TEST BANK For Primary Care Psychiatry, 2nd Edition by Robert McCarron, Glen Xiong, Verified Chapters 1 - 26, Complete Newest Version.pdf

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Test Bank For Primary Care Psychiatry
2nd Edition by Robert McCarron, Glen Xiong
Chapter 1 - 26

Primary Care Psychiatry 2nd Edition McCarron Xiong Test Bank
Table of Contents:
Chapter 1. The Primary Care Psychiatric Interview
Chapter 2. Primary Care and Psychiatry: An Overview of the Collaborative Care Model
Chapter 3. Preventive Medicine and Behavioral Health
Chapter 4. The Patient and You: Psychological and Cultural Consideration
Chapter 5. Anxiety Disorders
Chapter 6. Obsessive–Compulsive and Related Disorders
Chapter 7. Trauma-Related Disorders
Chapter 8. Mood Disorders—Depression
Chapter 9. Treatment-Resistant Depression
Chapter 10. Psychiatric Disorders: Bipolar and Related Disorders
Chapter 11. Psychotic Disorders
Chapter 12. Neurocognitive Disorders
Chapter 13. Substance Use Disorders—Alcohol
Chapter 14. Substance Use Disorders—Illicit and Prescription
Drugs Chapter 15. Personality Disorders
Chapter 16. Cognitive Behavioral Therapy
Chapter 17. Supportive Psychotherapy in Primary Care
Chapter 18. Motivational Interviewing
Chapter 19. Fundamentals of Psychopharmacology
Chapter 20. Geriatric Behavioral Health
Chapter 21. Child and Adolescent Behavioral Health
Chapter 22. Suicide and Violence Risk Assessment
Chapter 23. Somatic Symptom and Related Disorders
Chapter 24. Insomnia
Chapter 25. Sexual Dysfunction
Chapter 26. Eating Disorders

Chapter 1: The Primary Care Psychiatric Interview
Primary Care Psychiatry 2nd Edition McCarron Xiong Test Bank
MULTIPLE CHOICE
1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt
emotionally drained, as though I hadnt rested well. Which response should the nurse
use to clarify the patients comment?
a. It sounds as though you were uncomfortable with the content of your dream.
b. I understand what youre 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?
ANSWER: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the
patients statement. Asking for a definition of stoned directly asks for clarification. Restating
that the patient is uncomfortable with the dreams content is parroting, a non-therapeutic
technique. The other responses fail to clarify the meaning of the patients comment.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through
the fluorescent lights in this room. Be careful what you say. Which response by the nurse
would be most therapeutic?
a. Lets talk about something other than the CIA.
b. It sounds like youre 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.
ANSWER: B
It is important not to challenge the patients beliefs, even if they are unrealistic. Challenging
undermines the patients trust in the nurse. The nurse should try to understand the underlying
feelings or thoughts the patients message conveys. The correct response uses the therapeutic
technique of reflection. The other comments are non-therapeutic. Asking to talk about
something other than the concern at hand is changing the subject. Saying that the CIA is
prohibited from operating in health care facilities gives false reassurance. Stating that the
patient has lost touch with reality is truthful, but uncompassionate.
3. The patient says, My marriage is just great. My spouse and I always agree. The nurse
observes the patients foot moving continuously as the patient twirls a shirt button. The
conclusion the nurse can draw is that the patients communication is:
a. clear. c. precise.
b. mixed. d. inadequate.
ANSWER: B
Mixed messages involve the transmission of conflicting or incongruent messages by the
speaker. The patients verbal message that all was well in the relationship was modified by the
nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal
message being clear, explicit, or inadequate.
PTS: 1 DIF: Cognitive Level: Understand
(Comprehension) REF: mcs 150-151 TOP: Nursing
Process: Assessment

4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies
the communication technique of offering self.
a. Ive 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. Id like to sit with you for a while to help you get comfortable talking to me.
ANSWER: D
Offering self is a technique that should be used in the orientation phase of the nurse-patient
relationship. Sitting with the patient, an example of offering self, helps to build trust and
convey that the nurse cares about the patient. Two incorrect responses are ineffective and non-
therapeutic. The other incorrect response is therapeutic but is an example of offering hope.
5. Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as Did you feel angry?
c. Making a judgment about the patients problem.
d. Saying, I understand what youre saying.
ANSWER: A
Restating allows the patient to validate the nurses understanding of what has been
communicated. Restating is an active listening technique. Judgments should be suspended in a

nurse-patient relationship. Close-ended questions such as Did you feel angry? ask for specific
information rather than showing understanding. When the nurse simply states that he or she
understands the patients words, the patient has no way of measuring the understanding.
6. A patient 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 understanding that . . .
d. Tell me everything from the beginning.
ANSWER: C
Asking, Am I correct in understanding that permits clarification to ensure that both the nurse
and patient share mutual understanding of the communication. Asking about common
elements encourages comparison rather than clarification. The remaining responses are
implied questions that suggest the nurse was not listening.
7. A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most
therapeutic response.
a. Dont talk that way. Of course you will leave here!
b. Keep up the good work, and you certainly will.

c. You dont think youre making progress?
d. Everyone feels that way sometimes.
ANSWER: C
By asking if the patient does not believe that progress has been made, the nurse is reflecting by
putting into words what the patient is hinting. By making communication more explicit, issues
are easier to identify and resolve. The remaining options are non-therapeutic techniques.
Telling the patient not to talk that way is disapproving. Saying that everyone feels that way at
times minimizes feelings. Telling the patient that good work will always result in success is
falsely reassuring.
8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient
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 patient is giving positive feedback about the nurses
communication techniques.
b. The nurse is viewing the patients behavior through a cultural filter.
c. The patients verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors.
ANSWER: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and
incongruent. Some clinicians call it a mixed message. It is inaccurate to say that the patient is
giving positive feedback about the nurses communication techniques. The concept of a cultural
filter is not relevant to the situation because a cultural filter determines what we will pay

attention to and what we will ignore. Data are insufficient to draw the conclusion that the
patient is demonstrating psychotic behaviors.
REF: mcs 150-151 TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial
Integrity
9. While talking with a patient diagnosed with major depression, a nurse notices the patient
is unable to maintain eye contact. The patients chin lowers to the chest, while the patient
looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication c. A cultural barrier
b. A message filter d. Social skills
ANSWER: A
Eye contact and body movements are considered nonverbal communication. There are
insufficient data to determine the level of the patients social skills or whether a cultural barrier
exists.
Process: Assessment MSC: Client Needs: Psychosocial
Integrity
10. During the first interview with a parent whose child died in a car accident, the nurse
feels empathic and reaches out to take the patients hand. Select the correct analysis of the
nurses behavior.
a. It shows empathy and compassion. It will encourage the patient to continue
to express feelings.
b. The gesture is premature. The patients cultural and individual interpretation
of touch is unknown.

c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched.
ANSWER: B
Touch has various cultural and individual interpretations. Nurses should refrain from using
touch until an assessment can be made regarding the way in which the patient will perceive
touch. The other options present prematurely drawn conclusions.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: mcs 150 (dm 9-1) | mcs 158-159 TOP: Nursing Process: Evaluation
11. During a one-on-one interaction with the nurse, a patient frequently looks nervously at
the door. Select the best comment by the nurse regarding this nonverbal communication.
a. I notice you keep looking toward the door.
b. This is our time together. No one is going to interrupt us.
c. It looks as if you are eager to end our discussion for today.
d. If you are uncomfortable in this room, we can move someplace else.
ANSWER: A
Making observations and encouraging the patient to describe perceptions are useful
therapeutic communication techniques for this situation. The other responses are
assumptions made by the nurse.
REF: mcs 153-154 (dm 9-2) TOP: Nursing Process: Implementation

12. A black patient says to a white nurse, Theres no sense talking. You wouldnt
understand because you live in a white world. The nurses best action would be to:
a. explain, Yes, I do understand. Everyone goes through the same experiences.
b. say, Please give an example of something you think I wouldnt understand.
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing.
ANSWER: B
Having the patient speak in specifics rather than globally will help the nurse understand
the patients perspective. This approach will help the nurse engage the patient.
Reassurance and changing the subject are not therapeutic techniques.
REF: mcs 154 (dm 9-2) | mcs 158-159
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
13. A Filipino American patient had a nursing diagnosis of situational low self-esteem related
to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the
patients self-esteem, but after 3 weeks, the patients eye contact did not improve. What is the
most accurate analysis of this scenario?
a. The patients eye contact should have been directly addressed by role-playing
to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis,
and planning for this patient.
c. The patients poor eye contact is indicative of anger and hostility that
were unaddressed.
d. The nurse should have assessed the patients culture before making this
diagnosis and plan.
ANSWER: D

The amount of eye contact a person engages in is often culturally determined. In some
cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian
Americans, including persons from the Philippines, often prefer not to engage in direct eye
contact.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
Evaluation MSC: Client Needs: Psychosocial
Integrity
14. When a female Mexican American patient and a female nurse sit together, the patient
often holds the nurses hand. The patient also links arms with the nurse when they walk. The
nurse is uncomfortable with this behavior. Which analysis is most accurate?
a. The patient is accustomed to touch during conversation, as are members of
many Hispanic subcultures.
b. The patient understands that touch makes the nurse uncomfortable and
controls the relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient
is reassured and comforted.
d. The patient is trying to manipulate the nurse using nonverbal techniques.
ANSWER: A
The most likely answer is that the patients behavior is culturally influenced. Hispanic women
frequently touch women they consider to be their friends. Although the other options are
possible, they are less likely.
(Comprehension) REF: mcs 150 (dm 9-1) | mcs 159-160
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
15. A Puerto Rican American patient uses dramatic body language when describing
emotional discomfort. Which analysis most likely explains the patients behavior? The
patient:

a. has a histrionic personality disorder.
b. believes dramatic body language is sexually appealing.
c. wishes to impress staff with the degree of emotional pain.
d. belongs to a culture in which dramatic body language is the norm.
ANSWER: D
Members of Hispanic American subcultures tend to use high affect and dramatic body language
as they communicate. The other options are more remote possibilities.
16. During an interview, a patient attempts to shift the focus from self to the nurse by
asking personal questions. The nurse should respond by saying:
a. Why do you keep asking about me?
b. Nurses direct the interviews with patients.
c. Do not ask questions about my personal life.
d. The time we spend together is to discuss your concerns.
ANSWER: D
When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto
the patient. Telling the patient that interview time should be used to discuss patient concerns
refocuses discussion in a neutral way. Telling patients not to ask about the nurses personal life
shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Why
questions are probing and non-therapeutic.

17. Which principle should guide the nurse in determining the extent of silence to use
during patient interview sessions?
a. A nurse is responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said was understood.
ANSWER: C
Silence can be helpful to both participants by giving each an opportunity to contemplate what
has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a
principle related to silences. It is inaccurate to say that patients withdraw during long silences
or that silence helps patients know that they are understood. Feedback helps patients know
they have been understood.
REF: mcs 151-154 (dm 9-2) TOP: Nursing Process: Planning
18. A patient is having difficulty making a decision. The nurse has mixed feelings about
whether to provide advice. Which principle usually applies? Giving advice:
a. is rarely helpful.
b. fosters independence.
c. lifts the burden of personal decision making.
d. helps the patient develop feelings of personal adequacy.
ANSWER: A

Giving advice fosters dependence on the nurse and interferes with the patients right to make
personal decisions. It robs patients of the opportunity to weigh alternatives and develop
problem- solving skills. Furthermore, it contributes to patient feelings of personal inadequacy.
It also keeps the nurse in control and feeling powerful.
19. A school age child tells the school nurse, Other kids call me mean names and will not sit
with me at lunch. Nobody likes me. Select the nurses most therapeutic response.
a. Just ignore them and they will leave you alone.
b. You should make friends with other children.
c. Call them names if they do that to you.
d. Tell me more about how you feel.
ANSWER: D
The correct response uses exploring, a therapeutic technique. The distracters give advice, a non-
therapeutic technique.
20. A patient with acute depression states, God is punishing me for my past sins. What is
the nurses most therapeutic response?
a. You sound very upset about this.
b. God always forgives us for our sins.

c. Why do you think you are being punished?
d. If you feel this way, you should talk to your minister.
ANSWER: A
The nurse reflects the patients comment, a therapeutic technique to encourage sharing for
perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and
giving advice, all of which are non-therapeutic.
MULTIPLE RESPONSE
1. A patient cries as the nurse explores the patients feelings about the death of a close friend.
The patient sobs, I shouldnt be crying like this. It happened a long time ago. Which responses
by the nurse facilitate communication?Select all that apply.
a. Why do you think you are so upset?
b. I can see that you feel sad about this situation.
c. The loss of a close friend is very painful for you.
d. Crying is a way of expressing the hurt you are experiencing.
e. Lets talk about something else because this subject is upsetting you.
ANSWER: B, C, D
Reflecting (I can see that you feel sad, This is very painful for you) and giving information
(Crying is a way of expressing hurt) are therapeutic techniques. Why questions often imply
criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is
a barrier to communication.

2. Which benefits are most associated with use of telehealth technologies? Select all that apply.
a. Cost savings for patients
b. Maximize care management
c. Access to services for patients in rural areas
d. Prompt reimbursement by third party payers
e. Rapid development of trusting relationships with patients
ANSWER: A, B, C
Telehealth has shown it can maximize health and improve disease management skills and
confidence with the disease process. Many rural parents have felt disconnected from services;
telehealth technologies can solve those problems. Although telehealths improved health
outcomes regularly show cost savings for payers, one significant barrier is the current lack of
reimbursement for remote patient monitoring by third party payers. Telehealth technologies
have not shown rapid development of trusting relationships.
Process: Implementation MSC: Client Needs: Safe,
Effective Care Environment
3. Which comments by a nurse demonstrate use of therapeutic communication techniques?
Select all that apply.
a. Why do you think these events have happened to you?
b. There are people with problems much worse than yours.
c. Im glad you were able to tell me how you felt about your loss.
d. I noticed your hands trembling when you told me about your accident.

e. You look very nice today. Im proud you took more time with your appearance.
ANSWER: C, D
The correct responses demonstrate use of the therapeutic techniques making an observation and
showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving
approval, which are non-therapeutic techniques.
REF: mcs 154-155 (dm 9-2) | mcs 156 (dm 9-3)
4. A nurse is interacting with patients in a psychiatric unit. Which statements reflect use
of therapeutic communication? Select all that apply.
a. Tell me more about that situation.
b. Lets talk about something else.
c. I notice you are pacing a lot.
d. Ill stay with you a while.
e. Why did you do that?
ANSWER: A, C, D
The correct responses demonstrate use of the therapeutic techniques making an observation
and showing empathy. The incorrect responses demonstrate changing the subject and probing,
which are non-therapeutic techniques.
Chapter 2. Primary Care and Psychiatry: An Overview of the Collaborative Care Model
MULTIPLE CHOICE

1. A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect
to ask an advanced practice nurse to perform which action for patients?
a. Perform mental health assessment interviews.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANSWER: B
Prescriptive privileges are granted to masters-prepared nurse practitioners who have taken
special courses on prescribing medication. The nurse prepared at the basic level performs
mental health assessments, establishes relationships, and provides individualized care
planning.
(Comprehension) REF: mcs 127 TOP: Nursing Process:
Implementation MSC: Client Needs: Safe, Effective Care
Environment
2. A newly admitted patient diagnosed with major depression has gained 20 pounds over a few
months and has suicidal ideation. The patient has taken an antidepressant medication for 1
week without remission of symptoms. Select the priority nursing diagnosis.
a. Imbalanced nutrition: more than body requirements
b. Chronic low self-esteem
c. Risk for suicide
d. Hopelessness
ANSWER: C
Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan
to carry out the suicidal intent. Imbalanced nutrition, hopelessness, and chronic low self-
esteem may be applicable nursing diagnoses, but these problems do not affect patient safety as
urgently as would a suicide attempt.

REF: mcs 123-124 TOP: Nursing Process: Diagnosis/Analysis
3. A patient diagnosed with major depression has lost 20 pounds in one month, has chronic
low self-esteem, and a plan for suicide. The patient has taken an antidepressant medication
for 1 week. Which nursing intervention has the highest priority?
a. Implement suicide precautions.
b. Offer high-calorie snacks and fluids frequently.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
ANSWER: A
Implementing suicide precautions is the only option related to patient safety. The other
options, related to nutrition, self-esteem, and medication therapy, are important but are not
priorities.
REF: mcs 126-127 TOP: Nursing Process: Planning
MSC: Client Needs: Safe, Effective Care Environment
4. The desired outcome for a patient experiencing insomnia is, Patient will sleep for a
minimum of 5 hours nightly within 7 days. At the end of 7 days, review of sleep data shows
the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. The nurse
will document the outcome as:
a. consistently demonstrated. c. sometimes demonstrated.
b. often demonstrated. d. never demonstrated.
ANSWER: D

Although the patient is sleeping 6 hours daily, the total is not one uninterrupted session at
night. Therefore, the outcome must be evaluated as never demonstrated. See relationship to
audience response question.
REF: mcs 127 TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity
5. The desired outcome for a patient experiencing insomnia is, Patient will sleep for a
minimum of 5 hours nightly within 7 days. At the end of 7 days, review of sleep data shows
the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the
nurses next action?
a. Continue the current plan without changes.
b. Remove this nursing diagnosis from the plan of care.
c. Write a new nursing diagnosis that better reflects the problem.
d. Examine interventions for possible revision of the target date.
ANSWER: D
Sleeping a total of 5 hours at night remains a reasonable outcome. Extending the period for
attaining the outcome may be appropriate. Examining interventions might result in planning
an activity during the afternoon rather than permitting a nap. Continuing the current plan
without changes is inappropriate. Removing this nursing diagnosis from the plan of care would
be correct when the outcome was met and the problem resolved. Writing a new nursing
diagnosis is inappropriate because no other nursing diagnosis relates to the problem.
REF: mcs 127 TOP: Nursing Process: Evaluation

6. A patient begins a new program to assist with building social skills. In which part of the
plan of care should a nurse record the item, Encourage patient to attend one
psychoeducational group daily?
a. Assessment c. Implementation
b. Analysis d. Evaluation
ANSWER: C
Interventions are the nursing prescriptions to achieve the outcomes. Interventions should be
specific.
REF: mcs 126-127 TOP: Nursing Process: Implementation
7. Before assessing a new patient, a nurse is told by another health care worker, I know that
patient. No matter how hard we work, there isnt much improvement by the time of
discharge. The nurses responsibility is to:
a. document the other workers assessment of the patient.
b. assess the patient based on data collected from all sources.
c. validate the workers impression by contacting the patients significant other.
d. discuss the workers impression with the patient during the assessment interview.
ANSWER: B
Assessment should include data obtained from both the primary and reliable secondary sources.
The nurse, bearing in mind the possible effects of counter-transference, should evaluate biased
assessments by others as objectively as possible.
REF: mcs 117-118 TOP: Nursing Process: Assessment

8. A patient presents to the emergency department with mixed psychiatric symptoms. The
admission nurse suspects the symptoms may be the result of a medical problem. Lab results
show elevated BUN (blood urea nitrogen) and creatinine. What is the nurses next best
action?
a. Report the findings to the health care provider.
b. Assess the patient for a history of renal problems.
c. Assess the patients family history for cardiac problems.
d. Arrange for the patients hospitalization on the psychiatric unit.
ANSWER: B
Elevated BUN (blood urea nitrogen) and creatinine suggest renal problems. Renal
dysfunction can often imitate psychiatric disorders. The nurse should further assess the
patients history for renal problems and then share the findings with the health care
provider.
REF: mcs 119-120 (Box 7-3) TOP: Nursing Process: Assessment
9. A patient states, Im not worth anything. I have negative thoughts about myself. I feel
anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never
wake up. Which nursing intervention should have the highest priority?
a. Self-esteembuilding activities c. Sleep enhancement activities
b. Anxiety self-control measures d. Suicide precautions
ANSWER: D
The nurse would place a priority on monitoring and reinforcing suicide self-restraint because it
relates directly and immediately to patient safety. Patient safety is always a priority concern.
The

nurse should monitor and reinforce all patient attempts to control anxiety, improve
sleep patterns, and develop self-esteem, while giving priority attention to suicide self-
restraint.
REF: mcs 124-125 (dm 7-2) | mcs 125 (dm 7-3) TOP: Nursing Process: Planning
10. Select the best outcome for a patient with the nursing diagnosis: Impaired social
interaction related to sociocultural dissonance as evidenced by stating, Although Id like to, I
dont join in because I dont speak the language very well. Patient will:
a. show improved use of language.
b. demonstrate improved social skills.
c. become more independent in decision making.
d. select and participate in one group activity per day.
ANSWER: D
The outcome describes social involvement on the part of the patient. Neither cooperation nor
independence has been an issue. The patient has already expressed a desire to interact with
others. Outcomes must be measurable. Two of the distracters are not measurable.
REF: mcs 124 TOP: Nursing Process: Outcomes Identification
11. Nursing behaviors associated with the implementation phase of nursing process
are concerned with:
a. participating in mutual identification of patient outcomes.
b. gathering accurate and sufficient patient-centered data.

c. comparing patient responses and expected outcomes.
d. carrying out interventions and coordinating care.
ANSWER: D
Nursing behaviors relating to implementation include using available resources, performing
interventions, finding alternatives when necessary, and coordinating care with other team
members.
REF: mcs 126-127 TOP: Nursing Process: Implementation
12. Which statement made by a patient during an initial assessment interview should serve as
the priority focus for the plan of care?
a. I can always trust my family.
b. It seems like I always have bad luck.
c. You never know who will turn against you.
d. I hear evil voices that tell me to do bad things.
ANSWER: D
The statement regarding evil voices tells the nurse that the patient is experiencing
auditory hallucinations and may create risks for violence. The other statements are vague
and do not clearly identify the patients chief symptom.
REF: mcs 117 | mcs 120-121 TOP: Nursing Process:
Assessment MSC: Client Needs: Physiological Integrity
13. Which entry in the medical record best meets the requirement for problem-oriented charting?

a. A: Pacing and muttering to self. P: Sensory perceptual alteration related to
internal auditory stimulation. I: Given fluphenazine HCL (Prolixin) 2.5 mg po
at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge
to watch TV.
b. S: States, I feel like Im ready to blow up. O: Pacing hall, mumbling to self. A:
Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg po. I: Haloperidol
(Haldol) 2 mg po given at 0900. E: Returned to lounge at 0930 and quietly
watched TV.
c. Agitated behavior. D: Patient muttering to self as though answering an unseen
person. A: Given haloperidol (Haldol) 2 mg po and went to room to lie down.
E: Patient calmer. Returned to lounge to watch TV.
d. Pacing hall and muttering to self as though answering an unseen person.
haloperidol (Haldol) 2 mg po administered at 0900 with calming effect in 30
minutes. Stated, Im no longer bothered by the voices.
ANSWER: B
Problem-oriented documentation uses the first letter of key words to organize data: S for
subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for
evaluation. The distracters offer examples of PIE charting, focus documentation, and narrative
documentation.
14. A nurse assesses an older adult patient brought to the emergency department by a
family member. The patient was wandering outside saying, I cant find my way home. The
patient is confused and unable to answer questions. Select the nurses best action.
a. Record the patients answers to questions on the nursing assessment form.
b. Ask an advanced practice nurse to perform the assessment interview.
c. Call for a mental health advocate to maintain the patients rights.
d. Obtain important information from the family member.

ANSWER: D
When the patient (primary source) is unable to provide information, secondary sources should
be used, in this case, the family member. Later, more data may be obtained from other
information sources familiar with the patient. An advanced practice nurse is not needed for this
assessment; it is within the scope of practice of the staff nurse. Calling a mental health advocate
is unnecessary. See relationship to audience response question.
REF: mcs 118-119 | mcs 122-123 TOP: Nursing Process:
Assessment MSC: Client Needs: Safe, Effective Care Environment
15. A nurse asks a patient, If you had fever and vomiting for 3 days, what would you
do? Which aspect of the mental status examination is the nurse assessing?
a. Behavior c. Affect and mood
b. Cognition d. Perceptual disturbances
ANSWER: B
Assessing cognition involves determining a patients judgment and decision making. In this
case, the nurse would expect a response of Call my doctor if the patients cognition and
judgment are intact. If the patient responds, I would stop eating or I would just wait and see
what happened, the nurse would conclude that judgment is impaired. The other options refer
to other aspects of the examination.
REF: mcs 121 (Box 7-4) TOP: Nursing Process: Assessment

16. An adolescent asks a nurse conducting an assessment interview, Why should I tell
you anything? Youll just tell my parents whatever you find out. Which response by the
nurse is appropriate?
a. That isnt true. What you tell us is private and held in strict confidence.
Your parents have no right to know.
b. Yes, your parents may find out what you say, but it is important that they
know about your problems.
c. What you say about feelings is private, but some things, like suicidal
thinking, must be reported to the treatment team.
d. It sounds as though you are not really ready to work on your problems and
make changes.
ANSWER: C
Adolescents are very concerned with confidentiality. The patient has a right to know that most
information will be held in confidence but that certain material must be reported or shared with
the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse.
The incorrect responses are not true, will not inspire the confidence of the patient, or are
confrontational.
REF: mcs 118 TOP: Nursing Process: Implementation
17. A nurse wants to assess an adult patients recent memory. Which question would best
yield the desired information?
a. Where did you go to elementary school?
b. What did you have for breakfast this morning?
c. Can you name the current president of the United States?
d. A few minutes ago, I told you my name. Can you remember it?
ANSWER: B

The patients recall of a meal provides evidence of recent memory. Two incorrect responses are
useful to assess immediate and remote memory. The other distracter assesses the patients fund
of knowledge.
REF: mcs 121 (Box 7-4) TOP: Nursing Process: Assessment
18. When a nurse assesses an older adult patient, answers seem vague or unrelated to
the questions. The patient also leans forward and frowns, listening intently to the
nurse. An appropriate question for the nurse to ask would be:
a. Are you having difficulty hearing when I speak?
b. How can I make this assessment interview easier for you?
c. I notice you are frowning. Are you feeling annoyed with me?
d. Youre having trouble focusing on what Im saying. What is distracting you?
ANSWER: A
The patients behaviors may indicate difficulty hearing. Identifying any physical need the
patient may have at the onset of the interview and making accommodations are important
considerations. By asking if the patient is annoyed, the nurse is jumping to conclusions.
Asking how to make the interview easier for the patient may not elicit a concrete answer.
Asking about distractions is a way of asking about auditory hallucinations, which is not
appropriate because the nurse has observed that the patient seems to be listening intently.
Assessment MSC: Client Needs: Physiological
Integrity
19. At what point in an assessment interview would a nurse ask, How does your faith help you
in stressful situations? During the assessment of:

a. childhood growth and development c. educational background
b. substance use and abuse d. coping strategies
ANSWER: D
When discussing coping strategies, the nurse might ask what the patient does when upset,
what usually relieves stress, and to whom the patient goes to talk about problems. The
question regarding whether the patients faith helps deal with stress fits well here. It would be
out of place if introduced during exploration of the other topics.
REF: mcs 120-121 (Box 7-5) TOP: Nursing Process: Assessment
20. When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of
the unit, and discusses the daily schedule. The nurse is engaged in:
a. counseling. c. milieu management.
b. health teaching. d. psychobiological intervention.
ANSWER: C
Milieu management provides a therapeutic environment in which the patient can feel
comfortable and safe while engaging in activities that meet the patients physical and mental
health needs. Counseling refers to activities designed to promote problem solving and
enhanced coping and includes interviewing, crisis intervention, stress management, and
conflict resolution. Health teaching involves identifying health education needs and giving
information about these needs. Psychobiological interventions involve medication
administration and monitoring response to medications.
Process: Implementation

21. After formulating the nursing diagnoses for a new patient, what is a nurses next action?
a. Designing interventions to include in the plan of care
b. Determining the goals and outcome criteria
c. Implementing the nursing plan of care
d. Completing the spiritual assessment
ANSWER: B
The third step of the nursing process is planning and outcome identification. Outcomes cannot
be determined until the nursing assessment is complete and nursing diagnoses have been
formulated.
Process: Implementation MSC: Client Needs: Safe,
Effective Care Environment
22. Select the most appropriate label to complete this nursing diagnosis: related
to feelings of shyness and poorly developed social skills as evidenced by watching television
alone at home every evening.
a. Deficient knowledge c. Social isolation
b. Ineffective coping d. Powerlessness
ANSWER: C
Nursing diagnoses are selected based on the etiological factors and assessment findings,
or evidence. In this instance, the evidence shows social isolation that is caused by shyness
and poorly developed social skills.

23. QSEN refers to:
a. Qualitative Standardized Excellence in Nursing
b. Quality and Safety Education for Nurses
c. Quantitative Effectiveness in Nursing
d. Quick Standards Essential for Nurses
ANSWER: B
QSEN represents national initiatives centered on patient safety and quality. The primary goal
of QSEN is to prepare future nurses with the knowledge, skills, and attitudes to increase the
quality, care, and safety in the health care setting in which they work.
PTS: 1 DIF: Cognitive Level: Remember (Knowledge)
REF: mcs 115-117 (Box 7-1) TOP: Nursing Process: N/A
24. A nurse documents: Patient is mute despite repeated efforts to elicit speech. Makes no eye
contact. Inattentive to staff. Gazes off to the side or looks upward rather than at speaker.
Which nursing diagnosis should be considered?
a. Defensive coping c. Risk for other-directed violence
b. Decisional conflict d. Impaired verbal communication
ANSWER: D
The defining characteristics are more related to the nursing diagnosis of impaired verbal
communication than to the other nursing diagnoses.

25. A nurse prepares to assess a new patient who moved to the United States from
Central America three years ago. After introductions, what is the nurses next comment?
a. How did you get to the United States?
b. Would you like for a family member to help you talk with me?
c. An interpreter is available. Would you like for me to make a request for
these services?
d. Are you comfortable conversing in English, or would you prefer to have
a translator present?
ANSWER: D
The nurse should determine whether a translator is needed by first assessing the patient for
language barriers. Accuracy of the assessment depends on the ability to communicate in a
language that is familiar to the patient. Family members are not always reliable translators. An
interpreter may change the patients responses; a translator is a better resource.
Assessment MSC: Client Needs: Psychosocial
Integrity
26. The nurse records this entry in a patients progress notes:
Patient escorted to unit by ER nurse at 2130. Patients clothing was dirty. In interview room, patient
sat with hands over face, sobbing softly. Did not acknowledge nurse or reply to questions. After several
minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, Let me out of here. Verbal
intervention unsuccessful. Order for stat dose 2 mg haloperidol PO obtained; medication administered
at 2150. By 2215, patient stopped shouting and returned to sit wordlessly in chair. Patient placed on
one-to-one observation.

How should this documentation be evaluated?
a. Uses unapproved abbreviations
b. Contains subjective material
c. Too brief to be of value
d. Excessively wordy
e. Meets standards
ANSWER: E
This narrative note describes patient appearance, behavior, and conversation. It mentions that
less-restrictive measures were attempted before administering medication and documents
patient response to medication. This note would probably meet standards. A complete nursing
assessment would be in order as soon as the patient is able to participate. Subjective material is
absent from the note. Abbreviations are acceptable.
REF: mcs 127-128 (dm 7-4) | mcs 128 (Box 7-7) TOP: Nursing Process:
Evaluation MSC: Client Needs: Safe, Effective Care Environment
MULTIPLE RESPONSE
1. A nurse assessed a patient who reluctantly participated in activities, answered questions
with minimal responses, and rarely made eye contact. What information should be included
when documenting the assessment? Select all that apply.
a. The patient was uncooperative
b. The patients subjective responses
c. Only data obtained from the patients verbal responses
d. A description of the patients behavior during the interview
e. Analysis of why the patient was unresponsive during the interview

ANSWER: B, D
Both content and process of the interview should be documented. Providing only the patients
verbal responses would create a skewed picture of the patient. Writing that the patient was
uncooperative is subjectively worded. An objective description of patient behavior would be
preferable. Analysis of the reasons for the patients behavior would be speculation, which is
inappropriate.
REF: mcs 117-118 | mcs 127-128 (Box7-7)
TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment
2. A nurse performing an assessment interview for a patient with a substance use disorder
decides to use a standardized rating scale. Which scales are appropriate? Select all that apply.
a. Addiction Severity Index (ASI)
b. Brief Drug Abuse Screen Test (B-DAST)
c. Abnormal Involuntary Movement Scale (AIMS)
d. Cognitive Capacity Screening Examination (CCSE)
e. Recovery Attitude and Treatment Evaluator (RAATE)
ANSWER: A, B, E
Standardized scales are useful for obtaining data about substance use disorders. The ASI, B-
DAST, and RAATE are scales related to substance abuse. AIMS assesses involuntary
movements associated with anti-psychotic medications. The CCSE assesses cognitive function.
REF: mcs 123 (dm 7-1) TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial Integrity
3. What information is conveyed by nursing diagnoses? Select all that apply.

a. Medical judgments about the disorder
b. Unmet patient needs currently present
c. Goals and outcomes for the plan of care
d. Supporting data that validate the diagnoses
e. Probable causes that will be targets for nursing interventions
ANSWER: B, D, E
Nursing diagnoses focus on phenomena of concern to nurses rather than on medical diagnoses.
4. A patient is very suspicious and states, The FBI has me under surveillance. Which
strategies should a nurse use when gathering initial assessment data about this patient?
Select all that apply.
a. Tell the patient that medication will help this type of thinking.
b. Ask the patient, Tell me about the problem as you see it.
c. Seek information about when the problem began.
d. Tell the patient, Your ideas are not realistic.
e. Reassure the patient, You are safe here.
ANSWER: B, C, E
During the assessment interview, the nurse should listen attentively and accept the patients
statements in a nonjudgmental way. Because the patient is suspicious and fearful, reassuring
safety may be helpful, although trust is unlikely so early in the relationship. Saying that
medication will help or telling the patient that the ideas are not realistic will undermine
development of trust between the nurse and patient.

Chapter 3. Preventive Medicine and Behavioral Health
MULTIPLE CHOICE
1. The nurse explains that the main goal of primary prevention is the reduction of the of
mental disorders.
a. severity
b. duration
c. incidence
d. prevalence
ANSWER: C
Primary prevention is lowering the incidence of a mental disorder or reducing the rate at which
new cases of the disorder develop. Secondary prevention reduces the prevalence of a mental
disorder. Tertiary prevention reduces the severity of a mental disorder and its associated
disability.
DIF: Cognitive Level: Comprehension REF: Text mcs: 169
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. A psychiatric nurse is assessing the need for mental health services at the clinic. When
estimating the number of patients with bipolar disorder in the community, the nurse
places highest priority on which data-gathering technique?
a. Community forums that solicit data shared by patients and families
b. Epidemiological studies that indicate incidence and prevalence of disease
c. Use of key informants, such as local social service personnel, nurses, and
physicians
d. Statistics from local public reports about race, marital status, population
density, and substance abuse
ANSWER: B

Epidemiological studies examine the incidence (number of new cases) and prevalence (number
of current existing cases) of a disease or disorder in a defined population over a specified period.
The nurse who is trying to plan for services would find these data very helpful. The remaining
options refer to other methods of assessing community needs, but they are not as well suited to
gathering the data identified by this question.
DIF: Cognitive Level: Application REF: Text mcs: 169
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. What is the essential difference between the nursing prevention model and the
medical prevention model?
a. The medical model targets universal populations; the nursing model targets
a selective population.
b. The medical model assumes that all people are at equal risk; the nursing
model attempts to identify those who are more vulnerable.
c. The medical model attempts to identify the most likely cause of the disease;
the nursing model stresses that mental disorders are multicausal.
d. The medical model offers a continuum of nonspecific preventive measures; the
nursing model offers one specific, tested, preventive measure.
ANSWER: C
The primary difference is the medical models attempt to identify a single cause of a disease; the
nursing model assumes that mental disorders result from the interplay of several risk and
protective factors.
DIF: Cognitive Level: Comprehension REF: Text Pages: 169-170
TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity
4. A psychiatric nurse is responsible for providing patient-focused health education. In order
to promote primary prevention of mental health problems, the nurse stresses:
a. trust.

b. resilience.
c. networking.
d. motivation.
ANSWER: B
The health education strategy of primary prevention in mental health involves the
strengthening of individuals and groups through building of competence or resilience. The
other answers do not address this particular trait.
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
5. A nurse whose primary focus is tertiary prevention of mental disorders would focus on:
a. providing prompt treatment of an individuals mental disorder.
b. identifying social supports to prevent the need for hospitalization.
c. funding rehabilitative activities to reduce the disability associated with
mental disorders.
d. forming a preretirement counseling program staffed by professional mental
health nurses.
ANSWER: C
The nurses work in tertiary prevention involves rehabilitative efforts.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
6. A nurse who works in community mental health identifies a minority neighborhood group
as having low self-efficacy and being particularly susceptible to a number of stressors. In
which phase of the nursing process did this activity take place?
a. Assessment

b. Analysis
c. Planning
d. Implementation
e. Evaluation
ANSWER: C
The analysis/nursing diagnosis phase of the nursing process is in use when the nurse identifies
problem areas. Assessment identifies symptoms while planning and implementation involves
putting solutions into the therapy plan. Evaluation reviews the outcomes of the therapy plan.
TOP: Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity
7. People with low self-efficacy:
a. are often found to engage in antisocial and/or criminal behavior.
b. usually require an inordinately large percentage of the available
community health resources.
c. are usually well motivated and handle stress well and typically have
low vulnerability to depression.
d. give up in the face of difficulty, recover slowly from setbacks, and easily fall
victim to depression.
ANSWER: D
Low self-efficacy negatively affects an individuals thoughts, motivation, mood, and health. A
person with low self-efficacy dwells on obstacles and personal deficiencies, and such a person is
depression prone. Successful interventions for groups with low self-efficacy can be planned and
implemented.

8. When a community mental health nurse focuses on intervention strategies designed to
increase self-efficacy among members of a minority neighborhood group, a realistic primary
prevention goal would be:
a. elimination of mental illness in the community.
b. resolving social problems within the community.
c. reducing both stressors and suffering in the group.
d. reducing the incidence of depression in the group.
ANSWER: D
Primary prevention is aimed at reducing the incidence of mental illness. Depression is a
frequent outcome of low self-efficacy. Therefore a goal of intervention to raise self-efficacy is to
reduce the incidence of depression in the group.
DIF: Cognitive Level: Analysis REF: Text mcs: 171
TOP: Nursing Process: Outcome Identification
MSC: NCLEX: Psychosocial Integrity
9. The identification of intervention strategies designed to increase self-efficacy among
members of a minority neighborhood group would occur in which phase of the nursing
process?
a. Assessment
b. Analysis
c. Planning
d. Implementation
e. Evaluation
ANSWER: C
Planning is the elaboration of strategies designed to achieve a specific goal.

10. A nurse assessing a person who is deemed to be at high risk for mental disorders will
find that, as suggested by the nursing primary prevention model, the person has:
a. fewer stressors.
b. more protective factors.
c. unusual developmental tasks.
d. inadequate coping mechanisms.
ANSWER: D
Factors that place a person at high risk include the presence of many stressors, fewer protective
factors, and inadequate coping mechanisms. (Developmental tasks are considered universal.)
11. In the event that a vaccine is developed to prevent schizophrenia, which population
group would be selected to receive it first?
a. The universal population
b. The indicated population
c. The developmental population
d. The epidemiological population
ANSWER: B
An indicated population is one made up of high-risk individuals identified as having biological
markers that indicate a predisposition for the disorder.

12. Which person is most vulnerable to the development of psychiatric illness based
on sociocultural factors?
a. A 16-year-old who has a parent with bipolar disorder
b. A 55-year-old who has retired with full pay from a job as a high school teacher
c. A 24-year-old who was raised by a grandparent after both parents died in a
plane crash
d. A 67-year-old from a minority group who is poor and has no social
support system
ANSWER: D
Being a minority, living in poverty, being elderly, and having no social support are sociocultural
risk factors.
DIF: Cognitive Level: Analysis REF: Text mcs: 176
13. To effectively use the nursing primary prevention model, it is most important for a nurse
to have knowledge of:
a. personality types.
b. psychiatric medications.
c. normal growth and development.
d. the DSM-IV-TR diagnostic categories.
ANSWER: C
Knowledge of normal growth and development is necessary for assessing a persons functioning
and for choosing appropriate preventive nursing interventions.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. A nurse working in a community health agency wishes to implement a primary
preventive program in mental health for the elderly. Which action should occur first?
a. Elaboration of specific preventive strategies
b. Identification of stressors that precipitate maladaptive responses
c. Application of selected nursing interventions to enhance adaptation
d. Determination of the effectiveness of the existing nursing activities
ANSWER: B
Assessment is the first phase of the nursing process.
15. A psychiatric nurse is working with patients in a health education group on strategies to
improve anger management. The nurse would best evaluate the effectiveness of this
intervention by determining changes in a patients:
a. routinely used coping skills.
b. opinion about own self-worth.
c. knowledge of people and events that trigger anger.
d. underlying mental health disorder, exhibited by the symptom of anger.
ANSWER: A
Health education for patients with mental health disorders can include interventions to increase
the coping skills of the individual or group, such as problem solving, communication skills,
tolerance of stress and frustration, motivation, hope, anger management, and self-esteem. The
remaining options do not relate to an increase in coping skills related to anger management.
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

16. A nurse working with adolescents recognizes which factor as being of greatest importance
to this age group?
a. Normal growth and development
b. Peer relationships
c. Career selection
d. Child rearing
ANSWER: B
Topics that tend to be important to adolescents include those that discuss peer relationships,
sexuality, or potential problems, such as drug abuse or promiscuity. Groups devoted to normal
growth and development and child rearing are groups of most importance to parents. Career
selection does not relate directly to health education, but it may indirectly affect the stressors in
ones life.
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
17. A nurse focuses on increasing gang members problem-solving and coping skills. This is
an example of:
a. crime reduction.
b. community service.
c. competency building.
d. environmental manipulation.
ANSWER: C
Competency is improved when an individual is capable of critical thinking and possesses
effective coping skills.

18. An individual considering a self-help group says to a nurse, I might go to the bereavement
group meeting, but what if Im required to make changes I dont like? The nurses most
therapeutic response would be:
a. Perhaps youre not quite ready to join a group. Give yourself a few more weeks.
b. These are natural concerns. Trying something new activates all our insecurities.
c. Most group members will feel just like you do. They will help you hold your
own against aggressive group members.
d. Self-help groups are designed so that each member has sole responsibility
for making changes in his or her own life.
ANSWER: D
This option acknowledges and provides an explanation for the patients expressed concern.
19. A nurse working with mentally ill patients recognizes which factor as having the
greatest impact on a patients tendency to seek treatment?
a. Social stigma
b. Financial burden
c. Lack of support services
d. Ineffective family support
ANSWER: A
The impact of stigma is enormous, with nearly two thirds of the population with diagnosable
mental disorders failing to seek treatment as a result of real or imagined effects of stigma.

TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Primary prevention in mental health is based on the assumption that many
maladaptive responses result from: (Select all that apply.)
a. a lack of ability to manage ones own life.
b. ineffective coping strategies.
c. ineffective health education.
d. environmental change.
e. poor self-esteem.
ANSWER: A, B, C, E
An individual is more likely to experience mental health problems if he or she lacks good self-
esteem and is incapable of controlling his or her life especially because of poor coping skills.
Poor or ineffective health education adds to the problem. Environment is not a primary factor in
primary prevention.
2. Which interventions would be helpful in achieving the goal of improving the social
support system of an individual at risk for developing maladaptive coping responses?
(Select all that apply.)
a. Hospitalization in a mental health facility
b. Encouraging participation in a self-help group
c. Explaining to concerned others how they can help
d. Providing services in a caring and supportive manner
e. Identifying consequences for ineffective coping strategies

ANSWER: B, C, D
Hospitalization is more directed toward stabilizing a patient while identifying consequences
and has little impact on improving social support. Providing social support includes
cushioning the effects of potential stressors. Improving links between the individual and the
community, strengthening natural caregiving networks, using informal support groups, and
providing nursing support all are ways to increase social support for an individual.
Chapter 4. The Patient and You: Psychological and Cultural Consideration
MULTIPLE CHOICE
1. Which Western cultural feature may result in establishing unrealistic outcomes for patients
of other cultural groups?
a. Interdependence
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems
ANSWER: D
Directly confronting problems is a highly valued approach in the American culture but not
part of many other cultures in which harmony and restraint are valued. American nurses
sometimes mistakenly think that all patients should take direct action. Patients with other
values will be unable to meet this culturally inappropriate outcome. Present orientation,
interdependence, and a flexible perception of time are not valued in Western culture. These
views are more predominant in other cultures. See relationship to audience response question.
(Comprehension) REF: mcs 88 (dm 5-4) TOP: Nursing
Process: Planning MSC: Client Needs: Psychosocial
Integrity

2. A psychiatric nurse leads a medication education group for Hispanic patients. This nurse
holds a Western worldview and uses pamphlets as teaching tools. Groups are short and
concise. After the group, the patients are most likely to believe:
a. the nurse was uncaring. c. the teaching was efficient.
b. the session was effective. d. they were treated respectfully.
ANSWER: A
Hispanic individuals usually value relationship behaviors. Their needs are for learning through
verbal communication rather than reading and for having time to chat before approaching the
task.
REF: mcs 85-86 (dm 5-2) TOP: Nursing Process: Evaluation
3. To provide culturally competent care, the nurse should:
a. accurately interpret the thinking of individual patients.
b. predict how a patient may perceive treatment interventions.
c. formulate interventions to reduce the patients ethnocentrism.
d. identify strategies that fit within the cultural context of the patient.
ANSWER: D
The correct answer is the most global response. Cultural competence requires ongoing effort.
Culture is dynamic, diversified, and changing. The nurse must be prepared to gain cultural
knowledge and determine nursing care measures that patients find acceptable and helpful.
Interpreting the thinking of individual patients does not ensure culturally competent care.
Reducing a patients ethnocentrism may not be a desired outcome.

REF: mcs 93 TOP: Nursing Process: Planning/Outcomes Identification
4. A black patient, originally from Haiti, has a diagnosis of depression. A colleague tells the
nurse, This patient often looks down and is reluctant to share feelings. However, Ive
observed the patient spontaneously interacting with other black patients. Select the nurses
best response.
a. Black patients depend on the church for support. Have you consulted the
patients pastor?
b. Encourage the patient to talk in a group setting. It will be less intimidating
than one-to-one interaction.
c. Dont take it personally. Black patients often have a resentful attitude that takes
a long time to overcome.
d. The patient may have difficulty communicating in English. Have you
considered using a cultural broker?
ANSWER: D
Society expects a culturally diverse patient to accommodate and use English. Feelings are
abstract, which requires a greater command of the language. This may be especially difficult
during episodes of high stress or mental illness. Cultural brokers can be helpful with
language and helping the nurse to understand the Haitian worldview and cultural nuances.
Implementation MSC: Client Needs: Psychosocial
Integrity
5. A Haitian patient diagnosed with depression tells the nurse, Theres nothing you can do. This
is a punishment. The only thing I can do is see a healer. The culturally aware nurse assesses
that the patient:
a. has delusions of persecution.
b. has likely been misdiagnosed with depression.

c. may believe the distress is the result of a curse or spell.
d. feels hopeless and helpless related to an unidentified cause.
ANSWER: C
Individuals of African American or Caribbean cultures who have a fatalistic attitude about
illness may believe they are being punished for wrongdoing or are victims of witchcraft or
voodoo.
They may be reticent to share information about curses with therapists. No data are present in
the scenario to support delusions. Misdiagnosis more often labels a patient with depression as
having schizophrenia.
REF: mcs 86 (dm 5-2) | mcs 88 (dm 5-4)
6. A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient,
who was recently discharged from United States Marine Corps, arrives at 0945. Which
analysis best explains this behavior?
a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behavior indicates feelings of self-importance that the patient wants others
to appreciate.
ANSWER: C
Culture is more than ethnicity and social norms; it includes religious, geographic,
socioeconomic, occupational, ability- or disability-related, and sexual orientation-related beliefs
and behaviors. In this instance, the patients military experience represents an aspect of the
patients behavior. The military culture values timeliness. The distracters represent
misinterpretation of the patients behavior and have no bearing on the situation.
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