Chapter 3: Multiple choice questions

Try the multiple choice questions below to test your knowledge of this chapter. Once you have
completed the test, click on 'Submit Answers' to get your results.

This activity contains 10 questions.

Within mood disorders, two key symptoms of a major depressive episode are:

Problems in concentration and compulsive behaviours.

Lack of interest in usual activities and recurrent thoughts of death.

Diminished need for sleep and loss of energy.

Very low mood and agoraphobia.

Within mood disorders, two key symptoms of a manic episode are:

Hallucinations and flight of ideas.

Delusional thinking and intense fear of weight gain.

Extremely elevated mood and grandiose ideas.

Distractibility and social phobia.

Dysthymic disorder differs from major depressive disorder in the following ways:

Symptoms are more severe and last longer.

Symptoms only affect women during the winter months.

Symptoms are less severe but last longer.

Symptoms include hallucinations and delusional thinking.

Bipolar disorder used to be known as:

Antisocial personality disorder.

Munchausen syndrome.

Messiah complex.

Manic-depression.

Bipolar disorder 1 differs from bipolar disorder 2because:

Manic symptoms are more severe and there may be the presence of psychosis.
 Manic symptoms are less severe and obsessional thoughts are common.

Hypomanic symptoms are present and there are recurrent thoughts of death.

Manic symptoms are more severe and sexual dysfunction is present.

Rapid-cycling bipolar disorder is where:

There are extreme fluctuations of mood on a daily basis.

There are four or more episodes of manic and depressive symptoms per year.

The alternating symptoms of major depression and mania are more severe than
is usual in bipolar disorder.

The symptoms of bipolar disorder disappear very quickly.

Which of the following is not an explanation of the causes of depression:

Being born into a large family.

Faulty cognition.

Insufficient availability of the neurotransmitters serotonin and norepinephrine.

Genetic abnormalities.
In the pharmacological treatment of depression, antidepressants known as SSRIs are
often used. SSRI stands for:

Selective serotonin reuptake inhibitors.

Standard serotonin restoration intake.

Selective serotonin restoring injections.

Serotonin safely restoring imbibings.

Behavioural explanations for mania suggest that:

Individuals with mania copy the behaviour of their parents.

Individuals with mania feel less embarrassment than those without mania.

Individuals with mania get more pleasure from a positive event than those
without mania

Classical conditioning is the primary cause of mania.

 The main mood-stabilising medication used in bipolar disorder is:

Risperidone.

Fluoxetine.

Lorazepam.

Lithium.

PSYCHIATRIC DISORDERS PRACTICE QUESTIONS

1. Antidepressant medication is an initial primary treatment modality for moderate to severe major
depressive disorder unless:

1. ECT is planned

2. Patient is less than 18 years of age

3. Patient is admitted to hospital

4. Patient is age 65 and older

2. Dysthymia may be treated with all of the following except:

1. Antidepressants

2. Cognitive behavioral therapy

3. ECT

4. Interpersonal therapy

3. Symptoms of depression in children and adolescents include all of the following except:

1. Persistent depressive or sad mood

2. Irritability

3. Gregariousness

4. Anhedonia

4 Prior to initiating bright light therapy for seasonal affective disorder, it is important to:

1. Try a course of antidepressant drugs

2. Consider ophthalmological evaluation for persons with a history of eye disorders

3. Initiate milieu therapy

 4. Complete a course of cognitive behavioral therapy

5. All of the following are associated with bipolar disorder except:

1. Functional impairment

2. Manic episodes

3. Rapid cycling

4. Frequent spontaneous resolution of all symptoms

6. Which of the following statement about children and adolescents with bipolar disorder is not true?

1. Most require ongoing treatment to prevent relapse and some require lifelong treatment

2. Many have co-occurring disorders such as substance abuse, suicidality, and psychosocial issues

3. Treatment generally involves a combination of medication and behavioral/psychosocial

interventions

4. A significant proportion outgrows the disorder and requires no further follow-up

7. The goals of acute treatment for schizophrenia include all except:

1. Encouraging introspection and reflection

2. Eliminating or reducing symptoms such as disturbed behavior

3. Reducing the severity of psychosis and associated symptoms

4. Preventing harm

8. When may ECT be used to treat adults with schizophrenia or schizoaffective disorder?

1. In both the acute phase and stable phase for psychotic symptoms that have not responded to
pharmacological treatment

2. Only during the acute phase

3. Only during the stable phase

4. Only in persons who have not been treated with antipsychotic agents

9. The most common behavioral health problem in adults, adolescents and children is:

1. Depression

2. Anxiety

3. ADHD

4. Thought disorders

10. An effective intervention for many anxiety disorders is:

 1. Antipsychotic agents alone

2. Antidepressants alone

3. Behavioral health treatment, especially cognitive behavioral therapy

4. ECT and pharmacotherapy

11. The percentage of persons with generalized anxiety disorder with a comorbid condition is:

1. 25%

2. >50%

3. <20%

4. 15%

12. Symptoms of panic disorder may include all of the following except:

1. Chest pain and tachycardia

2. Feelings of impending doom

3. Dizziness and shortness of breath

4. Fever and shaking chills

13. All of the following are true about panic disorder except:

1. Panic attacks do not occur during sleep

2. It affects an estimated 6 million adults in the United States

3. Twice as many women are affected

4. The tendency to develop panic attacks appears to be heritable

14. Trichotillomania is an impulse control disorder that involves:

1. Disordered eating

2. An irresistible urge to pull out hair

3. Compulsive gambling

4. Harming pets and small animal

15. All of the following statements about oppositional defiant disorder are true except:

1. It involves recurrent patterns of hostility and negative behaviors

2. It arises from a combination of genetic, biological and environmental causes

3. It is a developmentally appropriate behavior displayed by children

4. Early onset is associated with poorer prognosis

16. Persons with intermittent explosive disorder generally display all of the following except:

1. Aggressive outbursts and violence

2. Destruction of property

3. Remorse, regret and embarrassment about their actions

4. Bulimia

17. All of the following are impulse disorders or disruptive behaviors except:

1. Pathological gambling

2. Kleptomania

3. Mania

4. Pyromania

18. Naltrexone may be used as pharmacotherapy for which of the following disorders:

1. Mood disorders

2. Impulse and Disruptive Behaviors

3. Schizoaffective disorder

4. Substance use disorders

19. Outpatient detoxification may be contraindicated for all of the following groups except:

1. Persons with a history of delirium tremens or withdrawal seizures

2. Persons with unstable medical conditions such as diabetes, hypertension, or pregnancy

3. Persons whose withdrawal signs and symptoms are sufficiently severe to require 24-hour
inpatient care

4. Adolescents

20. Nearly one-half of patients with schizophrenia have which type of comorbid disorders?

1. Hypertension

2. ADHD

3. Trichotillomania

4. Substance use disorders

Answers and Explanations

1. A

Antidepressant medication is an initial primary treatment modality for mild major depressive disorder as
well as moderate to severe major depressive disorder. For psychotic depression, a combination of
antipsychotic and antidepressant medication or ECT may be prescribed. Psychotherapy alone as an
initial treatment modality may be used for patients with mild to moderate depressive disorder.

2. C

Drug treatment for dysthymia is similar to treatment for depression and may include tricyclic
antidepressants, selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors
(MAOIs). Along with the above-mentioned therapies, persons with dysthymia also may respond to
cognitive therapy and behavioral therapy.

3. C

Additional symptoms of depression in children and adolescents include the following: irritable mood;
loss of interest and pleasure; persistent thoughts of death; suicidal ideation or attempts; changes in
appetite, weight or sleep; diminished activity, concentration or energy; and changes in feelings of self-
worth and guilt. Depressed children may withdraw socially, present with somatic complaints, exhibit low
tolerance for frustration, and throw temper tantrums.

4. B

Because bright light therapy has the potential to cause eyestrain and headaches, an ophthalmologic
exam is advised for persons with a history of eye diseases. In is important to bear in mind that in bright
light treatment has the potential to trigger episodes of hypomania or mania in vulnerable patients.

5. D

Bipolar disorder is associated with functional impairments even during periods of euthymia. Along with
periodic episodes of mania and depression, some patients experience rapid cycling – four or more mood
disturbances in a single year that meet the criteria for a major depressive, mixed, manic, or hypomanic
episode.

6. D

Children and adolescents with bipolar disorder should be carefully evaluated for all of the above-
mentioned co-occurring disorders as well as medical problems. Primary treatment for mania is
pharmacotherapy; however, psychotherapy is an important component of comprehensive treatment.

7. A

The goals of treatment during the acute phase of illness are to prevent harm, control disturbed
behavior, reduce symptoms such as agitation and aggression, evaluate and address the stressors that
triggered the acute episode, and enable rapid return to the best level of functioning. As with other
psychiatric disorders it is vitally important to develop an alliance with the patient and family, establish
attainable objectives of treatment, and follow-up with appropriate care.

8. A
A combination of ECT and antipsychotic medications may be prescribed for patients with schizophrenia
or schizoaffective disorder with severe psychotic symptoms that have not responded to pharmacological
treatment. Maintenance ECT may benefit some patients who have responded to acute treatment with
ECT but for whom pharmacological prophylaxis alone has not prevented relapse or is not tolerated.

9. B

An estimated 40 million adults in the United States have an anxiety disorder. Anxiety disorders include
panic disorders with or without agoraphobia, specific phobias, social anxiety disorder, obsessive-
compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD).

10. C

A combination of psychotherapy and medication management is helpful for most anxiety disorders. Of
psychotherapeutic interventions, cognitive-behavioral therapy (CBT) has demonstrated efficacy;
however, it requires the patient to commit to approximately 12 to 20 sessions of treatment.

11. B

More than half of persons diagnosed with generalized anxiety disorder have a comorbid condition such
as panic disorder and major depressive disorder is the most common. Panic disorder is often comorbid
with substance abuse. Because the anxiety disorders share many common signs and symptoms, it is
imperative to conduct a thorough assessment to establish the primary diagnosis.

12. D

People who have panic disorder are often disabled by the condition; they avoid normal activities of daily
living such as shopping and riding buses or trains. About one-third becomes housebound or able to
confront a feared situation only when accompanied. Panic disorder is one of the most treatable of all
the anxiety disorders; most people respond well to pharmacological and psychosocial interventions.

13. A

Panic attacks occur suddenly, often without warning, and can occur at any time, even during sleep. Panic
attacks commonly begin in late adolescence or early adulthood, but not everyone who experiences
panic attacks will develop panic disorder. Many people have a single attack and do not develop the
persistent pattern that characterizes panic disorder.

14. B

A combination of pharmacological and psychotherapeutic treatment appears to be most effective.

Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice and cognitive behavioral therapy
is the psychotherapeutic modality of choice.

15. C

Oppositional defiant disorder (ODD) is not the oppositional behavior displayed by children in the course
of normal development; ODD is an extreme and significant exaggeration of developmentally normal
behaviors. Because ODD is frequently a co-morbid condition, it is vital that other conditions/disorders be
identified and treated.
16. D

Intermittent explosive disorder is characterized by repeated outbursts of aggressive, violent behavior

People with intermittent explosive disorder may attack and harm others and vandalize and destroy
property. Following these outbursts they are often contrite, expressing remorse, regret and
embarrassment about their actions.

17. C

Although persons with mania may behave impulsively, mania is a mood disorder characterized by
abnormal affect, inflated feelings of self-worth, pressured speech, scattered ideas, increased interest in
goal-directed activities and high-risk behaviors, unexplained euphoria, irritable mood, decreased need
for sleep, and magical thinking.

18. D

Naltrexone, an opioid receptor antagonist, may be used as a pharmacotherapy for alcohol-dependent

and opioid-dependent patients. It has demonstrated efficacy in helping alcohol-dependent patients
adhere to treatment by reducing cravings, thereby, reducing the frequency and severity of relapse.
Naltrexone has not demonstrated comparable efficacy for opioid dependency, largely because there is
lower adherence to treatment in this population.

19. D

Persons with mild to moderate withdrawal symptoms may be effectively managed in intensive
outpatient programs or partial hospitalization programs. Because many such programs are on medical
center campuses or close to hospitals, immediate transfer to a higher level of care is feasible.

20. D

Many patients with schizophrenia self-medicate with alcohol, prescription drugs, and street drugs. It is
vitally important to identify the presence of comorbid substance use and to develop a treatment plan
that effectively addresses schizophrenia and substance use.

1. A patient who was admitted yesterday with an adjustment disorder and depressed mood has not left
his or her room. The psychiatric-mental health nurse's most appropriate approach at meal time today is
to respond:

"I will bring your tray to your room, if it will make you more comfortable."
"I will walk with you to the dining room and sit with you while you eat."
"Where would you like to eat your meal this noon?"
"You will feel better if you go to the dining room and eat with the others."
2. A 17-year-old, female patient with anorexia nervosa has just been released from the hospital. To
facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:

discourage the patient from sneaking food between meals, by unobtrusively reducing her access to
the kitchen.

encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving
information and materials around the house.
permit the patient to eat her meals privately in her bedroom to discourage family preoccupation
with meals.

recommend that the patient joins in routine family meals and clears the dishes after dinner, even if
she does not eat.

3. A supervisor observes inconsistency in the psychiatric-mental health nurse's behavior toward a

patient; the nurse is unreasonably concerned, overly kind, or irrationally hostile. The most appropriate
explanation is that the nurse is displaying:

countertransference.
empathic resonance.

splitting behavior.
transference.

4. The first step in the treatment of incest is to:

believe the child who reports the activity.

notify the proper authorities.

objectively confront the accused family member.

remove the child from the home.

5. A couple in counseling reports fighting with their son when they are angry with each other. This
behavior typifies:

coalition.
indirect communication.
 transference.
triangulation.

6. The severe feeling of restlessness produced by some psychotropic medications, which is often
misinterpreted by patients as anxiety or a recurrence of psychiatric symptoms, is known as:

akathisia.

akinesia.
bradykinesia.

dystonia.

7. During an initial patient interview, the psychiatric and mental health nurse begins by asking the
patient to describe his or her:

current situation.
feelings about the current situation.

personal history.
thoughts about the current situation.

8. A female patient reports an intense, overwhelming fear of driving a car. The fear has disrupted all
elements of the patient's life. The patient does not go to the grocery store unless someone transports
her, has relinquished her job, and has few social contacts. The patient's treatment plan includes:

assertiveness training.
biofeedback.

stress management assistance.

systematic desensitization.

9. A short-term goal for a patient with Alzheimer's disease is:

improved functioning in the least restrictive environment.

improved problem solving in activities of daily living.
 increased self-esteem and improved self-concept.
regained sensory perception and cognitive function.

10. Older adults have reached Erikson's developmental stage of ego integrity when they:

acknowledge that one cannot get everything one wants in life.

assess their lives and identify actions that had value and purpose.

express a wish that life could be relived differently.

feel that they are being punished for things they did not do.

11. A patient states that unit staff members have been avoiding him or her since an attempt to self-
mutilate. The psychiatric-mental health nurse's most appropriate response is to:

apologize for the staff's behavior.

explain that feelings of rejection are typical after self-mutilation.

listen, redirect the patient to his or her feelings, and explore the issue with the staff.
report the matter to the nurse manager.

12. When planning inpatient psychotherapeutic activities for a patient who has antisocial personality
disorder, the psychiatric-mental health nurse:

focuses on group, rather than individual, therapy.

provides a permissive atmosphere, so the patient feels a sense of control.

provides an organized, structured environment.

recognizes that the disorder is characterized by social withdrawal.

13. Accompanied by many family members, a 16-year-old Chinese-American female patient is admitted
to the unit with reports of sadness and suicidal ideation. The patient and her family emigrated from
mainland China five years ago. Regarding the family, the psychiatric and mental health nurse:

encourages the patient to communicate her need for privacy to her family.
gently asks the family members to leave the room.
 privately asks the mother for her assistance in clearing the room.
provides care for the patient while the family members are present.

14. According to family systems theory, removing the "identified patient" from the environment most
likely causes the:

patient to decompensate, due to the loss of his or her support system.

patient to significantly improve, often with minimal or no additional therapy.

remaining family members to decompensate, as evidenced by new dysfunctional behavior.

remaining family members to lose motivation and withdraw from therapy.

15. A psychiatric-mental health nurse, who is teaching a couple how to use positive reinforcement
techniques with their child, recommends:

agreeing with the child's statements, whether negative or positive, and simply restating the child's
statements without other comment.
controlling the child's behavior, so there is no chance of negative behavior.
removing adverse consequences to produce positive results.
rewarding positive behaviors to promote their recurrence.

16. A common nursing diagnosis for a patient with antisocial personality disorder is:

chronic low self-esteem, related to poor self-image and excessive fear of failure.
disturbed thought processes, related to sensory-perceptual alterations.
impaired social interaction, related to manipulative behaviors.
social isolation, related to anxiety in social situations.

17. A patient who is admitted to the psychiatric unit with a diagnosis of obsessive-compulsive disorder
spends a significant amount of time during the day and night washing his or her hands. On the third
hospital day, the patient reports feeling better and more comfortable with the staff and other patients.
The psychiatric-mental health nurse knows that the most appropriate nursing intervention is to:
 acknowledge the ritualistic behavior each time and point out that it is inappropriate.
allow the patient to carry out the ritualistic behavior, since it is helping him or her.

collaborate with the patient to reduce the amount of time he or she engages in ritualistic behavior.
ignore the ritualistic behaviors, and the behaviors will be eliminated due to lack of reinforcement.

18. A selective serotonin reuptake inhibitor targets which part of the brain?

Basal ganglia.
Frontal cortex.
Hippocampus.

Putamen.

19. To evaluate whether patient teaching for coping skills has been effective, the psychiatric-mental
health nurse asks an adolescent patient to:

consider the outcomes objectively.

keep a written journal.
perform a return demonstration.
set measurable goals.

20. The psychiatric-mental health nurse knows that the patient's spouse clearly understands the side
effects of lithium carbonate (Eskalith), when he or she says:

"I should call the doctor if my spouse shakes badly."

"I should make sure my spouse drinks as much water as she or he can."
"My spouse must remain on a salt-free diet."
"When the lithium level is 1.6 mEq/L, my spouse can go back to work."

21. A school-aged patient with attention-deficit/hyperactivity disorder is displaying disruptive behaviors

at home. The psychiatric-mental health nurse modifies the treatment plan for the social domain, by
advising the patient's parents to:
 establish eye contact before giving directions.
initiate a point system, to reward the patient for appropriate behavior.

instruct the patient to work on one homework assignment at a time.

maintain a predictable environment in the home.

22. After taking an antidepressant for about a week, a patient reports constipation and blurred vision,
with no improvement in mood. The psychiatric-mental health nurse informs the patient:

"It takes approximately two to four weeks for depression to lessen, and side effects usually
diminish over time."
"Stop the medication immediately and contact your primary care physician."
"You should contact your doctor. The doctor may need to change your medication."
"You should schedule an appointment with your ophthalmologist."

23. A patient is being discharged after spending six days in the hospital, due to depression with suicidal
ideation. The psychiatric-mental health nurse knows that an important outcome has been met when the
patient states:

"I can't wait to get home and forget that this ever happened."

"I feel so much better. If I continue to feel this way, I can probably stop taking my medications
soon."
"I have a list of support groups and a crisis line that I can call, if I feel suicidal."
"I have to leave here soon, if I want to make it to the shelter before they run out of beds."

24. When screening families for post-traumatic stress disorder following a major natural disaster,
psychiatric-mental health nurses are practicing which type of disease prevention?

Primary.

Secondary.
Tertiary.
Universal.
25. When a research study is based on a small sample size, the findings may:

be statistically significant, but will be less generalizable than if the sample size had been larger.

be statistically significant, but will not be clinically significant.

not be statistically significant, because the research design was quasi-experimental, instead of
experimental.
not be statistically significant, because the research was poorly conducted.

Information
First Name:
Last Name:

You have made the following errors

Question 1
The right answer was "I will walk with you to the dining room and sit with you while you eat."

Question 2
The right answer was recommend that the patient joins in routine family meals and clears the dishes
after dinner, even if she does not eat.

Question 3
The right answer was countertransference.

Question 4
The right answer was believe the child who reports the activity.

Question 5
The right answer was triangulation.

Question 6
The right answer was akathisia.

Question 7
The right answer was current situation.

Question 8
The right answer was systematic desensitization.

Question 9
The right answer was improved functioning in the least restrictive environment.

Question 10
The right answer was assess their lives and identify actions that had value and purpose.
Question 11
The right answer was listen, redirect the patient to his or her feelings, and explore the issue with the
staff.

Question 12
The right answer was provides an organized, structured environment.

Question 13
The right answer was provides care for the patient while the family members are present.

Question 14
The right answer was remaining family members to decompensate, as evidenced by new dysfunctional
behavior.

Question 15
The right answer was rewarding positive behaviors to promote their recurrence.

Question 16
The right answer was impaired social interaction, related to manipulative behaviors.

Question 17
The right answer was collaborate with the patient to reduce the amount of time he or she engages in
ritualistic behavior.

Question 19
The right answer was perform a return demonstration.

Question 20
The right answer was "I should call the doctor if my spouse shakes badly."

Question 21
The right answer was initiate a point system, to reward the patient for appropriate behavior.

Question 22
The right answer was "It takes approximately two to four weeks for depression to lessen, and side effects
usually diminish over time."

Question 23
The right answer was "I have a list of support groups and a crisis line that I can call, if I feel suicidal."

Question 24
The right answer was Secondary.

Question 25
The right answer was be statistically significant, but will be less generalizable than if the sample size had
been larger.

You have made 24 errors.

Total score: 1.