1. Piaget's theory of cognitive development includes which stage?

Anticipation of disapproval

Basic anxiety

Concrete operational

Generativity versus self-absorption

2. Older adults have reached Erikson's developmental stage of ego integrity when they:

acknowledge that one cannot get everything one wants in life.

assess their lives and identify actions that had value and purpose.

express a wish that life could be relived differently.

feel that they are being punished for things they did not do.
3. A supervisor observes inconsistency in a psychiatric and mental health nurse's behavior
toward a patient as unreasonably concerned, overly kind, or irrationally hostile. The best
explanation is that the nurse is displaying:

countertransference.

empathic resonance.

negative transference.

seductive behavior.
4. When coping with a patient's inappropriate expression of anger, the first step is to
recognize:

appropriate limit-setting techniques.

defense mechanisms that the patient is using.

one's own response to anger in others.

systems theory approaches for effecting change.

5. A female patient complains to a psychiatric and mental health nurse that staff members
have been avoiding her since an incident of self-mutilation. The nurse's most appropriate
response is to:
 apologize for the staff's behavior.

explain that feelings of rejection are not unusual after self-mutilation.

listen, redirect the patient to her feelings, and privately explore the matter with unit
staff.

report the matter to the nurse manager

6. The first step in the treatment of incest is to:

believe the child who reports the activity.

notify the proper authorities.

objectively confront the accused family member.

remove the child from the home.

7. During a weekly counseling session, a 26-year-old male patient reports that he suspects
his wife is "running around." He says that he has considered getting a divorce but needs his
wife too much to go through with it. The nurse's most appropriate initial response is to:

ask the patient to bring his wife with him to the next session.

encourage the patient to further express his feelings and his perception of the problem.

help the patient to consider alternative solutions.

suggest appropriate reading material on the subject.

8. A patient has clenched fists and is yelling and swearing while pacing around the dayroom.
This behavior is typical of which phase of the assault cycle?

Compulsivity

Crisis

Disorientation

Escalation
9. The severe feeling of restlessness produced by some psychotropic medications, which is
often misinterpreted by patients as anxiety or a recurrence of psychiatric symptoms, is
known as:
 akathisia.

akinesia.

bradykinesia.

dystonia.
10. A common nursing diagnosis for patients who have antisocial personality disorder is:

altered thought processes, related to sensory-perceptual alterations.

impaired social interaction, related to manipulative behaviors and repeated lying.

self-esteem disturbance, related to poor self-image and excessive fear of failure.

social isolation, related to anxiety in social situations.

11. A male patient, who was admitted yesterday with an adjustment disorder with depressed
mood, has not left his room. The psychiatric and mental health nurse's most appropriate
approach at mealtime today is to say:

“I will bring your tray to your room if it will make you more comfortable.”

“I will walk with you to the dining room and sit with you while you eat.”

“Where would you like to eat your meal this noon?”

“You will feel better if you go to the dining room and eat with the others.”
12. Which statement indicates that a patient is ready to terminate intensive case
management services?

“I am no longer suicidal and group therapy is helping.”

“I am not the only person who has ever felt like this.”

“I just can't go outside. I get so anxious.”

“I miss our weekly sessions. I get so lonely.”

13. The nursing staff at a community mental health center is helping to formulate an
outpatient treatment plan for a 30-year-old female patient with schizophrenia. A major
consideration is that the:
 patient will need a referral to vocational rehabilitation services.

patient will probably need weekly supportive treatment for life.

patient's contact with the center will diminish as she becomes stable, but she will
continue to need some minimal ties.

patient's contact with the center will gradually decrease until her therapy can be
terminated.
14. After completing a third electroconvulsive therapy treatment, a patient says, "I haven't
been able to remember anything since that last treatment. It wasn't like this before." The
psychiatric and mental health nurse's best response is to:

check the patient's record to see if the voltage was increased during the last treatment.

encourage the patient to continue keeping a daily journal of thoughts and feelings.

notify the physician of the patient's increased memory loss.

reassure the patient that most patients who receive this type of therapy experience
some temporary memory loss.
15. Selective serotonin-reuptake inhibitors (SSRI) target which part of the brain?

Basal ganglia

Frontal cortex

Hippocampus

Putamen
16. A 67-year-old patient is confused and disoriented with a depressed affect and mood. The
patient has recent and remote memory deficits, but attempts to mask any confusion with
confabulation. The patient's signs and symptoms indicate:

a dissociative disorder.

a major depressive disorder.

a major depressive episode with psychotic features.

an organic brain disorder.

17. The most serious side effect of clozapine (Clozaril) is:

aplastic anemia.

opisthotonos.

seizures.

tardive dyskinesia.
18. A couple, who are in counseling, report fighting with their son when they are angry with
each other. This behavior is an example of:

coalition.

indirect communication.

transference.

triangulation.
19. According to family systems theory, removing the "identified patient" from the
environment most likely causes:

a drastic improvement in the patient, often with little or no additional therapy.

a loss of motivation of family members and their withdrawal from therapy.

decompensation of remaining family members, evidenced by new dysfunctional

behavior.

rapid further decompensation of the patient because of the loss of the usual support
system.
20. A 16-year-old Chinese-American female patient is admitted to the unit with reported
feelings of sadness and suicidal ideation. The patient and her family emigrated from
mainland China five years ago. The psychiatric and mental health nurse notes that
numerous family members are present. The nurse's best approach is to:

ask the family members to leave the room.

encourage the patient to communicate her need for privacy to her family.
 take the mother aside and ask for her assistance in clearing the room.

try to care for the patient while the family members are present.
21. In which area is advocacy urgently needed to address the increasing numbers of
homeless persons who have severe and persistent mental illness?

Constructing more and larger shelters

Ensuring less restrictive treatment environments

Offering decentralized, separate services for individualized care

Providing integrated, comprehensive forms of care

22. In a quality assurance program, a retrospective audit involves:

examining the charts of discharged patients and using specific criteria to determine the
quality of patient care.

inspecting the facility to monitor the therapeutic quality of the environment and to
suggest improvements.

reviewing patient charts to determine how appropriately hospital resources are being
used.

using a case conference format for staff to discuss ways to improve a particular patient's
care.
23. A psychiatric and mental health nurse manager of a milieu treatment team receives a
report that a nurse was threatened and frightened by a patient. No assault occurred;
another staff member intervened to calm the patient. The threatened nurse is visibly
shaken. After ensuring the safety of the milieu, the nurse manager:

has the threatened nurse attend Managing Assault Behavior classes.

identifies ways that the threatened nurse could have prevented the confrontation.

spends time with the threatened nurse and the team to process attitudes and feelings.

tells the threatened nurse that this situation is a normal risk of psychiatric and mental
health nursing.
24. When a research study is based on a small sample size, then the research findings:
 may have statistical significance, but will be less generalizable than if the sample size
had been larger.

may have statistical significance, but will not be clinically significant.

will not be significant, because the research design was quasi-experimental instead of
experimental.

will not be significant, because the research was poorly conducted.

25. Patient confidentiality may be breached by staff in which circumstance?

A supervisor inquires about the patient

The family inquires about the patient without the patient's knowledge

The patient appears sincere in threatening to harm another person

The patient has participated in illegal activity