MENTAL HEALTH (PSYCH) HESI–FINAL EXAM-with 100% verified solutions-2023-2024 GRADED A+, Exams of Nursing

Download MENTAL HEALTH (PSYCH) HESI–FINAL EXAM-with 100% verified solutions-2023-2024 GRADED A+ and more Exams Nursing in PDF only on Docsity! 1 MENTAL HEALTH (PSYCH) HESI – FINAL EXAM- with 100% verified solutions-2023-2024 Which is necessary as a defining feature in mental illness? • The individual must have difficulties in functioning that cause distress and/or impairment of some type. Which provides the best definition for mental illness? • Inability to function in a manner that manages both external and internal stressors effectively Which skill is in the psychiatric–mental health registered nurse's scope of practice? • Evaluating the effectiveness of psychiatric medications A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's best response? • “Mental health is marked by productivity, fulfilling relationships, and adaptability.” Which intervention is appropriate for a psychiatric–mental health nurse at the basic level of practice? • Promoting symptom management Which is the greatest barrier to an individual's ability to obtain the most effective and safest psychiatric medication? • These medications are often not covered by the managed care system because they are expensive. What percentage of adults requiring mental health services get the care they need? • 25% (Only about 25%, or 1 in 4, of adults requiring mental health services get the care that they need) Chlorpromazine is a drug in which classification? • Antipsychotic When providing care to a client, the psychiatric–mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? 2 • Hildegard Peplau 5 Which intervention is appropriate for a psychiatric–mental health nurse at the basic level of practice? • Promoting symptom management When providing care to a client, the psychiatric–mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? • Hildegard Peplau One of the primary reforms accomplished by Dorothea Lynde Dix was the ... • establishment or enlargement of state hospitals. The psychiatric mental health nurse is planning the care of a client. What action best addresses the client's needs in the social domain? • Collaborating with the client's family to organize support Which is a result of deinstitutionalization? • A "revolving door" of repetitive hospital admissions During the moral treatment period, clients were routinely placed into which environment? • Asylums Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship? • Hildegard Peplau In early Christian times, what was thought to cause mental illness? • Demonic control A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client? • Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. Which is an inaccurate depiction of self-awareness? 6 • It involves changing one's values or beliefs. Which activity is a function solely of the advanced practice psychiatric–mental health nurse? • Conducting individual psychotherapy The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure? • Peplau Which sets professional standards of care? • Professional nursing organizations The nursing instructor asks the student to perform an assessment of a mentally ill client. What should the student do when executing this task? • Collect comprehensive data The psychiatric–mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply. • Contraindications • Adverse reactions • Food and drug interactions • Indications for use The basic units of structure and function in the nervous system are called what? • Neurons Which is the most commonly seen adverse side effect of typical antipsychotics? • Extrapyramidal symptoms and tardive dyskinesia Dietary modifications are most likely necessary when a client is being treated with which antidepressant? • Monoamine oxidase inhibitors(MAOIs) 7 A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter? • Cholinergic A nurse is aware that the likelihood a client will be in adherence with psychotropic medications is affected by what? • Receiving education and information about the medication. Which is the primary role of neurotransmitters? • Communicate information from one cell or cell group to another Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)? • Sexual dysfunction Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply. • Urinary retention • Constipation • Dry mouth A client has been diagnosed with Parkinson’s disease. His symptoms of spasticity are related to a decrease in which neurotransmitter? • Dopamine The therapeutic level of lithium range includes what? • 1 to 1.5 mEq/L Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)? • Atypical antipsychotics block both serotonin and dopaminergic receptors. Which client is most likely to benefit from treatment with an antiparkinsonism agent? • A client who has a medication-induced movement disorder 10 The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test? • White blood cell count A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he "cannot sit still." The nurse documents this finding as what? • Akathisia A client has been diagnosed with Parkinson’s disease. His symptoms of spasticity are related to a decrease in which neurotransmitter? • Dopamine A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence? • Changing the client's medication route to intramuscular depot Which is considered the first-line treatment for bipolar disorder? • Lithium A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family? • “You may experience noticeable weight gain while taking this medication.” A client who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects what? • Agranulocytosis A nurse administers a prescribed dose of lithium at 8 p.m. The nurse would schedule a specimen to be obtained for a blood concentration at which time? • 8 a.m. After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid what? • Tap beers 11 The nurse recognizes that the difference between a voluntary and an involuntary commitment is what? • An involuntarily committed client may not initiate his or her own discharge What is the therapeutic goal of seclusion? • Give the client the opportunity to gain self-control When promoting client safety on an inpatient psychiatric unit, which interventions would be used as the measure of last resort? • Four-point restraint Which are functions of assertive community treatment? Select all that apply. • Reduces inpatient service use • Promotes continuity of outpatient care • Increases the stability of people with serious mental illnesses What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? • A guideline for nurses regarding ethical conduct A client with depression who is undergoing a colonoscopy tomorrow is receiving preoperative education regarding the procedure. Which nursing task best describes the explanation of the procedure and the associated risks and benefits? • Acquiring informed consent Which client most likely has the legal right to refuse treatment? • A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client? • A guardian appointed by the court 12 A client with a psychiatric illness has become extremely aggressive and the nurse decides that the client needs to be restrained. Which action would be considered human restraint? • The nurse and a group of paramedics hold the client. Which is the most important reason for psychiatric nurses to understand law, legislation, and legal processes that relate to professional nursing practice? • Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients. When it is discovered that a nurse did not act reasonably when providing care in accordance with the standards of professional practice, which factor would confirm the nurse has been negligent? • The nurse was responsible for client injury A client diagnosed with schizophrenia insists on stopping medication because it causes the client to gain weight. The client is exercising which ethical principle? • Autonomy A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should: • File for a civil commitment to detain. Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? • Danger to others A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what? • Battery A hospital client has attributed the long-standing struggle with depression to the fact that the client was sexually abused by the client's father as a child and early adolescent. The client has admitted to the nurse that the client intends to seek out the father and “do some justice.” What is the nurse's primary responsibility in response to the client's threat? • Report the client's threat to the appropriate authorities. 15 The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle? • Beneficence A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should: • File for a civil commitment to detain. A nurse is explaining assisted outpatient treatment to a client who is being discharged from the hospital. Which instructions should the nurse give the client regarding the assisted outpatient treatment? Select all that apply. • The client must attend the follow-ups as per the schedule. • The client must attend specific group therapy programs. • The client must take prescribed medications as per the dosing schedule. A psychiatric-mental health nurse is practicing at the advanced level. Which function would this nurse be able to perform based on the nurse's advanced level of preparation? • Psychotherapy Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who: • is screaming in the street disturbing neighbors. A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client? • Justice A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle? 16 • Veracity The nurse is assessing whether a room is fit for seclusion of clients. What are the requirements of a seclusion room? Select all that apply. • The room should have facility for direct visual monitoring. • The room should not have any sharp objects. • The room should have a bed that is bolted to the floor. A nurse is reviewing that standards of practice. Which component would the nurse identify as appropriate? • Outcomes identification Client 1 has been talking to Client 2 about Client 2's frequent denial in the group for two weeks. On the third week, Client 2 comes late to the group. When they begin to discuss Client 2's lateness, Client 2 gets up and leaves. The content of this exchange is the discussion. The process that is occurring may be that ... • Client 2 is angry with Client 1 for the confrontation. One of the most valuable applications of group therapy is to allow group members to gain an understanding concerning what personal aspect? • Interacting with others and receiving feedback on how others perceive and react to the client Which defense mechanism is being used when a student decides not to think about a parent's illness but to rather concentrate on studying for an upcoming test? • Suppression According to Maslow, an individual who has developed to the individual's fullest potential has achieved what level of his hierarchy? • Self-actualization The nurse is conducting an admission interview with an adult mental health client. The client begins to talk in a childish voice about riding a bike and playing outside. What defense mechanism is this client demonstrating? • Regression 17 Which are two of the most important reasons that nurses utilize theories in their approach to helping clients with psychiatric disorders? • Theories provide knowledge expansion in the field, and they are a way of incorporating known findings into a framework for understanding clients. The nursing theorist Peplau identified which as the essence of psychiatric–mental health nursing? • The nurse–client relationship A client asks the nurse to help the client understand what a psychologist meant when the psychologist said that the client displaced anger. Which is the best definition for displacement the nurse can provide? • Transferring feelings—such as frustration, hostility, or anxiety—from an idea, person, or object to one that is less threatening A nurse is integrating Peplau's model when providing care to a client with a mental illness. Which would the nurse identify as a key component? • anxiety A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations. Which therapeutic approach is the nurse employing? • Cognitive therapy According to Freud's theory, when a woman's id is attempting to cope with substantial stressors, including being a single mother of three, the resulting behavior might include: • compulsive overeating. The nurse has a client who reminds the nurse of the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? • Countertransference The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that the needs for psychotherapy are effectively met. How should the nurse best work toward this goal? 20 • denial. Which theorist’s contribution led nurses to recognize that personality development begins at birth? • Erik Erikson The client's parents have begun a program of therapy that includes giving the client a token each time the client follows directions. Which theoretical framework provides the background for such a program? • Behavioral theory Based on the theory of transference, if a client's childhood experiences teach the client to mistrust authority figures, the client will do what as an adult? • Resist advice given by the mental health care professionals The nurse observes an elderly client teaching an adolescent how to crochet a pot holder. The nurse evaluates this behavior as evidence of resolution of Erickson's developmental stage of what? • Generativity vs. stagnation Which theorist viewed interpersonal relations as a basis of human development and behavior? • Harry Stack Sullivan A basic function of psychiatric nurses is to implement a group that focuses on helping individuals coping with their illness. This refers to ... • a supportive therapy group. The psychiatrist states that repressed memories in the client's unconscious are causing depression. This reasoning implies that the psychiatrist uses which theory? • Psychoanalytic theory Health promotion and health maintenance interventions related to psychiatric–mental health nursing include what? • Teaching stress-reduction techniques 21 A student nurse does not want to think about the upcoming final exam. The student nurse will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism? • Suppression In viewing the stages of the family life cycle, those families in later life undergo which emotional transition? • Accepting the shifting of generational roles What best describes the use of psychotherapy as a mental health intervention? • bringing about a change in feelings, attitudes, thinking, and behavior The greatest impact case management has had on mental health care is that it has caused what? • Has increased client access to appropriate mental health care When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness: • spend more time in jail. Which type of care provides periodic relief to caregivers of a mentally ill client? • Respite residential care What are some of the goals of psychiatric rehabilitation? Select all that apply. • Recovery from mental illness • Personal growth • Increased independence • Increased involvement in treatment decisions Which is the most restrictive setting in the continuum? • Acute inpatient hospitalization Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? 22 • It exists to promote rehabilitation alliance. Which would not be considered an impediment to successful discharge planning? • Compliance with the therapeutic regimen Which statement regarding those with serious and persistent mental illness (SPMI) is correct? • Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what? • Ensuring a sustainable living situation A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? • Symptom stabilization Which best defines a community support system in relation to mental illness? • A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation Which best describes the scope of what community support services provide? • A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? • To address the needs of adults with mental illness and increase their ability to function Which is accurate regarding assertive community treatment (ACT)? • It offers intensive community-based services. 25 A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services? • Identifying and meeting the client's health and human service needs The greatest impact case management has had on mental health care is that it has caused what? • Has increased client access to appropriate mental health care Which client is suitable for psychiatric transitional care services? • An individual being discharged from hospital with residual symptoms of mania Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... • collaborative mental health care. Which client would be most likely to qualify for psychiatric care in a long-term care setting? • A client who has multiple sclerosis and a history of depression A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future? • The fact that there are high rates of mental illness among the populations of jails and prisons A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care? • A 42-year-old who would like to enter marriage counseling A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? • Ability to provide services in a variety of locations A client is in need of a family-like environment with a high level of support. Which would be most appropriate? • Therapeutic foster care 26 Which statement would indicate that the nurse has a non-judgmental attitude? • "The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself." Avoiding which outcome is the primary reason for establishing professional boundaries with clients? • The loss of therapeutic effectiveness Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child? • “That must have been terribly hurtful experience for you.” A client tells the nurse, “I had to slap my child, I couldn’t help that." Which response of the nurse indicates that the nurse is in the state of unknowing? • “What was going on for you when this happened?” A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper’s patterns of nursing knowledge, which pattern of knowing is this indicative of? • Empirical knowing The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? • Countertransference A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, “What's the use? I don't ever see this changing.” The client's statement is suggestive of a potential problem with what factor that influences communication? • Attitude Termination takes place during the resolution phase of a nurse–client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client: • is attempting to prolong the nurse–client relationship. 27 The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? • “What types of dresses do you like wearing?” During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply. • Reassure the client that they already covered these issues. • Review with the client the learned methods to control the problems. During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, “I know I am doing the wrong thing for my kids, but I just can't stop using drugs.” The nurse maintains eye contact and nods occasionally. The nurse responds by saying, “You're going through a difficult time.” The nurse's actions and words are an example of: • empathy. Which is a nurse's primary tool for treating clients with mental disorders? • The therapeutic use of self In what phase of the therapeutic relationship does the assessment process begin? • During the initiating or orienting phase When engaged in a therapeutic relationship, the nurse's focus is on what? • The client A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibility that the relationship may be moving outside professional boundaries? Select all that apply. • The client brings the nurse a baked item for their lunch. • The nurse is spending more time with the client than the others in the group. • The nurse tells a friend that the nurse is the only one who truly understands this client. Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? 30 • Feeling the same emotions that the client is feeling at a given time A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take? • Remind the client about the importance of boundaries to keep the relationship therapeutic Which would indicate that the nurse–client relationship has passed from the orienting phase to the working phase? • The client recognizes feelings of anger and expresses them appropriately. A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? • Client self-exploration When engaged in a therapeutic relationship, the nurse's focus is on what? • The client When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response? • "Will this conversation involve your desire to harm yourself?" A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply. • The nurse should respond openly to the client. • The nurse should actively listen to the client. • The nurse should address the client by name. A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper’s patterns of nursing knowledge, which pattern of knowing is this indicative of? • Empirical knowing 31 The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? • Orientation A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse’s questions. Which would most likely be the reason for this behavior? • The client is nervous and insecure. A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? • Presenting reality Which would not be considered a goal of therapeutic communication? • Self-exploration of feelings by the nurse A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: • permit the client to gather the client's thoughts. The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication? • "This is overwhelming for you, it is okay to cry." A nurse is conducting an initial assessment of a client. When the client enters the nurse's office, the client finds the nurse sitting with arms folded across the chest and an emotionless facial expression. The nurse is exhibiting which nonverbal communication technique? • closed body position and impassive face A client has repeatedly been physically abused by the spouse. The client asks the nurse whether to leave the spouse like the mother has demanded. The nurse responds most therapeutically when answering: • "How would leaving your spouse make you feel?" 32 Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? • Emphasis When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind? • The client is the primary focus of the interaction. A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply. • Maintaining eye contact with the client • Leaning toward the client A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? • "What you are saying and how you say it does not seem to match." A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship? • Self-awareness Which is an example of a nontherapeutic communication technique? • Giving approval Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries? • The client's room Which term is used to refer to signals that encourage effective communication? • Cue The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? 35 Which term is used to refer to signals that encourage effective communication? • Cue Which statement by the nurse reflects the use of a therapeutic statement? • “You look upset. Would you like to talk about it?” The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? • The client may have difficulty maintaining spacial boundaries. Which statement by the nurse is an example of assertive communication? • "I understand that group can be difficult to attend but coming late is disruptive." The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? • 3 to 6 feet "Get the stuff from him" is an example of which type of message? • Abstract Which arrangement is likely to be the least threatening to a psychiatric–mental health client? • Sitting at an angle, 4 to 5 feet apart Which is often considered the most difficult yet most effective communication technique? • silence A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a long term client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response? • "I've been off for the past four days. What have you done since I last saw you?" Which includes the circumstances or parts that clarify the meaning of the content of the message? 36 • Context Which type of touch, according to Knapp, is used in greeting, such as a handshake? • Social-polite Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" • Broad openings During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way? • The nurse may lack confidence in therapeutic communication. The nurse is caring for a client with severe depression. The client tells the nurse, “I really just want to sleep and not have to wake up.” What may the nurse interpret from this covert cue? • The client may have suicidal ideations. In which culture is autonomy utilized in making health care decisions? • Western A female nurse enters the room of a male Cambodian client who is about to undergo a procedure. When the nurse tries to apply cardiac monitoring leads to the client's chest, the client recoils and makes a disapproving facial expression. Which explains the client's reaction to the nurse's actions? • Politeness is highly valued in the Cambodian culture The mental health nurse is interviewing a client of Asian descent regarding the client's health care practices. The nurse understands that cultural competence is important in the care of this client. Cultural competence in health care can be best described as what? • Striving to achieve the ability to work within the cultural context of an individual or community from a diverse cultural or ethnic background When a nurse tells a coworker that an Asian client probably did not want any pain medication because “Asian women typically are stoic,” the nurse is expressing a belief known as ... 37 • stereotype. A culturally competent nurse can identify that some cultural and ethnic groups feel that mental illness is caused by what? • Disruption of harmony As a culture, what do African Americans believe is the cause of mental illness? • Lack of spiritual balance A female nurse is conducting a family assessment of a Hispanic client. When the nurse asks questions about family problems, the nurse notices that the client is reluctant to answer. A possible cause for this behavior is that members of the Hispanic culture believe what? • Personal matters are considered to be family problems. What is one way in which nurses can develop cultural self-awareness? • Objectively examine personal beliefs, values, and practices. A nurse receives feedback from a colleague that the nurse tends to maintain direct eye contact while speaking to clients. Which client may interpret this nonverbal communication as disrespectful? • South Asians Which statement about culture is true? • Cultural identity reflects what determines behavior. An occupational health nurse is asked to see an employee who follows the Muslim faith. The client has been referred to the nurse because the client appears lethargic and has been noted to skip having lunch with other employees as the client had done formerly. Which step should the culturally competent nurse take next? • Ask the client if the client is participating in a religious or cultural ritual. The nurse in a psychiatric inpatient facility encourages clients to attend daily prayer sessions. What is the most likely reason for the nurse's action? Choose the best answer. • Prayer helps in coping with stress. 40 The nurse working in the psychiatric unit observes that the African American clients experience more side effects from psychotropic drugs compared to the White clients. This is most likely for which reason? • African Americans metabolize psychotropic drugs more slowly. Racial bias is evident in mental health care treatment, as reflected by what? • Nonwhite clients are institutionalized much more frequently than are whites. In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take? • Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief When interviewing a Native American client, the nurse avoids which behavior because it is deemed unacceptable by the client's culture? • Prolonged eye contact A client who recently immigrated from Eastern Europe comes to the clinic for an evaluation. During the assessment, the nurse notes that the client has adopted the local area's mannerisms and dress. The nurse interprets this as what? • Acculturation A Haitian American client has a history of not keeping follow-up appointments for necessary lab work. What intervention should the nurse implement to help the client keep the appointments? • Provide an explanation about the importance of keeping the appointment Which scenario conveys the application of cultural competence in the provision of nursing care? • A new nurse has a client who speaks Spanish; the nurse has asked a Hispanic colleague to tell the new nurse about the culture, ideas for care, and how cultural beliefs might influence the client's response to health care interventions. When providing care for a cognitively impaired client who is strongly tied to the client's culture of origin, the nurse supports these expectations by doing what? • Including family when discussing new medication treatment options 41 A client visits the clinic and tells the nurse about experiencing a great deal of stress on the job for the past 2 months. The nurse should instruct the client that two antecedents of the stress response are the person-environment relationship and which additional client factor? • Perception On assessment, the nurse finds that a client has low self-esteem. Which intervention implies the nurse is facilitating improvement of the client’s self-efficacy with the use of social modeling? • The nurse encourages the client to observe other people with high self- efficacy. The nurse is teaching new parents about the developmental stages. When discussing trust vs. mistrust, which parenting skills should be included? Select all that apply. • Feed the baby when hungry. • Use a car seat while travelling. • Change diapers when wet or soiled. • Keep the baby close. The nurse makes certain that her client, who is Hispanic, is able to attend Mass each Sunday morning in the hospital chapel. The client had asked the nurse to help the client get to Mass. The nurse is engaging in what type of behavior? • Culturally competent nursing care When an Arabic client newly diagnosed with type 2 diabetes is insistent that the client's family provide all food, the nurse initially ... • provides the client and the client's family with detailed instructions with the dietary requirements of the condition. An elderly client in the hospital has not had a bowel movement for 3 days and the nurse planned to give the client a stool softener this morning. The client declined the medication, however, stating that the client's spouse will be bringing the client a herbal medication later in the day that is often used by members of their ethnic group. Which reaction demonstrates cultural care accommodation/negotiation? 42 • Documenting the client's wishes and informing the client's care team what the client will be taking For a client who belongs to an ethnic group that is known to have poor metabolism of psychotropic medications, the nurse should anticipate that the client may be at risk for which problem? • Adverse drug effects On assessment, the nurse finds that the client demonstrates low hardiness. Which can the nurse anticipate regarding the client based on this observation? Choose the best answer. • The client has difficulty in problem solving under stress. Which mental health service is an advanced-level function? • Psychotherapy The Substance Abuse and Mental Health Services Administration (SAMSHA) estimates that more than what percentage of Americans aged 18 years and older has a diagnosable mental disorder? • 18.6% The major goal of the Community Mental Health Act of 1963 was what? • Build mental health centers that would provide mental health care within the local community. Which is a clinical activity of only the advanced practice registered nurse? • Psychotherapy What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care? • Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. The client cannot remember anything before an accident yesterday. Which brain structure might be injured? • Hippocampus 45 The nurse is looking to assess the client's ability to concentrate. Which task should the nurse ask the client to perform? • Spell “America” backward. A nurse is conducting an interview with a psychiatric–mental health client and notices the client is using made-up words. This is known as what? • Neologisms A nurse documents that “the client describes the recent breakup of a dating relationship with an emotionless tone and a flat facial expression.” In which section of the mental status exam would the nurse have documented this statement? • affect A nurse assesses a 29-year-old client in the outpatient mental health clinic. The nurse notes the client is speaking very quickly and jumping from topic to topic very rapidly. There is some connection between ideas, but they are difficult to follow. Which term most accurately describes this thought process? • Flight of ideas The nurse is performing an assessment of a client with a psychiatric illness. The nurse has 10 cards with different inkblot shapes. Which test is the nurse about to perform? • The Rorschach Test During a mental status exam, what conclusion should the nurse draw when the client is able to complete fewer than half of tasks accurately? • The client's cognitive deficit is significant As the nurse is conducting an interview with a client with a diagnosis of schizophrenia, the client states, “Bunnies are cute as a button, buttons are on my shirt, shirts can be bought in a store.” Which is a term used to describe this thought process? • Loose associations While talking with a schizophrenic client, the nurse observes that the client is looking straight ahead, maintains no eye contact, and moves facial muscles very little, even though the client is telling the nurse about a very emotional episode the client just experienced with a roommate. When describing the client's affect, the nurse documents it as what? • Flat 46 A 20-year-old client who has a diagnosis of schizophrenia frequently experiences delusions of persecution. At the prompting of the client's mother, the nurse attempts to determine the character and severity of these delusions on a particular day. In doing so, the nurse is conducting what type of assessment? • Focused The nurse has entered a hospital client's room and asked the client if the client plans to attend the morning's scheduled group life-skills session. Which response should signal the presence of thought blocking to the nurse? • “I might. I'll give it some…” The nurse is performing a psychosocial assessment of a client with a mental illness. What information should the nurse gather while taking the history? Select all that apply. • The age of the client • The spiritual beliefs of the client Which would not be included as a purpose of the psychosocial assessment? • Previous compliance with treatment regimen A client with psychosis who was recently admitted to a psychiatric unit says to the nurse, “The car is red. Are you ready for lunch? My head is hurting. Dogs bark loud.” The client is exhibiting which type of speech? • Loose associations A mental health nurse is caring for a client with schizophrenia. The nurse observes the client laughing about the recent death of the client's father. The nurse would correctly document this mood as what? • Incongruent The nurse is caring for a client who has recently developed psychomotor retardation. Based on this information, which behavior would the nurse expect to see in this client? • Slowness of body movements If the client provides a literal explanation of a proverb and cannot interpret its meaning, which thought process is lacking? 47 • Abstract thinking Asking the client to complete serial sevens assesses what? • Concentration While conducting an interview with a psychiatric–mental health client, the nurse is observing the client's facial expressions and nonverbal cues. What are these physical manifestations known as? • Affect Which question would be best for the nurse to ask in order to assess recent memory? • “What did you eat for breakfast today?” The nurse finds that the client is constantly rubbing the hands. Under which component of psychosocial assessment should the nurse document this finding? • The general assessment and motor behavior component A nurse is assessing a hospitalized client who is hearing voices due to psychosis. The client is easily distracted, and this is creating a barrier to completing the assessment. What is the most effective way for the nurse to proceed? • Complete the assessment in several short interactions. The psychiatric nurse correctly identifies the client's form of communication as circumstantiality when the client does what? • Provides long, irrelevant explanations when asked why the client abuses alcohol. The nurse has been asked to identify a location to conduct an interview with a psychiatric– mental health client. Which is an essential consideration when choosing a location? • The client's right to privacy A nurse has been asked to complete a mental status examination of a psychiatric– mental health client. Which is a necessary component of this assessment? • Evaluation of insight and judgment During assessment of a client with schizophrenia, the nurse notes the client has ideas of reference. Which statement of the client would have led the nurse to conclude this? 50 A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? • the nurse who has worked with the client before and after the amputation Which is a cognitive response to grief? • Attempting to keep the lost one present A client has experienced the death of a spouse. They were married for 50 years; the client depended on the spouse for simple activities of daily living. While assessing the client for depression, of what should the nurse be most aware? • The client's risk for physical illness is relatively high. The nurse is caring for a hospitalized client who just received the news that a mass in the neck is malignant. As the nurse engages in an assessment of the client's needs, the nurse asks, "Who has been a helpful person to you in the past when you were having a difficult time?" Which component of the assessment is the nurse exploring? • support while grieving A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills? • "I just want you to know that I am available to talk when you are feeling up to it." Which is the most frequent and persistent bereavement-associated symptom? • Sleep disturbances A client has just been diagnosed with terminal brain cancer and given approximately 2 months to live. The client wishes to visit the client's mother soon to “say goodbye.” The nurse acknowledges this reaction as what? • Anticipatory The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? • Loss related to self-actualization 51 A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client’s pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings? • The client feels that the nurse would not consider the grief as significant. The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) • death by suicide • death of a child • sudden, unexpected death A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience? • Anticipatory grief Which assessment findings can most accurately be described as complicated grieving? • A person is unable to return to work after a sister’s death 18 months ago The client’s mother passed away and the client is crying incessantly. According to George Engel’s stages of grieving, which stage of grief is the client in? • Developing awareness The nurse is caring for a client who has been placed in palliative care. The nurse observes the client constantly looking at photographs from youth. According to the tasks of grieving by Rando, which task is being accomplished here? • Recollect A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? • the nurse who has worked with the client before and after the amputation 52 Which is a term used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially? • Disenfranchised grief After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz’s stages of loss and adaptation, which stage is this indicative of? • Working through A nurse is caring for a Jewish client with a terminal illness who is on a ventilator. The spouse of the client intends to stay near the client when the ventilator is removed. What is the reason for such a request, according to the Jewish culture? Choose the best answer. • The soul of the deceased should not be alone while leaving the body. A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? • physiologic A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating: • "Are there any rituals you will observe here for your loved one?" During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? • Phase of recognition Which type of grief occurs when a person is stuck in a state of chronic grieving? • complicated grief A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge? • Stages of grief reactions may overlap and are individualized Which likely takes place in the fourth stage of Kubler-Ross's stages of grieving? 55 The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse’s death. Which term correctly describes the client's response to the loss? • Complicated grief A female client who has recently been diagnosed with end-stage lymphoma tells the nurse, "I need to be able to go to my son's wedding. God, will you please just give me a little more time so I can see my first grandchild?" The nurse identifies that the client is experiencing which stage of Kubler-Ross' stages of grieving? • bargaining According to Mardi Horowitz (2001), life begins to feel "normal" again in which stage? • Completion A client is arranging a funeral ceremony for the client's child. According to the Worden’s tasks of grieving, which task is being accomplished? • Acceptance of the reality of the loss A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? • “Please don't tell my mom anything we've talked about.” Which term describes the process by which a person experiences grief? • Bereavement The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) • death by suicide • death of a child • sudden, unexpected death 56 Which culture believes that leaving the body alone after death is disrespectful? • Orthodox Jewish Americans After receiving word from the oncologist that the client's tumor is malignant, the client says to the nurse, “If you people had the faintest clue what you were doing, I wouldn't be like this.” The nurse should recognize that the client may be experiencing which stage of grief? • Anger Which factor is likely to have the greatest impact on how a client responds to grief? • Cultural influences A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? • physiologic A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience? • disorganization and despair The nurse is caring for a hospitalized client who is suspicious and guarded. The client tells the nurse that the client does not want anyone to tell the family about the client's condition. What is the nurse's best response when the family calls the hospital unit to inquire about the client's condition? • "You are welcome to share any information that you think would be helpful." The nurse asks the client to explain the meaning of the proverb “a stitch in time saves nine.” Which explanation given by the client indicates concrete thinking? • You should not forget to sew up holes in your clothes. When considering where to conduct a psychosocial assessment, the nurse can effectively interview which client in the unit's conference room? • the anxious client Which factor does not influence the grieving person's return to homeostasis? 57 • Adequate self-awareness on the part of the nurse The nurse is meeting with a client who has two young children. The client and family have decided it is best for the client to quit the client's job to care for the children. The client reports often feeling unhappy. According to Maslow's hierarchy, the client's unhappiness is related to which human need? • loss of self-esteem Which can correctly be identified as a behavioral response to grief? • Crying uncontrollably A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state: • Bereavement is the process of mourning and grief is the emotional reaction. The nurse meets with a client who reports meeting with siblings yesterday to chose a coffin for the deceased mother. How can the nurse most accurately describe this process to the client? • mourning Which is an example of a perceived loss? • An older client grieves for the loss of independence The client has been recently diagnosed with cancer. When the nurse tells the client about the diagnosis, the client says, “I have been eating healthy food and working out regularly.” According to the Kubler-Ross’s stages of grieving, which stage of grief is the client in? • Denial A nurse is facilitating a support group for family members of people who have committed suicide. One client states,"My kids and I are just not the same. It was so selfish of my husband to do this." The nurse can accurately identify this as which type of response to grief? • emotional A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? 60 Which medication classification blocks serotonin reuptake? • Antidepressant A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what? • Positron emission tomography (PET) scan Benzodiazepines and buspirone are included in which therapeutic category? • Anxiolytics A decrease in which neurotransmitter has been implicated in seizure disorders? • GABA A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs? • Hyperpyrexia, severe hypertension, and diaphoresis A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what? • Potency A nurse administers haloperidol to a client to promote deescalation. The nurse finds that after administering the drug, the client has started having jerky and involuntary movements of the head and arms. Which medication would be useful in treating this problem? • Benztropine What is the primary factor that contributes to the high cost of providing mental health care? • most mental illnesses are chronic in nature A client with bipolar disorder has responded well to lithium therapy in the inpatient setting and is now being prepared for discharge. What should the nurse teach the client about outpatient lithium therapy? 61 • "Try to time your visit to the laboratory for the morning, around 12 hours after your most recent dose." An adult client has just been prescribed paroxetine by his primary care provider. When assessing the client prior to the beginning of drug therapy, the nurse should include what assessment? • Sexual function The following events are important in the development of psychiatric–mental health nursing practice. Which event occurred first? • Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey One of the primary reforms accomplished by Dorothea Lynde Dix was the ... • establishment or enlargement of state hospitals. Freud’s personality theory was based on what? • Drives A client with mental illness has come to an outpatient mental health clinical for a counselling session with the community mental health nurse. Which areas should be the focus of counselling for this client? Select all that apply. • Stress management • Behavior modification • Communication skills Which is a criterion for mental health? • Satisfaction with personal relationships and self During the 1800s, Pinel believed that the cure for mental illness was ... • moral treatment. What are the standards of professional performance that a nurse should implement when caring for a mentally ill client? Select all that apply. • Integration of research 62 • Collegial interaction • Collaboration with clients and their families The nurse is working with a family that has indicated a desire to learn better communication skills. The nurse role-plays assertive communication techniques with each family member. The role-play is an example of which type of family intervention? • Behavioral Which psychotherapy pioneer introduced the term parataxis? • Harry Stack Sullivan Which cognitive theorist conceptualized distorted cognitions as a basis for depression? • Aaron Beck In terms of Maslow’s hierarchy of need, families living in poverty may be focused more on which type of needs rather than self-actualization? • Survival Why are the developmental theories important to nursing practice? • They outline the process of human growth and development. When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by what? • Facilitating the nurse's understanding of how these beliefs affect the client's perception of the disorder Which represents the best definition of a theory? • A person's or group's beliefs about how something happens or works A 55-year-old client is being treated for narcissistic personality disorder. The therapist shows caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory? • Modeling When assessing a client from a Freudian developmental perspective, the nurse determines that the client is functioning in the latency stage based on which behavior? 65 dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier? • Clients commonly struggle with trusting others. The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, “It's been so difficult taking care of our child. We need a break. But our child needs constant supervision.” Which would be appropriate for the nurse to suggest? • Respite residential care A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client’s family members that the primary focus of the client's hospitalization is what? • Stabilize acute symptoms Individuals may need assistance with the coordination of care and community service programs related to what? • The complexity of access to the community service programs available A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention? • Tertiary A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time? • A day-treatment program A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus? • Improved access to less costly services 66 The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? • Coordination of care During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy? • Support A client with psychiatric illness is referred to the day treatment program. Which services should the nurse include while teaching the client about the program? Select all that apply. • Development of social skills. • Stabilization of symptoms. • Training to perform activities of daily living. Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? • Assertive community treatment Which client is suitable for psychiatric transitional care services? • An individual being discharged from hospital with residual symptoms of mania A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize? • Services that promote the client's reintegration into the community Which type of service is provided to medically stable clients who do not require inpatient, residential, or home care environments? • Outpatient care A client is in need of a family-like environment with a high level of support. Which would be most appropriate? • Therapeutic foster care 67 A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client’s family members that the primary focus of the client's hospitalization is what? • Stabilize acute symptoms The nurse is advising the caregiver of a client to encourage the client to join an evolving consumer household. What may be the reason for the nurse to give this advice to the caregiver? • The client will be able function independently. A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care? • A 42-year-old who would like to enter marriage counseling A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? • Ability to provide services in a variety of locations Which is an example of secondary prevention in the forensic setting? • Crisis intervention A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services? • Identifying and meeting the client's health and human service needs Which mental health treatment setting is not a residential treatment setting? • Partial hospitalization programs Which goal for an individual client is consistent with the overall objectives of community support service programs? • The client's functional ability will improve. Coordination of care uses services that enable individualized care. Which type of service is also known as the “broker” model? 70 A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what? • The exploration of behaviors to uncover the client perspective During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what? • Acting out Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? • getting an appointment with the client at the time previously agreed upon What activity should be included in the first step of self-reflection? • identifying one's own values, attitudes, strengths and weakness A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client? • Unconditional positive regard Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts? • Countertransference A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper’s patterns of nursing knowledge, which pattern of knowing is this indicative of? • Empirical knowing When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply. • Name • Level of education 71 • Reason for being on the unit Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? • "Our relationship is one of a professional nature." A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited? • Impassive Which is an inaccurate depiction of concrete questions? • They require rephrasing of unclear questions. A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? • Formulation of an idea During a therapy session, the nurse asks the client, “Tell me more about your relationship with your parents.” The nurse is using which therapeutic communication technique? • Probing A group of nursing students is preparing a presentation about therapeutic communication. As part of the presentation, the group is planning to give examples of maintaining a nonjudgmental attitude. Which would be appropriate to include? • "The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself." According to Purnell's model of cultural competence, which would not be included as a primary cultural characteristic? • Occupation A Native American client discusses cultural beliefs with the nurse providing care. In order to recognize any negative feelings or stereotypes the nurse has, which should the nurse do to ensure culturally competent nursing care can be provided? • Reflect on how the client's beliefs are different from the nurse's own. 72 The nurse should anticipate that an individual's culture will have the most significant influence on which situation? • An Arab American has begun grieving because her husband of several decades has just died. The nurse caring for several clients on a surgical unit notes that one of the clients the nurse is caring for is Muslim. The nurse decides to remove all pork from the client's meal tray prior to delivering it to the room. What best describes the nurse's action? • Stereotyping Which culture has a belief that mental illness is a planned attempt to manipulate others? • Arab American In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take? • Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief The nurse wants to ensure culturally competent care to a Black American who was born and raised on a Caribbean-speaking island. The nurse considers that a client from this culture may hold values and beliefs consistent with what? • A spiritual approach and the use of rituals When interviewing a Native American client, the nurse avoids which behavior because it is deemed unacceptable by the client's culture? • Prolonged eye contact A nurse who provides care in a large, inner-city hospital is aware of the large influence of culture on health. The nurse recognizes that culture is best understood as a shared system that encompasses what? • Beliefs, values, and behavioral expectations Which statement made by the client demonstrates hardiness when faced with a health issue? • "What do I need to do to manage this illness?" Which culture is more comfortable at distances greater than 2 or 3 feet? 75 inappropriately and states, "My spouse just up and left me!" Which is the nurse's best response? • The nurse should recognize the incongruity between content and behavior and find ways of exploring further The nurse is assessing a client with psychiatric disorder. The nurse finds that when asked a question, the client gives excessive and unnecessary details followed by the answer. This is indicative of which impairment of thought content? • Circumstantial thinking How should the nurse describe the mood and affect of a client who has a mask-like facial expression but states, "I'm really happy"? • Incongruent Considering the nature of its content, which areas may be the most uncomfortable or difficult for the nurse to assess? • Sexuality When conducting a psycho-social assessment, the nurse inquires about the client's social supports. In order to effectively do this, which does the nurse need to explore? • The length and quality of relationships A nurse is performing a psychosocial assessment of the client. Which questions asked by the nurse can be identified as open ended? Select all that apply. • “How can we help you?” • “How did your problems begin?” The nurse is preparing a psychosocial assessment for use with clients with various mental health conditions. For which group of clients should the nurse include mostly closed- ended questions? • Clients with adult attention deficit hyperactivity disorder A client receives a court order for commitment. Which best exemplifies the concept of “least restrictive environment”? • Involuntary commitment to an outpatient community mental health center 76 A nurse is attempting to determine a client's right to independence and the extent to which the nurse would offer beneficial treatment to the client. Which ethical principle would the nurse identify as being involved? Select all that apply. • Autonomy • Beneficence When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as what? • Nonmaleficence A new nursing student is studying ethics in nursing and informs a client who wants to stop medication about its benefits and how the client will continue to feel better only if use of the drug continues. Which concept is the nursing student using? • Beneficence A psychiatric-mental health nurse is providing care to several clients. Some of the clients have been voluntarily admitted while others have been involuntarily admitted. Which description about voluntary admissions demonstrates that the nurse understands the differences between these two types of admissions? • They have agreed to the hospitalization. The nurse recognizes that the difference between a voluntary and an involuntary commitment is what? • An involuntarily committed client may not initiate his or her own discharge A mental health nurse is caring for a client with an anxiety and substance use disorder. The family is requesting to see the client's records. The nurse understands that this would be a violation of which law? • Health Insurance Portability and Accountability Act (HIPAA) A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware? • The client can refuse medication. Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? 77 • A client who is being held involuntarily in a secure psychiatric setting Which statement accurately describes the insanity defense? • It is rarely successful Which client would a nurse determine to be the most likely candidate for involuntary commitment? The client who: • is screaming in the street and disturbing neighbors. A psychiatric nurse is assigned to perform observation of a client in restraints. The nurse knows that this client must be checked on how often? • Constantly for the first hour A client with bipolar disorder has been following the prescribed medication regimen. The client indicates to the nurse a desire to stop the medication now that the client is feeling better. The nurse tells the client that most likely the client will have to remain on the medication for life to keep the condition under control. The nurse is practicing which principle? • Veracity Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members? • Danger to others. A nurse recruiter is interveiwing a nurse for a psychiatric-mental health nursing position at the community clinic. When reviewing the applicant's educational background, the recruiter would identify which as the preferred level of preparation? • Bachelor’s degree Which ethical principle requires a nurse to prevent clients from harming themselves or others? • Nonmaleficence While conducting an interview with a 14-year-old mental health client, the client tells the nurse that the client has a plan to kill students at the client's school because they will not stop picking on the client. The client says, “I have everything I need all set up, including a gun.” What would be the nurse's responsibility after hearing this statement? 80 The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz’s stages of loss and adaptation, this is indicative of which stage? • Denial and intrusion A client who has recently lost his same-sex partner in a motor vehicle accident tells the nurse, "My family doesn't speak to me because of my lifestyle. I feel like I have no one to talk to about my loss." The client is experiencing: • disenfranchised grief. When working with a grieving client, which is the most effective intervention a nurse can use? • Encourages the client to express grief verbally Which explanation would be the nurse's best response when asked about the denial stage of grief? • It provides the individual with a temporary escape from the reality of dying Which is an example of a perceived loss? • An older client grieves for the loss of independence A client's children have downplayed their grief following the death of their mother's partner, claiming that their mother and her partner were only together for a few months and that “he was no good for her anyways.” The client is at risk of experiencing which type of grief? • Disenfranchised grief Which is a cognitive response to grief? • Attempting to keep the lost one present After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz’s stages of loss and adaptation, which stage is this indicative of? • Working through 81 A client is arranging a funeral ceremony for the client's child. According to the Worden’s tasks of grieving, which task is being accomplished? • Acceptance of the reality of the loss Which experience could be the possible cause of grief due the loss of security and belonging for the client? • Divorce A client is crying continuously from having lost a friend in an accident. According to the tasks of grieving by Rando, which task of grief is expected to be accomplished next? • Recollect and reexperience A female client tells the nurse she has had low appetite and motivation since the recent breakup of a long-term relationship. The client states, "I just can't stand not having her around. I need her back." The client is experiencing which of Bowlby's phases of grieving? • yearning Which client is most at risk for experiencing anticipatory grief? • 61-year-old spouse of a client experiencing symptomology of moderate- stage Alzheimer disease Which occurs in the second phase of Bowlby's grieving process? • Emotional yearning for the loved one When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse? • Public A client has recently been diagnosed with cancer. The client says, “What did I do wrong to get such a disease?” Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. • A fearful tone of voice • A sad facial expression 82 A client with a history of depression has told the nurse that the client is feeling especially "low" this morning. The nurse has responded by stating, "Try thinking about some of the blessings you have in your life." How should the nurse's statement be best interpreted? • The nurse has inhibited therapeutic communication by giving advice A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication? • 3 to 6 feet Which type of cue is being used when the client states, "Nothing can help me"? • Covert The nurse is assessing the behavior of a client. The client has a cheerful expression, erect posture, and a confident tone. Which statement made by the client along with these nonverbal cues conveys a congruent message? • “I feel great and am able to do my exercises properly." A client expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, “Do you mean that the work in the office is causing stress, which is why you are not able to sleep?” Which type of therapeutic communication technique is this conversation indicative of? • Consensual validation A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs? • more time to think A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply. • Focus on the client during the interaction • Ensure the client's confidentiality • Employ theoretically based interventions 85 • temporal The prescription of clozapine requires weekly blood samples for which time frame? • 6 months A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's most therapeutic response? • "I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you." The psychiatric nurse considers online psychotherapy most appropriate for the which client? • 59-year-old male with chronic alcohol abuse and mobility problems Deinstitutionalization has reduced the number of public hospital beds by what percentage? • 80% Which is not an action expected of a benzodiazepine? • Antidepressant Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years? • Pressures to reduce health care costs associated with inpatient care Which statement by the client is most suggestive of the use of unconscious resistance as a defense? • “Sorry I'm late again. They keep changing the bus schedule on me!” Cognitive interventions are based on the concept of cognition. Who developed cognitive behavioral therapy? • Aaron Beck A nurse is reviewing the medical records of several clients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a client at greater risk for tardive dyskinesia? 86 • history of depression A psychiatric-mental health nurse is preparing a review class for a group of colleagues on the various theoretical models used in psychiatric–mental health nursing. When describing cognitive theories, which statement would the nurse practitioner <b>most</b> likely include about what these theories attempt to do? • "Link internal thought processes with behavior." A psychiatric-mental health nurse is describing to a group of colleagues how information is gathered about the inheritance of mental disorders using population genetics. The nurse determines that additional discussion is needed when the group identifies which method as being used for evaluation? • risk factor analysis One goal of transitional care in mental health care is what? • Provide an alternative for inpatient admission Dorothea Dix’s solution to gain humane treatment for the mentally ill population included what? • State hospitals A client has been recently diagnosed with schizophrenia and is just beginning treatment with olanzapine. What anticipatory guidance should the nurse provide to the client? • Strategies for preventing and managing weight gain How should the nurse best explain the purpose of the DSM-5 to the client recently diagnosed with bipolar disorder? • "It is used to assist in identifying the underlying causes of your disorder." A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care? • It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client. Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason? 87 • Nonverbal communication provides additional client information that is acted out unconsiously Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening? • General leads Which developmental task occurs in the middle adult growth area? • Creation of a comfortable home A client begins discussing frankly the client's history of sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. The nurse does this for what reason? • To reduce the nurse's own anxiety Why is understanding a client's cultural context important to a psychiatric mental health nurse? • It influences perceptions of health and illness. A psychiatric–mental health client informs the nurse that a tornado that hit a neighboring town was the client's fault because the client dislikes a neighbor. This disturbance of thought content is known as what? • Ideas of reference When conducting an assessment with a client from another country, what can a nurse do to ensure the client receives culturally sensitive care? • Show genuine interest in the client’s culture and personal life experiences. A South Asian client is being discharged from the hospital after knee surgery. The nurse is informing the client about the necessary follow-up appointment. Which should the nurse anticipate regarding the client's follow-up appointment? • Plan to see the client at the scheduled time, sharp. A nurse is performing a psychosocial assessment of the client. Which questions asked by the nurse can be identified as open ended? Select all that apply. • “How did your problems begin?”