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Chapter 01: Science and the Therapeutic Use of Self in Psychiatric Mental Health

Nursing

Varcarolis: Essentials of Psychiatric Mental Health Nursing: A Communication

Approach to Evidence-Based Care, 4th Edition

MULTIPLE CHOICE

1. Which outcome, focused on recovery, would be expected in the plan of care for a patient

living in the community and diagnosed with serious and persistent mental illness? Within 3

months, the patient will demonstrate what behavior?

a. Denying suicidal ideation

b. Reporting a sense of well-being

c. Taking medications as prescribed

d. Attending clinic appointments on time

ANS: B

Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving

role performance. The goal of recovery is to empower the individual with mental illness to

achieve a sense of meaning and satisfaction in life and to function at the highest possible level

of wellness. The incorrect options focus on the classic medical model rather than recovery.

DIF: Cognitive Level: Application (Applying)

TOP: Nursing Process: Outcomes Identification

MSC: NCLEX: Health Promotion and Maintenance

2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a

divorce. Select the nurse’s most caring comment.

a. “Let’s discuss healthy means of coping when you have suicidal feelings.”

b. “I understand why you’re so depressed. When I got divorced, I was devastated

too.”

c. “You should forget about your marriage and move on with your life.”

d. “How did you get so depressed that hospitalization was necessary?”

ANS: A

The nurse’s communication should evidence caring and a commitment to work with the

patient. This commitment lets the patient know the nurse will help. Probing and advice are not

helpful for therapeutic interventions.

DIF: Cognitive Level: Application (Applying)

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. In the shift-change report, an off-going nurse criticizes a patient who wears extremely heavy

makeup. Which comment by the nurse who receives the report best demonstrates advocacy?

a. “This is a psychiatric hospital, so we expect our patients to behave bizarrely.”

b. “Let’s all show acceptance of this patient by wearing lots of makeup too.”

c. “Your comments are inconsiderate and inappropriate. Keep the report objective.”

d. “Our patients need our help to learn behaviors that will help them get along in

society.”

ANS: D

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Accepting patients’ needs for self-expression and seeking to teach skills that will contribute to

their well-being demonstrate respect and are important parts of advocacy. The on-coming

nurse needs to take action to ensure that others are not prejudiced against the patient. Humor

can be appropriate within the privacy of a shift report but not at the expense of respect for

patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show

compassion for each other.

DIF: Cognitive Level: Application (Applying)

TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which

statement is an example of “attending”?

a. “We all have stress in life. Being in a psychiatric hospital is not the end of the

world.”

b. “Tell me why you felt you had to be hospitalized to receive treatment for your

depression.”

c. “You will feel better after we get some antidepressant medication started for you.”

d. “I’d like to sit with you for a while, so you may feel more comfortable talking with

me.”

ANS: D

Attending is a technique that demonstrates the nurse’s commitment to the relationship and

reduces feelings of isolation. This technique shows respect for the patient and demonstrates

caring. Generalizations, probing, and false reassurances are nontherapeutic.

DIF: Cognitive Level: Application (Applying)

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. A patient shows the nurse an article from the Internet about a health problem. Which

characteristic of the website’s address most alerts the nurse that the site may have biased and

prejudiced information?

a. Address ends in “.org.”

b. Address ends in “.com.”

c. Address ends in “.gov.”

d. Address ends in “.net.”

ANS: B

Financial influences on a site are a clue that the information may be biased. “.com” at the end

of the address indicates that the site is a commercial one. “.gov” indicates that the site is

maintained by a government entity. “.org” indicates that the site is nonproprietary; the site

may or may not have reliable information, but it does not profit from its activities. “.net” can

have multiple meanings.

DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

6. A nurse says, “When I was in school, I learned to call upset patients by name to get their

attention; however, I read a descriptive research study that says that this approach does not

work. I plan to stop calling patients by name.” Which statement is the best appraisal of this

nurse’s comment?

a. One descriptive research study rarely provides enough evidence to change practice.

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b. Staff nurses apply new research findings only with the help from clinical nurse

specialists.

c. New research findings should be incorporated into clinical algorithms before using

them in practice.

d. The nurse misinterpreted the results of the study. Classic tenets of practice do not

change.

ANS: A

Descriptive research findings provide evidence for practice but must be viewed in relation to

other studies before practice changes. One study is not enough. Descriptive studies are low on

the hierarchy of evidence. Clinical algorithms use flowcharts to manage problems and do not

specify one response to a clinical problem. Classic tenets of practice should change as

research findings provide evidence for change.

DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

7. Two nursing students discuss career plans after graduation. One student wants to enter

psychiatric nursing. The other student asks, “Why would you want to be a psychiatric nurse?

All they do is talk. You will lose your skills.” Select the best response by the student

interested in psychiatric nursing.

a. “Psychiatric nurses’ practice in safer environments than other specialties and

nurse-to-patient ratios are better because of the nature of patients’ problems.”

b. “Psychiatric nurses use complex communication skills, as well as critical thinking,

to solve multidimensional problems. I’m challenged by those situations.”

c. “I think I will be good in the mental health field. I do not like clinical rotations in

school, so I do not want to continue them after I graduate.”

d. “Psychiatric nurses do not have to deal with as much pain and suffering as

medical-surgical nurses. That appeals to me.”

ANS: B

The practice of psychiatric nursing requires a different set of skills than medical-surgical

nursing, although substantial overlap does exist. Psychiatric nurses must be able to help

patients with medical and mental health problems, reflecting the holistic perspective these

nurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased,

similar to other specialties. Psychiatric nursing involves clinical practice, not simply

documentation. Psychosocial pain is real and can cause as much suffering as physical pain.

DIF: Cognitive Level: Application (Applying)

TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

8. Which research evidence would most influence a group of nurses to change their practice?

a. Expert committee report of recommendations for practice

b. Systematic review of randomized controlled trials

c. Nonexperimental descriptive study

d. Critical pathway

ANS: B

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Research findings are graded using a hierarchy of evidence. A systematic review of

randomized controlled trials is level A and provides the strongest evidence for changing

practice. Expert committee recommendations and descriptive studies lend less powerful and

influential evidence. A critical pathway is not evidence; it incorporates research findings after

they have been analyzed.

DIF: Cognitive Level: Comprehension (Understanding) TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment

9. A bill introduced in Congress would reduce funding for the care of people diagnosed with

mental illnesses. A group of nurses write letters to their elected representatives in opposition

to the legislation. Which role have the nurses fulfilled?

a. Advocacy

b. Attending

c. Recovery

d. Evidence-based practice

ANS: A

An advocate defends or asserts another’s cause, particularly when the other person lacks the

ability to do that for him or herself. Examples of individual advocacy include helping patients

understand their rights or make decisions. On a community scale, advocacy includes political

activity, public speaking, and publication in the interest of improving the individuals with

mental illness; the letter-writing campaign advocates for that cause on behalf of patients who

are unable to articulate their own needs.

DIF: Cognitive Level: Comprehension (Understanding)

TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

10. An informal group of patients discuss their perceptions of nursing care. Which comment best

indicates a patient’s perception that his or her nurse is caring?

a. “My nurse always asks me which type of juice I want to help me swallow my

medication.”

b. “My nurse explained my treatment plan to me and asked for my ideas about how to

make it better.”

c. “My nurse told me that if I take all the medicines the doctor prescribes, I will get

discharged soon.”

d. “My nurse spends time listening to me talk about my problems. That helps me feel

like I’m not alone.”

ANS: D

Caring evidences empathic understanding as well as competency. It helps change pain and

suffering into a shared experience, creating a human connection that alleviates feelings of

isolation. The incorrect options give examples of statements that demonstrate advocacy or

giving advice.

DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

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