Psych Exam 1

ch. 2 (theories & therapies), ch. 3 (neurobiology & pharmacotherapy), ch. 9 (therapeutic communication), ch. 10 (stress response & stress management), ch. 11 (childhood & neurodevelopment disorders), ch. 12 (schizophrenia spectrum disorders), ch. 14 (depressive disorders), ch. 17 (somatic symptom disorders)

ch. 2 - a parent says, “my 2-year-old child refuses toilet training and shouts ‘no!’ when given directions. what do you think is wrong?” what is the nurse’s best reply?

a) “your child needs firmer control. it is important to set limits now.”

b) “this is normal for your child’s age. the child is striving for independence.”

c) “there may be developmental problems. most children are toilet trained by age 2.”

d) “some undesirable attitudes are developing. a child psychologist can help you develop a plan.”

b) “this is normal for your child’s age. the child is striving for independence.” - rationale: this behavior is conventional of a child around the age of 2 years, whose developmental task is to develop autonomy. 

ch. 2 - a nurse wants to find information on current evidence-based research, programs, and practices regarding mental illness and addictions. which resource should the nurse consult?

a) american psychiatric association

b) american psychological association (apa)

c) clinician’s quick guide to interpersonal psychotherapy

d) substance abuse and mental health services administration (samhsa)

d) substance abuse and mental health services administration (samhsa) - rationale: the samhsa maintains a national registry of evidence-based practices and programs.

ch. 2 - a 26-month-old displays negative behavior, refuses toilet training, and often says, “no!” which psychosocial crisis is evident?

a) trust versus mistrust

b) initiative versus guilt

c) industry versus inferiority

d) autonomy versus shame and doubt

d) autonomy versus shame and doubt - rationale: the crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training.

ch. 2 - a 4-year-old grabs toys from other children and says, “i want that now!” from a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality?

a) id

b) ego

c) superego

d) preconscious

a) id - rationale: the id operates on the pleasure principle, seeking immediate gratification of impulses.

ch. 2 - the parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. these qualities are likely to be internalized and become part of which system of the personality?

a) id

b) ego

c) superego

d) preconscious

c) superego - rationale: the superego contains the “shoulds,” or moral standards internalized from interactions with significant others.

ch. 2 - a nurse supports a parent for praising a child who behaves in helpful ways to others. when this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result?

a) guilt

b) anxiety

c) humility

d) self-esteem

d) self-esteem - rationale: the individual will be living up to the ego ideal, which will result in positive feelings about self.

ch. 2 - an adult says, “i never know the answers,” and “my opinion does not count.” which psychosocial crisis was unsuccessfully resolved for this adult?

a) initiative versus guilt

b) trust versus mistrust

c) autonomy versus shame and doubt

d) generativity versus self-absorption

c) autonomy versus shame and doubt - rationale: these statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully.

ch. 2 - which statement by a client would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy?

a) “i know how to do things right, so i prefer jobs where i work alone rather than on a team.”

b) “i do not allow other people to truly get to know me.”

c) “i depend on frequent praise from others to feel good about myself.”

d) “i usually need to do things several times before i get them right.”

b) “i do not allow other people to truly get to know me.” - rationale: according to erikson, the developmental task of infancy is the development of trust.

ch. 2 - a client is suspicious and is frequently sarcastic toward others. to which psychosexual stage do these traits relate?

a) oral

b) anal

c) phallic

d) genital

a) oral - rationale: the behaviors develop from attitudes formed during the oral stage, when an infant first learns to relate to the environment.

ch. 2 - a client expresses a desire to be cared for by others and often behaves in a helpless fashion. which stage of psychosexual development is most relevant to the client’s needs?

a) latency

b) phallic

c) anal

d) oral

d) oral - rationale: fixation at the oral stage sometimes produces dependent infantile behaviors in adults.

ch. 2 - a nurse listens to a group of recent retirees. one says, “i volunteer with meals on wheels, coach teen sports, and do church visitation.” another laughs and says, “i’m too busy taking care of myself to volunteer to help others.” which psychosocial developmental task do these statements contrast?

a) trust and mistrust

b) intimacy and isolation

c) industry and inferiority

d) generativity and self-absorption

d) generativity and self-absorption - rationale: both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption.

ch. 2 - an adult dies in a tragic accident. afterward, the siblings plan a funeral service. which statement by a sibling best indicates a sense of self-actualization?

a) “of all of us, i am the most experienced with planning these types of events.”

b) “funerals are supposed to be conducted quietly, respectfully, and according to a social protocol.”

c) “this death was unfair, but i hope we can plan a service that everyone feels is a celebration of life.”

d) “this death was probably the consequence of years of selfish and inconsiderate behavior by our sibling.”

c) “this death was unfair, but i hope we can plan a service that everyone feels is a celebration of life.” - rationale: the correct response shows an accurate perception of reality as well as a focus on solving the problem in a way that involves others.

ch. 2 - a student nurse says, “i don’t need to interact with my clients. i learn what i need to know by observation.” an instructor can best interpret the nursing implications of sullivan’s theory to this student by providing what response?

a) “interactions are required in order to help you develop therapeutic communication skills.”

b) “nurses cannot be isolated. we must interact to provide clients with opportunities to practice interpersonal skills.”

c) “observing client interactions will help you formulate priority nursing diagnoses and appropriate interventions.”

d) “it is important to pay attention to clients’ behavioral changes, because these signify adjustments in personality.”

b) “nurses cannot be isolated. we must interact to provide clients with opportunities to practice interpersonal skills.” - rationale: sullivan’s theory emphasizes that nurses must form relationships with clients to model and foster effective interpersonal communication.

ch. 2 - a nurse consistently encourages a client to do his or her own activities of daily living. if the client is unable to complete an activity, the nurse helps until the client is once again independent. this nurse’s practice is most influenced by which theorist?

a) betty neuman

b) patricia benner

c) dorothea orem

d) joyce travelbee

c) dorothea orem - rationale: orem’s theory centers on supporting and promoting self-care, especially when clients are temporarily unable to meet their own needs.

ch. 2 - a nurse uses maslow’s hierarchy of needs to plan care for a client diagnosed with mental illness. which problem will receive priority?

a) refusal to eat or bathe

b) reporting feelings of alienation from family

c) reluctance to participate in unit social activities

d) being unaware of medication action and side effects

a) refusal to eat or bathe - rationale: physiological needs—such as food, water, and hygiene—are the most basic level of maslow’s hierarchy and must be met before addressing higher-level needs.

ch. 2 - operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. which technique applies?

a) encourage the child to observe others talking

b) include the child in small group activities

c) give the child a small treat for speaking

d) teach the child relaxation techniques

c) give the child a small treat for speaking - rationale: operant conditioning uses positive reinforcement to increase desired behaviors.

ch. 2 - the parent of a child diagnosed with schizophrenia tearfully asks the nurse, “what could i have done differently to prevent this illness?” what is the nurse’s best response?

a) “although schizophrenia results from impaired family relationships, try not to feel guilty. no one can predict how a child will respond to parental guidance.”

b) “schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. you are not to blame for your child’s illness.”

c) “there is still hope. changing your parenting style can help your child learn to cope effectively with the environment.”

d) “most mental illnesses result from genetic inheritance. your genes are more at fault than your parenting.”

b) “schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. you are not to blame for your child’s illness.” - rationale: schizophrenia is primarily a biological brain disorder.

ch. 2 - a nurse influenced by peplau’s interpersonal theory works with an anxious, withdrawn client. what principle will the interventions be focused on?

a) rewarding desired behaviors

b) using assertive communication

c) changing the client’s self-concept

d) administering medications to relieve anxiety

b) using assertive communication - rationale: peplau emphasized therapeutic interpersonal relationships as the core of nursing.

ch. 2 - a client participated in psychotherapy weekly for 5 months. the therapist used free association, dream analysis, and facilitated transference to help the client understand conflicts and foster change. what is the term that applies to this method?

a) rational-emotive behavior therapy

b) psychodynamic psychotherapy

c) cognitive-behavioral therapy

d) operant conditioning

b) psychodynamic psychotherapy - rationale: psychodynamic psychotherapy uses psychoanalytic techniques such as free association and transference to address unconscious conflict.

ch. 2 - consider this comment from a therapist: “the client is homosexual but has kept this preference secret. severe anxiety and depression occur when the client anticipates family reactions to this sexual orientation.” which perspective is evident in the speaker?

a) theory of interpersonal relationships

b) classical conditioning theory

c) psychosexual theory

d) behaviorism theory

a) theory of interpersonal relationships - rationale: the theory of interpersonal relationships (e.g., sullivan) focuses on how unmet social and security needs can lead to mental distress like anxiety.

ch. 2 - a psychotherapist works with an anxious, dependent client. which strategy is most consistent with psychoanalytic psychotherapy?

a) identifying the client’s strengths and assets

b) praising the client for describing feelings of isolation

c) focusing on feelings developed by the client toward the therapist

d) providing psychoeducation and emphasizing medication adherence

c) focusing on feelings developed by the client toward the therapist - rationale: psychoanalytic therapy explores transference—emotions toward the therapist that reflect unresolved conflicts with others. 

ch. 2 - a person says, “i was the only survivor in a small plane crash. three business associates died. i got depressed and saw a counselor twice a week for 4 weeks. we talked about my feelings related to being a survivor, and i’m better now.” which type of therapy was used?

a) systematic desensitization

b) psychoanalysis

c) behavior modification

d) interpersonal psychotherapy

d) interpersonal psychotherapy - rationale: interpersonal psychotherapy focuses on grief, role transitions, and interpersonal issues, helping restore function after loss or trauma.

ch. 2 - which technique is most applicable to aversion therapy?

a) punishment

b) desensitization

c) role modeling

d) positive reinforcement

a) punishment - rationale: aversion therapy uses punishment or pairing unpleasant stimuli with unwanted behavior to discourage that behavior.

ch. 2 - a client says to the nurse, “my father has been dead for over 10 years but talking to you is almost as comforting as the talks he and i had when i was a child.” which term applies to the client’s comment?

a) superego

b) transference

c) reality testing

d) countertransference

b) transference - rationale: transference occurs when a client projects feelings about a significant person onto the nurse or therapist.

ch. 2 - a college student received an invitation to attend the wedding of a close friend who lives across the country. the student is afraid of flying. which type of therapy would be most helpful for this client?

a) psychoanalysis

b) aversion therapy

c) systematic desensitization

d) short-term dynamic therapy

c) systematic desensitization - rationale: systematic desensitization gradually exposes the client to feared stimuli while using relaxation techniques to reduce anxiety.

ch. 2 - a client repeatedly stated, “i’m stupid.” which statement by that client would show progress resulting from cognitive-behavioral therapy?

a) “sometimes i do stupid things.”

b) “things always go wrong for me.”

c) “i always fail when i try new things.”

d) “i’m disappointed in my lack of ability.”

a) “sometimes i do stupid things.” - rationale: cognitive-behavioral therapy helps identify and challenge distorted thoughts.

ch. 2 - a client says, “all my life i’ve been surrounded by stupidity. everything i buy breaks because the entire american workforce is incompetent.” this client is experiencing what type of reaction?

a) self-esteem deficit

b) cognitive distortion

c) deficit in motivation

d) deficit in love and belonging

b) cognitive distortion - rationale: this reflects an automatic thought pattern (cognitive distortion) that generalizes blame to others irrationally.

ch. 2 - a client is fearful of riding on elevators. the therapist first rides an escalator with the client. the therapist and client then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. which technique has the therapist used?

a) classic psychoanalytic therapy

b) systematic desensitization

c) rational emotive therapy

d) biofeedback

b) systematic desensitization - rationale: systematic desensitization exposes clients gradually to feared situations while they use relaxation techniques to reduce anxiety.

ch. 2 - a client says, “i always feel good when i wear a size 2 petite.” which type of cognitive distortion is evident?

a) disqualifying the positive

b) overgeneralization

c) catastrophizing

d) personalization

b) overgeneralization - rationale: overgeneralization occurs when one positive attribute (wearing a size 2) is used to define self-worth across situations.

ch. 2 - which comment best indicates a client is self-actualized?

a) “i have succeeded despite a world filled with evil.”

b) “i have a plan for my life. if i follow it, everything will be fine.”

c) “i’m successful because i work hard. no one has ever given me anything.”

d) “my favorite leisure is walking on the beach, hearing soft sounds of rolling waves.”

d) “my favorite leisure is walking on the beach, hearing soft sounds of rolling waves.” - rationale: self-actualized individuals find meaning and joy in simple, peaceful activities and express contentment with life.

ch. 2 - a nurse presents a community education program about mental illness. which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective?

a) “some people experience life events so traumatic that they cannot be overcome.”

b) “disturbed and conflicted family relationships are usually a starting place for mental illness.”

c) “my friend has had bipolar disorder for years and many problems have resulted. it’s not her fault.”

d) “mental illness is the result of developmental complications that cause a person not to grow to their full potential.”

c) “my friend has had bipolar disorder for years and many problems have resulted. it’s not her fault.” - rationale: the biological model views mental illness as originating from physical or genetic causes.

ch. 2 - which client is the best candidate for brief psychodynamic therapy?

a) an accountant with a loving family and successful career who was involved in a short extramarital affair

b) an adult with a long history of major depression who was charged with driving under the influence

c) a woman with a history of borderline personality disorder who recently cut both wrists

d) an adult male recently diagnosed with anorexia nervosa

a) an accountant with a loving family and successful career who was involved in a short extramarital affair - rationale: brief psychodynamic therapy is most appropriate for well-functioning individuals with specific, focused issues and good insight, such as the client in option a.

ch. 2 - a client states, “i’m starting cognitive-behavioral therapy. what can i expect from the sessions?” which responses by the nurse would be appropriate? (select all that apply)

a) “the therapist will be active and questioning.”

b) “you will be given some homework assignments.”

c) “the therapist will ask you to describe your dreams.”

d) “the therapist will help you look at your ideas and beliefs about yourself.”

e) “the goal is to increase subjectivity about thoughts that govern your behavior.”

a) “the therapist will be active and questioning.”

b) “you will be given some homework assignments.”

d) “the therapist will help you look at your ideas and beliefs about yourself.”

rationale: cognitive therapists are active, assign homework, and help clients examine and test beliefs. dream analysis is psychoanalytic, and increasing subjectivity is not a goal.

ch. 2 - which comments by an elderly person best indicate successful completion of the individual’s psychosocial developmental task? (select all that apply)

a) “i am proud of my children’s successes in life.”

b) “i should have given to community charities more often.”

c) “my relationship with my father made life more difficult for me.”

d) “my experiences in the war helped me appreciate the meaning of life.”

e) “i often wonder what would have happened if i had chosen a different career.”

a) “i am proud of my children’s successes in life.”

d) “my experiences in the war helped me appreciate the meaning of life.”

rationale: pride and appreciation reflect integrity, which is the developmental task of old age. regret and blaming suggest despair.

ch. 2 - which comments by an adult best indicate self-actualization? (select all that apply)

a) “i am content with a good book.”

b) “i often wonder if i chose the right career.”

c) “sometimes i think about how my parents would have handled problems.”

d) “it’s important for our country to provide basic health care services for everyone.”

e) “when i was lost at sea for 2 days, i gained an understanding of what is important.”

a) “i am content with a good book.”

d) “it’s important for our country to provide basic health care services for everyone.”

e) “when i was lost at sea for 2 days, i gained an understanding of what is important.”

rationale: self-actualized people value simple pleasures, have concern for others, and reflect meaningfully on life experiences. self-doubt and parental comparison reflect unresolved development.

ch. 2 - which activities represent the caring foundation of nursing? (select all that apply)

a) administering medications on time to a group of clients

b) listening to a new widow grieve her husband’s death

c) helping a client obtain groceries from a food bank

d) teaching a client about a new medication

e) holding the hand of a frightened client

b) listening to a new widow grieve her husband’s death

c) helping a client obtain groceries from a food bank

e) holding the hand of a frightened client

rationale: caring behaviors involve presence, empathy, advocacy, and physical comfort. benner’s model emphasizes compassion beyond technical tasks.

ch. 2 - which therapies involve electrical brain stimulation for treatment of mental illness? (select all that apply)

a) aversion therapy

b) operant conditioning

c) systematic desensitization

d) electroconvulsive therapy (ect)

e) transcranial magnetic stimulation (tms)

d) electroconvulsive therapy (ect)

e) transcranial magnetic stimulation (tms)

rationale: ect and tms use direct or magnetic electrical stimulation to affect brain function and are used to treat depression and other disorders.

ch. 3 - a client asks, “what are neurotransmitters? my doctor said mine are imbalanced.” what is the nurse’s best response?

a) “how do you feel about having imbalanced neurotransmitters?”

b) “neurotransmitters protect us from harmful effects of free radicals.”

c) “neurotransmitters are substances we consume that influence memory and mood.”

d) “neurotransmitters are natural chemicals that pass messages between brain cells.”

d) “neurotransmitters are natural chemicals that pass messages between brain cells.” - rationale: neurotransmitters are chemical messengers in the brain that transmit signals across synapses, which is what the client asked.

ch. 3 - the parent of an adolescent diagnosed with schizophrenia asks the nurse, “my child’s doctor ordered a pet. what kind of test is that?” what is the nurse’s best reply?

a) “this test uses a magnetic field and gamma waves to identify problem areas in the brain. does your teenager have any metal implants?”

b) “pet means positron-emission tomography. it is a special type of scan that shows blood flow and activity in the brain.”

c) “a pet scan passes an electrical current through the brain and shows brain-wave activity. it can help diagnose seizures.”

d) “it’s a special x-ray that shows structures of the brain and whether there has ever been a brain injury.”

b) “pet means positron-emission tomography. it is a special type of scan that shows blood flow and activity in the brain.” - rationale: a pet scan shows metabolic activity and blood flow in the brain, helping identify functional abnormalities.

ch. 3 - a client with a long history of hypertension and diabetes now develops confusion. the health care provider wants to make a differential diagnosis between alzheimer’s disease and multiple cerebral infarcts. which diagnostic procedure should the nurse expect to prepare the client for first?

a) skull x-rays

b) computerized axial tomography (ct) scan

c) positron-emission tomography (pet)

d) single photon emission computed tomography (spect)

b) computerized axial tomography (ct) scan - rationale: a ct scan is typically the first imaging study used to detect structural brain changes such as infarcts or atrophy.

ch. 3 - a client’s history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. which part of the central nervous system is most likely dysfunctional for this client?

a) amygdala

b) parietal lobe

c) hippocampus

d) hypothalamus

d) hypothalamus - rationale: the hypothalamus regulates basic drives like hunger and thirst; dysfunction can lead to extreme behaviors.

ch. 3 - the nurse prepares to assess a client diagnosed with major depressive disorder for disturbances in circadian rhythms. which question should the nurse ask this client?

a) “have you ever seen or heard things that others do not?”

b) “what are your worst and best times of the day?”

c) “how would you describe your thinking?”

d) “do you think your memory is failing?”

b) “what are your worst and best times of the day?” - rationale: depression often includes disturbances in circadian rhythms, which can be revealed by identifying patterns of mood variation throughout the day.

ch. 3 - the nurse administers a medication that potentiates the action of γ-aminobutyric acid (gaba). which effect would be expected?

a) reduced anxiety

b) improved memory

c) more organized thinking

d) fewer sensory perceptual alterations

a) reduced anxiety - rationale: gaba is an inhibitory neurotransmitter that calms neural activity, so enhancing its action typically reduces anxiety.

ch. 3 - a nurse would anticipate that treatment for a client with memory difficulties might include medications designed to do what?

a) inhibit gaba

b) prevent destruction of acetylcholine

c) reduce serotonin metabolism

d) increase dopamine activity

b) prevent destruction of acetylcholine - rationale: acetylcholine is associated with learning and memory.

ch. 3 - a client has disorganized thinking associated with schizophrenia. neuroimaging would likely show dysfunction in which part of the brain?

a) hippocampus

b) frontal lobe

c) cerebellum

d) brainstem

b) frontal lobe - rationale: the frontal lobe is responsible for reasoning, planning, and problem-solving, all of which are impaired in schizophrenia.

ch. 3 - the nurse should assess a client taking a drug with anticholinergic properties for inhibited function of which system or structure?

a) parasympathetic

b) sympathetic

c) reticular activating

d) medulla oblongata

a) parasympathetic - rationale: anticholinergic drugs inhibit acetylcholine, which is primarily involved in the parasympathetic nervous system.

ch. 3 - the therapeutic action of neurotransmitter inhibitors that block reuptake bring about what response?

a) decreased concentration of the blocked neurotransmitter in the central nervous system

b) increased concentration of the blocked neurotransmitter in the synaptic gap

c) destruction of receptor sites specific to the blocked neurotransmitter

d) limbic system stimulation

b) increased concentration of the blocked neurotransmitter in the synaptic gap - rationale: blocking reuptake leaves more neurotransmitter available in the synaptic cleft, enhancing its effect.

ch. 3 - a client taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. which drug action causes these symptoms to develop?

a) anticholinergic effects

b) dopamine-blocking effects

c) endocrine-stimulating effects

d) ability to stimulate spinal nerves

b) dopamine-blocking effects - rationale: blocking dopamine can lead to extrapyramidal symptoms such as akathisia (motor restlessness), commonly seen with antipsychotics.

ch. 3 - a fearful client has an increased heart rate and blood pressure. the nurse suspects increased activity of which neurotransmitter?

a) gaba

b) norepinephrine

c) acetylcholine

d) histamine

b) norepinephrine - rationale: norepinephrine activates the sympathetic nervous system, causing physiological responses like elevated heart rate and blood pressure.

ch. 3 - a client has acute anxiety related to an automobile accident 2 hours ago. the nurse should teach the client about medication from which group?

a) tricyclic antidepressants

b) antipsychotic drugs

c) mood stabilizers

d) benzodiazepines

d) benzodiazepines - rationale: benzodiazepines act quickly and are effective for short-term relief of acute anxiety symptoms.

ch. 3 - a client is hospitalized for severe major depressive disorder. the nurse can expect to provide the client with teaching about what medication?

a) chlordiazepoxide

b) clozapine

c) sertraline

d) tacrine

c) sertraline - rationale: sertraline is a selective serotonin reuptake inhibitor (ssri) commonly used to treat major depression.

ch. 3 - a client diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, and irritability. the nurse expects the health care provider to prescribe a medication from which group?

a) psychostimulants

b) mood stabilizers

c) anticholinergics

d) antidepressants

b) mood stabilizers - rationale: the symptoms reflect mania, which is best treated with mood stabilizers such as lithium or anticonvulsants.

ch. 3 - a drug causes muscarinic receptor blockade. the nurse will assess the client for what side effect?

a) dry mouth

b) gynecomastia

c) pseudoparkinsonism

d) orthostatic hypotension

a) dry mouth - rationale: muscarinic receptor blockade produces anticholinergic side effects such as dry mouth, blurred vision, constipation, and urinary retention.

ch. 3 - a client begins therapy with a phenothiazine medication. what teaching should the nurse provide related to the drug’s strong dopaminergic effect?

a) chew sugarless gum

b) increase dietary fiber

c) arise slowly from bed

d) report changes in muscle movement

d) report changes in muscle movement - rationale: phenothiazines block dopamine, increasing the risk for extrapyramidal symptoms (eps); early signs include changes in muscle movement.

ch. 3 - a client tells the nurse, “my doctor prescribed paroxetine for my depression. i assume i’ll have side effects like i had when i was taking imipramine.” the nurse’s reply should be based on the knowledge that paroxetine is included in what class of medication?

a) selective norepinephrine reuptake inhibitor (snri)

b) tricyclic antidepressant

c) monoamine oxidase (mao) inhibitor

d) selective serotonin reuptake inhibitor (ssri)

d) selective serotonin reuptake inhibitor (ssri) - rationale: paroxetine is an ssri, which generally has fewer side effects than tricyclic antidepressants like imipramine.

ch. 3 - a nurse can anticipate anticholinergic side effects are likely when a client is prescribed which medication?

a) lithium

b) buspirone

c) imipramine

d) risperidone

c) imipramine - rationale: imipramine is a tricyclic antidepressant with strong anticholinergic effects, such as dry mouth, constipation, and blurred vision.

ch. 3 - which instruction has priority when teaching a client about clozapine?

a) avoid unprotected sex

b) report sore throat and fever immediately

c) reduce foods high in polyunsaturated fats

d) use over-the-counter preparations for rashes

b) report sore throat and fever immediately - rationale: clozapine can cause agranulocytosis.

ch. 3 - the nurse will order a special diet for the client who is prescribed which medication?

a) carbamazepine

b) haloperidol

c) phenelzine

d) trazodone

c) phenelzine - rationale: phenelzine is a monoamine oxidase inhibitor (maoi) requiring a low-tyramine diet to prevent hypertensive crisis.

ch. 3 - a nurse instructs a client taking a drug that inhibits monoamine oxidase (mao) to avoid certain foods and drugs because of the risk of

a) cardiac dysrhythmia

b) hypotensive shock

c) hypertensive crisis

d) hypoglycemia

c) hypertensive crisis - rationale: mao inhibitors prevent breakdown of tyramine, which can lead to a hypertensive crisis if high-tyramine foods are consumed.

ch. 3 - a nurse caring for a client taking a selective serotonin reuptake inhibitor (ssri) will develop outcome criteria related to what?

a) coherent thought processes

b) improvement in depression

c) reduced levels of motor activity

d) decreased extrapyramidal symptoms

b) improvement in depression - rationale: ssris are prescribed to relieve depressive symptoms. 

ch. 3 - by which mechanism do selective serotonin reuptake inhibitor (ssri) medications improve depression?

a) destroying increased amounts of serotonin

b) making more serotonin available at the synaptic gap

c) increasing production of acetylcholine and dopamine

d) blocking muscarinic and α1 norepinephrine receptors

b) making more serotonin available at the synaptic gap - rationale: ssris block the reuptake of serotonin, allowing more to remain in the synaptic cleft to enhance mood.

ch. 3 - the laboratory report for a client taking clozapine shows a white blood cell count of 3000 mm³. what is the nurse’s best action?

a) report the results to the health care provider immediately

b) administer the next dose as prescribed

c) give aspirin and force fluids

d) repeat the laboratory test

a) report the results to the health care provider immediately - rationale: a wbc of 3000 mm³ suggests possible agranulocytosis, a serious adverse effect of clozapine, and must be reported immediately.

ch. 3 - when a drug blocks the attachment of norepinephrine to α1 receptors, the client may experience what side effect?

a) hypertensive crisis

b) orthostatic hypotension

c) severe appetite disturbance

d) an increase in psychotic symptoms

b) orthostatic hypotension - rationale: α1 receptor blockade causes vasodilation, which can lead to orthostatic hypotension and increase the risk of fainting or falls.

ch. 3 - the nurse should be most alert for problems associated with fluid and electrolyte imbalance when a client is prescribed which medication?

a) lithium

b) clozapine

c) fluoxetine

d) venlafaxine

a) lithium - rationale: lithium is a salt and can disrupt fluid and electrolyte balance, leading to polyuria, edema, and potential toxicity.

ch. 3 - medications that block which receptors would contribute to further weight gain?

a) h1

b) 5-ht2

c) acetylcholine

d) gaba

a) h1 - rationale: h1 histamine receptor blockade is associated with increased appetite and weight gain.

ch. 3 - an individual hiking in the forest encounters a large poisonous snake on the path. which change in this individual’s vital signs is most likely?

a) pulse rate changes from 90 to 72

b) respiratory rate changes from 22 to 18

c) complaints of intestinal cramping begin

d) blood pressure changes from 114/62 to 136/78

d) blood pressure changes from 114/62 to 136/78 - rationale: the sympathetic nervous system is activated during a fear response, increasing blood pressure, heart rate, and respiratory rate.

ch. 3 - consider these medications: carbamazepine, lamotrigine, gabapentin. which medication below also belongs to this group?

a) galantamine

b) valproate

c) buspirone

d) tacrine

b) valproate - rationale: valproate is an anticonvulsant also used as a mood stabilizer, like the others listed.

ch. 3 - a professional football player is seen in the emergency department after losing consciousness from an illegal block. prior to discharge, the nurse assists the client to schedule an outclient computed tomography (ct) scan for the next day. which strategy should the nurse use to ensure the client remembers the appointment?

a) write the appointment day, time, and location on a piece of paper and give it to the player

b) log the appointment day, time, and location into the player’s cell phone calendar feature

c) ask the health care provider to admit the client to the hospital overnight

d) verbally inform the client of the appointment day, time, and location

b) log the appointment day, time, and location into the player’s cell phone calendar feature - rationale: this player may have sustained head trauma involving the hippocampus, a brain structure responsible for memory. 

ch. 3 - a nurse prepares to administer a second-generation antipsychotic medication to a client diagnosed with schizophrenia. additional monitoring for adverse effects will be most important if the client has which co-morbid health problems? (select all that apply.)

a) parkinson’s disease

b) grave’s disease

c) hyperlipidemia

d) osteoarthritis

e) diabetes

a) parkinson’s disease

c) hyperlipidemia

e) diabetes

rationale: second-generation antipsychotics can cause weight gain, glucose dysregulation, and lipid abnormalities, increasing risks for clients with diabetes, hyperlipidemia, or parkinson’s disease.

ch. 3 - which questions asked by the nurse in a nonjudgmental manner would be most helpful when obtaining information about a client’s use of complementary and herbal remedies? (select all that apply)

a) “you don’t regularly take herbal remedies, do you?”

b) “what herbal medicines have you used to relieve your symptoms?”

c) “what over-the-counter medicines, vitamins, and nutritional supplements do you use?”

d) “what differences in your symptoms do you notice when you take herbal supplements?”

e) “have you experienced problems from using herbal and prescription drugs at the same time?”

b) “what herbal medicines have you used to relieve your symptoms?”

c) “what over-the-counter medicines, vitamins, and nutritional supplements do you use?”

d) “what differences in your symptoms do you notice when you take herbal supplements?”

e) “have you experienced problems from using herbal and prescription drugs at the same time?”

rationale: neutral and open-ended questions like options b, c, d, and e encourage honest disclosure about complementary remedy use without bias.

ch. 3 - an individual is experiencing problems with memory. which of these structures are most likely to be involved in this deficit? (select all that apply.)

a) amygdala

b) hippocampus

c) occipital lobe

d) temporal lobe

e) basal ganglia

a) amygdala

b) hippocampus

d) temporal lobe

rationale: the hippocampus, amygdala, and temporal lobe are heavily involved in memory processing and storage.

ch. 3 - a client’s sibling says, “my brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fmri) test. that test is too expensive and will just increase the hospital bill.” what are the nurse’s appropriate responses? (select all that apply.)

a) “sometimes there are physical causes for psychiatric symptoms. this test will help us understand whether that is the situation.”

b) “some mental illnesses are evident on fmris. this test will give information to help us plan the best care for your brother.”

c) “this test will indicate whether your brother has been taking his psychotropic medications as prescribed.”

d) “it sounds like you do not truly believe your brother had a mental illness.”

e) “it would be better for you to discuss your concerns with the health care provider.”

a) “sometimes there are physical causes for psychiatric symptoms. this test will help us understand whether that is the situation.”

b) “some mental illnesses are evident on fmris. this test will give information to help us plan the best care for your brother.”

rationale: options a and b provide education about fmri usefulness in psychiatric care and treatment planning. the other options are either accusatory or inaccurate.

ch. 9 - __________ is the purposeful use of verbal and non-verbal communication; it is patient-centered, goal-directed, and grounded in evidence-based techniques

therapeutic communication

ch. 9 - __________ helps build trust and rapport, increases patient satisfaction, and enhances safety

therapeutic communication

ch. 9 - __________ involves a communicator sending a message through a channel to a receiver, with feedback exchanged; both parties encode and decode messages within a specific context, influenced by environmental noise

the transactional model of communication

ch. 9 - was a psychiatric nurse theorist who developed the Interpersonal Theory of Nursing, emphasizing the nurse-patient relationship as central to care

Hildegard Peplau

ch. 9 - __________ in communication ensures both the nurse and patient understand the intended meaning of messages

clarity

ch. 9 - __________ helps link the patient’s thoughts, emotions, and experiences to support therapeutic progress

continuity

ch. 9 - __________ like depression, cognitive status, or cultural/language barriers can influence how patients communicate and receive care

personal factors

ch. 9 - __________ such as the physical setting can impact comfort, privacy, and openness in communication

environmental factors

ch. 9 - __________, including perceived authority of the nurse, can affect the patient’s willingness to share and participate in care

relationship dynamics

ch. 9 - __________ includes all spoken words, which reflect beliefs, values, and perceptions; it can express understanding, judgement, and honesty

verbal communication

ch. 9 - therapeutic communication uses different types of __________—open-ended, closed-ended, projective, and the miracle __________.

question(s)

ch. 9 - __________ involve the use of electronic and telecommunication tools; they allow real-time interaction and data tracking

information communication technologies

ch. 9 - video conferencing, phone consultations, online resources, and image or video transmission for clinical use

examples of information communication technologies

ch. 9 - __________ help monitor and diagnose patients; widely used due to easy access and availability, including SAMHSA apps for mental health and prevention

mobile health apps

ch. 9 - privacy, unclear effectiveness, liability risks, and a need for stronger research and ethical guidelines

concerns with mobile health apps

ch. 9 - __________ by controlling pace, choosing a quiet, private setting, and setting clear personal boundaries

prepare for interviews

ch. 9 - use effective __________ such as posture, gestures (kinesics), and tone and volume (paralanguage)

nonverbal cues

ch. 9 - keep introductions __________ and initiate interviews respectfully, remembering the patient is not a friend or social media subject

professional

ch. 9 - __________ help improve communication skills and prevent unprofessional or nontherapeutic interactions

clinical supervision and debriefing

ch. 9 - __________ is a written account of a nurse–patient interaction, helping to identify patterns and improve therapeutic communication skills

a process recording

ch. 9 - a client says to the nurse, “i dreamed i was stoned. when i woke up, i felt emotionally drained, as though i hadn’t rested well.” which response should the nurse use to clarify the client’s comment?

a) “it sounds as though you were uncomfortable with the content of your dream.”

b) “i understand what you’re saying. bad dreams leave me feeling tired, too.”

c) “so you feel as though you did not get enough quality sleep last night?”

d) “can you give me an example of what you mean by ‘stoned’?”

d) “can you give me an example of what you mean by ‘stoned’?” - rationale: clarification is a therapeutic communication technique that promotes mutual understanding.

ch. 9 - a client diagnosed with schizophrenia tells the nurse, “the cia is monitoring us through the fluorescent lights in this room. the cia is everywhere, so be careful what you say.” which response by the nurse is most therapeutic?

a) “let’s talk about something other than the cia.”

b) “it sounds like you’re concerned about your privacy.”

c) “the cia is prohibited from operating in health care facilities.”

d) “you have lost touch with reality, which is a symptom of your illness.”

b) “it sounds like you’re concerned about your privacy.” - rationale: this response reflects the underlying emotion without challenging the delusion, which helps preserve trust and encourages further communication.

ch. 9 - the client says, “my marriage is just great. my spouse and i always agree.” the nurse observes the client’s foot moving continuously as the client twirls a shirt button. what conclusion can the nurse draw about the client’s statement?

a) it is clear.

b) it may be distorted.

c) it is incongruous.

d) it is inadequate.

c) it is incongruous. - rationale: incongruent messages occur when verbal communication does not align with nonverbal cues.

ch. 9 - a nurse interacts with a newly hospitalized client. which of the nurse’s comments applies the communication technique of “offering self?”

a) “i’ve also had traumatic life experiences. maybe it would help if i told you about them.”

b) “why do you think you had so much difficulty adjusting to this change in your life?”

c) “i hope you will feel better after getting accustomed to how this unit operates.”

d) “i’d like to sit with you for a while to help you get comfortable talking to me.”

d) “i’d like to sit with you for a while to help you get comfortable talking to me.” - rationale: offering self is a therapeutic technique that demonstrates availability, presence, and willingness to be there for the client without demanding anything in return.

ch. 9 - which technique will best communicate to a client that the nurse is interested in listening?

a) restating a feeling or thought the client has expressed.

b) asking a direct question, such as “did you feel angry?”

c) making a judgment about the client’s problem.

d) saying, “i understand what you’re saying.”

a) restating a feeling or thought the client has expressed. - rationale: restating shows active listening and allows the client to confirm or clarify what was said.

ch. 9 - a client discloses several concerns and associated feelings. if the nurse wants to seek clarification, which comment would be appropriate?

a) “what are the common elements here?”

b) “tell me again about your experiences.”

c) “am i correct in my understanding of that?”

d) “tell me everything from the beginning.”

c) “am i correct in my understanding of that?” - rationale: asking “am i correct in my understanding of that?” promotes mutual understanding and gives the client an opportunity to correct or affirm the nurse’s interpretation.

ch. 9 - a client tells the nurse, “i don’t think i’ll ever get out of here.” what is the nurse’s most therapeutic response?

a) “don’t talk that way. of course, you will leave here!”

b) “keep up the good work, and you certainly will.”

c) “you don’t think you’re making progress?”

d) “everyone feels that way sometimes.”

c) “you don’t think you’re making progress?” - rationale: this response uses paraphrasing and encourages the client to reflect on their progress.

ch. 9 - documentation in a client’s chart states, “throughout a 5-minute interaction, client fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘i enjoy spending time with you.’” which analysis is most accurate?

a) the client is giving positive feedback about the nurse’s communication techniques.

b) the nurse is viewing the client’s behavior through a cultural filter.

c) the client’s verbal and nonverbal messages are incongruent.

d) the client is demonstrating psychotic behaviors.

c) the client’s verbal and nonverbal messages are incongruent. - rationale: when verbal and nonverbal messages do not align, the message is considered incongruent.