bh midterm

6. The nurse knows that rapport has been established when the client begins to do what action? (Select all that apply.) A) Tries to isolate himself or herself from others in the group. B) Acknowledge that they wish to keep many topics off limit and private. C) Develop a sense of sharing. D) Display decreased anxiety and feels comfortable in the presence of the nurse. E) Begin speaking with a more rapid repetitive speech.

: C, D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 96 Feedback: When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) nurse-client relationship. The other distractors are signs that the client is distrustful of the therapeutic relationship.

14.Which features appear when motivational interviewing is being used? (Select all that apply.) A) Eliciting and strengthening client change talk B) Negotiating change plans C) Firming up client commitment D) Trying to "stick to the plan" without adapting to the moment E) Utilizing feedback at the very last session

: A, B, C Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 101 Feedback: Eight identified features of motivational interviewing (MI) that should appear in every application of this technique include "openness to collaboration with clients' own expertise; proficiency in client centered counseling, including accurate empathy; recognition of key aspects of client speech that guides the practice of MI; eliciting and strengthening client change talk; rolling with resistance; negotiating Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) change plans; consolidating client commitment, and; switching flexibly between MI and other intervention styles." Multiple Select

5. The nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. With which steps would the client be involved? (Select all that apply.) A) Beginning to identify a need B) Testing new ways for problem solving C) Testing the relationship D) Discussing problems related to needs E) Examining personal issues

: B, D, E Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 98 Feedback: During the working phase, the client discusses problems underlying the needs, uses the emotional safety of the relationship to examine personal issues, and tests new ways of solving problems. Identifying a need and testing the relationship typically occur during the orientation phase of the relationship.

18. A nurse is reading a journal article about epidemiologic research and mental illness. Which of the following mental health conditions would the nurse expect to find as being projected as the leading burden of disease worldwide by the year 2030? A) Depression B) Anxiety C) Substance abuse D) Anorexia nervosa

A Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 2 Feedback: Based on epidemiologic research, depression is one of the leading disease burdens in middle- and high-income countries, such as the United States. By 2030, depression is projected to be the leading burden worldwide.

2. A hospitalized client diagnosed with depression asks the nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection? A) "Should you go home for the weekend?" B) "Home means what to you?" C) "It sounds as if you don't want to go home this weekend." D) "I doubt that you really should go home this weekend."

: A Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 4 Page Number: 86 Feedback: Reflection is used when the client wants the nurse's approval or judgment. The statement by the nurse that uses reflection is, "Should you go home for the weekend?" This allows the client the opportunity to discuss the matter further. The question: "Home means what to you?" seeks clarification. The question: "It sounds as if you don't want to go home this weekend" reflects the technique of Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) interpretation. The question: "I doubt that you really should go home" offers the nurse's opinion and is judgmental.

3. A client who is hospitalized with depression tells the nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate? A) "Have you ever thought about hurting yourself?" B) "It's important that you take this medication." C) "I agree with you. I wouldn't want to take this medication either." D) "Another client took that medication, and he really felt better."

: A Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 4 Page Number: 88 Feedback: The nurse's best response is, "Have you ever had feelings of hurting yourself?" This response seeks to clarify the client's statement about hurting themselves and opens the door to allow a therapeutic discussion, since clients with depression may have suicidal thoughts. Telling the client to take the medication, agreeing with the client, or giving advice will block the therapeutic communication.

8. A nurse is giving a presentation to colleagues about verbal communication. The audience demonstrates understanding of the information when they identify which component as the first in the process? A) Formulation of an idea B) Message encoding C) Transmission of message D) Message reception

: A Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 2 Page Number: 83 Feedback: With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.

5. A nurse engaged in an interaction with a client recognizes body space zones. Which description best explains an individual's personal zone? A) Beginning at the boundary of the intimate zone and ending at the social zone B) Extending outward from the border to the public zone C) Surrounding and protecting an individual from others, especially outsiders D) The most distant boundary that can be used for recognizing intruders

: A Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 6 Page Number: 88, 89 Feedback: The four zones are intimate, personal, social, and public. The personal zone begins at the boundary of the intimate zone and ends at the social zone. The intimate zone varies widely in different cultures. The social zone begins at the end of the personal zone and ends at the public zone. The public zone begins at the end of the social zone and extends outward.

1. A client is talking to the nurse about the recent death of the client's grandmother. The client is sad and crying. The nurse remembers feeling sad when the nurse's own grandmother died the previous summer. The nurse puts a hand on the client's shoulder and says, "This must be very difficult for you." What indicates that the nurse is demonstrating empathy? A) The nurse's response reflects an attempt to communicate understanding of the client's feelings. B) The nurse's response and use of reassuring touch reinforce the nurse's concern for the client. C) The nurse demonstrates understanding of how the client feels because of her own grandmother's death. D) The nurse's statement expresses compassion and kindness toward the client.

: A Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Objective: 1 Page Number: 96, 97 Feedback: Empathy involves the nurse receiving information from the client with open, nonjudgmental acceptance. The nurse should communicate this understanding of the experience and feelings so the client feels understood. It is not necessary for the nurse to have had the same experience, but the nurse needs to imagine how having the experience feels to the client. Sympathy is the expression of compassion and kindness.

4. When engaged in a nontherapeutic relationship, which action would the nurse identify as occurring first? A) Failure to recognize the client as a person with a need B) Client avoiding the nurse C) The nurse being perceived as rude D) Client feeling hopeless and frustrated

: A Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 4 Page Number: 99, 100 Feedback: In a nontherapeutic relationship, the withholding phase occurs first, in which the nurse fails to recognize that the client is a person with an illness or health Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) needs. The client avoiding the nurse and the nurse being perceived as rude are characteristics of the avoiding and ignoring phase. Feelings of client hopelessness and frustration characterize the end phase of "struggling with and making sense of . . . ." Multiple Select

17. The nurse has been providing regular care to a client diagnosed with an anxiety-related disorder for the past 2 weeks. Which statement made by the nurse suggests a possible professional boundary issue? A) "I am going to rearrange my schelude today so we can spend more time talking." B) "We can meet at 2:30 PM today to practice stress management techniques." C) "It would be helpful if your family attended your next session with me." Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) D) "It is good to see you smiling today."

: A Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 97 Feedback: Maintaining professional boundaries may be more difficult in an ongoing therapeutic relationship. Indicators that the relationship may be moving outside of professional boundaries are gift giving on either party's part, providing the client with a personal phone number, or spending more time than usual with a particular client. None of the other options present with behaviors or attitudes that breech the criteria for professional boundaries. Multiple Select

19. A client accused the nurse of "really not caring" and has is now consistently 10 minutes late for sessions. To best perserve the nurse--client relationship, how should the nurse respond? A) The nurse continues to arrive for the session at the agreed upon time. B) The nurse tells the client, "I do care and I am surprised you think I do not." C) The nurse asks the client, "What can I do to prove I really do care about you?" D) The nurse reschedules the sessions to start 10 minutes later than originally agreed upon.

: A Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 98 Feedback: The first part of the orientation phase, also called the "honeymoon phase," is usually pleasant but the client usually begins to test the relationship to be convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late for appointments. Clients may also express anger at something a nurse says or may accuse the nurse of breaking confidentiality. If the nurse simply accepts the behavior and continues Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) to be available and consistent with the client, these behaviors usually subside. Testing needs to be understood as a normal way that human beings develop trust. Neither rescheduling the time of the sessions nor demonstrating such personal responses to the client's claim will help preserve the nurse--client relationship. Multiple Select

15. During a training session, a group of nurses are role-playing situations in order to practice using therapeutic communication techniques. Which would the nurses identify as verbal communication? A) Emotion underlying the words B) Gestures C) Body language D) Expressions

: A Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 2 Page Number: 82, 83 Feedback: Verbal communication, which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said. Nonverbal communication includes gestures, expressions, and body language. Multiple Select

17. A nurse is working with a client diagnosed with chronic depression. Which statement(s) made by the nurse demonstrates compliance with the basic principles of therapeutic communication? (Select all that apply.) A. "Our talks are confidential unless what you share poses a danger to you or someone else." B. "Tell me more about what you mean when you call your partner abusive." C. "I have been depressed before and found medication to be most helpful." D. "It is very hard to help you when you miss our sessions so often." E. "My divorce was the most painful thing I have ever experience."

: A, B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 4 Page Number: 82 Feedback: Principles of therapeutic communication include maintaining client confidentiality unless there is a danger present and clarifying information the client has presented. The focus on the interaction should be the client, not the personal feelings or experiences of the nurse. The nurse should avoid being judgmental about the client or the client's behavior. Multiple Choice

16. Which statement(s) made by a nurse whose family immigrated to the United States 4 years ago demonstrates an effective process of personal self-awareness? (Select all that apply.) A. "Living through the stress of adjusting to a new country has taught me patience and empathy." B. "I work very hard at seeing all my clients as individuals not members of a group." C. "I realize that not everyone is comfortable with my Muslim heritage." D. "Meditation is a very effective stress management technique." E. "Today's world is a difficult, stressful place to live."

: A, B, C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Culture and Spirituality Objective: 1 Page Number: 81 Feedback: "Self-awareness is the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations, and recognizing how they affect others. The options that focus on "I" and personal experiences are reflective of self-awareness while meditation and a stressful environment are more general in mature and not necessary based on an understanding of self. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

10. A nurse is preparing a presentation on therapeutic and nontherapeutic techniques of communication. The nurse should select which techniques to demonstrate as therapeutic? (Select all that apply.) A) Confrontation B) Open-ended statements C) Reflection D) Reassurance E) Agreement F) Challenges

: A, B, C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: 85, 86 Feedback: Therapeutic communication techniques include confrontation, open-ended statements, and reflection. Reassurance, agreement, and challenges are techniques that inhibit communication. Multiple Choice

8. Which item should the nurse discuss with the client about the clients' responsibilities during the first meeting? (Select all that apply.) A) Attendance is expected for each session. B) Participation is expected during each session. C) How to make-up sessions if they don't feel like attending meetings. D) If they feel anxious, they should take additional antianxiety medications. E) Should be able to focus on the topics and not interrupt others during the session.

: A, B, C Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 98 Feedback: The client is responsible for attending agreed-upon sessions, interacting during the sessions, and participating in the nurse--client relationship. The nurse should also explain clearly to the client meeting times, handling of missed sessions, and the estimated length of the relationship. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Multiple Choice

20. The nurse has been conducting a group for clients diagnosed with anxiety and depression. Which event(s) best demonstrates that a specific nurse--client relationship is experiencing mutual withdrawal? (Select all that apply.) A) The client consistently changes focus of the sessions' discussions. B) The nurse frequently shortens the length of the scheduled sessions. C) The client has family members plan visits during the time sessions are scheluded. D) The client reverts to "safe topics" rather than discuss issues previously identified as important. E) The nurse schedules sessions for late in the shift and frequently gets "too busy" and cancels.

: A, B, C, D, E Chapter 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 99 Feedback: In a nontherapeutic relationship, the nurse and client both feel very frustrated and eventually, the frustration becomes so great that the pair gives up on each other and moves onto a phase of mutual withdrawal. The nurse may schedule seeing this client at the end of the shift and "run out of time" so that the meeting never happens. The client will leave the unit, or otherwise be unavailable during scheduled meeting times. If a meeting does occur, the nurse will try to keep it short, thinking, "What is the point—we just cover the same old ground anyway." The client will attempt to keep it superficial and stay on safe topics. The client will attempt to find focus by frequently changing topics. When that is unsuccessful, the mutual withdrawal will likely occur. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Test Generator Questions, Chapter 10, The Psychiatric--Mental Health Nursing Process Multiple Choice

7. Which actions indicate that the relationship between nurse and client may be moving outside the professional boundaries? (Select all that apply.) A) Client brings the nurse a baked item for their lunch. B) Nurse is spending more time with the client than the others in the group. C) Nurse objectively listens and contributes to the team meeting about behaviors the client is displaying. D) Nurse tells a friend that the nurse is the only one that truly understands this client. E) Nurse informs their supervisor that the client asked the nurse to "keep a secret from the rest of the staff."

: A, B, D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 97 Feedback: Indicators that the relationship may be moving outside the professional boundaries are gift giving on either party's part, spending more time than usual with a particular client, strenuously defending or explaining the client's behavior in team meetings, the nurse feeling that he or she is the only one who truly understands the client, keeping secrets, or frequently thinking about the client outside of the work situation.

13.What actions usually occur during the middle phase of a deteriorating relationship? (Select all that apply.) A) The client trying to avoid the nurse. B) The nurse trying to smother the client with attention. C) The client begins to break as many rules as possible. D) The nurse ignores and avoids the client's requests for help. E) The client feels frustrated and hopeless.

: A, D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 100, 101 Feedback: The middle phase of a deteriorating relationship consists of two subphases: avoiding and ignoring. The client begins to avoid the nurse and perceives that the nurse is avoiding him or her. The client abides by the rules and because he or she does not want to cause problems. The nurse is perceived as rude and condescending. The nurse ignores and avoids the client's requests for help; in turn, the client becomes more anxious, frustrated, and fearful. The end phase is named struggling with and making sense of. In the final phase of a nontherapeutic the client feels hopeless and frustrated as a result of the lack of support received by the nurse.

20. When attempting to discuss the feelings associated with an impending divorce, a client begins crying after stating,"I will never be able to get over this failure." Which statement made by the nurse will most likely support the client's ability to adopt a more positive view of the divorce? A."I agree that you are never the same after a divorce." B. "Let's talk about what is making you feel so hopeless." C. "Many people experience these feelings; things will improve." D. "Let's talk about this later after you have a change to compose yourself."

: B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Objective: 3 Page Number: 87 Feedback: Talking about the feelings is appropriate and likely to encourage a positive change of view. Agreeing denies the client the opportunity to change his or her point of view, because it has been validated by the nurse. The nurse should not provide assurance that may not be attainable nor should attention to the client's needs be postponed. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Test Generator Questions, Chapter 9: The Nurse--Patient Relationship

19. Which nursing response would likely inhibit communication and be nontherapeutic in helping the client achieve treatment goals related to improving poor self-esteem? A. "I cannot promise things will improve, but I can assure you we are here to support you." B. "If you are serious about getting better you need to get a job and support yourself." C. "Life presents everyone with challenges that we need to work at overcoming." D. "All people have good qualities and you certainly have talents to be proud of."

: B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Objective: 4 Page Number: 87 Feedback: Ineffective communication techniques include giving advice that attempts to solve the individual's identified problem. The remaining options offer support and guidance and avoid making inappropriate assurances.

12.How might a client respond in a nontherapeutic relationship? A) Go to the supervisor and ask to be placed in another group. B) Get angry and start attacking the nurse. C) Leave the unit and not be available for the scheduled meeting. D) Ask the nurse to talk about her relationships outside of work.

: C Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 99 Feedback: In a nontherapeutic relationship, the nurse and client both feel very frustrated and keep varying their approach with each other in an attempt to establish a meaningful relationship. Eventually, the frustration becomes so great that the pair gives up on each other and moves to a phase of mutual withdrawal. The client will leave the unit or otherwise be unavailable during scheduled meeting times. If a meeting does occur, the nurse will try to keep it short, thinking, "What's the point—we just cover the same old ground anyway." The client will attempt to keep it superficial and stay on safe topics. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Multiple Select

14. A nurse is discussing defense mechanisms with a client. The nurse determines that the client understands the concept when the client makes what statement? A) "Most defense mechanisms are considered to be maladaptive, regardless of the situation." B) "Defense mechanisms help mediate a person's response to emotional conflicts and external stressors." C) "Use of defense mechanisms indicates that the person's mental state is dysfunctional." D) "Persistent use of defense mechanisms commonly enhances a person's quality of life."

: B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 7 Page Number: 89 Feedback: Defense mechanisms (also known as coping styles) are defined in the Diagnostic and Statistical Manual of Mental Disorders-5 as mechanisms that mediate the [client's] reaction to emotional conflicts and to external stressors. Some defense mechanisms (e.g., projection, splitting, acting out) are almost invariably maladaptive. Others (e.g., suppression, denial) may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur. While defense mechanisms might seem to indicate the existence of problematic mental state, this is not true. Healthy individuals in many different contexts use defense mechanisms. As with some other mental illnesses, the use of defense mechanisms becomes maladaptive when its persistent use reduces the client's quality of life. The degree to which a particular defense mechanism is maladaptive varies.

1. When engaged in therapeutic communication with a client who has a mental disorder, what is most important for the nurse to keep in mind? A) The nurse should self-disclose when indicated. B) The client is the primary focus of the interaction. C) The nurse should have an empathetic relationship with the client. D) The client's conversations should be recorded.

: B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 83 Feedback: A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with an open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

12. During an interview, a client tells the nurse that they were recently let go from their job. As the interaction continues, the client states, "I was really overqualified for that position anyway. It was definitely below my area of expertise." The nurse interprets this information as reflecting which mechanism? A) Denial B) Intellectualization C) Projection D) Passive aggression

: B Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 90 Feedback: The client is attempting to use abstract thinking or make generalizations to control or minimize his feelings associated with the loss of his job. Refusing to acknowledge the painful aspect—for example, "I really didn't want that job"—would reflect denial. With projection, an individual falsely attributes to another person his or her own acceptable feelings, thoughts, or impulses. Passive aggression reflects a façade of overt compliance that masks covert resistance, resentment, or hostility. Multiple Select

9. A nurse responds to a client's statement with silence, because the nurse knows that this technique is used primarily for what reason? A) To allow the nurse to determine an appropriate response B) To permit the client to gather his or her thoughts C) To encourage self-reflection by the nurse D) To demonstrate passive listening

: B Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 86 Feedback: By maintaining silence, the nurse allows the client to gather his or her thoughts and to proceed at his or her own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed on allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process. Multiple Select

13. A nurse is engaged in active listening. Which techniques would the nurse use? (Select all that apply.) A) Changing the subject to gather more information B) Responding indirectly to statements C) Using open-ended statements D) Concentrating on what the client says E) Allowing the client to talk as he wishes

: B, C, D Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 85 Feedback: Through active listening, the nurse focuses on what the client is saying to Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) interpret and respond to the message objectively. While listening, the nurse concentrates only on what the client is saying and on the underlying meaning. The nurse usually responds indirectly, using techniques such as open-ended statements, reflection, and questions that elicit additional responses from the client. Changing the subject is avoided. Allowing the client to talk as he wishes reflects passive listening, which does not foster a therapeutic relationship. Multiple Choice

18. The nurse is providing care for a group of clients diagnosed with and being treated for anxiety and depression. Which nursing statement(s) identifies an action associated with the orientation phase of the nurse--client relationship? (Select all that apply.) A) "Today we will spend time working on relaxation techniques." B) "We will meet each Monday and Wednesday at 11:30 AM for 45 minutes." C) "Our main goal is to discuss the things that tend to trigger your symptoms." D) "So you feel that your relationship with your siblings causes your depression." E) "I am the nurse who will be working with you; please come to me with your concerns."

: B, C, E Chapter: 9 Client Needs: Psychosocial Integrity Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 97 Feedback: The orientation phase begins when the nurse and patient meet and ends when the patient begins to identify problems to be examined. Introductions, expectations, and rapport building are focused on during this phase. Discussion and work on specific client issues occur in the working phase of the relationship. Multiple Choice

18. Which component of a conversation between the nurse and a client being prepared for surgery is the best example of decoding and validation of the message? A. The nurse asks, "Is there anything I can get for you?" B. The client states, "I am OK; I do not need anything." C. The nurse responds to the client, "While you say everything is alright, you seem anxious." D. The client responds to the nurse, "Maybe a little; I have never had any kind of surgery before." Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

: C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Objective: 2 Page Number: 83 Feedback: The client formulates an idea, encodes that message (puts ideas into words), and then transmits the message with emotion. The client's words and their underlying emotional tone and connotation communicate the individual's needs and emotional problems. The nurse receives the message, decodes it (interprets the message, including its feelings, connotation, and context), and then responds to the client. Validation is essential to ensure that the nurse has received the information accurately. While offering or declining services involves addressing needs neither option demonstrates validation as effectively as further exploring the verbal and nonverbal responses of the client. The client's response to the nurse's inquiry regarding anxiety does not demonstrate validation effectively, because the client minimizes the anxiety.

4. A psychiatric client is talking to the nurse about why they are hospitalized. The client begins to discuss their relationship with their same-sex partner. The client describes the things in their relationship that cause discomfort, and the client asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse? A) "Of course you should; being gay is just not natural." B) "Yes, I think you should pursue building a relationship with someone of the opposite sex." C) "It sounds like you're beginning to be uncomfortable in this relationship." D) "You need to focus on yourself rather than the relationship right now."

: C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Caring Objective: 4 Page Number: 82 Feedback: Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. The response about the relationship becoming uncomfortable reflects both a nonjudgmental attitude and understanding. Telling the client that being gay is unnatural, or telling the client to pursue a relationship with someone of the opposite sex, reflects the nurse's beliefs, gives advice, and is judgmental. Telling the client to focus on themselves ignores the client's Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) concern.

6. While providing care to a client with a mental disorder, the client asks the nurse, "Does mental illness run in your family?" Which response by the nurse would be most inappropriate? A) "Mental illnesses do run in families, and I've had a lot of experience caring for people with mental illness." B) "It sounds like you are concerned that there may be a family connection to your current problem?" C) "Yes, it does. I have a sister who was diagnosed several years ago with severe major depression." D) "Mental illness can be family related. Let's focus the discussion on you and how you're doing today."

: C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 84 Feedback: The statement about the nurse's sister suffering from depression is inappropriate because it involves self-disclosure that serves no therapeutic purpose. In addition, it ignores the underlying concern of the client's statement---mental illnesses and family. The statements about having experience dealing with mental illnesses, sounding concerned about a family connection, and focusing the discussion on the client serve to redirect the interaction back to the client. Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

7. A nurse is providing training to a new nurse on the team and is describing the nurse-client relationship. What does the nurse emphasize as being crucial for establishing and maintaining the relationship? A) Rapport B) Empathy C) Self-awareness D) Values

: C Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: 81, 82 Feedback: Self-awareness is crucial for the nurse-client relationship. Without it, nurses will find it impossible to establish and maintain therapeutic relationships with clients. Although rapport and empathy are important considerations for the nurse- client relationship, self-awareness is key. Values are inherent in the nurse and the nurse must be self-aware of his or her own values.

11. When communicating with a client, how should the nurse convey positive body language? A) Sit erect with back against the chair B) Cross the arms over the chest C) Sit at the client's eye level D) Keep the feet on the floor with the legs crossed

: C Chapter: 8 Client Needs: Psychosocial Integrity Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 84 Feedback: Positive body language includes sitting at the same eye level as the client with a relaxed posture, leaning slightly forward with the arms and legs uncrossed.

9. Which response would be considered "usual or expected" during the first few sessions? A) Showing up late for the first session. B) Being confrontational with nurse and other group members. C) Rambling due to nervousness. D) Bragging about sexual conquests.

: C Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 98 Feedback: The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

2. The nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information is most important for the nurse to obtain about the client? A) Known allergies B) Recent hospitalizations C) Perception of the problem D) Family history

: C Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files) Objective: 3 Page Number: 97, 98 Feedback: Although information about allergies, hospitalizations, and family history are important in the orientation phase, it is most important for the nurse to ask the client with a mental disorder about the nature of the problem from the client's perspective. Some clients deny that a problem exists; other clients may have misperceptions about the problem.

11. During the termination phase, a client begins to raise old problems that have already been resolved. What are the most appropriate responses by the nurse? (Select all that apply.) A) Immediately stop the client and inform them that the nurse is running the session. B) Get angry at the client and ask them to leave the session. C) Reassure the client that they already covered these issues. D) Review with the client the learned methods to control the problems. E) Do not acknowledge this issue and continue on with the session as planned.

: C, D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 99 Feedback: A typical termination behavior is raising old problems that have already been resolved. The nurse may feel frustrated if clients in the termination phase present resolved problems as if they were new. The clients are attempting to prolong the relationship and avoid its ending. Nurses should avoid addressing these problems. Instead, they should reassure clients that they already covered those issues and learned methods to control them. Multiple Choice

16. The nurse is providing care to a client who recently lost a long-time domestic partner. Which statement best demonstrates the nurse's desire to develop empathy with the client? A) "I am so sorry to hear about the terrible loss of your parner." B) "Please let me know what I can do to help with the loss of your partner." C) "Losing a partner must be the most difficult things you have ever experienced." D) "Please talk with me about how losing your partner has affected you personally."

: D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 2 Page Number: 97, 98 Feedback: Empathy is the ability to experience, in the present, a situation as another did at some time in the past. The nurse does not actually need to have had the experience for oneself but must be able to imagine the feelings associated with it. For empathy to develop, there must be a "giving of self" to the other individual, demonstrated by the request to talk about how the loss of a partner has affected the client. Expressing sorrow is a demonstration of sympathy not empathy. The nurse should not assume how the loss has affected the client. Offering help is appropriate but does not suggest a true interest in the client's feelings as does the asking the client to discuss those feelings.

3. 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 toward which to work. The nurse interprets the client's action as indicating what feeling in the client? A) Anger that the nurse is abandoning him B) Wish for additional therapy C) Belief that the therapy was ineffective D) Wish to prolong the nurse-client relationship

: D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 3 Page Number: 99 Feedback: It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed, or that the therapy was ineffective.

10. Which behavior would be considered a "testing behavior" that usually happens during the "honeymoon phase" of the relationship? A) Talking nonstop and monopolizing the conversation. B) Sitting away from the group and not participating in the discussion. C) Accusing the nurse of being too controlling during the session. D) Expressing anger and accusing the nurse of breaking confidentiality.

: D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 98 Feedback: This first part of the orientation phase, called the "honeymoon phase," is usually pleasant. However, the therapeutic team typically hits rough spots before completing this phase. The client begins to test the relationship to become convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late. Clients may also express anger at something a nurse says or accuse the nurse of breaking confidentiality. Multiple Select Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

15. Which statement best reflects measures to address public stigma? A) "The client with schizophrenia needs additional assistance." B) "The bipolar in room 222 is really out of control today." C) "That client down the hall is a raving maniac." D) "That hyperactive client is acting like a psycho."

A Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 4 Feedback: One way to reduce public stigma is to use nonstigmatizing language. Rather than referring to the client as schizophrenic or bipolar, it is more appropriate to say "the client with schizophrenia" or "the client with bipolar disorder." Terms such as maniac and psycho reinforce the negative images of mental illness.

19. Which of the following would be used to document a specific pattern of symptoms that occurs within a community? A) Cultural syndrome B) Stigma C) Wellness D) Stereotype

A Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 3 Feedback: A cultural syndrome refers to a specific pattern of symptoms that occurs within a specific cultural group or community. Stigma refers to a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others. Wellness is a purposeful process of individual growth, integration of experience, and meaningful connection with others. It reflects personally valued goals and strengths, and results in being well and living by values. Multiple Select

1. As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? Epidemiology: A) Helps promote understanding of the patterns of occurrence associated with mental disorders. B) Helps explain research findings about the neurophysiology that causes mental disorders. C) Provides a thorough theoretical explanation of why specific mental disorders occur. D) Predicts when a specific psychiatric client will recover from a specific mental disorder.

A Chapter: 1 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: 2 Feedback: Epidemiology is the study of patterns of disease distribution and determinants of health within populations. It contributes to the overall understanding of the mental health status of population groups, or aggregates, and it examines the associations among possible factors. Epidemiology does not explain research findings about neurophysiology, provide theoretical explanations for why specific disorders occur, or predict recovery.

19. A nurse is reading a journal article about anger and violence. Which condition does the nurse expect to see as being linked to excessive, outwardly directed anger? A) Myocardial infarction B) Hypertension C) Arthritis D) Chronic pain

A Chapter: 14 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 193 Feedback: Maladaptive anger (excessive, outwardly directed anger or suppressed anger) is linked to psychiatric conditions, such as depression (Perugi, Fornaro, & Akiskal, 2011), as well as a plethora of medical conditions. For example, excessive, outwardly directed anger is linked to coronary heart disease (Ketterer et al., 2011) and myocardial infarction (Mostofsky, Maclure, Tofler, Muller, & Mittleman, 2013). Suppressed anger is related to arthritis, breast and colorectal cancer, chronic pain, and hypertension (Burns, Quartana, & Bruehl, 2011; Thomas, 2009). Furthermore, suppressed anger was a predictor of early mortality for both men and women in a large 17-year study (Potpara & Lip, 2011). Multiple Select

15. A nurse is leading an anger management group in the inpatient program. A client says, "I'm feeling really tense, and I'm fidgety today." What is the nurse's most appropriate response to the client's comment? A) Explore what is underlying the client's physical and emotional state B) Encourage the client to engage in a relaxation exercise prior to joining the group the the rest of the session C) Ask the client if the client feels triggered by another client in the group D) Ask another client in the group to respond to the client's comment

A Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 5 Page Number: 195 Feedback: Identifying the feelings reduces the frustration. Attempt to discover the concern and respond with empathy, interest, and willingness to help. Encourage the client to describe and clarify the client's experience using open-ended questions to increase the client's awareness of problematic feelings and what triggers them.

8. A group of new graduate nurses is reviewing information about maladaptive anger. The nurses demonstrate a need for additional review when they identify which physical condition as being linked to suppressed anger? A) Coronary heart disease B) Arthritis C) Hypertension D) Breast cancer

A Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 1 Page Number: 193 Feedback: Suppressed anger is related to arthritis, breast and colorectal cancer, and hypertension. Excessive, outwardly directed anger is linked to coronary heart disease, reduced left ventricular ejection fraction, and myocardial infarction.

16. While talking with a client who has been experiencing aggression and intense anger, the nurse identifies that the client feels isolated and anxious. Which statement by the nurse is most appropriate? A) "This must be scary for you." B) "Once you relax, things will improve." C) "I really understand how you feel."" D) "If you calm down, I can help you."

A Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 7 Page Number: 201 Feedback: The most appropriate response would be to acknowledge and validate the client's feelings, perhaps by stating that this must be scary for him. In doing so, the nurse helps the client feel understood and supported. The statements about relaxing and calming down do not address the client's underlying feelings. Telling the client that the nurse really understands is nontherapeutic because only the client can truly know what he or she is feeling.

17. An advanced practice psychiatric nurse is preparing to conduct a support group for psychiatric-mental health nurses who have been assaulted by clients. Which of the following would the nurse need to keep in mind with this group? A) Nurses experience a conflict between the role of caregiver and victim. B) Nurses who are victims often go on to prosecute the client attackers. C) Nurses actively express the feelings associated with client assaults. D) Nurses as victims of client assaults rarely experience guilt or shame.

A Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: 204 Feedback: Because of their role as caregivers, nurses may suppress the normal range of feelings after an assault, believing that it is wrong to experience strong feelings of anger and fear in this situation. This belief may relate to the conflict nurses experience in having to care for clients who have hurt them. The conflict is between one's professional role as a caregiver and one's own needs as an assault victim. Nurses seldom prosecute their attackers. Feelings of guilt and shame are common.

1. The nurse is planning a presentation to a community group on the topic of anxiety disorders. Which statement would the nurse include when describing panic disorder? A) Individuals may believe they are having a heart attack when a panic attack occurs. B) People with panic attacks often have fewer attacks if they also have agoraphobia. C) Typically, individuals experience this disorder after the age of 30 years. D) Persons rarely have an underlying comorbid condition of depression.

A Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 261, 262 Feedback: Clients diagnosed with a panic disorder may believe they are having a heart attack when a panic attack occurs. Panic disorder peaks during the teenage years and does not usually manifest after the age of 30 years. Individuals with panic disorder (with or without agoraphobia) experience recurrent and unexpected panic attacks.

6. A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, "I'm so nervous. My hands are shaking, and I'm sweating. I feel as if I'm having a stroke right now." What would be the priority intervention at this time? A) Stay with the client while remaining calm B) Move the client to a safe environment C) Tell the client that the attack will soon pass D) Teach the client deep breathing techniques to calm her

A Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 276 Feedback: The first nursing intervention should be to stay with the client while remaining calm. A calm presence will help to relax the client. The nurse should use short sentences to provide clear directions and then assist the client to an environment with minimal stimuli. The client experiencing panic is unable to process information, so telling the client that the attack will soon pass would be ineffective. Educating the client on deep breathing techniques would be appropriate later, after the panic subsides and the client is amenable to hearing and processing information.

16.When explaining behavioral sensitization to a group of nursing students in their mental health rotation, the best explanation would be: A) With repeated re-experiencing of the traumatic event, PTSD symptoms become more easily triggered with time. B) After combat exposure the client has little or no reaction when a car backfires on the road. C) The sensitized person will no longer react to later, milder stressors similar to their initial exposure. D) The symptoms associated to the stressor will correlate to a decrease in dopamine activity.

A Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 286 Feedback: Behavioral sensitization may be one mechanism underlying the hyperarousal seen in PTSD. This phenomenon, sometimes referred to as kindling, occurs after exposure to severe, uncontrollable stressors. The sensitized person reacts with a magnified stress response to later, milder stressors. Research shows that traumatic exposure can alter neurotransmitter connectivity in the frontal areas resulting in severe reaction to a minor stressor. This finding would account for the fact that some individuals with PTSD experience intense fear, anxiety, and panic in response to minor stimuli. One example of behavioral sensitization is that PTSD after combat exposure is more likely to develop in veterans who are survivors of childhood abuse than in those who have not experienced prior trauma.

7. While providing in-serve training on the psychodynamic theory behind OCD symptoms, the nurse mentions reaction formation. Which statement is characteristic of this theory? A) When parents are too harsh during potty training, the child may feel dirty and ashamed. Then the child may deliberately soil his or her clothes as an act of rebellion. B) Fear in individuals with OCD will trigger a fear associated with unwashed hands that are very unlikely to cause real harm. However, they keep washing their hands frequently. C) Compulsions are rewarded by immediate reduction of distress or anxiety. Clients carrying out the compulsive rituals but never get to test out their faulty thinking that there is not a dire consequence if they make a mistake. D) Clients report their symptoms. Such report is retrospective and so may not be accurately recalled and yields subjective data vulnerable to bias and distortion.

A Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: 300 Feedback: The psychodynamic theory hypothesizes that OCD symptoms and character traits arise from three unconscious defense mechanisms: isolation, undoing and reaction formation. The answer is an example of reaction formation (behavior and consciously stated attitudes that oppose underlying impulses). Distractors B and C are based on behavioral explanation, while distractor D is based on cognitive theory. Multiple Select

6. What symptoms might parents notice in their child who is exhibiting obsessive-- compulsive disorder (OCD)? A) Is failing classes due to lack of concentration B) Spending excessive amount of time in their room C) Frequently "stares off into space" D) Is jittery and nervous all the time

A Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 298 Feedback: Because children subscribe to myths, superstition, and magical thinking, obsessive and ritualistic behaviors may go unnoticed. Behaviors such as touching every third tree, avoiding cracks in the sidewalk, or consistently verbalizing fears of losing a parent in an accident may have some underlying pathology but are common behaviors in childhood. Typically, parents notice that a child's grades begin to fall as a result of decreased concentration and great amounts of time spent performing rituals. Isolating themselves, staring off into space, and being nervous could be considered normal behavior at certain developmental ages.

8. A psychiatrist informs a client that they think the client needs to participate in a three-month outpatient aftercare program after discharge. What would protect the client's right to request a second opinion before agreeing to this suggestion? A) Self-determinism B) Least restrictive environment C) Confidentiality D) Mandates to inform

A Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 17, 18 Feedback: The right of self-determination entitles all clients to refuse treatment, to obtain other opinions, and to choose other forms of treatment. It is one of the basic clients' rights established by Title II, Public Law 99-139, outlining the Universal Bill of Rights for Mental Health Patients. Least restrictive environment means that an individual cannot be restricted to an institution when he or she can be successfully treated in the community. Confidentiality is an ethical duty of nondisclosure. "Mandates to inform" is a term referring to the legal obligation to breach confidentiality when there is a judgment that the client has harmed, or is about to injure, another person.

3. A client receives a court order for commitment. Which best exemplifies the concept of "least restrictive environment"? A) Involuntary commitment to an outpatient community mental health center B) Medication administration for sedation so the client cannot get out of bed C) Placing the client in a locked padded room in response to threats of self-harm D) Restraining the client with the fewest number of restraint points possible

A Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 20 Feedback: An example of the concept of "least restrictive environment" is involuntary commitment of a client to an outpatient mental health center. Medications cannot be given unnecessarily, such as to keep a client in bed. An individual cannot be restrained or locked in a room unless all other "less restrictive" interventions are attempted first. Although clients should be physically restrained with the fewest restraint points possible, there is no indication that this client requires restraint. Physical restraints should be applied only after all other interventions have been used and the client continues to be a danger to self or others.

14. A nurse is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? A) Part of personal life not governed by society's laws B) Ethical duty for nondisclosure C) Involvement of two individuals D) Knowledge of treatment costs and benefits

A Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 5 Page Number: 22 Feedback: Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality refers to an ethical duty of nondisclosure. Confidentiality also involves two people: the individual who discloses the information, and the person with whom the information is shared. Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment.

1. A nurse is explaining advance care directives, or "living wills," to a client and the client's spouse. Which statement would the nurse include in the description? A) The document tells what treatment is to be omitted if the client is unable to make the decision. B) It requires that the client sign the "living will" document while an attorney is present. C) The client's physician must act as a witness when the client signs the document. D) An attorney draws up the papers to be given to the client and his or her family.

A Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 1 Page Number: 17 Feedback: Advance care directives, or "living wills," state what treatment should be omitted or refused if the client is unable to make those decisions. An advance care directive requires two witnesses and notarization but does not require an attorney.

15. A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, "I stopped taking the alprazolam about two days ago. I was feeling really sleepy and tired." Which symptom would alert the nurse to suspect possible withdrawal? (Select all that apply.) A) Apprehension B) Irritability C) Dry, flushed skin D) Weight gain E) Muscle flaccidity

A, B Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 5 Page Number: 273 Feedback: Symptoms associated with withdrawal of benzodiazepine therapy are more likely to occur after high doses and long-term therapy. They can also occur after short-term therapy. Withdrawal symptoms manifest in several ways, including psychological (apprehension, irritability, agitation). Multiple Choice

20.If a client is experiencing "moderate" anxiety, which clinical manifestations will the nurse observe? (Select all that apply.) A) Can sustain attention on a particular focus. B) Verbally states, "For some reason, I am feeling anxious now." C) Flights of ideas and confusion noted. D) Because of inadequacy of observed data, they make distorted inferences. E) May pace, run, or fight violently if asked to perform a task they do not want to perform.

A, B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: 258 Feedback: With "moderate" anxiety, the client sees, hears, and grasps less than previously. The client can attend to more if directed to do so. They are able to sustain attention on a particular focus; selectively inattentive to contents outside the focal area. Usually able to state, "I am anxious now." With severe anxiety, Inferences drawn may be distorted because of inadequacy of observed data. With panic, the client has feelings of unreality, flights of ideas or confusion, and fear. They often repeat a detail. Many relief behaviors used automatically (without thought). The enormous energy produced by panic must be used and may be mobilized as rage. May pace, run, or fight violently. Test Generator Questions, Chapter 19, Trauma- and Stressor- Related Disorders: Nursing Care of Persons With Posttraumatic Stress and Other Trauma-Related Disorders Multiple Select

8. When the client with extremely severe OCD is no longer responding to intensive drug therapy or behavioral therapy, what other treatment options should the nurse prepare to educate the client/family about? (Select all that apply.) A) Stereotactic surgical procedures B) Deep brain stimulation with electrical current C) Biofeedback techniques D) Service and companion dogs E) Hypnotherapy

A, B Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 5 Page Number: 302 Feedback: Psychosurgery is sometimes used to treat extremely severe OCD that has not responded to prolonged and intensive drug treatment, behavioral therapy, or a combination of the two. Modern stereotactic surgical techniques that produce lesions of the cingulum bundle (a bundle of connective tissue) or anterior limb of the internal capsule (a region near the thalamus and part of the circuit connecting to the cortex) may bring about substantial clinical benefit in some individuals without causing significant morbidity. Other treatment options include radiotherapy and deep brain stimulation in which electrical current is applied through an electrode inserted into the brain. Biofeedback is helpful when relaxation is needed. Service animals and hypnotherapy are useful treatments for clients with PTSD. Multiple Choice

20. A client diagnosed with posttraumatic stress disorder (PTSD) has been encouraged to engage in exposure therapy. What education should the nurse provide to help the client prepare to effectively engage in this treatment? (Select all that apply.) A) Therapy will help you face and control fear by controlled expose to the trauma. B) Physically revisiting the site where the traumatic event will be helpful for you, when possible. C) Writing down or journaling the details of the trauma will be therapuetic. D) Therapy will teach how trauma has changed personally held thoughts and beliefs. E) Therapy will help you reframe the traumatic experience in a more realistic manner.

A, B, C Chapter: 19 Client Needs: Psychological Integrity Cognitive Level: Understand Client Needs: Psychological Integrity Integrated Process: Teaching/Learning Objective: 8 Page Number: 287 Feedback: Psychotherapeutic approaches to the treatment of clients with posttraumatic stress disorder include exposure therapy, which helps people face and control their fear by exposing them to the trauma in a safe way. Strategies include mental imagery, writing, or visits to the place where the event happened. Cognitive restructuring helps people make sense of the bad memories by reframing their experiences in a more realistic way. Cognitive processing therapy helps people understand how traumatic experiences changed thoughts and beliefs and influenced current feelings and behaviors. Test Generator Questions, Chapter 20, Obsessive--Compulsive and Related Disorders: Nursing Care of Persons With Obsessions and Compulsions Multiple Choice

5. When presenting about PTSD to a community group, the nurse gives examples of traumatic events that may precede PTSD. Which events does the nurse include? (Select all that apply.) A) Personal assault by a family member B) Military combat mission where there were casualties C) Surviving an EF 4 tornado D) Falling off a playground swing E) Urinary incontinence due to prolapsed bladder

A, B, C Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 284 Feedback: Examples of traumatic events are violent personal assault, rape, military combat, natural disasters, terrorist attacks, being taken hostage, incarceration as a prisoner of war, torture, an automobile accident, or being diagnosed with a life- threatening illness. Falling off a swing is not necessarily a trauma, but a typical accident common among children. Prolapsed bladder is not a traumatic event and can be easily corrected with various surgical procedures. Multiple Choice

14. After working with a client who has a history of violent behavior to identify possible clues that suggest the behavior is escalating, the nurse and client develop a plan for prevention. Which strategies will the nurse be most likely to include? (Select all that apply.) A) Counting to 10 B) Taking slow, deep breaths C) Playing loud music D) Taking a voluntary time out

A, B, D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 8 Page Number: 202 Feedback: Turning up the music loudly would add additional stimulation, which could contribute to increasing the stress and stimulation of the situation. Rather, the suggestion would be to listen to quiet music or read. Counting to 10, taking slow deep breaths, and taking a voluntary time out would be appropriate. Multiple Choice

20. A teen has been diagnosed with body dysmorphic disorder (BDD). Which assessment question(s) demonstrates the nurse's effective understanding of comorbid coexisting psychiatric disorders associated with this disorder? (Select all that apply.) A) "Do you generally feel hopeful about your life?" B) "Would you consider yourself to be more anxious than your friends?" C) "Do you ever find yourself thinking about or planning to end your life?" D) "How do you handle yourself when someone or something makes you angry?" E) "Would you say that you rely a lot on rituals to help manage fears or anxiety?"

A, B, C Chapter: 20 Client Needs: Psychological Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 6 Page Number: 307 Feedback: Individuals with BDD focus on real (but slight) or imagined defects in appearance. Preoccupation with the perceived defect causes significant distress and interferes with the ability to function socially. These clients feel so self-conscious that they avoid work or public situations, which can significantly impair an individual's quality of life. Sixty percent of the clients with BDD also have an anxiety disorder and the risk of depression, suicide ideation, and suicide is high. While anxiety is a factor, obsessive-compulsive rituals are not generally associated with BDD. A client may present with anger management problems, but this is not generally considered to be related to BDD. Stuvia.com

16. A client has been diagnosed with OCD. While further assessing this individual, the nurse should be aware of which of the other mental health disorders that may be associated with OCD? (Select all that apply.) A) Depression B) Bipolar disease C) Mood disorder D) Schizophrenia E) Psychosis

A, B, C Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 299 Feedback: It is estimated that one third of persons with OCD experience depression because of OCD's effects on their lifestyle. Bipolar, cyclothymic, panic, mood, eating, and impulse control disorders also commonly occur in those with OCD. A significant number of older depressed persons have OCD. Schizophrenia and psychosis are not comorbidities for OCD. Multiple Choice

20. A psychiatric-mental health nurse is preparing a presentation about recovery for a group of newly hired nurses at the mental health facility. Which would the nurse identify as important concepts? (Select all that apply.) A) Self-direction B) Peer support C) Respect D) Hope E) Culturally-based

A, B, C, D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 6 Page Number: 5 Feedback: Recovery is multifactorial. It encompasses self-direction, peer support, and respect as fundamental components for recovery; hope-the catalyst of the recovery process-is one of the most important concepts. It is through hope that individuals and families can overcome the barriers and obstacles facing them. Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are key in determining a person's journey and unique pathway to recovery.

19. Which statement(s) made by the parent of a minor diagnosed with acute depression, indicates an understanding of self-determination applicable for their child? (Select all that apply.) A) "We will stop treatment if we think it is not working." B) "What kinds of appropriate outpatient treatment is available?" C) "We would like a second opinon before agreeing on a voluntary admission." D) "What is likely to happen if we decide not to agree to medication therapy?" E) "It is important that the hospitalization is over by the beginning of the school year."

A, B, C, D Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 1 Page Number: 26 Feedback: The right of self-determination entitles all clients to refuse treatment, to obtain other opinions, and to choose other forms of treatment. It is one of the basic clients' rights established by Title II, Public Law 99-139, outlining the Universal Bill of Rights for Mental Health Patients. The decisions regarding the length of necessary treatment are up to the treatment team, the client/guardians may refuse treatment if they disagree.

20. When assessing a client's anger, which element is important for the nurse to determine? (Select all that apply.) A) How the person expresses the anger B) Problems at work due to the anger C) Frequency of the anger episodes D) Evidence of coping techniques E) The intensity of the anger, outwardly or inwardly

A, B, C, D, E Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Nursing Process Objective: 8 Page Number: 195 Feedback: The manner of anger expression is not the only important aspect of assessment. The difficulty in regulating the frequency and intensity of anger must also be assessed, along with the extent to which anger is creating problems in work or intimate relationships. The nurse should also assess for the presence or absence of coping techniques such as calming or diffusion through vigorous exercise.

2. A client is admitted to the inpatient adult psychology unit with posttraumatic stress disorder (PTSD). During the assessment, what events would the nurse consider to be causes of psychological trauma? (Select all that apply.) A) Experienced abuse from a former partner. B) Was raped while walking home from work one evening. C) Lost their mother with whom they had very close to relationship. D) Had a car accident where they suffered head trauma. E) Regularly cuts their wrists as a form of self-inflected trauma.

A, B, C, D, E Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 282, 283 Feedback: Harassment, embarrassment, child abuse, sexual abuse, employment discrimination, police brutality, bullying, and domestic violence are examples of events that can lead to psychological trauma. Family violence, loss of family members, acts of terrorism and natural disasters are all traumatic events. Physical trauma may result from bodily injury resulting from an accident, self-inflicted damage, or violence perpetrated by others. Automobile accidents are a major threat to adolescents. Self-inflicted physical trauma is often associated with mental disorders.

16. The nurse should understand which element is required to prove negligence? (Select all that apply.) A) Duty to provide care B) Proximate cause C) Resultant damages D) Breach of duty E) Cause in fact F) Evidence of simple mistake

A, B, C, D, E Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Understand Integrated Process: Nursing Process Objective: 2 Page Number: 25 Feedback: Five elements are required to prove negligence: duty, breach of duty, cause in fact, cause in proximity, and damages. Simple mistakes are not negligent acts. Multiple Choice

20. The nurse is providing educational information to a client prescribed medication therapy for the treatment of severe depression. Which statement(s) made by the nurse demonstrates an understanding of the client's right to provide informed consent? (Select all that apply.) A) "I would really prefer to take my daily doses of medication around meal time." B) "This medication can make me dizzy so I need to get up slowly from a sitting position." C) "Let's discuss which type of antidepressant I think my provider should prescribe for me." D) "I should not stop taking my medication without first talking to my health care provider." E) "It may take several weeks of taking the medication in order to notice any positive changes."

A, B, D, E Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 19 Feedback: A client who is competent to give informed consent should be able to achieve the following: communicate choices, understand relevant information, and appreciate the situation and its consequences. In this situation, deciding the appropriateness of a particular class of antidepressant is a medical decision not a client decision.

13. A unit in an inpatient psychiatric facility is experiencing an increase in violence episodes by clients. A group of nurses working on this unit is developing a plan to address this issue. When developing this plan, which problem areas are the nurses most likely to address? (Select all that apply.) A) Inconsistent unit activities B) Medication power struggles C) Empathetic staff response D) Clearly set boundaries E) Little client participation in treatment plan

A, B, E Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3, 5 Page Number: 200 Feedback: Areas that may contribute to violence in inpatient units include a lack of meaningful and predictable ward activities, power struggles related to medications, failure of the staff to listen or be empathetic, boundary violations, and a lack of client control over treatment plan.

18. To promote sleep hygiene, the nurse should encourage the PTSD client to incorporate which strategies into their routine? (Select all that apply.) A) Go to bed at a regular time nightly B) Sleep in during the mornings when one had a restless night of sleep C) Avoid drinking alcohol D) Enjoy a cup of caffeinated tea in the mid-afternoon if one gets sleepy E) Exercise within 2 hours of bedtime will make you tired and you will fall to sleep faster

A, C Chapter: 19 Client Needs: Physiological Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 7 Page Number: 291 Feedback: Some persons with PTSD find that they cannot sleep in their bed, but can sleep in a chair. Some of the following strategies may be helpful: (1) Establish and maintain a regular bedtime and rising time; (2) Avoid naps; (3) Abstain from alcohol. Although alcohol may assist with sleep onset, an alerting effect occurs when it wears off; (4) Refrain from caffeine after midafternoon. Avoid nicotine before bedtime and during the night. Caffeine and nicotine are strong stimulants and cause fragmented sleep; and, (5) Exercise regularly, avoiding the 3 hours before bedtime.

3. Which statement is accurate with regard to resilience in clients who have experienced PTSD? (Select all that apply.) A) The stronger the resilience, the less likely the person will develop maladaptive behaviors. B) When one is feeling out of control in one's life, resilience is no longer possible. C) As positive self-concept increases, resilience will also increase over time. D) Everyone who experiences a traumatic event can develop resilience. E) Only those with supportive family can develop resilience.

A, C Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 283 Feedback: The stronger the resilience, the less likely the individual will experience reactions that lead to maladaptive behaviors and outcomes. An important mental health promotion nursing strategy is enhancing resilience, especially for persons with mental and/or substance abuse problems. Resilience develops in association with a positive self-concept and self-worth, a feeling of being in control of one's life, and a feeling of power. Resilience is acquired over time, Positive family and community support also play a role in developing resilience. Multiple Choice

7. In PTSD, which signs/symptoms could be classified as intrusive? (Select all that apply.) A) When the client re-experiences a traumatic image B) No longer dream during REM sleep C) Have feelings that the event is reoccurring D) Complain of excessive sleeping, usually 12 hours/day or more E) Feel like they are suspended in outer space and can't find their way home

A, C Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 284 Feedback: Often the intrusive thoughts are associated with cues that symbolize or resemble the original event. Sometimes, the traumatic images, thoughts, or perceptions are re-experienced. Nightmares are common. Intrusive symptoms also include dissociative reactions (i.e., feeling or acting as if the event is reoccurring). Sleeping is difficult. Terrifying flashbacks and nightmares often include fragments of traumatic events exactly as they happened. Multiple Choice

10. A nursing instructor is preparing a class discussion on the topic of self-determinism. Which would the instructor expect to include? (Select all that apply.) A) Personal autonomy as a key value B) Choices based on pleasing others C) Activities reflect personal goals D) Right to refuse treatment E) Lack of empowerment

A, C, D Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 1 Page Number: 16, 17 Feedback: Self-determinism is defined as being empowered or having the free will to make moral judgments. Personal autonomy and avoidance of dependence are key values. A self-determined individual is internally motivated to make choices based on personal goals, not to please others or be rewarded. It is the right to choose one's own health-related behaviors and refuse treatment. Multiple Choice

2. A client is diagnosed with obsessive--compulsive disorder (OCD) and is to receive medication therapy. Which of agents might the nurse expect to be prescribed? (Select all that apply.) A) Clomipramine B) Lithium C) Sertraline D) Fluvoxamine E) Paroxetine F) Alprazolam

A, C, D, E Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 303, 304, 307 Feedback: The SSRIs and TCAs are considered to be the most effective treatment agents used for OCD. Clomipramine was the first drug to produce significant advances in treating people with OCD. Other medications have proved effective, including sertraline, fluoxetine, fluvoxamine, and paroxetine. Lithium is used to treat bipolar disorder. Alprazolam may be used to treat panic disorder. Multiple Choice

18. A nurse is preparing a presentation about social anxiety disorder. Which information will the nurse include when describing a person with this condition? (Select all that apply.) A) Fear that others will judge them negatively B) Openly speak up in crowds to reduce fear C) Are insensitive to other's criticism D) Demonstrate a distorted view of their own strengths E) Exaggerate personal flaws

A, D, E Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 278 Feedback: People with social anxiety disorder fear that others will scrutinize their behavior and judge them negatively. They often do not speak up in crowds out of fear of embarrassment. They go to great lengths to avoid feared situations. If avoidance is not possible, they suffer through the situation with visible anxiety. People with social anxiety disorder appear to be highly sensitive to disapproval or criticism, tend to evaluate themselves negatively, have poor self-esteem, and a distorted view of their personal strengths and weaknesses. They may magnify their personal flaws and underrate their talents. Multiple Choice

11. When assessing a client experiencing aggression, the nurse applies the general aggression model. Which factors would the nurse assess as the person factors? (Select all that apply.) A) Client's personality traits B) Insult initiating the behavior C) Previous behavior patterns D) Shouting by the client E) Client's mood F) Client's gender

A, F Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 199 Feedback: The person factors include characteristics such as gender, personality traits, beliefs and attitudes, values, goals, and behavior patterns. Situational factors include the actual provocation (insults, slights, verbal and physical aggression, interference with achieving goals) and cues that trigger memories of similar situations. Cognition includes hostile thoughts and scripts (previous behavior patterns and responses to similar episodes). Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component. Arousal can be physiologic, psychological, or both.

11. Place these nursing interventions for a client with PTSD in order of priority, with #1 being the highest priority, followed by #4 being the least priority. A) Ensure that the client's physical needs are met. B) Have the client identify the original trauma that started the PTSD. C) Establish suicidal/aggressive safety measures. D) Begin intensive one-on-one counseling.

A; C; B; D Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 288 Feedback: After the physical health needs are met and suicidal/aggressive safety measures are established, the mental health nursing assessment targets specific areas. These include identification of the original trauma, specific physical symptoms, and the emotional and behavioral consequences of the client's PTSD. Multiple Choice

17. A PTSD client who is having recurring nightmares may be prescribed which medication (as an off-label use) to treat the nightmares and improve sleep? A) Lorazepam, benzodiazepines B) Prazosin, an alpha1 inhibitor C) Metoprolol, a β-adrenergic blocking agent D) Zolpidem, a sedative

B Chapter: 19 Client Needs: Physiological Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 287 Feedback: The selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and β-blockers have been shown to be effective in reducing the symptoms of PTSD. Recently, off-label use of prazosin, an alpha1 inhibitor, has been shown to be effective in treating nightmares and improving sleep in PTSD clients. Multiple Select

5. While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the clients is "really psycho." Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) Lack of knowledge B) Public stigma C) Label avoidance D) Self-stigma

B Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 4 Feedback: The receptionist's statement reflects the negative effects of stigmatization, more specifically public stigma. Self-stigma reflects a person's internalization of a negative stereotype; that is, the person with the mental illness begins to believe that he or she is what the public thinks he or she is. Label avoidance refers to avoiding treatment or care so as not to be labeled mentally ill. Lack of knowledge is often the underlying theme associated with any type of stigma.

8. A psychiatric-mental health nurse is providing care for a client with a mental disorder. The client is participating in the decision-making process. The nurse interprets this as which component of recovery? A) Self-direction B) Collaborative C) Person-centered D) Holistic

B Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 4 Feedback: In recovery-oriented care, the person with a mental health problem develops a partnership with a clinician to manage the illness, strengthen coping abilities, and build resilience for life's challenges. Being involved in decision making helps the client transition from a dependent-driven relationship to a collaborative recovery-oriented one. Self-direction is reflected as individuals define their own goals and design a path to meet those goals. Individualized and person-centered is reflected by the individual's use of his or her own unique strengths and resilience as well as needs, preferences, experiences, and cultural background. Holistic involves the whole life of the individual—mind, body, spirit, and community.

9. While interviewing a client, a nurse asks, "What do you do when you get angry?" Which client response indicates to the nurse that the client engages in anger suppression? A) "I've been known to fly off the handle when I'm angry." B) "People say I withdraw and pout about the problem." C) "I usually approach the person directly to talk about it." D) "I try to discuss how I'm feeling about it with a close friend."

B Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 194 Feedback: Anger suppression is characterized by acting as though nothing has happened; withdrawing from people; and sulking, pouting, or ruminating. Unhealthy, outward anger expression is characterized by flying off the handle or expressing anger in an attacking or blaming way, yelling, or using profanity. Approaching a person directly to talk about it, or discussing how the person feels with a close friend, reflects constructive anger discussion.

10. The plan of care for a client with anger includes behavioral interventions. Which intervention is the nurse be likely to find? A) Self-monitoring of cues B) Anger management C) Relaxation training D) Response disruption

B Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 196, 197 Feedback: Anger management is a psychoeducational intervention. Behavioral treatment of anger involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance, and convinces clients that they can indeed learn to calm themselves when they are angry. Multiple Select

5. The nurse is working with a potentially violent client in a community clinic. What action should the nurse take to minimize personal risk? A) Use protective devices B) Stay close to a door C) Keep the door closed to ensure privacy D) Wear expensive jewelry to distract the client

B Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 & 8 Page Number: 203 Feedback: The nurse can take a position near the door so immediate access to an exit is available in case the client becomes violent. Protective devices would be inappropriate. Closing the door would be unsafe. The nurse should remove or not wear accessories such as jewelry that could be used to harm the nurse.

14. A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which medication does the nurse most likely expect to administer? A) Benzodiazepine B) Selective serotonin reuptake inhibitor (SSRI) C) Monoamine oxidase inhibitor (MAOI) D) Tricyclic antidepressant (TCA)

B Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 271 Feedback: Although all of the agents can be used to treat panic disorder, SSRIs are recommended as the first drug option for treatment. Benzodiazepines (antianxiety agents) are used only for short periods of time. MAOIs are reserved for clients who do not respond to SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs). The use of tricyclic antidepressants is declining. Multiple Select

3. A client with a panic disorder has been prescribed a benzodiazepine medication. Which risk would the nurse emphasize as being associated with using this medication? A) Dietary restrictions B) Withdrawal symptoms C) Agitation D) Fecal impaction

B Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 5 Page Number: 272 Feedback: Although benzodiazepines are well tolerated and tremendously useful in treating intensely distressed individuals, they carry the risks of physical dependence and withdrawal symptoms with discontinuation. Dietary restrictions are not necessary with benzodiazepines. Sedation, rather than agitation, occurs with this class of drugs. Fecal impaction is not associated with benzodiazepines.

7. A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client tells the nurse how things have been going since he was discharged. The nurse determines that the client's therapy has been effective when the client makes which statement? A) "I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital." B) "When my mother-in-law comes over now, I go out to my workshop and work on one of my projects." C) "I'm still drinking coffee; I can't quit after drinking it all these years." D) "I've learned having a beer after I get home from work helps me relax."

B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 6 Page Number: 274 Feedback: Evaluation should focus on the individual's ability and skills in using techniques that control anxiety, such as relaxation, positive self-talk, and stress management. Reducing personal and environmental stress (e.g., removing himself from his mother-in-law's company) can indicate success, as can incorporating practices that foster relaxation into daily routines. Although alcohol is relaxing for this client, it has the potential for dependency, and encouraging its routine use should be avoided. The statement about stress and things being different at home indicate that the client is still experiencing anxiety. Caffeine is a stimulant and should be avoided.

2. A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to use? A) "Are you feeling much better now that you are lying down?" B) "What did you experience just before and during the attack?" C) "Do you think you will be able to drive home?" D) "What do you think caused you to feel this way?"

B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 261, 262 Feedback: After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if he feels better provides no information for the nurse and lying down may or may not be effective. Asking the client if he thinks he can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.

13. A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitive behavioral concepts associated with panic disorders, which issue would the nurse expect to address? A) Personal losses B) Conditioned response C) Early separation D) Dysfunctional family communication

B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: 264 Feedback: Learning theory underlies most cognitive behavioral explanations of panic disorder with classic conditioning and interoceptive conditioning as the basis. Classic conditioning theory suggests that one learns a fear response by linking an adverse or fear-provoking event, such as a car accident, with a previously neutral event, such as crossing a bridge. One becomes conditioned to associate fear with crossing a bridge. Personal losses and separation reflect psychodynamic theories. Families affected by panic disorder have difficulty with overall communication, reflecting the family response to the disorder.

5. The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack? A) "I am feeling very nervous right now." B) "I can handle this anxiety; it will be over shortly." C) "I am taking medication to eliminate these symptoms." D) "Relax your muscles, relax your muscles."

B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 5 Page Number: 274 Feedback: An example of positive self-talk is when the client says, "This is only anxiety; it will be over shortly." These types of positive statements can give the individual a focal point and reduce fear when panic symptoms begin.

10. A group of new nurses is reviewing information about anxiety disorders in preparation for their first day on the job. The nurses demonstrate understanding of the material when they make what statement? A) Anxiety disorders rank second to depression in psychiatric illnesses being treated. B) Women experience anxiety disorders more often than do men. C) Most anxiety disorders tend to be short term with individuals achieving full recovery. D) Anxiety disorders are more common in children than in adolescents.

B Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 261 Feedback: Women experience anxiety disorders more often than do men by a 2:1 ratio. Anxiety disorders are the most common of the psychiatric illnesses treated by health care providers. They tend to be chronic and persistent illnesses with full recovery more likely among those who do not have other mental or physical illnesses. Anxiety disorders are the most common condition of adolescents, with one in three having an anxiety disorder.

15. Which statement is accurate regarding PTSD and children? A) The risk of developing PTSD following leukemia treatment is about the same as all children of the same age. B) Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse. C) In the family unit where one child is diagnosed with cancer, all the children in the household are at increased risk for developing PTSD. D) Children who were abused during childhood were more likely to be diagnosed with obsessive compulsive disorder rather than PTSD.

B Chapter: 19 Client Needs: Physiological Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 285, 286 Feedback: For adolescents, PTSD was associated with an increased risk of drug use. Childhood cancer survivors have been found to have four times the risk of developing PTSD as their siblings. Similarly, high rates of PTSD have been reported among clients with alcohol and drug dependence who have experienced childhood abuse.

8. Which statement made by a client diagnosed with PTSD leads the nurse to believe the client is experiencing dissociative symptoms? A) "It's like I'm having flashbacks every time I fall asleep." B) "I describe my feelings like I'm having an out-of-body experience." C) "Loud noises always make me a little jittery now." D) "I feel guilty that I survived the attack and my friend didn't."

B Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 9 Page Number: 284 Feedback: Dissociation is a disruption in the normally occurring linkages among subjective awareness, feelings, thoughts, behavior, and memories. A person who dissociates is making him- or herself "disappear." That is, the person has the feeling of leaving his or her body and observing what happens to it from a distance. During trauma, dissociation enables a person to observe the event while experiencing no pain or only limited pain and to protect him- or herself from awareness of the full impact of the traumatic event. Flashbacks are common with PTSD; Loud noises associated with the trauma cause flashbacks. Guilt is common for survivors. Multiple Select

10. A client with PTSD asks the nurse about this eye movement, desensitization, and reprocessing (EMDR) treatment. How would the nurse most appropriately explain this treatment? A) Takes a long time because you have to have counseling sessions a minimum of twice/week. B) Guides the client through images of the trauma, allowing for progressive desensitization. C) Blocks the trauma from appearing in their psychological frame using carefully placed electrical stimuli. D) Helps the client understand why recovering from the trauma is difficult, but gives them new ways of coping.

B Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 287 Feedback: EDMR is a process of reviewing and visualizing disturbing memories of traumatic or distressing experiences to reduce the long-term impact of the events. The client is guided through images of the trauma, allowing for progressive desensitization. Under deep relaxation, the client maintains an image of the traumatic event while focusing on the lateral movement of the clinician's finger. This recent approach has been successful in minimizing the fear response and avoidance pattern of those with PTSD. Counseling, blocking trauma via electrical stimuli, and using cognitive processing therapy are not a part of EDMR, but are separating possible treatment plans. Ordering

3. A client diagnosed with obsessive--compulsive disorder comes to the clinic with their spouse. During the visit, the spouse states that the client is "always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time. Isn't checking once enough?" An understanding of which aspect of this disorder would the nurse need to incorporate into the response? A) The client is attempting to exert control over the situation. B) The client performs the ritual to relieve anxiety temporarily. C) The client's behavior reflects a need for safety. D) The client is attempting to use thought stopping to decrease her behavior.

B Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 1 Page Number: 297 Feedback: The nurse needs to explain to the client's spouse that the compulsion is done to relieve anxiety temporarily. The compulsion is necessary, not pleasurable, and if not performed, anxiety and distress increase. The compulsion is an anxiety response, not a means to control the situation or promote safety. Thought stopping is a mechanism used to control obsessions.

5. A client explains to the health care provider that a cleaning ritual must be completed every day. If something disrupts this cleaning schedule, what effect does the client experience? A) Depression B) Extreme anxiety C) Aggression to the point of lashing out D) Isolation from others

B Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 297 Feedback: Obsessions create tremendous anxiety; individuals perform compulsions to relieve the anxiety temporarily. If the compensatory ritual is not performed, the person feels increased anxiety and distress. Compulsions are necessary, not pleasurable. They are often recognized as odd or strange to the individual. Initially, attempts are made to resist the compulsive behavior, but eventually, resistance fails, and the repetitive behaviors are incorporated into daily routines. Depression, aggression, and isolation are not usual response to this behavior.

12.When using cognitive restructuring for the OCD client, the nurse teaches the client to monitor automatic thoughts and recognize the connection between thoughts, emotional response and behavior. What is the client's goal with this technique? A) Decrease their compulsive actions by 50%. B) Analyze their thoughts as incongruent with reality. C) Improve their sleeping patterns. D) Build time in their daily schedule to perform the compulsion without interruption.

B Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 305 Feedback: With cognitive restructuring, the client is taught to monitor automatic thoughts and then to recognize the connection between thoughts, emotional response, and behaviors. The distorted thoughts are examined and tested by for- or-against evidence presented by the therapist, which helps the individual to realistically assess the likelihood that the feared event will happen if the compulsive behavior is not performed. The person begins to analyze his or her thoughts as incongruent with reality. For example, even if the alarm clock is not checked 30 times before going to bed, it will still go off in the morning, and the person will not be disciplined for tardiness at work. Maybe it needs to be checked only once or twice. There is no research to support that the actions will decrease 50%. Relaxation techniques assist with improving sleep pattern.

18. New research by Singh & Jones (2013) found that clients diagnosed with hoarding may benefit from what intervention? A) Increased dose of an antianxiety medication regularly. B) Using a "buddy" system where members support each other outside the group. C) Daily visits from a social worker trained to perform hypnosis. D) Waste treatment companies stopping by to offer their services at a reduced rate.

B Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 47 Feedback: Using group processes, the group members became supportive of each other when undertaking changes. The group developed a buddy system where members supported each other outside the group. Through using the visual methods, the individuals were able to distance themselves from the problem and decrease the feeling of being overwhelmed. They were able to be more objective and develop an action plan. Medication, daily visits and having trash companies visit would not be helpful for these clients and may make the problem worse. Multiple Select

6. The nurse is providing care to a client who is hospitalized with a diagnosis of schizophrenia. Which statement would be appropriate for the nurse to include in the client's medical record? A) "Client stated that they had a good night with no complaints." B) "Reported they are unable to sleep because he heard voices throughout the night." C) "Had a typical night without incidence of insomnia or nightmares." D) "Acted crazily throughout the night; kept hearing voices and noises."

B Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 10 Page Number: 25, 26 Feedback: The most appropriate statement to be recorded is: "Reported they are unable to sleep because he heard voices throughout the night." This statement clearly depicts the client's problem and the reason why. The nurse should avoid jargon and stereotypical statements, such as "having a good night" or "no complaints" or acting crazily. Only meaningful, accurate, objective descriptions of the behavior should be used.

9. A nurse is preparing to administer an as-needed (PRN) medication. What would the nurse need to keep in mind when documenting administration? A) Reason for administration, dosage, route, and response to the medication the first time it is administered to a client. B) Reason for administration, dosage, route, and response to the medication every time it is administered to a client. C) Reason for administration, dosage, and route the first time it is administered to a client. D) Reason for administration, dosage, and route every time it is administered to a client.

B Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 10 Page Number: 26 Feedback: Medications prescribed on a PRN basis require including a reason for administration, dosage, route, and response to the medication. Documenting responses is the only way to document treatment outcomes, and because the outcome may be different each time, the response along with the reason for administration, dosage, and route should be documented every time the PRN medication is given. Multiple Select

17. A psychiatric-mental health nurse is documenting information in a client's medical record. Which would be least likely to increase the nurse's legal liability? A) "Client reported that he was feeling better today than yesterday." B) "Administered haloperidol 10 mg IM stat as ordered for agitation." C) "Client was talking with another staff member and started screaming." D) "Applied restraints to all four client extremities."

B Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 10 Page Number: 26 Feedback: The entry about medication administration is the most complete and clear because it states the name of the medication, the dosage and route, and why it was administered. The nurse should document objective data, not subjective opinion based on what the nurse observed. The nurse would then be responsible for following up this documentation with information about how the client responded to the medication. The statement about the client feeling better, and the statement about talking with a staff member and screaming are both vague and general. The statement about applying restraints is incomplete. The statement needs to include information about why the restraints were applied, that an order was obtained for the restraints, and how the client responded to the restraints.

5. Which client would the nurse determine to be the most likely candidate for involuntary commitment? The client who: A) Refuses to take the prescribed medication B) Is screaming in the street disturbing neighbors C) Refuses to participate in the planned therapy D) Is homeless and has been diagnosed with a mental disorder.

B Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 21, 22 Feedback: The client who is screaming in the street is more likely to be judged as a danger to themselves or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others.

2. A psychiatric-mental health nurse determines that a client is competent when they are able to do which action? A) Speak coherent English B) Communicate their choices C) Write a "living will" D) Comply with the medical regimen

B Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Integrated Process: Nursing Process Objective: 3 Page Number: 19 Feedback: The client who is competent to give an informed consent should be able to communicate choices, understand relevant information, appreciate the situation and its consequences, and use a logical thought process to compare the risks and benefits of treatment.

13. A client is involuntarily committed without a court order. The nurse understands that the emergency, short-term hospitalization can occur for how long? A) A maximum of 24 hours B) 48 to 92 hours C) three to five days D) One week

B Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Integrated Process: Nursing Process Objective: 4 Page Number: 22 Feedback: Although commitment procedures vary among states, most have provisions for an emergency, short-term hospitalization of 48 to 92 hours authorized by a certified mental health provider without a court order. At the end of that period, the individual must either agree to voluntary treatment or extended commitment procedures are initiated.

9. Which common manifestations following a traumatic experience would the nurse identify in a client experiencing physiologic hyperarousal? (Select all that apply.) A) Frequent urination B) Startles easily C) Overreacts to others D) Avoids places associated with the event E) Has vivid dreams

B, C Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 285 Feedback: After a traumatic experience, the stress system seems to go on permanent alert, as if the danger might return at any time. In this state of physiologic hyperarousal, the traumatized person is hypervigilant for signs of danger, startles easily, reacts irritably to small annoyances, and sleeps poorly. The state of hyperarousal causes the affected individual to be irritable and overreacts to others which cause others to avoid the person. Frequent urination and vivid dreams are not associated with PTSD. Avoiding places associated with the trauma is common but not associated with hyperarousal. Multiple Choice

17. A nurse is explaining to a client the signs and symptoms associated with anxiety. The client demonstrates an understanding of the information when they identify which symptoms as cognitive symptoms? (Select all that apply.) A) Edginess B) Feelings of unreality C) Difficulty concentrating D) Tunnel vision E) Apprehensiveness F) Speech dysfluency

B, C, D Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 258, 259 Feedback: Cognitive symptoms include feelings of unreality, difficulty concentrating, and tunnel vision. Edginess and apprehensiveness are affective symptoms. Speech dysfluency is a behavioral symptom.

12. When caring for a client with panic disorder, the nurse knows that which neurotransmitters are implicated in this disorder? (Select all that apply.) A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-aminobutyric acid (GABA) E) Acetylcholine (Ach)

B, C, D Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: 263, 264 Feedback: Biologic theories suggest involvement of serotonin, norepinephrine, and GABA as playing a role in panic disorder. Neither dopamine nor acetylcholine is associated with this condition. Multiple Choice

1. The nurse is assessing a client with posttraumatic stress disorder (PTSD). Which symptoms would the nurse categorize as reflecting intrusion? (Select all that apply.) A) Irritability B) Difficulty sleeping C) Flashbacks D) Acting as if the event is reoccurring E) Dissociation

B, C, D, E Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: 284 Feedback: Intrusion is reflected by flashbacks and nightmares as well as altered memory function. Intrusive symptoms also include dissociative reactions (feeling or acting as if the event is reoccurring). Irritability and difficulty sleeping reflect hyperarousal. Dissociation reflects avoidance and numbing.

12. A nurse is presenting an in-service program about aggression and violence to a group of newly hired nurses who will be working in an inpatient psychiatric facility. When describing characteristics that may predict the risk for violence and aggression in clients, which of the following would the nurse include? (Select all that apply.) A) Age B) Intimidating stare C) Raised voice D) Gender E) Demanding comment

B, C, E Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 199 Feedback: The age, gender, and race of clients are not good predictors, but several research reports suggest that particular characteristics are predictive of violent behaviors. Usually, but not always, there are some observable precursors to aggression and violence: staring or glaring in an intimating manner, raising voice tone or volume, making sarcastic or demanding comments, and pacing.

19. When giving a community lecture about PTSD for clients and their families, the nurse will include which topics for discussion? (Select all that apply.) A) Daily use of a sedative to assist with rest and sleep. B) Try to identify triggers that lead to re-experiencing trauma. C) Finding people who can assist with watching the client during stressful periods. D) Try various treatment options if one does not help. E) Do not discuss smoking cessation techniques if the client is stressed.

B, D Chapter: 19 Client Needs: Physiological Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 292 Feedback: When caring for a person with a PTSD, be sure to include the following topic areas in the teaching plan: Identification of individual triggers and cues that lead to re-experiencing trauma Safety plans for stressful periods Recovery plans that focus on personal strengths Risk factors for reoccurrence of symptoms Various treatment options: if one does not help, others exist Avoid substances such as alcohol and drugs Nutrition Exercise Sleep hygiene Follow-up appointments Community services

14. Which of the following would be a major barrier affecting the treatment of individuals with mental health problems? A) Lack of a diagnostic criteria B) Inability to obtain epidemiologic data C) Stigma associated with mental health problems D) Limited hope for recovery

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 3 Feedback: Stigma is one of the major treatment barriers facing individuals with mental health problems and their families. Diagnostic criteria have been established for mental disorders, and evidence through epidemiologic research provides valuable information about the mental health status of population groups and associated factors. A guiding principle of recovery is hope, the belief that recovery is real and that the people can and do overcome the internal and external challenges, barriers and obstacles confronting them.

12. A nurse is working as part of the multidisciplinary team and developing a plan of care for a client who is receiving recovery-oriented treatment. Which of the following would the nurse integrate into this plan? A) Focusing primarily on the mind B) Limiting support from others C) Using hope as motivation D) Avoiding underlying trauma

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 5 Feedback: Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.. Recovery is also holistic, addressing an individual's whole life, including body, mind, spirit and community. Recovery is supported by peers and allies and through relationships and social networks. Finally, recovery is supported by addressing trauma, such that services and supports should be trauma-informed to foster safety.

7. A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) "Mental disorders are defined by an underlying biological pathology." B) "Numerous laboratory tests are used to aid in the diagnosis of mental disorders." C) "Clusters of behaviors, thoughts, and feelings characterize mental disorders." D) "Manifestations of mental disorders are within normal, expected parameters."

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 2 Feedback: Unlike many medical disorders, mental disorders are defined by clusters of behaviors, thoughts, and feelings, not underlying biologic pathology. The alterations in thoughts, behaviors, and feelings are unexpected and outside the normal, culturally defined limits. Laboratory tests are not used in diagnosing mental disorders.

9. A nurse is explaining recovery to the family of a client diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this process? A) "It is a step-by-step process from being ill to being well." B) "The client focuses mainly on the emotional aspects of their condition." C) "The client is helped to live a meaningful life to their fullest potential." D) "Although peer support is important, the self-acceptance is essential."

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: 4 Feedback: Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. It is a nonlinear process with setbacks. It also is strength-based. Peer support is important, but so is respect by the community and consumers, along with self-acceptance to ensure inclusion and participation in all aspects of life.

2. A nurse is working in a community mental health center that provides care to a large population of people of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address? A) Public stigma B) Self-stigma C) Label avoidance D) Negative life events

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 5 Page Number: 4 Feedback: Although public stigma and self-stigma may be areas needing to be addressed, in this cultural group, label avoidance would be most important. Label avoidance or avoiding treatment/care so as not to be labeled mentally ill is a type of stigma that influences why so few people with mental health problems actually receive assistance. Asian cultures commonly have negative views of mental illness that influence the willingness of members to seek treatment; they possibly ignore the symptoms or refuse to seek treatment because of this stigma. Negative life events affect anyone, not just those of the Asian culture.

6. After educating a group of students on mental health and mental illness, the instructor determines that the education was successful when the group identifies which of the following as reflecting mental disorders? A) Capacity to interact with others B) Ability to deal with ordinary stress C) Alteration in mood or thinking D) Lack of impaired functioning

C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 3 Page Number: 3 Feedback: Mental disorders are health conditions characterized by alterations in thinking, mood, or behavior and are associated with distress or impaired functioning. Mental health is the emotional and psychological well-being of an individual who has the capacity to interact with others, deal with ordinary stress, and perceive one's surroundings realistically.

3. A son brings his father to the clinic and tells the nurse that his father has begun to act strangely in the past few days, with unprovoked outbursts of anger. After the incidents, the father expresses remorse for his outburst. The son says, "I've never seen him act this way." Which question is most appropriate for the nurse to ask next? A) "Does your father have a history of an anxiety disorder, such as panic disorder?" B) "Has your father exhibited previous problems expressing anger appropriately?" C) "Has your father suffered any traumatic injury to his brain recently?" D) "Has your father injured the back of his head or neck in the past week?"

C Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 197, 198 Feedback: Asking about injury to the brain would be most appropriate, because the brain structures most frequently associated with aggressive behavior are the limbic system and cerebral cortex. Clients with a history of damage to the cerebral cortex are more likely to exhibit increased impulsivity, decreased inhibition, and decreased judgment than are those who have not experienced such damage. Schizophrenia and substance abuse are also associated with violent behavior. Asking about previous problems with anger would be important to know but would not be the priority. Additionally, the son states that the father has never done this before. Injury to the back of the head or neck is not associated with aggression.

19.A nurse was confronted by pharmacy staff about a medication error that was detected in the automated dispensing device. The medication administered to a client receiving palliative care may have caused an earlier demise because the medication decreases the client's respiratory rate significantly when given at the administered dose. Which of the following statements by the nurse displays the use of rationalization? A) "Thank you for pointing this error out. I will fill out an incident report immediately." B) "Please don't tell my supervisor. She will put me on probation if she knows this information." C) "I didn't think I needed to disclose this error since the client is going to die anyway." D) "Are you sure I made this error? I can't recall this incident."

C Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 260 Feedback: Rationalization is when one avoids anxiety by explaining an unacceptable or disappointing behavior or feeling in a logical, rationale way. May protect self-esteem and self-concept. Suppression reduces anxiety by intentionally avoiding thinking about disturbing problems, wishes, feelings or experiences. Useful in many situations such as test taking situations. Denial avoids feelings associated with recognizing a problem. Multiple Select

9. A nurse determines that a client who is experiencing anxiety is using relief behaviors. The nurse determines that the client is experiencing which degree of anxiety? A) Mild B) Moderate C) Severe D) Panic

C Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: 258 Feedback: A client experiencing severe anxiety typically uses relief behaviors. With mild anxiety, the client is able to recognize and name anxiety easily. With moderate anxiety, the client is usually able to state that he or she is anxious. With panic, the client is perplexed and self-absorbed.

11. During an interview with a nurse, the client reports an intense fear of spiders, stating, "I can't be near them. I get so upset. I start to sweat and hyperventilate if I see one." The nurse documents this as what finding? A) Algophobia B) Entomophobia C) Arachnophobia D) Cynophobia

C Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 278 Feedback: The client is describing arachnophobia, a fear of spiders. Algophobia is a fear of pain, entomophobia is a fear of insects, and cynophobia is a fear of dogs. Multiple Select

14. When explaining dissociative disorders to a client, what feature of these disorders would the nurse describe? A) Total amnesia of the events that caused the disorder B) Overuse of sedatives like alcohol C) Failure to integrate identity, memory, and consciousness D) Disinhibited social engagement, being overly friendly with strangers.

C Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 9 Page Number: 293 Feedback: The essential feature of these disorders involves a failure to integrate identity, memory, and consciousness. That is, unwanted intrusive thoughts disrupt one's contact with the here and now or memories that are normally accessible are lost. These disorders are closely related to the trauma- and stressor-related disorders but are categorized separately.

9. When planning for a client with OCD who has been admitted for severe exacerbation of symptoms, the nursing care should prioritize which intervention? A) Giving medications in a timely fashion to maintain steady blood levels. B) Starting all group sessions on time and incorporating all group members into the discussion. C) Assessing the client for suicide risk since they may also have a major depression. D) Discussing with the client if their obsessions involve self-mutilation acts like pulling their hair.

C Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Objective: 5 Page Number: 302 Feedback: Assessing for suicidal thoughts is always the priority. The person may feel a sense of hopelessness and helplessness and may contemplate suicide to end the suffering. An additional risk for suicide is created by the high probability of major depression, which often accompanies OCD. Clients may feel a need to punish themselves for their intrusive thoughts (e.g., religious coupled with sexual obsessions). Some persons have aggressive obsessions, so that external limits may have to be imposed for the protection of others. All clients should expect medications to be given on time and group sessions to start when posted time arrives.

15.In order to rule a behavior and OCD, the nurse knows that the obsession or compulsion must have which characteristic? A) Be their primary thought process throughout the entire day. B) Cause considerable anguish if not performed first thing in the morning. C) Take up more than one hour/day and cause stress to the individual. D) Convince the individual that their obsessive thoughts are true.

C Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 298 Feedback: OCD is diagnosed when recurrent obsessions or compulsions (or both) take up more than one hour a day or cause considerable stress to the individual. These obsessions or compulsions are not caused by substance or medication use or other disorders. Some individuals recognize that these obsessions or compulsions are excessive and unrealistic; others have limited insight and are unsure whether the obsessive thoughts are true, but continue to have the thoughts and feel compelled to perform the actions. Another group of individuals are convinced that their obsessive thoughts are true. These thoughts and compulsive behaviors are stressful and interfere with normal daily routines. Multiple Select

4. Parents visit the clinic with their teenager to discuss the teen's skin picking. Many bleeding wounds and various stages of scabs located up and down both of the teenager's arms. The parents are very upset about this behavior and want it to stop. What condition does the health care provider documents? A) Body dysmorphic disorder B) Disrupted family dynamics C) Excoriation disorder D) Control dysfunction

C Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 297 Feedback: Excoriation disorder (skin picking) is the inability to stop recurrent picking at skin for emotional release or anxiety release. Body dysmorphic disorder is a preoccupation with slight or imagined physical defects that are not apparent to others. There is not enough information to diagnose disrupted family dynamics or control issues within the family unit.

13. What action would a client diagnosed with body dysmorphic disorder (BDD) primarily focus on? A) Raising money to surgically repair their body part so that everything will return to "normal." B) Researching their family tree to pinpoint when their body part became defective. C) Real or imagined defects in appearance like having a "long" nose. D) Analyze why others think the client looks fine and should just get on with life.

C Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 307, 308 Feedback: Individuals with body dysmorphic disorder (BDD) focus on real (but slight) or imagined defects in appearance, such as a large nose, thinning hair, or small genitals. Preoccupation with the perceived defect causes significant distress and interferes with their ability to function socially. They feel so self-conscious that they avoid work or public situations. Some fear that their "ugly" body part will malfunction. Surgical correction of the problem by a plastic surgeon or a dermatologist does not correct their preoccupation and distress. BDD is an extremely debilitating disorder and can significantly impair an individual's quality of life.

7. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of Mr. Murray's latest laboratory work and psychological testing results so Mr. Murray's medical records in employee health can be kept up-to-date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? A) "I'm sorry; we're not allowed to give out that information about our client." B) "I'll have to get the client's signed consent before we can send that information to you." C) "I am unable to acknowledge whether or not a Mr. Murray is a client on this unit." D) "Sure, give me your address, and I will see that the information is sent to you."

C Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 6 Page Number: 22 Feedback: A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that Mr. Murray is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that Mr. Murray is receiving care in a psychiatric hospital.

11. A group of nursing students is reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify which organization as an example? A) American Hospital Association B) American Public Health Association C) State mental health provider D) The Joint Commission

C Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 2 Page Number: 18, 19 Feedback: Mental health care systems have internal rights protection systems or mechanisms to combat any violation of their clients' rights. Each state mental health provider is required to establish and operate a system that protects and advocates for the rights of individuals with mental illnesses. The American Hospital Association and American Public Health Association serve as advocates for the rights and treatment of mental health clients and are part of an external advocacy system. Clients' rights are also assured of protection by an agency's accreditation, such as accreditation by The Joint Commission.

15. A psychiatric-mental health client has an advance care directive on their medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which of the following? A) Assault B) Battery C) Medical battery D) False imprisonment

C Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Understand Integrated Process: Nursing Process Objective: 2 Page Number: 25 Feedback: Failure to respect a client's advance directive is considered medical battery. Assault is the threat of unlawful force to inflict bodily injury on another. Battery is the intentional and unpermitted contact with another. False imprisonment is the detention or imprisonment contrary to the provision of law. Multiple Select

19. The nurse is working with a client diagnosed with compulsive hoarding syndrome. Which client statement(s) suggests successful implementation of strategies introduced by cognitive behavioral therapy (CBT)? (Select all that apply.) A) "I was not raised to live like this; I do not like hoarding." B) "I know my kids are ashamed to bring friends home but I cannot help it." C) "I keep reminding myself what life would be like if all the clutter was gone." D) "I know my child's allergies would be so much less of a problem if the house was clean." E) "I feel so overwhelmed when I think about getting rid of some of the clutter in the house."

C, D, E Chapter: 20 Client Needs: Psychological Integrity Cognitive Level: Analyze Integrated Process: Communication and Documentation Objective: 6 Page Number: 308 Feedback: CBT is a talking therapy that can help manage problems by changing the way the client thinks and behaves. It is most commonly used to treat anxiety and depression but can be useful for other mental and physical health problems including hoarding. Helpful interventions include photographing cluttered areas in the home and determining what the client would like to overcome, imagining life without all of the clutter, and identifying how life and relationships are affected by the problem. This exercise helps the client recognize the problem and what to do about it. Through using the visual methods, the client is able to distance oneself from the problem and decrease the feeling of being overwhelmed. Most individuals with is disorder were not raised to live this way and they generally dislike and are ashamed of the state of their environment, so these comments are not related to effective therapy.

3. A nursing student is assigned to care for a client diagnosed with schizophrenia. When talking about this client in a clinical post-conference, the student would use which terminology when referring to the client? A) Committed client B) Schizophrenic C) Schizophrenic client D) Person with schizophrenia

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 5 Page Number: 4 Feedback: Just as a person with diabetes should not be referred to as a "diabetic" but rather as a "person with diabetes," a person with a mental disorder should never be referred to as a "schizophrenic" or "bipolar," but rather as a "person with schizophrenia" or a "person with bipolar disorder." Doing so helps to counteract the negative effects of stigma.

13. A nurse is assessing a client to evaluate the client's mental health and wellness. Applying the eight dimensions of wellness, which of the following would the nurse identify as reflecting emotional wellness? A) Finding ways to expand creative abilities B) Recognizing the need for sleep and nutrition C) Searching for meaning in life D) Developing skills for dealing with stress

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 2 Feedback: The emotional dimension of wellness focuses on developing skills and strategies to cope with stress. The intellectual dimension focuses on recognizing creative abilities and finding ways to expand one's knowledge and skills. The physical dimension focuses on recognizing the need for physical activity, diet, sleep and nutrition. The spiritual dimension focuses on the search for meaning and purpose in the human experience.

4. A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The student interprets this as which of the following? A) Rate B) Prevalence C) Point prevalence D) Incidence

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 3 Feedback: The article is describing incidence, which refers to a rate that includes only new cases that have occurred within a clearly defined time period. The most common time period evaluated is 1 year. Rate reflects the proportion of cases in the population compared with the total population. Prevalence refers to the total number of people with the disorder within a given population at a specified time, regardless of how long ago the disorder started. Point prevalence refers to the proportion of individuals in the population that have a disorder at a specific point in time.

16. When assessing a client with a mental illness, the nurse determines that the client is experiencing label avoidance when the client states which of the following? A) "I'm at the cause of my illness." B) "I'll never be able to function in the world." C) "I'm as crazy as everybody thinks I am." D) "I really don't need to see anyone."

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 4 Feedback: Label avoidance involves an individual not seeking treatment so as not to be labeled as mentally ill. The statement about not really needing to see anyone suggests label avoidance. The statements about being the cause of the illness, not being able to function in the world, and being as crazy as everyone says reflect self-stigma, the internalization of negative stereotypes by individuals with mental illness.

10. After teaching a group of nursing students on recovery, the instructor determines that more education is needed when the group identifies which of the following as a characteristic? A) Self-direction in life B) Improvement in health and wellness C) Achievement of full potential D) One-time change situation

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: 4 Feedback: Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

17. A nurse is describing the four dimensions of recovery to a group of new psychiatric--mental health nurses. Which dimension is the nurse describing when addressing relationships and social networks? A) Health B) Home C) Purpose D) Community

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: 4 Feedback: There are four dimensions that support recovery: health (managing disease and living in a physically and emotionally healthy way), home (a safe and stable place to live), purpose (meaningful daily activities and independence, resources and income), and community (relationships and social networks).

11. When describing the treatment of mental illness, which of the following would a nurse identify as the primary goal? A) Functional status B) Stigma reduction C) Stress reduction D) Recovery

D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 6 Page Number: 4 Feedback: Although reducing stigma, reducing stress, and improving functional status are important components involved in the treatment of mental illness, recovery is the single most important goal for individuals with mental disorders.

1. The nurse is caring for an older client in a residential care facility. The client has been extremely irritable the entire day. When modifying the client's plan of care, which snack is appropriate to offer the client in order to decrease the irritability? A) Chocolate candy bar B) Handful of raisins C) Granola bar D) Glass of milk

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 8 Page Number: 200 Feedback: Clients with longstanding poor dietary habits (e.g., indigent clients, clients with alcoholism) often have deficiencies of thiamine and niacin. Increased irritability, disorientation, and paranoia may result. Low serotonin levels are also associated with irritability. Assessing overall dietary intake is relevant, particularly noting good tryptophan sources, such as wheat, flour, corn, milk, and eggs.

6. The nurse is caring for a family of an older adult with dementia who is living in their home. The nurse has instructed the family about how to decrease the client's agitation. The nurse determines that the family has understood the instructions when they make what statement? A) "Restraints can help reduce my father's agitation." B) "I should place my father in the bedroom with me so I can watch him more closely." C) "It's important that he gets out shopping with us." D) "If I simplify our home environment, my father may be less agitated."

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 8 Page Number: 200 Feedback: The nurse determines that the family has understood the nurse's instructions when they say, "If we simplify our home environment, my father may be less agitated." The goal is to reduce environmental stimuli and adapt the environment to the client. Restraints are used only as a last resort. Continuous surveillance is unrealistic. Taking the client out shopping would add to the already intense and highly confusing stimulation.

2. The nurse is assessing a client on an inpatient psychiatric unit. Which aspect of the client's history should the nurse identify as the strongest indicator of risk for violence? A) Panic disorder B) Problematic anxiety C) Somatoform disorder D) Previous episodes of rage

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 199 Feedback: The client's history of violent behavior is probably the most important predictor of potential for violence. Important markers include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control. History of other psychiatric disorders would be less of a concern.

4. The nurse is caring for an older adult client who has no history of violence but is agitated and appears ready to strike out at a staff member. The nurse would assess the client for which condition? A) Panic disorder B) Epilepsy C) Bipolar disorder D) Sensory losses

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 8 Page Number: 199 Feedback: The nurse should assess the client for sensory losses. Impaired communication (including hearing loss and reduced visual acuity), disorientation, and depression have been found to be consistently associated with aggressive behavior among nursing home residents with dementia. Panic disorder, epilepsy, and bipolar disorder are unrelated to agitation in older adults.

7. A nurse is presenting to a group of colleagues about the relationships between anger, aggression, and violence. Which statement by the nurse would be most appropriate to include? A) "Anger, aggression, and violence are points along a continuum." B) "The terms used to describe anger are very precise." C) "Anger is a knee-jerk reaction to external events." D) "Women experience anger as frequently as men do."

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: 193 Feedback: Women experience anger as frequently as men do, but societal constraints may inhibit their expression of it. Anger, aggression, and violence should not be viewed as a continuum because one does not necessarily lead to another. Language related to anger is imprecise and confusing. People can choose to slow down their reactions and to think and behave differently in response to events; therefore, anger is not a knee-jerk reaction to external events.

18. After teaching a class about the General Aggression Model, the nurse determines that additional education is needed when the class identifies which of the following as an interactive component of the model? A) Cognition B) Affect C) Arousal D) Rewards

D Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: 198, 199 Feedback: The General Aggression Model (GAM) is a framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode. Cognition includes hostile thoughts and scripts (previous behavior patterns and responses to similar episodes). Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component. Arousal can be physiologic, psychological, or both. In Bandura's social learning theory, he focuses on the role of learning and rewards in the expression of aggression and violence.

4. A client is diagnosed with panic disorder. The client hasn't left the house in more than a month because the client is afraid of being attacked. The client visited the mental health clinic today only because a family member came along. Which nursing diagnosis would be a priority for this client? A) Powerlessness related to symptoms of anxiety B) Decisional Conflict related to fear of leaving the house C) Ineffective Family Coping related to symptoms of anxiety D) Social Isolation related to fear of recurrence of anxiety symptoms

D Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 5 Page Number: 269, 277 Feedback: The priority nursing diagnosis for the client is Social Isolation related to fear of recurrence of anxiety symptoms. The client's fear has led the client to avoid leaving the house. Powerlessness would be reflected in statements addressing feelings related to loss of control. Decisional Conflict would be reflected in statements about which way to act. Ineffective Family Coping would be reflected in statements about the family, and their inability to address or deal with the client's condition.

16. A nurse is providing to a client information about the etiology of generalized anxiety disorder (GAD). The client demonstrates understanding of this information when they identify which item as representing the basis for this disorder? A) Inaccurate environmental danger assessment B) Exposure to multiple stressful life events C) Kindling caused by overstimulation D) Intense worry and stress about work or simple family life.

D Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: 277 Feedback: Adults with GAD often worry about matters such as their job, household finances, health of family members, or simple matters (e.g., household chores or being late for appointments). The intensity of the worry fluctuates, and stress tends to intensify the worry and anxiety symptoms. Cognitive behavioral theory regarding the etiology of GAD proposes that the disorder results from inaccurate assessment of perceived environmental dangers. Although there are no specific sociocultural theories related to the development of GAD, a high-stress lifestyle and multiple stressful life events may be contributors. Kindling results from overstimulation or repeated stimulation of nerve cells by environmental stressors. Multiple Select

8. The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate? A) Demonstrate empathy for the client by trying to mimic the client's state of anxiety. B) Tell the client that you must leave to go report his symptoms to the psychiatrist on duty. C) Tell the client this is an acute exacerbation with a positive prognosis and low morbidity. D) Stay with the client, emphasizing that he is safe and that you will remain with him.

D Chapter: 18 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 276 Feedback: It is important to stay with the client and remain calm to help relax the client. Trying to mimic the client's symptoms would further add to the client's anxiety level. It is also important to stress that you will stay with the client and that the client is safe. The nurse should use clear, concise directions and short sentences. Medical jargon, such as telling the client this is an acute exacerbation with a positive prognosis, should be avoided.

6. Which symptom leads the nurse to suspect the young child is experiencing PTSD? A) Becomes disrespectful of authority figures B) Feel guilty that they could not save their friends during an attack at their school C) Having thoughts of revenge toward boys who were bullying him at school. D) Acts out the scary event during playtime

D Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 284 Feedback: PTSD symptoms in children include bedwetting after they had learned how to use a toilet; forgetting how or being unable to talk; acting out the scary event during playtime; and being unusually clingy with a parent or other adult. All of the other distractors are symptoms seen in the adolescent client. Multiple Select

4. An abused child has been placed in a loving foster home. The foster parents express concern when the child has not developed a positive attachment after living in their home for the past 9 months. The case manager concludes that the child has developed which condition? A) Acute stress disorder B) Adjustment disorder C) Disinhibited social engagement disorder D) Reactive attachment disorder

D Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 293 Feedback: Reactive attachment disorder (children) is defined as an inability to develop positive attachments to caregivers because of prior social neglect. Acute stress disorder is when the child develops symptoms of PTSD 3-7 days after the traumatic event. Adjustment disorder is when the child develops emotional symptoms in response to a stressful event that doesn't meet the criteria of PTSD. Disinhibited social engagement disorder is when the child is inappropriate and overly familiar with strangers. Multiple Select

12. A client with PTSD has begun to stay out late every night and "party" with their friends. When family members ask about when the client is going to return to work, they become extremely irritated and verbally lashes out, saying some very hurtful things. What would be the priority NANDA for this client? A) Risk of relocation stress syndrome B) Ineffective activity planning C) Anxiety D) Ineffective impulse control

D Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 289 Feedback: Depending on the trauma, posttrauma syndrome, rape trauma syndrome, risk for suicide, anxiety, defensive coping, hopelessness, ineffective impulse control and powerlessness, are examples of nursing diagnoses generated by assessment of a person with PTSD. Multiple Select

17. When prescribing an antidepressant for the treatment of an adolescent with OCD, a higher dose is usually ordered by the health care provider. When educating the client/family, the health care provider should warn them about safety due to an increased risk for which effect? A) Nightmares B) Sleepwalking C) Amnesia D) Suicidality

D Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 305 Feedback: All antidepressants have a black box warning for suicidality in children, adolescents, and young adults. This is the highest priority that must be assessed frequently. These medications often take several weeks or months to relieve compulsions and may take even longer to decrease obsessions. One of the older antidepressants, clomipramine, is commonly used in the treatment of OCD.

10. What is the most appropriate technique for the nurse to use while assessing a client with OCD at admission? A) Simple questions with Yes/No responses B) Short questions that require one or two sentences to answer C) Stopping the client and getting them to focus on the topic when they start to ramble D) Calm, nonauthoritarian approach with patience and active listening

D Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 5 Page Number: 303 Feedback: Establishing a therapeutic relationship with a person with OCD requires patience and active listening. The individual may go to great lengths to explain some minute aspect of her or his life. It is important not to interrupt or rush these explanations. Being unable to finish thoughts increases the client's anxiety and frustration. The nurse should interact with the individual in a calm, nonauthoritarian fashion without exhibiting any disapproval of the client or the client's behaviors while demonstrating empathy about the distress that the disorder has caused. The other responses would only heighten the client's anxiety.

1. A client with obsessive--compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, "These pills are making me sick. I think I'm getting a brain tumor because of the headaches." Which response by the nurse would be most appropriate? A) "Let's talk about how often you have been performing the rituals lately." B) "Tell me how many times you have washed your hands today." C) "Have you been practicing your deep breathing and relaxation exercises?" D) "These medications have side effects that can cause increased headaches."

D Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 5 Page Number: 304 Feedback: Individuals with obsessive--compulsive disorder need frequent reassurance that the side effects are a common response to the medication and that they are not becoming ill. Ignoring the client's concerns will only increase the client's anxiety. Multiple Select

14. A child has to verbalize their thoughts using 3 syllables at a time, pause, and then state another 3 syllables. If they are not allowed to do this, they get frustrated and angry. What is this behavior known as? A) Obsession with the number 3 B) Tradition that started when they were learning to formulate words C) Magical thinking performance D) Ritual behavior common in childhood

D Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 298 Feedback: Rituals are common compulsions in which objects must be in a certain order, motor activities are performed in a rigid fashion, or things are arranged in perfect symmetry. A ritual consumes a great deal of time to complete even the simplest task. Some individuals experience discontent, rather than anxiety, when things are not symmetrical or perfect. Behaviors such as touching every third tree, avoiding cracks in the sidewalk, or consistently verbalizing fears of losing a parent in an accident may have some underlying pathology but are common behaviors in childhood.

11. While planning care for a child who has excoriation disorder, what would the priority NANDA be? A) Hopelessness B) Dysfunctional family processes C) Ineffective role performance D) Impaired skin integrity

D Chapter: 20 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 307, 308 Feedback: The nursing diagnoses applied to clients with OCD can run the gamut from the primary diagnosis of Anxiety to other physiologic disturbances of the compulsion, such as Impaired Skin Integrity, which may result from continuous hand washing or picking at the skin.

4. A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client states which of the following? A) "I think that the federal government is spying on me." B) "I get really 'turned on' by your appearance." C) "That doctor I had today really made me angry." D) "When I get out of here, I'm going to kill my neighbor."

D Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 6 Page Number: 22, 23 Feedback: When there is a judgment that the client has harmed someone or is about to injure someone, the nurse is mandated to breach confidentiality and report this to the authorities. The statement about killing the neighbor is an example. Thinking that the federal government is spying on the person reflects paranoid thinking. The statement about being "turned on" reflects manipulative behavior. The statement about feeling angry about the doctor provides information about the client's feelings. The nurse would be mandated to report this statement only if the client went on to say that he or she was planning to "hurt" the doctor.

18. After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which of the following as a right? A) Freedom from restraints or seclusion B) Access to one's own mental health records on request C) An individualized written treatment plan D) Refuse treatment during an emergency situation

D Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 2 Page Number: 17, 18 Feedback: The Bill of Rights for persons receiving mental health services includes the right to be free from restraints or seclusion, access one's own mental health care records upon request, an individualized written treatment plan, and refuse treatment except during an emergency situation. Multiple Select

12. After educating a class on competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated? A) Communication of choices B) Understanding of relevant information C) Appreciation for situation and consequences D) Discussion of what is right and wrong

D Chapter: 3 Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 3 Page Number: 19 Feedback: A client who is competent is able to communicate choices, understand relevant information, appreciate the situation and consequences, and use a logical thought process to compare risks and benefits of treatment options. The ability to discuss what is right and wrong is not a component assessed when determining competency.

13. A client with PTSD has been prescribed sertraline (Zoloft). While educating this client about possible side effects, the nurse should stress that they need to call their health care provider if they experience which signs/symptoms? (Select all that apply.) A) Fatigue B) Constipation C) Dry eyes D) Muscle twitching E) Tachycardia [heart racing]

D, E Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 291 Feedback: Client/family should be taught to notify the health care provider if severe agitation, hallucinations, coordination problems, muscle twitching, racing heartbeat, high or low blood pressure, muscle rigidity, sweating or fever, nausea, vomiting, diarrhea occur. Multiple Choice

15. Which client statement(s) best supports that the nurse--client relationship has acheived a therapeutic rapport? (Select all that apply.) A) "I do not feel so alone with this problem anymore." B) "I enjoy the time we spend together." C) "Nurses are really good people." D) "I feel that you understand me." E) "It is really hard being sick."

wer: A, D Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: 96 Feedback: Rapport is the development of interpersonal harmony characterized by understanding and respect, and is important in developing a trusting, therapeutic relationship. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. Establishing rapport helps lessen feelings of being alone. While the other options present positive feelings about nurses in general and spending time with the nurse, none express the concepts of understanding and not feeling isolated. The option related to the client's feelings related to being sick demonstrates a sense of isolation. Multiple Choice Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)