Nursing Test Banks

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Free Practice Test:

CHAPTER 3—INTERFACING BIOLOGICAL-BEHAVIORAL CONCEPTS INTO PSYCHIATRIC NURSING PRACTICE

MULTIPLE CHOICE

1. If you were to work with the family of a person who has had mental illness for many years and you asked the family how they felt about neurobiological and genetic research findings, the most likely answer would be:
a. relief that family interactions are no longer thought to be the major cause of mental illness
b. happy that their family member will soon be able to be cured of mental illness
c. upset that findings indicate that some illnesses are due to structural changes
d. frightened that the person with mental illness will be taking newer, less tested drugs

ANS: A
In the past, parents and siblings were thought to be responsible for many mental illnesses, and they have felt demoralized and blamed for their loved one’s illness. With current research demonstrating that the cause of mental illness is more complex and may include neurobiological and genetic factors, the burden of blame and guilt is reduced.

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2. Which of the following ideas held by Hippocrates in the 14th century are still valid in psychiatric-mental health work today?
a. The hypothalamic-pituitary-adrenal axis has a great deal to do with mental disorders.
b. The brain gives rise to emotions and contributes to disturbances in affect or mood.
c. There is a tenuous balance of four humors in the body that contribute to mood.
d. All persons with mental disorders need to be treated kindly in a relaxing setting.

ANS: B
Hippocrates surmised that the brain gives rise to pleasure, joy, pain, and grief, and it contributes to disturbances in affect and mood. Hippocrates early description of the tenuous balance of four humors (blood, phlegm, and yellow and black bile) and their relationship to mood disorders proved inaccurate.

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3. You are administering medications to a group of clients in treatment for various mental illnesses. Which of the following medications in your medication cart is a selective serotonergic reuptake blocking agent?
a. fluoxetine (Prozac) c. clozapine (Clozaril)
b. quetiapine (Seroquel) d. haloperidol (Haldol)

ANS: A
Prozac is one of the serotonergic reuptake blocking agents. Other SSRIs include paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). Clozaril is an atypical antipsychotic and Haldol is one of the older major psychotropics (antipsychotics).

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4. You are preparing to administer medications to two of your assigned clients. One has an eating disorder and the other has an anxiety disorder. These two clients are on the same medications. You look up their medications to review appropriate usage as well as side effects. Which of the following medications would be most appropriate for treatment of both these clients and others with these two different diagnoses?
a. sertraline (Zoloft)
b. loxapine (Loxitane)
c. olanzapine (Zyprexa)
d. fluphenazine decanoate (Prolix Decanoate)

ANS: A
Both patients could receive Zoloft because it is a selective serotonergic reuptake blocking agent (SSRI). These medications have been found to be effective in treating major depression as well as eating, impulsivity, and anxiety disorders. Olanzapine (Zyprexa) is an atypical antipsychotic. Loxapine (Loxitane) and fluphenazine decanoate (Prolix Decanoate) are both typical antipsychotics.

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5. An elderly client is very concerned that she is aging and will become forgetful because she has heard that there are many changes in the brain as you age. Which of the following statements could you use in teaching this client about aging and the brain that would be true?
a. The brain gets bigger due to excess fluid as you age.
b. There is very little loss of neurons after the fifth decade.
c. There is no definitive evidence of mental decline with aging.
d. If you are going to become forgetful, it usually happens by age 60.

ANS: C
The brain does get smaller and there is significant loss of neurons after the fifth decade. There is no definitive evidence of mental decline with aging.

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6. Which of the following statements best describes the cause of mental illness?
a. neurotransmitter dysfunction
b. a variety of contributing factors
c. a failure of the immunological system
d. underlying structural defects in the brain

ANS: B
A variety of factors are implicated in the cause of mental illness. (No one cause has been found.) These factors include abnormalities in structure of the brain, neurotransmitter production or absorption, neuroendocrine responses, immune responses, and genetic predisposition. All have been found to contribute to mental disorders.

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7. When working with a client with a diagnosis of major depression, it is most important to assess these clients for any signs or symptoms of which one of following problems that has been shown by research to have adverse outcomes closely associated with depression?
a. astrocytomas c. liver disease
b. paresthesias d. heart disease

ANS: D
The link between mood disturbances, such as depression, and adverse outcomes in heart disease, specifically myocardial infarction, is well documented and accounts for half of the cases of depression in those recovering from myocardial infarction. Literature supports the fact that there is an arrhythmic mechanism that is the link between psychological factors and sudden cardiac death.

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8. When working with a client who is being treated for hypertension with a regimen of medications, exercise, and lifestyle changes, which of the following conditions would you set as a top priority to periodically assess?
a. a change in sexual functioning
b. uncontrollable coughing at times
c. effect of exercise on the client’s mood
d. any change in mood, especially depression

ANS: D
Many medications used to treat medical conditions contribute to a depressed mood, and this is possible with some medications used to treat hypertension. While it would be helpful to know the effect of exercise on mood, changes in sexual functioning, and problems with coughing associated with the medication, it is most important to assess for and treat any depression.

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9. When assessing a client with depression, you would most want to assess for which of the following problems that is often associated with depression?
a. bulimia c. ringing in the ears
b. nervous leg syndrome d. cognitive impairment

ANS: D
For years, health providers have recognized that cognitive impairment may be linked with depressive disorders. Negative self-reverent cognitions, which are related to perceptions of loss, are believed to be a mediator of depressive symptoms.

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10. Researchers have suggested that the brain adapts to aging by preserving an abundance of nerve cells rich in which of the following substances that are linked to higher cortical functioning?
a. GABA c. acetylcholine
b. dopamine d. norepinephrine

ANS: C
Some researchers have found that the brain adapts to aging by preserving an abundance of nerve cells rich in acetylcholine in neurotransmitter pathways between the hippocampus and the cerebral cortex. These changes are linked to higher cortical functioning.

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11. Which of the following signs or symptoms would you most likely find when assessing a client with frontotemporal dementia (FTD) which is primarily affecting the left frontotemporal lobe?
a. Jacksonian seizures c. occasional inappropriate affect
b. childlike silliness d. progressive speech difficulties

ANS: D
Frontotemporal dementia is characterized with symptoms similar to AD with progressive speech difficulties associated particularly with FTD when it affects primarily the left frontotemporal lobe.

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12. While reading the chart of a newly assigned client, you find that the physician has ordered donepezil (Aricept). In reviewing this drug, you will find that the expected action of this drug is to:
a. stimulate the production of cortisone
b. stimulate the respiratory center of the brain
c. regulate the production of thyroid hormones
d. prolong the life of existing cholinergic neurons

ANS: D
Drugs that prolong the life of existing cholinergic neurons include donepezil (Aricept) which is given to clients with Alzheimer’s disease.

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13. Which of the following drugs is given in hopes it will delay the clinical decline of clients with a diagnosis of Alzheimer’s disease?
a. aurothioglucose (Sogonal)
b. ceftuzixime sodium (Cefizox)
c. clonidine hydrochloride (Duraclon)
d. galantamine hydrobromide (Reminyl)

ANS: D
Like donepezil (Aricept), the drug galantamine hydrobromide (Reminyl) prolongs the life of existing cholinergic neurons and may delay the clinical decline in clients with Alzheimer’s disease.

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14. Which of the following neurotransmitters is classified as an inhibitory transmitter?
a. serotonin c. norepinephrine
b. acetylcholine d. gamma-aminobutyric acid

ANS: D
Scientists have identified norepinephrine, dopamine, acetylcholine, and serotonin as excitatory transmitters. They have identified gamma-aminobutyric acid as an example of an inhibitory transmitter.

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15. One of your clients describes being able to move a heavy car off the body of a friend to save the friend’s life. The client most likely was able accomplish this due to:
a. weeks of workouts with weight lifting
b. the release of large amounts of glucagon
c. the hypothalamic-pituitary-adrenal response
d. ability to control the mind with specific thoughts

ANS: C
The hypothalamic-pituitary-adrenal axis will respond when a person is subjected to stress including threats of harm or danger to self or others.

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16. Abnormalities in the hypothalamic-pituitary-adrenal axis have been found to contribute to and to be diagnostic of which of the following conditions?
a. myasthenia gravis c. functional psychosis
b. conversion disorder d. systemic lupus erythematosus

ANS: C
Abnormalities in the HPA axis are known to contribute to and are diagnostic of functional psychosis, phobias, bipolar disorder, depressive disorder, and anxiety disorder.

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17. The relatively new field of psychoneuroimmunology is a developing knowledge concerned with:
a. proving a connection between AIDS and the development of depression
b. interconnections between the nervous system and the immune system
c. providing clients at high risk for mental illness with preventative measures
d. immunizing clients with psychiatric illness against neurological problems

ANS: B
Psychoneuroimmunology is a developing knowledge concerned with the interconnections between the nervous system and the immune system.

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18. A client with systemic lupus erythematosus (SLE) asks the nurse to talk about the cause of this disease. Which of the following responses by the nurse would be most accurate?
a. “There is a deficiency in dopamine and/or specific dopamine receptors.”
b. “It is caused by a systemic virus that is most likely carried by a mosquito.”
c. “This involves the destruction of the myelin sheath and problems in conduction.”
d. “The immune system has attacked itself in a failure to recognize its own cells as self.”

ANS: D
When the immune system fails to differentiate self from nonself, it can attack itself as in autoimmune diseases like systemic lupus erythematosus (SLE).

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19. The family of a young adult who has panic disorder asks you about recent research related to the cause of panic disorders. Which of the following statements would you share with the family as a true statement?
a. “New research points to a relationship to thyroid dysfunction.”
b. “Panic disorders have been recently linked to immune dysfunction.”
c. “Early childhood experiences coupled with genetic defects are implicated.”
d. “This disorder is most likely a learned behavior according to recent research.”

ANS: B
Recently, psychiatric illnesses, notably affective disorders and panic disorders, have been linked to immune dysfunction.

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20. Genetic theories regarding the cause of schizophrenia began during which of the following times?
a. early 1900s c. the Korean conflict
b. World War II d. mid-1970s

ANS: A
Genetic theories regarding the cause of schizophrenia date back to Kraepelin in the early 1900s. Kraepelin observed that bizarre behavior was commonly found in families of clients with schizophrenia.

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21. Twin, adoption, and family studies of people with schizophrenia have supported which of the following premises?
a. Schizophrenia is most likely a group of related genetic disorders.
b. Lack of family support is the major cause of relapse and recidivism.
c. Environmental factors are just as relevant as genetic processes.
d. It is unlikely that the cause of schizophrenia is genetic in nature.

ANS: C
Twin, adoption, and family studies to determine the impact of environmental factors on genetic expression have shown that environmental factors are just as important as molecular-based genetic processes. Environmental factors include parental treatment or caregiving patterns, family structures, age spacing, and gender. These factors may buffer or protect genetically vulnerable clients.

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22. When trying to identify clients at risk for alcoholism and other addictions, the nurse most needs to keep in mind which of the following factors that place certain individuals at greatest risk?
a. living with a friend or relative who is an alcoholic
b. being in a location where there is access to alcohol
c. having an alcoholic parent or grandparent and being in college
d. suffering from bipolar disorder and having visual hallucinations

ANS: C
The role of genetic factors and alcoholism has been well supported by twin, family, and adoption studies. Some people with a genetic predisposition to alcoholism do not drink alcohol or abuse substances because they have seen the harm it does to an individual and the family. Affect and mood disorders are not as great a risk as having genetic markers and environmental factors such as peer pressure and access.

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23. A popular explanation for substance abuse lies in the mesolimbic-mesocortical areas of the brain and mainly involves which of the following neurotransmitters and receptors?
a. GABA c. acetylcholine
b. dopamine d. norepinephrine

ANS: B
The mesolimbic-mesocortical areas of the brain contain the various types of dopamine receptors including those that generate reward and reinforcement behaviors. Clients with a biochemical predisposition to alcoholism will gain reinforcement directly from the alcohol and its interaction with specific dopamine receptors.

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24. One area of newer technological advances is in the area of stem cell research. What is the hope of medicine in regard to stem cells?
a. They can be used to prolong the expected life span.
b. They can be used to control negative emotions.
c. Stem cells can be used as universal donor cells.
d. Use of stem cells will cure quicker and cheaper than drugs.

ANS: C
As universal donor cells, stem cells could offer cures to currently incurable diseases such as childhood diabetes, Alzheimer’s, and spinal cord injury.

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25. The psychiatric nurse will find that the use of herbal medicines in the past decade has done which of the following things?
a. sharply decreased c. increased a small amount
b. stayed about the same d. increased sharply

ANS: D
The use of herbal medicines has risen sharply over the past decade from 3% to 12%. Herbal therapy use exists across age, gender, culture, and ethnic groups. The most cited health problems addressed by this form of therapy include chronic pain, anxiety, arthritis, chronic fatigue syndrome, and headaches. One reason for the increased use of herbal medicine is that it is readily available on the Internet, pharmacies, and health food stores.

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26. Recent studies of lithium and valproate acid have found that these substances regulate which of the following things?
a. acetycholinesterase levels
b. adrenal hormonal production
c. protein kinase C (PKC) activities
d. dopamine receptor site receptivity

ANS: C
Lithium and valproate acid regulate protein kinase C (PKC) activities and have efficacy in the treatment of acute mania. PKC is a group of calcium and phospholipid-dependent enzymes and is found to be elevated during acute mania. Treatment with lithium and valproate acid depresses PKC activity during mania.

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27. Which of the following examples of your clients’ experiences would best exemplify “kindling”?
a. building experiences with others through repeated interactions
b. building a strong attachment bond between parent and child
c. repeated seizures with the seizure threshold seeming to decline over time
d. a sudden and prolonged burst of energy much like adding wood to a fire

ANS: C
Kindling is the electrophysiological process that over time produces an action potential after repetitive subthreshold stimulation or progressive sensitization of a neuron.

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28. Which of the following areas of the brain is most likely involved in modulating fear responses?
a. pons c. thalamus
b. amygdala d. frontal lobe

ANS: B
The amygdala acts as a powerful modulator of fear responses. It is believed that the amygdala plays a critical role in the emotional memory responses.

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29. In order for a nurse to gain an understanding of the severity of a sexual assault on a person, the nurse should most strongly consider:
a. the individual’s perception of the event
b. the age of the victim of the assault
c. whether any weapons were used
d. how long the actual assault lasted

ANS: A
The severity of a stressor is determined by the individual’s perception of the event. An individual’s perception of a stressful event is based on her analysis of the event as being either benign and nonthreatening or harmful to self.

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30. A nurse is working with a client who seems to be very calm during a crisis and also seems to have an exceptional buffering against emotional pain. Which of the following most likely plays a major role in producing calmness and protecting this client from emotional pain?
a. thyroxin c. ACTH
b. endorphins d. cortisol

ANS: B
Endorphins play a major role in managing severe stress. They function as a type of endogenous opiate producing calmness and buffering one from emotional pain.

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31. A client expresses a desire to have a series of electroconvulsive treatments (ECT) as this helped her in the past. Your understanding about the current use of ECT is that:
a. it is gaining renewed acceptance as an effective treatment modality for some conditions
b. the use of ECT has virtually disappeared from treatment centers that performed it in the past
c. it is considered to be very risky and may lead to serious injury of the brain and limbs
d. It is only given when the client has tried at least three of the newer neuroleptic drugs

ANS: A
The use of ECT is gaining renewed acceptance as an effective treatment modality.

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32. The nurse whose practice is based on the belief that mentally ill clients have a biochemical imbalance and a natural predisposition for mental illness would most likely base client care on:
a. neurobiological theories c. behavioral theories
b. interpersonal theories d. cognitive theories

ANS: A
The nurse would most likely focus on neurobiological theories. These theories suggests that behavior is a reflection of brain function, and all thought processes represent a range of functions mediated by nerve (neurons) cells in the brain.

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33. A nurse who provides care based on Erikson’s Ego Theory would plan nursing interventions directed at:
a. compensating for knowledge deficit
b. supporting the client’s developmental level
c. forcing the client to participate in age-appropriate activities
d. encouraging the client to regress to an age where she feels more comfortable

ANS: B
The nurse whose practice is based on Erikson’s Ego Theory would plan nursing interventions that support the client’s current developmental level. A major aspect of Erikson’s theory is the development of ego identity, which is a conscious sense of self that is developed through social interactions. According to Erikson, there are eight stages of psychosocial development. The first four stages involve the socialization of the child, and the succeeding four stages involve socialization of the adult.

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34. The most common approach to the treatment of adolescents with mental disorders would include:
a. token economy c. medication administration
b. light therapy d. electroconvulsive therapy

ANS: A
The approach most often used when treating adolescents is a behavioral approach. This type of approach would focus on using rewards and punishments to change behaviors. A token economy is one form of providing rewards to clients whose behavior is appropriate.

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35. Your client states that the voices are telling her she is bad and needs to be punished. An appropriate nursing diagnosis would be:
a. hallucinations of unknown origin
b. anxiety related to hospitalization
c. disturbed sensory perception (auditory)
d. disturbed sensory perception (visual)

ANS: C
Disturbed sensory perception (auditory) is the most appropriate nursing diagnosis for this client. The client did not mention anxiety or any visual hallucinations.

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36. Your client has a nursing diagnosis of “impaired social interaction.” An appropriate outcome objective would be to:
a. verbalize coherently with others by discharge
b. be able to bathe and dress self with minimal supervision
c. complain less of auditory and visual hallucinations
d. exhibit decreased agitation and aggression by discharge

ANS: A
Because the client with a diagnosis of “impaired social interaction” is experiencing difficulty in developing and maintaining healthy relationships with others, the most appropriate outcome objective would be that the client be able to verbalize coherently with others by discharge.

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37. A nursing intervention for a client experiencing visual and auditory hallucinations includes “Give direct and concrete explanations.” The rationale for this intervention is that it:
a. decreases anxiety and increases coherence
b. enables the client to learn effective communication
c. demonstrates the nurse’s ability to teach the mentally ill
d. enables the nurse to assess the basis of the client’s behavior and responses

ANS: B
By giving direct and concrete explanations, the client is able to learn effective communication.

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38. Which nursing intervention is the primary means of facilitating a trusting alliance and reducing anxiety and agitation in a client?
a. establishing rapport
b. assisting with self-care
c. giving direct and concrete explanations
d. reinforcing and validating clear communications

ANS: A
The foundation of therapeutic communication between the nurse and client is rapport. As the therapeutic relationship evolves, so does the client’s willingness to trust the nurse.

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39. Which of the following individuals would be more vulnerable to trauma?
a. a 1-year-old whose father is an alcoholic
b. a 19-year-old attending nursing school
c. a 35-year-old married business executive
d. a 52-year-old engineer with a wife and three children

ANS: A
The developmental stage during which trauma is experienced influences the impact of the trauma. Adults with adequate coping behaviors and support systems are likely to be less vulnerable to trauma than a child would be.

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MULTIPLE RESPONSE

1. Which of the following structures in the brain are connected with the production of memories and emotions? Select all that apply.
a. cortex d. pituitary gland
b. amygdale e. limbic system
c. hypothalamus f. optic nerve

ANS: A, B, C, D, E
The cortex, amygdale, hypothalamus, pituitary gland, and limbic system are all connected with the production of memories and emotions.

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2. As the nurse on a mental health unit, you are assigned to administer medications this morning. Several of your clients are receiving selective serotonergic reuptake blocking agents (SSRIs). You know that SSRIs are used to treat which of the following disorders? Select all that apply.
a. eating disorders d. depressive disorders
b. anxiety disorders e. impulsivity disorders
c. psychotic disorders f. inflammatory disorders

ANS: A, B, D, E
SSRIs are used to treat eating disorders, anxiety, depression, and impulsivity disorders. They are not used for psychotic or inflammatory disorders.

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3. You are the charge nurse on a unit where the majority of clients have been admitted with a diagnosis of post-traumatic stress disorder (PTSD). The clients’ ability to adapt to stress is related to which of the following? Select all that apply.
a. economic status d. developmental stage
b. educational level e. genetic vulnerability
c. severity of the stressor f. availability of a support system

ANS: C, D, E, F
Each individual will respond to trauma in her own unique way. Adaptation to trauma is related to a number of factors. These factors include severity of the stressor, genetic vulnerability, developmental stage, availability of a support system, history of trauma, and ego function (personality traits).

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