Test Bank Psychiatric Nursing Mental Health Fortinash edition 5th


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Sample Provided Below:

Chapter 03: The Nursing Process and Standards of Practice

Test Bank


1. The patient asks the nurse, “I’ve heard the student nurses talk about the nursing process. Why is there so much emphasis on using the nursing process?” The response that explains the need for nurses to understand and use the nursing process is:
a. “Do you think you have a better method we might use?”
b. “The nursing process is a systematic problem-solving method encompassing all components necessary to care for patients.”
c. “Using the nursing process is a way of legitimizing our profession and placing us on an equal footing with the pure sciences.”
d. “The nursing process is a unidimensional, static, linear approach used to guide nurses as they make clinical judgments.”

This response best explains the importance of the nursing process by description and relationship to patient care. Suggesting that the patient may have a better method is challenging and does not address the question posed by the patient. Providing legitimacy to the profession is a very limited explanation for use of the nursing process. The nursing process is not one-dimensional, static, or linear.

DIF: Cognitive Level: Knowledge REF: Page 40
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

2. When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ED) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by:
a. Reviewing the ED chart
b. Contacting the admitting physician
c. Directing the questions to the family members
d. Establishing a line of communication with the patient

The nurse should begin establishing the nurse–patient relationship by initially directing the questions to the patient. The nurse can confirm information and/or obtain supplementary information from the sources identified by the other options.

DIF: Cognitive Level: Application REF: Page 40
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

3. The nurse shows the ability to effectively state a nursing diagnosis reflective of the implications of depression on a patient’s life processes when stating in the patient’s plan of care that:
a. Patient outcomes were partially attained. Implementation of present plan to continue.
b. Patient will initiate and support conversation with nurse therapist by (date 3 weeks in future).
c. Oral medication for anxiety should be administered when depression is assessed to be at the moderate level.
d. Impaired verbal communication r/t impoverished thoughts secondary to depression as evidenced by monosyllabic responses.

This statement contains the various components of a nursing diagnosis while expressing the existence of an altered life process. The remaining options reflect other steps, such as evaluation and intervention planning.

DIF: Cognitive Level: Application REF: Pages 47-48 TOP: Nursing Process: Analysis
MSC: NCLEX: Safe and Effective Care Environment

4. When engaging in outcomes identification, the nurse:
a. Interviews and collects patient-focused data
b. Re-assesses the patient’s physical and emotional status evaluation
c. Reviews the patient’s existing problems and projects the results of the nursing care
d. Considers the patient’s presenting symptoms and identifies nursing-related problems

Outcomes are projections of expected influence that nursing interventions will have on the patient. Interviewing and collecting data is involved in the assessment process, re-assessing is involved in the evaluation process, and identifying related nursing problems is involved in determining appropriate nursing diagnoses.

DIF: Cognitive Level: Application REF: Page 49
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

5. While discussing assessment of suicidal patients, a novice nurse mentions, “I was taught to always base my care on concrete, evidence-based scientific reasoning and never to rely on intuition.” Which response by the experienced nurse shows understanding of intuitive reasoning?
a. “That’s wise, because intuition went out of favor with the scientific revolution.”
b. “Critical thinking and intuition are at opposite poles. Keep relying on your expertise.”
c. “It’s possible that intuition about suicidality is generated by transfer of feelings from the patient to the nurse.”
d. “It’s been determined that intuition is nothing more that extrasensory perception, so some folks have it, and some don’t.”

A “strong hunch” or a “gut feeling” is an example of intuitive reasoning that is believed to come from the therapeutic relationship’s sharing of feelings between nurse and patient. Most nurses agree that intuition is compatible with scientific reasoning, because both are likely linked to practice and experience. A nurse learns intuitive reasoning through clinical practice rather than from school or books.

DIF: Cognitive Level: Application REF: Page 45
TOP: Nursing Process: Analysis (Caring)
MSC: NCLEX: Safe and Effective Care Environment

6. A nurse shows effective critical thinking skills directed towards nursing care of a cognitively impaired patient who continues to socially isolate by:
a. Clearly stating that the patient must socially interact once daily
b. Documenting that the patient continues to resist socialization
c. Asking the patient to identify which unit activity they are willing to attend
d. Suggesting that staff take the patient with them when running errands off the unit

Critical thinking in this case involves the creation of alternative solutions to a problem that was not resolved by conventional methods. The remaining options, although not inappropriate, do not show critical thinking skills

DIF: Cognitive Level: Application REF: Page 45 TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

7. A depressed patient shares with the nurse that he, “has been thinking about ending it all”. Based on NANDA recommendations, the nurse:
a. Implements suicide precautions for this patient
b. Includes ‘Risk for Self Harm’ to the patient’s care plan
c. Documents regarding the patient’s safety every 15 minutes
d. Reviews the patient’s chart for references to past incidences of hopeless

NANDA states that a nurse is able to change any actual diagnosis on the NANDA list to a risk diagnosis if the problem has not occurred yet. The remaining options, although not inappropriate, do not related to NANDA.

DIF: Cognitive Level: Application REF: Page 48 TOP: Nursing Process: Analysis
MSC: NCLEX: Safe and Effective Care Environment

8. The nurse shows an understanding of the appropriate use of nursing outcomes regarding triggers for a patient diagnosed with chronic alcohol abuse when stating:
a. “Can you work on identifying three situations that cause you to abuse alcohol?”
b. ”I’ll help you to identify three triggers for your drinking during today’s session.”
c. ”I’m pleased you’ve identified three situations that trigger your abuse of alcohol.”
d. “Do you think you will be able to avoid the three triggers that cause you to drink?”

Outcomes sometimes referred to as behavioral goals are used to describe and evaluate the effectiveness of nursing interventions. The correct option shows that the patient was successful at accomplishing an outcome inferring the nursing interventions were successful. The remaining options do not indicate an evaluation of success or failure.

DIF: Cognitive Level: Application REF: Page 49 TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity: Chemical and Other Dependencies

9. When a patient experiencing acute depression asks what the difference is between a medical and a nursing diagnosis, the nurse responds best when stating:
a. Actually they are very similar in that they both are concerned with helping you get better and lead a happier life.
b. Medical diagnoses are focused on why you are depressed whereas nursing diagnoses are concerned about making your life less sad.
c. Nursing diagnoses are more directed at caring for you, unlike medical diagnoses that focus on finding the cause for your problem.
d. The medical diagnosis identifies that you are experiencing depression whereas the nursing diagnosis identifies how the depression is affecting you.

The medical diagnosis involves identifying a mental or physical problem that results in the symptoms that negatively affect a patient’s life. Although the nurse is knowledgeable about the disorders and their treatments, the nursing diagnosis focuses mainly on the patient’s responses to the disorder and the effects that the disorder has on the patient. The types of diagnoses have different foci that result in different actions and concerns.

DIF: Cognitive Level: Application REF: Page 49
TOP: Nursing Process: Implementation (Teaching and Learning)
MSC: NCLEX: Psychosocial Integrity: Therapeutic Communication

10. A nurse best shows an understanding of the role of evidence-based research in achieving therapeutic patient care outcomes when:
a. Subscribing to and reading a monthly psychiatric research nursing journal
b. Working on a committee to revise current facility policies regarding the use of chemical restraints
c. Registering to attend a psychiatric workshop on newly developed psychotropic medication therapies
d. Asking an experienced staff member to review the interventions being proposed for a newly admitted patient

Evidence-based practice is based on evidence and scientific principles that have been developed through research. The more closely clinical practice reflects relevant research, the more likely it is that patients will receive the best available care. The option that infers action directed at implementing the research is the one that shows best understanding. Reliance only on experience is not reflective of quality nursing care.

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