychiatric nurse researchers?
|a.||National Institute of Health Revitalization Act|
|b.||ANA Standards of Psychiatric-Mental Health Nursing|
|c.||Strategic Plan of the National Institute of Nursing Research|
|d.||National Institute of Nursing Research/NIMH Mentoring Program|
The National Institute of Nursing Research/NIMH Mentoring Program was created in response to the call from psychiatric mental health leaders to establish a cadre of researchers with PhDs and expand the number of psychiatric nurse researchers. This program will prove to be instrumental in improving the health care and quality of life for clients with mental illness.
- The nurse conducting mental health research knows that quantitative research is:
|b.||reductionistic||d.||Reasoning Dialectic, inductive|
Quantitative research is reductionistic. It focuses on collecting numeric information. Data is analyzed using descriptive and/or inferential statistics. Qualitative research allows for large quantities of data to be reduced in order to find meaning.
- As society becomes more diverse, psychiatric nurse researchers must develop research studies that will:
|a.||lead to interventions for every segment of the population|
|b.||distinguish novice researchers from expert researchers|
|c.||be implemented only with elderly clients since they are the fasting growing age group|
|d.||focus primarily on first-generation immigrants from Asia and Eastern European countries|
As society becomes more diverse, psychiatric nurse researchers must develop research studies that will lead to interventions for every segment of the population. New, culturally relevant data-collecting instruments should be developed if they are to truly reflect the experiences of a diverse population.
- A nurse on an inpatient unit wants to conduct a study to determine the experiences of his clients receiving ECT. The nurse should use which qualitative research design:
|a.||historical design||c.||grounded theory design|
|b.||ethnographic design||d.||phenomenological design|
Phenomenological research design is used to document the lived experiences of the subjects. This design is a qualitative research design. Data can be gathered through interviews with the individual clients.
- You are a nurse researcher and plan to conduct a study to examine the effects of psychotropic drugs on fifty African American males. The subjects of your study will be randomly selected. Your study would be generalizable to which population?
|a.||males receiving psychotropic drugs|
|b.||all clients receiving psychotropic drugs|
|c.||African Americans receiving psychotropic drugs|
|d.||African American males receiving psychotropic drugs|
Generalizability allows the researcher to make inferences that the results of the study can be applied to the larger population from which the sample was obtained. If the nurse researcher’s sample consisted of fifty randomly selected African American males receiving psychotropic drugs, the sample should be representative of all African American males receiving psychotropic drugs in the larger population. Generalizability may not exist with the other options. The first option, “males” includes males from a variety of ethnic groups. The second option, “all clients” includes women and different ethnic and age groups. The third option, “African Americans” includes males and females of all age groups.
- A nurse was requested to conduct a research study of a group of children who had been exposed to a traumatic event at their school. The nurse plans to use several established research tools including the State Anxiety Scale for Children. The children’s scores on the tools will be analyzed against demographic variables such as age, gender, and ethnicity. Which of the following would be the most appropriate research design for the nurse researcher to choose?
|a.||quantitative experimental||c.||qualitative grounded theory|
|b.||quantitative nonexperimental||d.||qualitative phenomenological|
The most appropriate research design would be quantitative nonexperimental. The researcher has chosen to use standardized instruments. These instruments will be interpreted using statistical analysis. Quantitative research focuses on numeric data. Also, no treatments or interventions are mentioned so the study would not be experimental or quasi-experimental.