6005 Exam 1

What are some overt verbal cues a patient might make give when considering suicide?

"I can't take it anymore" "Life isn't worth living anymore" "I wish I were dead" "Everyone would be better off if I died"

What are some covert verbal cues a patient might make when considering suicide?

"It's okay now. Soon everything will be fine" "Things will never work out" "I won't be a problem much longer" "Nothing feels good to me anymore and probably never will" "How can I give my body to medical science?"

What techniques can enhance communication?

- Exploring - Focusing - Giving information - Seeking clarification - Presenting reality - Accepting - Giving recognition - Voicing doubt - Offering self - Offering general leads - Giving broad openings - Placing the events in time or sequence - Making observations - Encouraging description of perception - Encouraging comparison - Restating - Reflecting

Acetylcholine

-Plays a role in learning, memory -Regulates mood; mania, sexual aggression -Affects sexual and aggressive behavior -Stimulates parasympathetic NS

A family who is worried that an adult female might hurt herself asks for her to be admitted to the hospital. An assessment indicates moderate depression with no risk factors for suicide other than a depressed mood. The patient denies any intent or thoughts about self-harm. The family agrees that the patient has not done or said anything to suggest that she might be a danger to herself. Which of the following responses is consistent with the concept of "least restrictive alternative" doctrine?

Arrange for an outpatient counseling appointment the next day

Which student behavior is consistent with therapeutic communication? A Offering your opinion when asked in order to convey support B Summarizing the essence of the patient's comments in your own words. C Interrupting periods of silence before they become awkward for the patient D Telling the patient he did well when you approve of his statements or actions

B Summarizing the essence of the patient's comments in your own words

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the responses would most likely be therapeutic? A) A new psychiatrist is a chance to start fresh; I'm sure it will go well for you B) You say you look forward to the meeting, but you appear anxious or unhappy C) I notice that you frowned and avoided eye contact just now; don't you feel well? D) I get the impression you don't really want to see your psychiatrist- can you tell me why?

B- You say you look forward to the meeting, but you appear anxious or unhappy

James is a 42-year old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night, demons came to my room and tried to rape me." Which response would be most therapeutic? A "There are no such things as demons; what you saw were hallucinations." B "It is not possible for anyone to enter your room at night; you are safe here." C "You seem very upset; please tell me more about what you experienced last night." D "That must have been very frightening, but we'll check on you at night and you'll be safe."

C "You seem very upset; please tell me more about what you experienced last night."

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has? A Provide emotional support and encourage him to contact his family to see if they can help him arrange and pay for inpatient care. B Advise him that hospitals serve all persons regardless of their ability to pay, and immediately contact a Mobile Crisis team or accompany him to the nearest hospital emergency department. C Help him apply for Medicaid coverage, arrange for him to be monitored by family and friends, and once Medicaid coverage is in place, take him to an emergency room for evaluation D Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

D Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

What is the most important assessment and intervention for a patient who is at risk for suicide?

Establishing a therapeutic relationship and directly asking about suicidal feelings

Glutamate association with mental health

Increase NMDA: -prolonged increased state can be neurotoxic -neurodegeneration in Alzheimer's disease Increase AMPA: -improvement of cognitive performance in behavioral tasks

"It must have been hard for you not to get that job" is an example of what type of question

Indirect of implied questions - a good approach when we don't want to pressure an individual to respond

The nurse who follows an order that is 1) known to be incorrect or 2) will harm the patient ...

Is responsible for any resulting patient harm

A patient identifies as gay. How does this affect his risk for suicide?

LGBT community is at a higher risk than heterosexual individuals

David has an overnight pass, and he plans to spend this time with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brothers and needs him to babysit. You notice that the patient becomes visibly agitated when she says this. How do you balance safety and the patient's right to confidentiality?

Meet with the patient's sister, sharing with her the patient's previous disclosure about his anger toward children and the resultant risk that his babysitting would present

The concepts at the heart of Sullivan's theory of personality are:

Needs and anxiety (According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety; he defined anxiety as any painful feeling or emotion that arises from social insecurity or prevents biological needs from being satisfied

"What are some of the stresses you are grappling with?" is an example of what type of question?

Open-ended

Brian, a patient with schizophrenia, has been ordered antipsychotic medication. The medication will likely benefit him, but there are side effects, in a small percentage of patients, it may also cause a dangerous side effect. After medication taking, Brian is unable to identify side effects and responds "I won't have any side effects because I am iron and cannot be killed." Which response would be most appropriate under these circumstances?

Petition the court to appoint a guardian as a substitute for Brian, as he is unable to comprehend the proposed treatment

The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist?

Sullivan

Which statement about nonverbal behavior is accurate?

The meaning of nonverbal behaviors varies with cultural and individual differences

A nurse makes a post on a social media page about his peer taking care of a patient with a crime relation gunshot wound during his shift in the ER. He does not use the name of the patient. It can be concluded that:

The nurse has violated confidentiality laws and can be held liable

Which contribution to modern psychiatric mental health nursing practice was made by Freud?

The theory of personality structure and levels of awareness

Is this a violation of HIPAA? The nurse's release of information to the patient's employer about the patient's condition?

Yes, this is a breach of confidentiality

When treating mental illnesses with psychotropic drugs what is the focus of the treatment? a) Altering brain neurochemistry. b) Correcting brain anatomical defects c) Regulating social behaviors d) Activating the body's normal response to stress.

a) Altering brain neurochemistry. Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.REF: 56-57

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles? a) Autonomy and beneficence b) Advocacy and confidentiality c) Veracity fidelity d) Justice and humanism

a) Autonomy and beneficence Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy.REF: 92

You are assessing a 6-year old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate? Select all that apply. a. Engage a child in a specific therapeutic game b. ask the child to draw a picture c. provide the child with an anatomically correct doll to act out a story d. Allow the child to tell a story

a. Engage a child in a specific therapeutic game b. ask the child to draw a picture c. provide the child with an anatomically correct doll to act out a story d. Allow the child to tell a story

Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in: a) dry mouth b) amenorrhea c) increased production of testosterone d) blurred vision

b) amenorrhea

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? a) A recent immigrant from Russia b) A deeply depressed client c) A Chinese American client d) A tearful client reporting pain

c) A Chinese American client Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.REF: 148

Emily is a 28-year old nurse on the psychiatric unit. She has been working with Jenna, a 27-year old who was admitted with depression. Emily and Jenna find they have much in common, including each having a 2-year old daughter and each having graduated the same high school. Emily and Jenna discuss getting together for lunch with their daughters after Jenna is discharged. This situation reflects: a. successful termination b. promoting interdependence c. boundary blurring d. a strong therapeutic relationship

c. boundary blurring

Venlafaxine (Effexor) exerts its antidepressant effect by selectively blocking the reuptake of: a) GABA b) dopamine c) serotonin d) norephinephrine e) c and d

e) serotonin and norephinephrine

Levels of prevention strategies in outpatient psychiatric care consist of primary prevention, secondary prevention, and _______ prevention

tertiary

What techniques hinder communication (obstructive)?

- False reassurance - Giving approval/agreeing - Giving disapproval/disagreeing - Advising - Asking why questions - Asking excessive questions - Change the subject - Showing non verbal signs of bored - Minimizing feelings - Making value judgement

Somatostatin

-Altered levels associated with cognitive disease Decrease: -Alzheimers disease -Decreased levels of SRIF found in spinal fluid of some depressed patients Increase: -huntingtons disease

Substance P

-Centrally active SP antagonist has antidepressant and anti-anxiety effects in depression -promotes and reinforces memory -enhances sensitivity to pain receptors to activate -Involved in regulation of mood and anxiety -Role in pain management

Glutamate

-Is excitatory -AMPA plays a role in learning and memory

Which of the following factors contribute to the movement of patients out of large institutions and into community based mental health treatment?

-State desire to save money by moving the patients to the community, where the federal government would pick up more of the cost -A system of coordinated and accessible community care was developed by forward thinking communities and offered more effective treatment -The community mental health centers act of 1963 required states to develop and offer care in communities-based treatment programs -Patient advocates exposed deficiencies of state hospitals and took legal action, leading to identification of a right to treatment in the lease restrictive setting -New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings

The criteria for admission to an in patient psychiatric unit that the patient:

-is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm

What are the three main elements to consider when evaluating lethality of suicide?

1) Is there a specific plan with details? 2) How lethal is the proposed method? 3)Is there access to the planned method? People who have definite plans for the time, place, and means are at high risk.

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? A. The student requests assignment to a patient of the same gender as the student. B. She limits sharing personal information and stresses the patient-centered focus of the conversation. C. She tells him that she will not talk about her personal life. D. She explains that if he persists in focusing on her, she cannot work with him.

B. She limits sharing personal information and stresses the patient-centered focus of the conversation.

The DO's of Charting

1. Chart pertinent observations in a timely manner 2. Chart a total patient assessment on each shift and on admission, discharge, and transfer 3. Chart follow-up care provided when a problem has been identified in early documentation 4. Chart facts surrounding unusual occurrences and incidents completely 5. Chart all nursing interventions, treatments and outcomes; teaching efforts, patient responses and safety and patient protection interventions

DONT'S of charting

1. Do not chart unsupported opinions 2. Do not defame patients by calling them names or by making derogatory statements 3. Do not chart before an event occurs 4. Do not chart generalizations, suppositions, or pat phrases such as "Pt is in good spirits" 5. Do not obliterate, alter, or destroy a record 6. Do not leave blank spaces for chronological notes

Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: a. milieu therapy. b. cognitive-behavioral therapy. c. behavior therapy. d interpersonal psychotherapy.

A- milieu therapy (use of the total environment to treat; all inclusive term that recognizes the people, the setting, the structure, and the emotional climate as all important to healing)

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" a) Focusing b) Restating c) Reflection d) Clarification

Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.REF: 142

"Did you sleep well yesterday?" is an example of what type of question?

Closed-ended

Acetylcholine association with mental health

Decrease- alzheimer's disease, huntington's, parkinson's Increase- depression

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction? *Select all that apply* A Apologize for the differential in height and proceed while standing to avoid delay B If permitted, raise the head of the bed and, with the patient's permission, sit on the bed C If permitted, raise the head of the bed to approximate the nurse's height while standing D Sit in whatever chair is available in the room to convey informality and increase comfort E Locate a chair or stool that would place the nurse at approximately the level of the patient F Remain standing and proceed so as not to create distraction by altering the arrangements

E) Locate a chair or stool that would place the nurse at approximately the level of the patient

Amanda was raised by a rejecting and abusive father and had a difficult childhood. As an inpatient, she frequently comments on how hard her nurse, Jane, works and on how other staff members do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Amanda. Jane appreciates her insightfulness, and realizes that the other staff members do not appreciate how hard she works and take her for granted. Jane enjoys the time she spends with Amanda and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient? A. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father B. Jane is idealizing Amanda, seeing in her strengths and abilities that Amanda does not possess; Jane should temporarily distance herself somewhat from Amanda C. Amanda is overidentifying with Jane, seeing similarities that do not in reality exist; Jane should label and explore this phenomenon in her interactions with Amanda D. Jane is experiencing countertransference in response to Amanda's meeting Jane's needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics

A. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father

GABA association with mental health

-Decrease anxiety disorders, schizophrenia, mania, huntington's disease Increase reduction of anxiety

Neurotensin (NT)

-Endogenous antipsychotic-like properties -Decrease levels found in spinal fluid in patients with schizophrenia

Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? Select all that apply

-Interact frequently with both individuals and groups on the unit -Initiate and support group interactions via therapeutic groups and activities -Provide and encourage opportunities to practice social and other life skills -Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others

Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? a. The nurse assess the patient at regular intervals. b. The nurse administers psychotropic medications. c. The nurse spends time sitting with a withdrawn patient. d. The nurse participates in team meetings with other professionals.

a. The nurse assess the patient at regular intervals.

Which theorist is associated with behavioral therapy? a) Freud b) Skinner c) Sullivan d) Peplau

b) Skinner B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.REF: 29

Gina is admitted for treatment of depression with suicidal ideation triggered by marital discord. Her spouse visits one night and informs Gina that he has decided to file for a divorce. The staff are aware of the visit and the husbands intentions regarding the divorce but take no further action, feeling that the q-15 minute suicide checks Gina is already on are sufficient. Thirty minutes after the visit ends, staff make rounds and discover Gina has hanged herself in her bathroom, using hospital pajamas she had tied together into a rope. Which of the following statements best describes the situation? Select all that apply.

The nurses have created liability for themselves and their employer by failing in their duty to protect gina; The nurses have breached their duty to reassess Gina for increased suicide risk after their husband's visit; Given Gina's history, the nurses should have expected an increased risk of suicide after the husbands announcement; The nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina's increased risk

What is the premise underlying behavioral therapy? a) Behavior is learned and can be modified b) Behavior is a product of unconscious drives c) Motives must change before behavior changes d) Behavior is determined by cognitions; change in cognitions produces new behavior.

a) Behavior is learned and can be modified. The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. None of the remaining options are true statements when considering behavioral therapy.REF: 22-23

What is the function of a neuron? a) Conduction of electrical impulses b) Diffuses an impulse across a space c) Provides a space at an axon terminal d) Provides an attachment point of the cell surface

a) Conduction of electrical impulses Neurons are nerve cells that conduct electrical impulses. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.REF: 40

A nurse administering a benzodiazepine should understand that the therapeautic effect of benzodiazepins results from potentiating the neurotransmitter: a) GABA b) dopamine c) serotonin d) acetylcholine e) a and c

a) GABA

What term is used to identify the structures that respond to stimuli, conduct electrical impulses, and release neurotransmitters? a) Neurons b) Synapses c) Dendrites d) Receptors

a) Neurons Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.REF: 40

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? a) They are assured the same as those for any other citizen. b) Their rights are altered to prevent use of poor judgment. c) Their rights are always ensured by appointment of a guardian. d) Their rights are limited to provision of humane treatment.

a) They are assured the same as those for any other citizen. Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client.REF: 95

The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving: a) lithium b) clozapine c) diazepam d) amitriptyline

a) lithium

Which assessment statement(s) would be appropriate to ask to assess suicide risk? (Select all that apply) a) Do ever think about suicide? b) Are you thinking of hurting yourself? c) Do you sometimes wish you were dead? d) Has it ever seemed as if life is not worth living? e) If you were to kill yourself, how would you do it? f) Does it seem as if others might be better off if you were dead?

a, b, c, d, e, f,

Which intervention(s) maximize the safety of a patient who is actively suicidal on an inpatient mental health unit? (Select all) a) Place the patient on every-15 -minute checks b) Place the patient in a room near the nurse's station c) Allow the patient periods of time alone for reflection to promote self-awareness d) Install breakaway curtain rods, coat hooks, and shower rods e) Allow the patient to keep personal objects such as a razor and hair dryer in his room to demonstrate trust f) Assign the patient to a private room to facilitate monitoring

a, b, d

Which are the purposes of a thorough mental health nursing assessment? Select all that apply. a. Establish a rapport between the nurse and patient. b. Assess for risk factors affecting the safety of the patient or others. c. Allow the nurse the chance to provide counseling to the patient. d. Identify the nurse's goals for treatment. e. Formulate a plan of care.

a. Establish a rapport between the nurse and patient. b. Assess for risk factors affecting the safety of the patient or others. d. Identify the nurse's goals for treatment. e. Formulate a plan of care.

Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications? a.Help Anna to understand her illness and share in decisions about her care. b.Advise Anna that if she stops her medications, her doctor will hospitalize her. c.Arrange for Anna to receive daily home care so that her use of medications is monitored. d.Discourage Anna from focusing on side effects and other excuses for stopping her pills.

a. Help Anna to understand her illness and share in decisions about her care.

A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship? a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. b. Offering the patient advice on how he could cope more effectively with stress. c. Controlling the pace of the relationship by selecting topics for each interaction. d. Limiting the discussion of termination issues so as not to sadden the patient unduly.

a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? a) "Don't let them beat you! Fight back!" b) "School is stressful. What do you find most stressful?" c) "I know just what you are going through. The stress is terrible." d) "You have only two more semesters. You will be glad if you stick it out."

b) "School is stressful. What do you find most stressful?" This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.REF: 142

Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages? a) SSRIs b) Antipsychotics c) Benzodiazepines d) Tricylclic antidepressants

b) Antipsychotics

Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority? a) Assessing the client's ability to fulfill appropriate developmental level tasks b) Assessing the client for strengths upon which a nurse-client relationship can be based c) Planning one-on-one time to assist in identifying the fears trigger the client's anxiety d) Evaluating the client's ability to learn and retain essential information regarding their current condition

b) Assessing the client for strengths upon which a nurse-client relationship can be based The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.REF: 27-28

Which ethical principle refers to the individual's right to make his or her own decisions? a) Beneficence b) Autonomy c) Veracity d) Fidelity

b) Autonomy Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions.REF: 92

Freud believed that individuals cope with anxiety by implementing which mechanism? a) The superego b) Defense mechanisms c) Security operations d) Cognitive distortions

b) Defense mechanisms The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings. None of the other options were proposed by Freud as a mechanism for dealing with anxiety.REF: 25-26

The nurse is caring for an adult client who experienced severe physical abuse from the age of 2 through 12. What information should the nurse provide the client concerning the function of the "id" and the ability to function as an adult? a) It has control over the emotional frustration felt as an adult. b) It is the source of one's survival instincts. c) It is severely damaged by abuse experienced before the age of 5 years. d) It provides an individual with the ability to differentiate believed and real experiences.

b) It is the source of one's survival instincts. Freud delineated three major and distinct but interactive systems of the human personality. At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us. The id provides an individual with the instincts to survive the emotional trauma associated with physical abuse. None of the other statements accurately describes the id's role in adult functioning.REF: 19-20

Role-playing is associated with which type of psychotherapy? a) Psychoanalysis b) Modeling c) Operant conditioning d) Systemic desensitization

b) Modeling In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy. Demonstration of specific behaviors are not supported by any of the remaining options.REF: 24

Which imaging technique can provide information about brain function? a) Computed tomography (CT) scan b) Positron emission tomography (PET) scan c) Magnetic resonance imaging (MRI) scan D) Skull radiograph

b) Positron emission tomography (PET) scan The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.REF: 45; Table 3-2

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? a) The nurse behind a desk and the client in a chair in front of the desk. b) The nurse and client sitting at a 90-degree angle to each other. c) The client sitting in a chair and the nurse standing a few feet away. d) The nurse and client sitting facing each other.

b) The nurse and client sitting at a 90-degree angle to each other. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.REF: 150

What nursing action supports a client's right to autonomy? a) Spending time with an extremely anxious client b) Witnessing the informed consent for electroconvulsive therapy from a client c) Spending equal amount of one-on-one time with each client on the unit d) Attending an inservice on a newly approved medication

b) Witnessing the informed consent for electroconvulsive therapy from a client Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care. Witnessing the client's informed consent demonstrates attention to the client's right to autonomy. None of the other options are associated with autonomy.REF: 92

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents a) assault b) battery c) defamation d) invasion of privacy

b) battery Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.REF: 101; Table 6-3

Which interventions are therapeutic for a 23-year-old woman with depression and suicidal ideation? a) Focus primarily on developing solutions to the problem that are leading the patient to feel suicidal b) Assess the patient thoroughly, and reassess the patient at regular intervals as levels of risk fluctuate c) Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior d) Meet regularly with the patient to provide opportunities for the patient to express and explore feelings e) Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in this age group f) Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic

b, d, e, f

you are performing a spiritual assessment on a patient. Which patient statement would indicate that there is an experiential concern in the patient's spiritual life? a. "I really believe that my spouse loves me" b. "My sister will never forgive me for what I did" c. "I try to find time every day to pray, even though it's not easy" d. "I am happy with my life choices, even if my mother is not"

b. "My sister will never forgive me for what I did"

A 43-year-old female patient is brought to the emergency department with complaints of bizarre speech, visual hallucination, and changes in beh. She has no psychiatric history. Before ordering a psychiatric consultation, the ER physician orders a battery of blood test as well as an MRI of the brain. The rationale for this is: a. To avoid lawsuit b. Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out c. Emergency room physicians are required to order a certain number of tests for the ER visit to be reimbursed d. To comply with hospital standards of care

b. Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out

What is forcing a patient to take a medication after they refuse constitutes what?

battery (battery= harmful or offensive touching of another person)

How does Harry Stack Sullivan's Interpersonal Theory view anxiety? a) An emotional experience felt after the age of 5 b) A sign of guilt in adults c) A painful emotion arising from social insecurity d) The result of trying to go beyond experiences of guilt and pain.

c) A painful emotion arising from social insecurity According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.REF: 21-22

The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience? a) Spending one-on-one time with staff to establish trust b) Providing them with the opportunity to select which unit activities they will participate in to gain autonomy c) Encouraging them to talk about their school plans to help achieve identity d) Assign them to help clean up the dayroom to develop a sense of industry

c) Encouraging them to talk about their school plans to help achieve identity According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. While appropriate activities none of the options are specifically identified with the developmental task for a 14-year-old.REF: 23; Table 2-2

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced which illegal act? a) Battery b) Defamation of character c) False imprisonment d) Assault

c) False imprisonment False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. None of the other options relate directly to such seclusion.REF: 101; Table 6-3

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle? a) Autonomy b) Veracity c) Fidelity d) Justice

c) Fidelity Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment.REF: 92

Which right of the client has been violated if he is medicated without being asked for his permission? a) Right to dignity and respect b) Right to treatment c) Right to informed consent d) Right to refuse treatment

c) Right to informed consent Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.REF: 96

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? a) The nurse is a safe person to interact with b) The nurse is a new friend c) They view the nurse as a stranger d) They view the nurse as a peer

c) They view the nurse as a stranger Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.REF: Page 151

The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The nurse may correctly assume that the client has met the criteria for which type of admission? a) Outpatient b) Emergency c) Voluntarily d) Involuntarily

c) Voluntarily Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria.REF: Page 93-94

What assumption can be made about the client who has been admitted on an involuntary basis? (Select all) a) The client can be discharged from the unit on demand of next of kin. b) For the first 48 hours, the client can be given medication over objection. c) The client has failed to agree to fully participate in treatment and care planning d) The client is a danger to self or others or unable to meet basic needs. e) The commitment was court ordered.

c, d, e Involuntary admission which is court ordered implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. Neither of the remaining options is accurate assumption regarding an involuntary admission.REF: 93-94

The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:

cognitive behavioral therapy (Based on the underlying theoretical principle that feelings and behaviors are largely determined by the way people think about the world and their place in it)

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? a) Quickly break the silence and encourage the client to continue. b) Reassure the client that the abuse was not her fault. c) Reach out and gently touch the client's arm. d) Allow the client to break the silence.

d) Allow the client to break the silence. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.REF: 141-142

Which person is at the highest risk for suicide? a) A 50-year-old married white male with depression who has a plan to overdose if circumstances do not improve b) A 45-year-old married white female who recently lost her parents, suffers from bipolar, and attempted suicide once as a teenager c) A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend. and has ready access to a gun he has hidden d) An older Hispanic who is Catholic, living with a debilitating chronic illness, is recently widowed, and states: "I wish that God would take me too"

d) An older Hispanic who is Catholic, living with a debilitating chronic illness, is recently widowed, and states: "I wish that God would take me too"

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? a) Using emotionally charged words and gestures b) Offering opinions and avoiding periods of silence c) Asking closed-ended questions requiring "yes" or "no" answers d) Asking open-ended questions and seeking clarification

d) Asking open-ended questions and seeking clarification Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.REF: 142-143

After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? a) Eliciting more information b) Encouraging evaluation c) Verbalizing implied d) Clarifying the message

d) Clarifying the message Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.REF: 142

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? a) The mental image of a word may not be the same for both nurse and client. b) One statement may simultaneously convey conflicting messages. c) Many of the client's remarks are no more than social phrases. d) Content of messages may be contradicted by process.

d) Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.REF: 140-141

Which client problem would be most suited to the use of interpersonal therapy? a) Disturbed sensory perception b) Impaired sensory perception c) Medication noncompliance d) Dysfunctional grieving

d) Dysfunctional grieving Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.REF: 21-22

A recent immigrant to the United States from which country would find direct eye contact a positive therapeutic technique? a) Korea b) Mexico c) Japan d) Germany

d) Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.REF: Page 147-148

According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory? a) Recent memory b) Long-term memory c) All memories d) Painful memories

d) Painful memories Freud described the conscious part of the mind as containing all of the material that the person is aware of at any one time and so as dysfunction of the conscious mind involves all memories.REF: 19

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? a) Giving information and encouraging evaluation b) Presenting reality and encouraging planning c) Clarifying and suggesting collaboration d) Reflecting and exploring

d) Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed.

A client reports to the nurse that once he is released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? a) None, because no explicit threat has been made. b) Ask the client if he is threatening his wife. c) Call the client's wife and report the threat. d) Report the incident to the client's therapist.

d) Report the incident to the client's therapist. The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.REF: 98-99

A patient states he has "given up on life." His wife left him, he was fired from his job, and he is four payments behind on his mortgage, meaning he will soon lose his house. Which nursing diagnosis is appropriate? a. Anxiety related to multiple losses b. Defensive coping related to multiple losses c. Ineffective denial related to multiple losses d. Hopelessness related to multiple losses

d. Hopelessness related to multiple losses