CHAPTER 3 1.

A client receiving a psychotropic drug reports to the nurse that he is drowsy all the time and is having difficulty focusing his attention. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate A) mood. B) thought. C) memory. D) sleep. 2. A client's communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms? A) Cerebrum B) Cerebellum C) Brainstem D) Basal ganglia 3. On the basis of the current understanding of neurotransmitters, the nurse can view a client's symptoms of profound depression as likely related in part to A) increased dopamine level. B) decreased serotonin level. C) increased norepinephrine level. D) decreased acetylcholine level. 4. A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as," someone with Alzheimer's." The nurse offers the following advice: A) "Try talking to him early in the day to get the best results. Fatigue disorganizes his thinking." B) "Schizophrenia and Alzheimer's disease both cause irreversible brain damage, so keep your conversations short when you talk to a client with either disorder." C) "His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support." D) "Make sure he eats the comfort foods he is served because they increase serotonin production and will help normalize his thoughts and speech." 5. The nurse caring for a client taking risperidone (Risperidal) observes the client carefully for: A) napping during the day, a weight gain, and reports of dizziness. B) reports of falls, heartburn and nausea. C) a rapid heartbeat, red rash and hives. D) dry mouth, poor urinary output, and constipation.

6. When the nurse cares for a client taking an antipsychotic medication that blocks muscarinic receptors, the nurse would assess for: A) sedation, drowsiness, hypotension, and weight gain. B) orthostatic hypotension and memory dysfunction. C) blurred vision, dry mouth, and constipation. D) tremors, tachycardia, and ejaculatory dysfunction. 7. The nurse responsible for the care of a client prescribed clonazepam (klonopin) would evaluate treatment as being successful when the client demonstrates: A) less anxiety. B) normal appetite. C) improved sleep pattern. D) reduced auditory hallucinations. 8. The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing: A) Laughing at a joke B) Exercising a sore shoulder C) Writes down his telephone number D) Going to his room to 'calm down' 9. The physician tells a client who demonstrates use of many rituals "We want to do an imaging study that will tell us which parts of your brain are particularly active. We believe the study will help us determine how to treat your symptoms." From this explanation, the nurse can determine that the physician will order a(n) A) computed tomography scan. B) positron emission tomography scan. C) ventriculogram. D) electroencephalogram. 10. A client is admitted to the hospital with severe depression. The nurse recognizes the possibility that depression may be related to a stress induced hormonal imbalance associated with: A) Luteinizing hormone B) Cortisol C) Gronadotropin D) Clomipramine

1. The basic functional unit of the nervous system is called a A) neuron. B) synapse. C) receptor. D) neurotransmitter. 2. Treatment of mental illnesses with psychotropic drugs is directed at A) altering brain neurochemistry. B) correcting brain anatomical defects. C) regulating social behaviors. D) activating the body's normal response to stress. 3. Which of the following is classified as a circadian rhythm? A) Sex drive B) Sleep cycle C) Skeletal muscle contraction D) Maintenance of a focused stream of consciousness 4. The incoherent thought and speech patterns of the client with schizophrenia are related to the brain's inability to A) regulate conscious mental activity. B) retain and recall past experience. C) regulate social behavior. D) maintain homeostasis. 5. Homeostasis is promoted by interaction between the brain and internal organs mediated by A) conscious behavior. B) the autonomic nervous system. C) the sympathetic nervous system. D) the parasympathetic nervous system.

6. Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called A) neurons. B) synapses. C) dendrites. D) receptors. 7. Which imaging technique can provide information about brain function? A) Computed tomography scan B) Positron emission tomography scan C) Magnetic resonance imaging scan D) Skull radiograph 8. When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate A) disequilibrium. B) abnormal eye movement. C) impaired social judgment. D) blood pressure irregularities. 9. Which organs secrete hormones that are a normal component of the body's general response to stress? A) Brain, thyroid gland, pancreas B) Brain, pituitary gland, adrenal glands C) Pituitary gland, pancreas, thyroid gland D) Adrenal glands, parathyroid glands 10. The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates norms and laws demonstrates problems related to the brain's inability to A) regulate conscious mental activity. B) retain and recall past experience. C) regulate social behavior. D) maintain homeostasis.

Chapter 7 1. The intervention that will be most effective in preventing a nurse from making decisions that will lead to legal difficulties is A) asking a peer to review nursing intervention related decisions. B) balancing the rights of the client and the rights of society. C) maintaining currency in state laws affecting nursing practice. D) seeking value clarification about fundamental ethical principles. 2. Which ethical principle refers to the individual's right to make his or her own decisions? A) Beneficence B) Autonomy C) Veracity D) Fidelity 3. If a nurse is charged with client abandonment, it is being suggested that the nurse's behavior has violated the ethical principle of A) autonomy. B) veracity. C) fidelity. D) justice. 4. In the course of providing best psychiatric care for a client the nurse must place greatest reliance on A) legal principles. B) ethical principles. C) independent judgment. D) institutional standards. 5. The civil rights of persons with mental illness who are hospitalized for treatment are A) the same as those for any other citizen. B) altered to prevent use of poor judgment. C) ensured by appointment of a guardian. D) limited to provision of humane treatment.

6. If a client with psychiatric illness is determined to be incompetent to make decisions affecting his care, A) staff is required to use their best judgment. B) no treatment other than custodial care can be provided. C) the court appoints a guardian to make decisions on his behalf. D) the doctrine of least restrictive alternative is null and void. 7. Which is true of mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit? A) The client can receive mail from only family and legal sources. B) Mail must first be opened and inspected by staff. C) Receipt of mail is considered a privilege accorded the client for compliance. D) The client has the right to social interaction with those outside the hospital. 8. Which right of the client has been violated if he is medicated over his objection? A) Dignity and respect B) Right to treatment C) Right to informed consent D) Right to punitive damages 9. A client who is forced to take medication against his will, in other than an emergency situation in which he presents a danger to self or others, can bring suit against the agency for A) assault. B) battery. C) defamation. D) invasion of privacy. 10. After the death of a client what, if any, rules regarding confidentiality should be followed by nurses who have cared for the client? A) Confidentiality is now reserved to immediate family. B) Only HIV status continues to be protected and privileged. C) Disclose nothing that would have been kept confidential before death. D) Confer with next of kin before divulging confidential, sensitive information.

1. A nurse is adequately representing the stated bioethical principle when valuing: A) autonomy by respecting a client's right to decide to refuse cancer treatment. B) justice by staying with a client who is suicidal C) fidelity by informing the client about the negative side effects of a proposed treatment D) beneficence when advocating for a client's right to enter into a clinical trail for a new medication 2. Which statement about right to treatment in public psychiatric hospitals is accurate? A) Hospitalization without treatment violates the client's rights. B) Right to treatment extends only to provision of food, shelter, and safety. C) All clients have the right to choose a primary therapist and case manager. D) The right to treatment for hallucinations has priority over treatment for anxiety. 3. What ethical principle is supported when a physician obtains informed consent for electroconvulsive therapy from a depressed client? A) Beneficence B) Autonomy C) Justice D) Fidelity 4. A psychiatric technician reports to the charge nurse that a client is going to sue for negligence because she intervened to prevent him from striking another client. The charge nurse shares with the psychiatric technician that negligence: A) is an act or failure to act in a way that a responsible employee would act. B) applies only when the client is abandon or mistreated. C) is an action that puts the client in fear of being harmed by the employee. D) means the employee has given malicious false information about the client. 5. The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of A) autonomy and beneficence. B) advocacy and confidentiality. C) veracity and fidelity. D) justice and humanism.

6. What assumption can be made about the client who has been admitted on an involuntary basis? A) The client can be discharged from the unit on demand. B) For the first 48 hours, the client can be given medication over objection. C) The client has agreed to fully participate in treatment and care planning. D) The client is a danger to self or others or unable to meet basic needs. 7. When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rule, the correct assumption is that the client was admitted: A) per legal requirements. B) for a non-emergency. C) voluntarily. D) involuntarily. 8. A client is released from involuntary commitment by the judge, who orders that a caseworker supervise him for the next 6 months. This is an example of A) conditional discharge. B) outpatient commitment. C) voluntary follow-up. D) discretionary treatment. 9. A client who is to be discharged the next day tells the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? A) None, because no explicit threat has been made B) Immediately cancel the client's discharge C) Call the client's wife and report the threat D) Report the incident to the client's therapist and document 10. If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client would have the right to bring suit against the hospital for A) battery. B) defamation of character. C) false imprisonment. D) assault.

Chapter 10 1. Student nurses on psychiatric units may not have the luxury of seeing patients in a private office or conference room. Of the following environments, which would be most conducive to a therapeutic session? A) Nurse's station B) A table in the coffee shop C) Quiet section of the day room D) Utility room 2. Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A) Using emotionally charged words and gestures B) Offering opinions and avoiding periods of silence C) Asking closed-ended questions requiring "yes" or "no" answers D) Asking open-ended questions and seeking clarification 3. What therapeutic communication technique is the nurse using when asking a newly admitted patient "Can you tell me what was happening to you that led to your being hospitalized here?" A) Using a minimal encourager B) Using an open-ended question C) Paraphrasing D) Reflecting 4. The content and direction of the clinical interview is determined by: A) The nurse B) The client C) The physician D) The health care team 5. The preferred seating arrangement for a nurse-client interview is with the A) nurse behind a desk and the client in a chair in front of the desk. B) nurse and client sitting at 90-degree angles to each other. C) client sitting in a chair and the nurse standing a few feet away. D) nurse and client sitting facing each other.

6. What is the focus during clinical supervision? A) The nurse's behavior in the nurse-client relationship B) Analysis of the client's motivation for transferences C) Devising alternative strategies for client growth D) Assisting the client to develop increased independence 7. Two main principles that can guide the communication process during the nurse-client interview are A) clarity and giving recognition. B) personal and environmental factors. C) passive listening and cultural caution. D) interpreting and speculating on client meaning. 8. When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy? Verbal communication relates to content as nonverbal communication relates to A) touch. B) conflict. C) process. D) double messages. 9. A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is A) African American. B) Hispanic American. C) Asian American. D) British American. 10. The best rule of thumb related to touching psychiatric clients is A) follow your instincts. B) touch the elderly, but avoid touching the young. C) check the facility's policy on the acceptability of touch. D) touch is perceived as a gesture of warmth and friendship that fosters a relationship.

1. When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a: A) Safe person to interact with B) New friend C) Stranger D) Peer 2. A client shares that, "I can't stand his controlling ways. I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nursing using when responding, "Are you saying that things would be better if you left your husband?" A) Focusing B) Restating C) Reflection D) Clarification 3. During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A) The mental image of a word may not be the same for both nurse and client. B) One statement may simultaneously convey conflicting messages. C) Many of the client's remarks are no more than social phrases. D) Content of messages may be contradicted by process. 4. During a therapeutic encounter the nurse remarks to a client "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A) Giving information and encouraging evaluation B) Presenting reality and encouraging planning C) Clarifying and suggesting collaboration D) Reflecting and exploring 5. After a client discusses her relationship with her father, the nurse asks "Tell me if I am understanding your relationship with your father. You feel dominated and controlled by him?" The nurse's purpose is to A) elicit more information. B) encourage evaluation. C) verbalize the implied. D) Clarify message.

6. Which statement by the nurse reflects the process occurring in the clinical interview? A) "Give me an example of something your wife does that 'drives you nuts.'" B) "What makes you think your doctor will give you a pass?" C) "When is your child custody hearing going to be held?" D) "You are frowning. What are you feeling?" 7. What is the most helpful nursing response to a client who reports he is thinking of dropping out of nursing school because it is too stressful? A) "Don't let them beat you! Fight back!" B) "School is stressful. What do you find most stressful?" C) "I know just what you are going through. The stress is terrible." D) "You have only two more semesters. You will be glad if you stick it out." 8. With which client would making direct eye contact help further the nurse-client relationship? A) Mrs. A, a recent immigrant from Korea B) Ms. B, a recent immigrant from Mexico C) Mr. C, a recent immigrant from Japan D) Mr. D, a recent immigrant from Germany 9. With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A) Ms. E, a client from Russia B) Mrs. F, a deeply depressed client C) Ms. G, a Chinese American client D) Mr. H, a tearful client reporting pain 10. During a clinical interview with a male nurse, the client falls silent after disclosing that she was sexually abused as a child. The nurse should A) quickly break the silence and encourage the client to continue. B) reassure the client that the abuse was not her fault. C) reach out and gently touch the client's arm. D) allow the client to break the silence.