Level 3 - RNSG 2213 - Review for Exam 1
Which outcome, focused on recovery, would be expected in the plan of care for a
patient living in the community with serious and persistent mental illness? Within 3
months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time. ✅- B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and
improving role performance. The goal of recovery is to empower the individual with
mental illness to achieve a sense of meaning and satisfaction in life and to function at
the highest possible level of wellness. The incorrect options focus on the classic
medical model rather than recovery.
A patient is hospitalized for depression and suicidal ideation after their spouse asks for
a divorce. Select the nurse's most caring comment.
a. "Let's discuss some means of coping other than suicide when you have these
feelings."
b. "I understand why you're so depressed. When I got divorced, I was devastated too."
c. "You should forget about your marriage and move on with your life."
d. "How did you get so depressed that hospitalization was necessary?" ✅- A
The nurse's communication should evidence caring and a commitment to work with the
patient. This commitment lets the patient know the nurse will help. Probing and advice
are not helpful or therapeutic interventions.
In the shift-change report, an off-going nurse criticizes a patient who wears heavy
makeup. Which comment by the nurse who receives the report best demonstrates
advocacy?
a. "This is a psychiatric hospital. Craziness is what we are all about."
b. "Let's all show acceptance of this patient by wearing lots of makeup too."
c. "Your comments are inconsiderate and inappropriate. Keep the report objective."
d. "Our patients need our help to learn behaviors that will help them get along in
society." ✅- D
Accepting patients' needs for self-expression and seeking to teach skills that will
contribute to their well-being demonstrate respect and are important parts of advocacy.
The on-coming nurse needs to take action to ensure that others are not prejudiced
against the patient. Humor can be appropriate within the privacy of a shift report but not
,at the expense of respect for patients. Judging the off-going nurse in a critical way will
create conflict. Nurses must show compassion for each other.
A nurse assesses a newly admitted patient with depression. Which statement is an
example of "attending"?
a. "We all have stress in life. Being in a psychiatric hospital isn't the end of the world."
b. "Tell me why you felt you had to be hospitalized to receive treatment for your
depression."
c. "You will feel better after we get some antidepressant medication started for you."
d. "I'd like to sit with you a while so you may feel more comfortable talking with me." ✅-
D
Attending is a technique that demonstrates the nurse's commitment to the relationship
and reduces feelings of isolation. This technique shows respect for the patient and
demonstrates caring. Generalizations, probing, and false reassurances are
nontherapeutic.
A patient shows the nurse an article from the Internet about a health problem. Which
characteristic of the web site's address most alerts the nurse that the site may have
biased and prejudiced information?
a. Address ends in ".org."
b. Address ends in ".com."
c. Address ends in ".gov."
d. Address ends in ".net." ✅- B
Financial influences on a site are a clue that the information may be biased. ".com" at
the end of the address indicates that the site is a commercial one. ".gov" indicates that
the site is maintained by a government entity. ".org" indicates that the site is
nonproprietary; the site may or may not have reliable information, but it does not profit
from its activities. ".net" can have multiple meanings.
A nurse says, "When I was in school I learned to call upset patients by name to get their
attention, but I read a descriptive research study that says that this approach doesn't
work. I'm going stop calling patients by name." Which statement is the best appraisal of
this nurse's comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse
specialists.
c. New research findings should be incorporated into clinical algorithms before using
them in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not
change. ✅- A
,Descriptive research findings provide evidence for practice but must be viewed in
relation to other studies before practice changes. One study is not enough. Descriptive
studies are low on the hierarchy of evidence. Clinical algorithms use flow charts to
manage problems and do not specify one response to a clinical problem. Classic tenets
of practice should change as research findings provide evidence for change.
Two nursing students discuss career plans after graduation. One student wants to enter
psychiatric nursing. The other student asks, "Why would you want to be a psychiatric
nurse? All they do is talk. You'll lose your skills." Select the best response by the
student interested in psychiatric nursing.
a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-
patient ratios must be better because of the nature of patients' problems."
b. "Psychiatric nurses use complex communication skills, as well as critical thinking, to
solve multidimensional problems. I'm challenged by those situations."
c. "I think I'll be good in the mental health field. I do not like clinical rotations in school,
so I don't want to continue them after I graduate."
d. "Psychiatric nurses don't have to deal with as much pain and suffering as medical
surgical nurses. That appeals to me." ✅- B
The practice of psychiatric nursing requires a different set of skills than medical surgical
nursing, although substantial overlap does exist. Psychiatric nurses must be able to
help patients with medical and mental health problems, reflecting the holistic
perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric
settings have increased, similar to other specialties. Psychiatric nursing involves clinical
practice, not simply documentation. Psychosocial pain is real and can cause as much
suffering as physical pain.
Which research evidence would most influence a group of nurses to change their
practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway ✅- B
Research findings are graded using a hierarchy of evidence. A systematic review of
randomized controlled trials is Level A and provides the strongest evidence for changing
practice. Expert committee recommendations and descriptive studies lend less powerful
and influential evidence. A critical pathway is not evidence; it incorporates research
findings after they have been analyzed.
A bill introduced in Congress would reduce funding for the care of people with mental
illnesses. A group of nurses write letters to their elected representatives in opposition to
the legislation. Which role have the nurses fulfilled?
, a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice ✅- A
An advocate defends or asserts another's cause, particularly when the other person
lacks the ability to do that for him- or herself. Examples of individual advocacy include
helping patients understand their rights or make decisions. On a community scale,
advocacy includes political activity, public speaking, and publication in the interest of
improving the individuals with mental illness; the letter-writing campaign advocates for
that cause on behalf of patients who are unable to articulate their own needs.
An informal group of patients discuss their perceptions of nursing care. Which comment
best indicates a patient's perception that his or her nurse is caring?
a. "My nurse always asks me which type of juice I want to help me swallow my
medication."
b. "My nurse explained my treatment plan to me and asked for my ideas about how to
make it better."
c. "My nurse told me that if I take all the medicines the doctor prescribes I will get
discharged soon."
d. "My nurse spends time listening to me talk about my problems. That helps me feel
like I'm not alone." ✅- D
Caring evidences empathic understanding, as well as competency. It helps change pain
and suffering into a shared experience, creating a human connection that alleviates
feelings of isolation. The remaining options give examples of statements that
demonstrate advocacy or giving advice.
A patient who immigrated to the United States from Honduras was diagnosed with
schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no
improvement. Which resource should the treatment team consult for information on
more effective medications for this patient?
a. Clinical algorithm
b. Clinical pathway
c. Clinical practice guideline
d. International Statistical Classification of Diseases and Related Health Problems (ICD)
✅- A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches
drawn from large databases of information. These guidelines help the treatment team
make decisions cognizant of an individual patient's needs, such as ethnic origin, age, or
gender. A clinical pathway is a map of interventions and treatments related to a specific
disorder. Clinical practice guidelines summarize best practices about specific health
problems. The ICD classifies diseases.
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