MENTAL HEALTH 1ST EXAM

For which reasons is the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) useful in the practice of psychiatric-mental health nursing? Select all that apply. 1. It informs the nurse of accurate and reliable psychiatric diagnoses. 2. It represents progress toward a more holistic view of mind and body. 3. It provides a framework for interdisciplinary communication. 4. It provides a template for psychiatric-mental health nursing care plans. 5. It provides a framework for communication with the client.

ANS: 1, 2, 3 1. This is correct. The DSM-5 is useful in the practice of psychiatric-mental health nursing because it provides information about accurate and reliable psychiatric diagnoses. 2. This is correct. The DSM-5 encourages a holistic view of mind and body and provides a framework for interdisciplinary communication. 3. This is correct. The DSM-5 provides a framework for interdisciplinary communication.

Place Kübler-Ross' stages of grief in the correct order. 1. _____Anger 2. _____Bargaining 3. _____Denial 4. _____Depression 5. _____Acceptance

ANS: 3, 1, 2, 4, 5

What is the purpose of a nurse providing appropriate feedback? 1. To provide the client with good advice 2. To advise the client on appropriate behaviors 3. To evaluate the client's behavior 4. To give the client critical information

ANS: 4 This is correct. The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

A client routinely uses an excessive amount of alcohol when under stress. When her husband arrived home one day and found her intoxicated, he began yelling at her about her chronic alcohol abuse. Which of the wife's actions demonstrates the defense mechanism of denial? 1. Hiding liquor bottles in a closet 2. Yelling at her son for slouching 3. Intentionally burning dinner 4. Stating "I don't drink too much!"

ANS: 4 This is correct. The woman's statement "I don't drink too much!" represents the use of the defense mechanism of denial. The client who refuses to acknowledge the existence of a real situation and the feelings associated with it is using the defense mechanism of denial.

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful to assist the client to cope with stress? Select all that apply. a. "Enjoy a pet." b. "Spend time with a loved one." c. "Listen to music." d. "Focus on the stressors." e. "Journal your feelings."

a. "Enjoy a pet." b. "Spend time with a loved one." c. "Listen to music." e. "Journal your feelings."

A nurse is interviewing a distressed client who reports being fired after 15 years of loyal employment. Which of the following questions best assist the nurse to determine the client's appraisal of the situation? Select all that apply. a. "What resources have you previously used in stressful situations?" b. "Have you ever experienced a similar stressful situation?" c. "Who do you think is to blame for this situation?" d. "Why do you think you were fired from your job?" e. "What skills do you possess that might lead to gainful employment?"

a. "What resources have you previously used in stressful situations?" b. "Have you ever experienced a similar stressful situation?" e. "What skills do you possess that might lead to gainful employment?"

In which situation would the nurse be required to employ Maslow's hierarchy of needs to determine if immediate intervention is required to fulfill a lower-level need? a. A client rudely complaining about limited visiting hours b. A client aggressive behavior toward another client c. A client stating expressing feelings of sadness and loneliness d. A client verbalizing feelings of failure and hopelessness

b. A client aggressive behavior toward another client

Which client should a nurse identify as a potential candidate for an involuntary commitment? a. A client living under a bridge in a cardboard box. b. A client verbalizing intent to commit suicide. c. A homeless client refusing to bathe. d. A client who eats waste out of a garbage can.

b. A client verbalizing intent to commit suicide.

A nurse is providing education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? a. Diagnostic blood test b. Awareness of factors creating stress c. Relaxation exercises d. Identification of support systems

b. Awareness of factors creating stress

22. Which neurotransmitters would the nurse expect to be elevated in a client with a diagnosis of catatonic schizophrenia? a. Serotonin b. Dopamine c. Norepinephrine d. Histamine

b. Dopamine

The nurse-client therapeutic relationship includes which of the following characteristics? Select all that apply. a. Meeting the psychological needs of the nurse and the client b. Ensuring therapeutic termination c. Promoting client insight into problematic behavior d. Collaborating to set appropriate goals e. Meeting the holistic needs of the client

b. Ensuring therapeutic termination c. Promoting client insight into problematic behavior d. Collaborating to set appropriate goals e. Meeting the holistic needs of the client

A 32 year old person is speaking to the office nurse at an initial visit. The nurse asked, "What brings you in today?" The client replied, "I have been having headaches three to four times a week for the past month or so. I'm not sleeping well and feel tired most of the time. I work 60 hours per week and am going through a divorce." The nurse determines the client's symptoms represent which of the following? a. Adaptive coping b. Maladaptive coping c. problem -solving d. Self-awareness

b. Maladaptive coping

Which provides the basis for selecting nursing interventions to achieve outcomes for which the nurse is accountable? a. Physician diagnosis b. Nursing diagnosis c. Critical pathways d. Case management

b. Nursing diagnosis

Which phase of the nurse-client relationship begins when the nurse and client first meet and is characterized by an agreement to continue meeting and working on setting client-centered goals? a. Pre Interaction b. Orientation c. Working d. Termination

b. Orientation

The school nurse is assessing a high school student who is distraught because her parents cannot afford horseback riding lessons. The nurse recognizes the student's perception is that the problem is: a. Endangering her well-being b. Personally relevant c. Based on immaturity d. Exceeding her capacity to cope

b. Personally relevant

During an intake assessment, the nurse asks a client both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart problems, not for my head." Which is the nurse's best response? a. "We ask all clients these questions." b. "Why are you concerned about these questions?" c. "Psychological stress can affect medical conditions." d. "We can ship these questions if you prefer."

c. "Psychological stress can affect medical conditions."

A client diagnosed with dependent personality disorder states, "Do you think I should move out of my parents' house and get a job?" Which nursing response is most appropriate? a. It would be best to do that to increase independence. b. Why would you want to leave a secure home? c. Let's discuss and explore all of your options. d. I'm afraid you would feel very guilty leaving your parents.

c. Let's discuss and explore all of your options.

A parent who has learned that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? a. "This situation is very sad, but time is a great healer." b. "You are sad, but you must be strong for your other children." c. "Once you cry it all out, things will seem so much better." d. "It must be horrible to lose a child; I'll stay with you until your spouse arrives."

d. "It must be horrible to lose a child; I'll stay with you until your spouse arrives."

Which statement should the nurse identify as correct regarding a client's right to refuse treatment? a. Clients can refuse pharmacological treatment by not psychological treatment. b. Clients can refuse any type of psychiatric treatment at any time. c. The only treatment a client can refuse is electroconvulsive therapy (ECT). d. Professionals can override treatment refusal if the client is actively suicidal.

d. Professionals can override treatment refusal if the client is actively suicidal.

A patient was admitted with a chronic level of major depression. The patient was started on an MAOI orally daily during this hospitalization. The nurse's discharge teaching should include which of the following? a. Continue taking medication as prescribed. You will continue to see improvement over the next few days. b. You will not need to follow up with outpatient psychotherapy, as you and the social worker have completed your therapy. c. You may be able to discontinue the medication within 6 months to 1 year but only under a doctor's supervision. However, there is a chance of recurring episodes. d. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine.

d. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine.

A new psychiatric-mental health nurse states, "This client's use of defense mechanisms should be eliminated." Which is the correct evaluation of the nurse's statement? 1. Defense mechanisms are self-protective responses to stress and do not need to be eliminated. 2. Defense mechanisms are maladaptive attempts of the ego to manage anxiety and should be eliminated. 3. Defense mechanisms are used by individuals with weak ego integrity and should not be eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

ANS: 1 This is correct. Defense mechanisms serve the purpose of reducing anxiety during times of stress. A client with no defense mechanisms may have a lower tolerance for stress, predisposing him or her to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

Most cultures label behavior as mental illness based on which of the following criteria? 1. Incomprehensibility and cultural relativity 2. Strength of character and ethics 3. Goal directedness and high energy 4. Creativity and good coping skills

ANS: 1 This is correct. Incomprehensibility and cultural relativity are most often the criteria used to define whether something is labeled mental illness.

A mental health nurse is speaking with parents who are concerned about their teenage children's responses to stress. One child becomes anxious and irritable and the other withdraws and cries. Which is the nurse's best response? 1. "Individual responses to stress are affected by many factors and can vary." 2. "Children from the same family should not react so differently to stress." 3. "Children should have similar dispositions and responses to stress." 4. "Environmental factors influence stress responses more than genetic factors."

ANS: 1 This is correct. Responses to stress are variable among individuals and may be influenced by perception, past experiences, environmental factors, and genetic factors.

Which psychoneurotic responses to severe anxiety are identified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)? 1. Somatic symptom disorder 2. Grief reaction 3. Psychosis 4. Bipolar disorder

ANS: 1 This is correct. Somatic symptom disorder is characterized by preoccupation with physical symptoms for which there is no demonstrable organic pathology. One of the diagnostic criteria is a high level of anxiety about health concerns or illness.

A mental health technician asks the nurse, "How do psychiatrists determine which diagnosis to give a client?" Which is the nurse's best response? 1. "Psychiatrists use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)." 2. "Psychiatrists are required to follow hospital policy to diagnose mental disorders." 3. "Psychiatrists make diagnoses based on the client's behavior and other factors." 4. "Psychiatrists use one of the 10 diagnostic labels from the American Medical Association (AMA)."

ANS: 1 This is correct. The DSM is published by the American Psychiatric Association (APA). It is an organized manual describing mental disorders and the criteria that determine whether a given diagnosis is appropriate. The purpose of the DSM is to facilitate accurate and reliable psychiatric diagnosis and treatment.

The nurse is caring for a client admitted to the palliative care unit. The client's spouse has been at the client's bedside since the client was admitted. One week ago, the spouse began to visit 2 or 3 hours a day. Which is the spouse experiencing? 1. Anticipatory grief 2. Bereavement overload 3. Depression 4. Resolution

ANS: 1 This is correct. The client's spouse is experiencing anticipatory grief. Individuals may begin the grieving process before the actual loss occurs. Family members facing the death of a loved one experience anticipatory grief when they complete the mourning process prematurely. They disengage from the dying person, who may then feel rejected during a time when psychological support is most needed.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? 1. Giving approval 2. Interpreting 3. Presenting reality 4. Making observations

ANS: 1 This is correct. The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? 1. "You appear to be talking to someone I do not see." 2. "Please describe what you are seeing." 3. "Why do you continually look in the corner of this room?" 4. "If you hum a tune, the voices may not be so distracting."

ANS: 1 This is correct. The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." 1. Restating 2. Offering general leads 3. Focusing 4. Accepting

ANS: 1 This is correct. The nurse is using the therapeutic communication technique of restating. Restating involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

Which statements regarding defense mechanisms are true? Select all that apply. 1. They are employed when there is a threat to biological or psychological integrity. 2. They are controlled by the id and deal with primal urges. 3. They are used to relieve mild to moderate anxiety. 4. They are protective devices for the superego. 5. They are mechanisms that are characteristically self-deceptive.

ANS: 1, 3, 5 1. This is correct. Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity. 3. This is correct. Defense mechanisms are employed by the ego to relieve mild to moderate anxiety. 5. This is correct. Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity to relieve mild to moderate anxiety. Because they redirect focus, they are characteristically self-deceptive.

Mental illness was attributed to which of the following factors prior to the influence of Middle Eastern countries? Select all that apply. 1. Supernatural forces 2. Medical conditions 3. Disequilibrium of humors 4. Personality 5. Demons

ANS: 1, 3, 5 1. This is correct. Middle Eastern countries believed mental illness was a medical condition. Prior to this, mental illnesses were attributed to several things, including supernatural forces. 3. This is correct. Middle Eastern countries believed mental illness was a medical condition. Prior to this, mental illnesses were attributed to several things including disequilibrium of humors. 5. This is correct. Middle Eastern countries believed mental illness was a medical condition. Prior to this, mental illnesses were attributed to several things, including demons.

Which behaviors indicate a client is experiencing moderate anxiety? Select all that apply. 1. Gastric discomfort 2. Urinary frequency 3. Palpitations 4. Focus on self 5. Feelings of dread

ANS: 1, 4 1. This is correct. Gastric discomfort occurs with moderate anxiety. 4. This is correct. Moderate anxiety may result in an increased focus on self.

Who believed mental illness was curable? 1. Benjamin Rush 2. Dorothea Dix 3. Florence Nightingale 4. Linda Richards

ANS: 2 This is correct. Dorothea Dix was among the first nurses to advocate for those with mental illness. She was unfaltering in her belief that mental illness was curable through humanistic therapeutic care.

The nurse recognizes that a client is mildly anxious when beginning a session that incudes client teaching. Which is the most appropriate interpretation of the situation? 1. The nurse should wait until the client is more anxious to enhance learning. 2. The mild anxiety the client displays will likely enhance learning for the client. 3. The nurse should wait until there is no anxiety to achieve the best learning. 4. The mild anxiety will have no impact on learning and does not need consideration.

ANS: 2 This is correct. Mild anxiety sharpens the senses, increases the perceptual field, and results in heightened awareness of the environment. Learning is enhanced.

A high school student is attracted to a female teacher. The student is uncomfortable with his feelings and says to his friend, "I know she wants me." Which defense mechanism is the student demonstrating? 1. Displacement 2. Projection 3. Rationalization 4. Sublimation

ANS: 2 This is correct. Projection refers to the attribution of one's unacceptable feelings or impulses to another person. When the client "passes the blame" of the undesirable feelings, anxiety is reduced.

Which disorder does the nurse recognize as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)? 1. Morbid obesity 2. Generalized anxiety disorder 3. Essential hypertension 4. Bereavement

ANS: 2 This is correct. The DSM-5 identifies several mental health disorders that are related to anxiety, including generalized anxiety disorder, somatic symptom disorder, and dissociative disorders.

Which best describes the impact that the National Mental Health Act of 1946 had on care for the mentally ill in the United States? 1. People were no longer perceived as demonized when displaying mental illness. 2. Mental health professionals were provided funding to increase their education. 3. A system of hospitals for the mentally ill was developed in communities. 4. The first hospital for just the mentally ill was opened and staffed by professionals

ANS: 2 This is correct. The National Mental Health Act of 1946 helped provide funding for educating mental health professionals who could provide care to the mentally ill.

Which statement demonstrates that the nurse understands an individual's experience of neurosis? 1. "The individual is unaware he or she is experiencing distress." 2. "The individual feels helpless to change his or her situation." 3. "The individual is aware of psychological causes of his or her behavior." 4. "The individual has lost contact with reality."

ANS: 2 This is correct. The client experiencing neurosis feels helpless to change his or her situation.

The nurse is interviewing a client with a history of excessive drinking and multiple arrests for impaired driving. The client states, "I work hard to provide for my family. I don't see why I can't drink to relax." Which defense mechanism is the client demonstrating? 1. Projection 2. Rationalization 3. Regression 4. Sublimation

ANS: 2 This is correct. The client is using rationalization, a common defense mechanism. The client is attempting to make excuses and create logical reasons to justify unacceptable feelings or behaviors.

Teaching regarding the concepts of mental health and mental illness is effective when the student nurse states which of the following? 1. "The concepts are rigid and based on religious beliefs." 2. "The concepts are multidimensional and culturally defined." 3. "The concepts are universal and unchanging." 4. "The concepts are fixed and unidimensional."

ANS: 2 This is correct. The concepts of mental health and mental illness are multidimensional and culturally defined. It is important for nurses to be aware of cultural norms when evaluating a client's mental state.

In which situation would the nurse be required to employ Maslow's hierarchy of needs to determine if immediate intervention is required to fulfill a lower-level need? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating expressing feelings of sadness and loneliness 4. A client verbalizing feelings of failure and hopelessness

ANS: 2 This is correct. The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Maslow's hierarchy of needs indicates that safety and security are lower-level needs, which must be fulfilled before higher-level needs can be met. This client demonstrates the lower-level need for safety and security.

A client diagnosed with posttraumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which utterance made by the nurse is an example of a broad opening? 1. "What occurred prior to the traumatic event, and when did you go to the emergency department?" 2. "What would you like to talk about?" 3. "I notice you seem uncomfortable discussing this." 4. "How can we help you feel safe during your stay here?"

ANS: 2 This is correct. The nurse's question "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E

ANS: 2 This is correct. The nurse's uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

A nurse is educating a client about the difference between mental health and mental illness. Which statement indicates that the teaching was effective? 1. "Mental health is characterized by an absence of stressors." 2. "Mental health is reflected by successful adaptation to stressors." 3. "Mental health is incongruence between feelings and behavior." 4. "Mental health is included in the diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)."

ANS: 2 This is correct. There are several definitions of mental health. This definition highlights concepts of successful adaptation to stressors, including thoughts, feelings, and behaviors that are age appropriate and congruent with cultural and societal norms.

Which indicates a client is likely demonstrating a mental disorder? 1. The client expresses mild anxiety and is eating more than usual before an examination. 2. The client displays an inability to concentrate, including reduced job performance. 3. The client describes engaging in fidgeting behavior consistently over a few days. 4. The client states an increase in smoking over a few days from 0.5 to 1 pack per day.

ANS: 2. This is correct. The client is unable to concentrate, and job performance has been negatively impacted. This demonstrates a possible mental disorder.

A supervisor openly disagrees with an employee's suggestions during a staff meeting. Which response by the employee would demonstrate the defense mechanism of displacement? 1. Confronting the supervisor assertively 2. Leaving the staff meeting abruptly 3. Criticizing a coworker after the meeting 4. Working to become a supervisor

ANS: 3 This is correct. Displacement refers to transferring feelings from one target to a neutral or less-threatening target. Angrily criticizing a coworker after the disagreement with the supervisor is an example of the defense mechanism of displacement.

The mental health nurse is conducting an intake interview with a couple seeking marital counseling. Which action by the husband demonstrates the ego defense mechanism of projection? 1. He stamps his feet and demands his wife honor her vows. 2. He ignores his wife's continued absence from the home. 3. He accuses his wife of infidelity and betrayal. 4. He takes out his frustration by verbally abusing his coworkers.

ANS: 3 This is correct. Projection is the attribution of feelings or impulses unacceptable to one's self to another person. In this situation, the husband is attributing his feelings of betrayal to his wife.

An eighth-grade boy is uncomfortable with his feelings for an older girl and interest in her. He teases the girl whenever he gets a chance and makes jokes about her appearance. The school nurse identifies the boy as using which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

ANS: 3 This is correct. The boy is using the defense mechanism of reaction formation. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors.

A woman devastated by the divorce from her abusive husband has been receiving grief counseling. Which demonstrates the woman is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so angry that my children and I put up with him as long as we did." 3. "It was a difficult marriage, but I think I learned from the experience." 4. "I still am not sleeping, don't have any appetite, and am losing weight."

ANS: 3 This is correct. The client is in the acceptance stage (stage 5) of Kübler-Ross's stages of grief. During this stage, the client is able to focus on the reality of the loss and its meaning in relation to life.

A nurse is performing a mental health assessment on an adult client. The nurse recognizes which action as demonstrating that the client has achieved the highest level of functioning according to Maslow's hierarchy of needs? 1. Maintenance of a long-term, faithful, intimate relationship 2. A high level of self-confidence and autonomy 3. A feeling of self-fulfillment and realization of full potential 4. Development of a sense of purpose and the ability to direct activities

ANS: 3 This is correct. The client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level of functioning on Maslow's hierarchy of needs.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" 1. Reflecting 2. Making observations 3. Formulating a plan of action 4. Giving recognition

ANS: 3 This is correct. The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

During an intake assessment, the nurse asks a client physiological and psychosocial questions. The client angrily responds, "I'm here for my heart problems, not for my head." Which is the nurse's best response? 1. "We ask all clients these questions." 2. "Why are you concerned about these questions?" 3. "Psychological stress can affect medical conditions." 4. "We can skip these questions if you prefer."

ANS: 3 This is correct. The nurse should not skip either physiological or psychosocial questions, as this would lead to an inaccurate assessment. The nurse should always attempt to educate the client on the negative effects of excessive stress on medical conditions.

The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? 1. "Do you know why you are here?" 2. "Are you feeling depressed or anxious?" 3. "Yes, I see. Go on." 4. "Can you chronologically order the events that led to your admission?"

ANS: 3 This is correct. The nurse's statement is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

Which of the following are included in Jahoda's six indicators of mental health? Select all that apply. 1. Acceptance 2. Creativity 3. Environmental mastery 4. Fulfillment 5. Integration

ANS: 3, 5 3. This is correct. Jahoda's six indicators of mental health include environmental mastery. 5. This is correct. Jahoda's six indicators of mental health include integration.

Which action by the nurse, who is first meeting a client, would likely send a nonverbal message that is inappropriate for the therapeutic relationship? 1. The nurse provides eye contact intermittently during the meeting. 2. The nurse is dressed in business casual attire; a tattoo is visible. 3. The nurse offers a handshake during initial interaction with the client. 4. The nurse gives a client a strong hug at the end of the meeting.

ANS: 4 This is correct. A strong hug is typically a gesture that demonstrates an attraction or attachment to another person and is inappropriate for establishing a therapeutic relationship.

Which is determined by the degree to which thoughts, feelings, and behaviors interfere with an individual's functioning? 1. Anxiety 2. Defense mechanisms 3. Mental health 4. Adaptation

ANS: 4 This is correct. Adaptation is determined by the degree to which thoughts, feelings, and behaviors interfere with an individual's functioning.

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. The nurse determines the client's behaviors: 1. Demonstrate typical variations in daily mood, not mental illness 2. Are clinically significant and indicate serious mental illness 3. Are incongruent with cultural norms and indicate mental illness 4. Show common symptoms of grief and do not indicate mental illness

ANS: 4 This is correct. Feelings of sadness are expected and normal following the loss of a pet. This client does not demonstrate changes in daily function but does demonstrate common symptoms of grief.

When the general population cannot understand the motivation behind one's behavior, which would be the appropriate term to use? 1. Anxiety 2. Defense mechanisms 3. Cultural relativity 4. Incomprehensibility

ANS: 4 This is correct. Incomprehensibility relates to the inability of the general population to understand the motivation behind one's behavior.

Which is the most significant consequence of excessive use of regression? 1. The superego is suppressed. 2. Emotions are experienced intensely. 3. Learning and personal growth are enhanced. 4. Problem-solving is limited.

ANS: 4 This is correct. Regression is the retreating to an earlier level of development and the comfort measures associated with a previous level of functioning. Regression results in limited problem-solving abilities.

Which demonstrates use of the ego defense mechanism of regression? 1. A parent blames the teacher for their child's failure in school. 2. A teenager becomes hysterical after seeing a friend killed in a car accident. 3. A person chooses a spouse exactly like a beloved parent. 4. An adult throws a temper tantrum when he does not get his own way.

ANS: 4 This is correct. Regression is the retreating to an earlier level of development and the comfort measures associated with that level of functioning. An adult throwing a temper tantrum demonstrates regression.

Which of the following does the nurse recognize as an example of the defense mechanism of repression? 1. A student who goes to a movie instead of studying for tomorrow's math test 2. A parent who does not believe the military report that his or her son was killed in Iraq 3. A person who is unhappily married and goes to school to become a marriage counselor 4. A person who was raped at 12 years old and does not remember it

ANS: 4 This is correct. Repression is the involuntary blocking of unpleasant feelings and experiences from one's awareness.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my partner or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." 1. Encouraging comparison 2. Exploring 3. Formulating a plan of action 4. Making observations

ANS: 4 This is correct. The nurse is using the therapeutic communication technique of making observations by noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? 1. The nontherapeutic technique of "giving advice" 2. The therapeutic technique of "formulating a plan of action" 3. The therapeutic technique of "presenting reality" 4. The nontherapeutic technique of "giving false reassurance"

ANS: 4 This is correct. The nurse's statement is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

Which individuals are communicating a message? Select all that apply. a. A parent spanking her child for playing with matches b. A teenager isolating himself and playing loud music c. A biker sporting an eagle tattoo on a bicep d. A teenager writing, "No one understands me" e. A parent checking for a new email on a regular basis.

a. A parent spanking her child for playing with matches b. A teenager isolating himself and playing loud music c. A biker sporting an eagle tattoo on a bicep d. A teenager writing, "No one understands me"

Meditation has been shown to be an effective stress management technique. Which finding indicates medication has been effective? a. Achieving a state of relaxation b. Attaining insight into one's feelings c. Demonstrating appropriate role behaviors d. Enhanced problem-solving

a. Achieving a state of relaxation

The nurse is preparing a teaching plan for the parent of a child diagnosed with attention deficit-hyperactivity disorder. The parent voices concern over the child's poor appetite and inability to gain weight. Which of the following interventions would be the most appropriate to address the parent's concerns? a. Administer the child's medication immediately after meals. b. Administer the child's medication at bedtime. c. Skip a dose of the medication when the child does not eat. d. Assure the parent that the child will eat when hungry.

a. Administer the child's medication immediately after meals.

A patient with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which is a fatal side effect that should be included in the teaching plan? a. Agranulocytosis b. Akathisia c. Dystonia d. Akinesia

a. Agranulocytosis

Which should the nurse perform to maximize client education prior to discharge teaching? a. Assess the client's readiness to learn b. Identify the priority nursing diagnosis c. Provide routine antidepressant medication d. Begin the teaching as soon as possible

a. Assess the client's readiness to learn

A client requests information on several medications to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice

a. Autonomy

When an individual's stress response is sustained over a long period, the nurse anticipates which physiological effect? a. Decreased resistance to disease b. Increased libido c. Decreased blood pressure d. Increased feeling of well-being

a. Decreased resistance to disease

Which concepts are essential to psychiatric-mental health nursing practice? Select all that apply. a. Evidence-based outcomes b. Holistic nursing practice c. Integration of biological knowledge d. Psychosocial adaptation and physical functioning e. Diagnostic criteria for psychiatric disorders

a. Evidence-based outcomes c. Integration of biological knowledge d. Psychosocial adaptation and physical functioning

Which preexisting conditions influence the outcome of communication? Select all that apply. a. Gender b. Distance c. Eye contact d. Values e. Paralanguage

a. Gender b. Distance d. Values

Which client statement indicates to the nurse that the client may be experiencing a transference reaction? a. I need a real nurse. You are young enough to be my daughter, and I don't want to tell you about my personal life. b. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor. c. I don't seem to be able to relate to people. I would rather stay in my room and be by myself. d. My mother is the source of my problem. She has always told me what to do and what to say.

a. I need a real nurse. You are young enough to be my daughter, and I don't want to tell you about my personal life.

For which reasons is the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) useful in the practice of psychiatric-mental health nursing? Select all that apply. a. It informs the nurse of accurate psychiatric diagnoses. b. It represents progress toward a more holistic view of mind and body. c. It provides a framework for interdisciplinary communication. d. It provides a template for psychiatric-mental health nursing care plans. e. It provides a framework for communication with the client.

a. It informs the nurse of accurate psychiatric diagnoses. b. It represents progress toward a more holistic view of mind and body. c. It provides a framework for interdisciplinary communication.

The nurse is preparing to assess a patient before the physician prescribes a regimen of psychopharmacological therapy. Which components will the nurse assess? Select all that apply. a. Medical history b. Physical examination findings c. Ethnocultural characteristics d. Current medication e. Signs of tardive dyskinesia

a. Medical history b. Physical examination findings c. Ethnocultural characteristics d. Current medication

Stress and its effect on the immune system as associated with which concepts? Select all that apply. a. Physical illness b. Severity of depression c. Insomnia d. Cognition e. Schizophrenia

a. Physical illness b. Severity of depression e. Schizophrenia

The nurse has realized that growing up in an alcoholic family may affect his or her ability to care for an individual client. This task is part of what phase of the therapeutic nurse-client relationship? a. Pre Interaction phase b. Orientation phase c. Working phase d. Termination phase

a. Pre Interaction phase

A psychiatric-mental health nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? a. Refuse to give any information to the caller and cite confidentiality. b. Refuse to give any information to the caller and hang up. c. Affirm only that the person has been seen at the facility. d. Suggest the caller contact the client's psychiatrist.

a. Refuse to give any information to the caller and cite confidentiality.

An increase in dopamine activity might play a significant role in the development of which disorder? a. Schizophrenia b. Depression c. Body dysmorphic disorder d. Parkinson's disease

a. Schizophrenia

Mental illness was attributed to which of the following factors prior to the influence of Middle Eastern Countries? Select all that apply. a. Supernatural forces b. Medical conditions c. Disequilibrium of humors d. Personality e. Demons

a. Supernatural forces c. Disequilibrium of humors e. Demons

After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria enable a physician to consider involuntary commitment? Select all that apply. a. The client is a danger to others. b. The client is homeless. c. The client is disruptive. d. The client is gravely disabled and unable to meet basic needs. e. The client is suicidal.

a. The client is a danger to others. d. The client is gravely disabled and unable to meet basic needs. e. The client is suicidal.

What is the legal significance of a nurse's action when the nurse threatens to restrain a client physically? a. The nurse can be charged with assault b. The nurse can be charged with negligence. c. The nurse can be charged with malpractice. d. The nurse can be charged with beneficence.

a. The nurse can be charged with assault

Which of the following can the psychiatric-mental health nurse utilize to best increase self-awareness? Select all that apply. a. Values clarification b. The johari window c. Concrete thinking d. Positive regard e. Personal boundaries

a. Values clarification b. The johari window

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? a. You appear to be talking to someone I do not see. b. Please describe what you are seeing. c. Why do you continually look in the corner of this room? d. If you hum a tune, the voices may not be so distracting.

a. You appear to be talking to someone I do not see.

A patient began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 pounds since then. Which is the most appropriate nursing response? a. "It is surprising that you have gained; weight loss is the typical pattern when taking lithium." b. "Your weight gain is more likely related to food intake and decreased activity than medication." c. "Weight gain is a common but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." d. "There's not much you can do about weight gain. It's better than being emotionally unstable though."

c. "Weight gain is a common but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits."

A client diagnosed with major depressive disorder states, "Why should I keep trying to get a job? I mess up everything I do." Which correctly written nursing diagnosis best reflects the content and mood themes in this client's statement? a. Hopelessness R/T poor job performance AEB client's unemployment b. Risk for impaired adjustment R/T inadequate social skills AEB isolation c. Altered role performance R/T the fear of failure AEB not seeking employment d. Chronic low-self esteem R/T major depressive disorder AEB self-hatred

c. Altered role performance R/T the fear of failure AEB not seeking employment

Which medication is most likely to be prescribed for the extrapyramidal side effects of antipsychotic medications? a. Diazepam (Valium) b. Amitriptyline (Elavil) c. Benztropine (Cogentin) d. Methylphenidate

c. Benztropine (Cogentin)

Which of the following are characteristics of accurately developed client outcomes? Select all that apply. a. Client outcomes are formulated by each nurse, independent of other team members. b. Client outcomes are not restricted by time frames. c. Client outcomes are specific and measurable d. Client outcomes are realistically based on client capability e. Client outcomes are formally approved by the psychiatrist and the nurse practitioner

c. Client outcomes are specific and measurable d. Client outcomes are realistically based on client capability

A supervisor openly disagrees with an employee's suggestions during a staff meeting. Which response by the employee would demonstrate the defense mechanism of displacement? a. Confronting the supervisor assertively b. Leavin the staff meeting abruptly c. Criticizing a coworker after the meeting d. Working to become a supervisor

c. Criticizing a coworker after the meeting

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, "I'm not well enough to switch to a different nurse." Which of the following does the nurse recognize the client is demonstrating? a. Manipulation to receive secondary gain b. The defense mechanism of denial c. Difficulty terminating the relationship d. Use of "splitting" of remain dependent on the nurse

c. Difficulty terminating the relationship

Which nursing statement is a good example of the therapeutic communication technique of giving recognition? a. You did not attend the group today. Can we talk about that? b. I'll sit with you until it is time for your family session. c. I noticed you are wearing a new dress and have washed your hair. d. I'm happy that you are now taking your medications. They will really help.

c. I noticed you are wearing a new dress and have washed your hair.

A client has experienced the death of a close family member and at the same time becomes unemployed. The client's 6-month score on the Recent Life Changes Questionnaire is 110. The nurse: a. Understands the client is at risk for significant stress-related illness. b. Determines the client is not at risk for significant stress-related illness. c. Needs further assessment of the client's coping skills to determine susceptibility to stress-related illness. d. Recognizes the client may view the losses aas challenges and perceive them as opportunities.

c. Needs further assessment of the client's coping skills to determine susceptibility to stress-related illness.

A client who will be receiving ECT must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? a. The client is demonstrating symptoms of paranoia. b. The client is 87 years old. c. The client is not oriented to person, date, or time. d. The client asks the spouse's opinion.

c. The client is not oriented to person, date, or time.

The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. Which client should the triage nurse expect to be admitted? a. The client who is experiencing tremors and has a need for medication adjustment. b. The client who is experiencing anxiety and a sad mood after separation from spouse c. The client who is a single parent and hears voices stating, "Kill your infant." d. The client who argued with her partner and inflicted a superficial cut on her arm.

c. The client who is a single parent and hears voices stating, "Kill your infant."

The nurse says to a newly admitted client, "tell me more about what led up to your hospitalization." What is the purpose of this therapeutic communication technique? a. To reframe the client's thoughts about mental health treatment. b. To put the client at ease c. To explore a subject, idea, experience, or relationship d. To communicate that the nurse is listening to the conversation

c. To explore a subject, idea, experience, or relationship

Which demonstrates use of the ego defense mechanism of regression? a. A parent blames the teacher for their child's failure in school. b. A teenager becomes hysterical after seeing a friend killed in a car accident. c. A person chooses a spouse exactly like a beloved parent. d. An adult throws a temper tantrum when he does not get his own way.

d. An adult throws a temper tantrum when he does not get his own way.

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? a. Does your husband treat you like this very often? b. What do you think is your role in this relationship? c. Why do you think he behaved like that? d. Describe what happened during your time with your husband?

d. Describe what happened during your time with your husband?

The nurse is providing therapeutic feedback to a client who exhibited an angry outburst in a group setting. Which is appropriate for the nurse to say to the client? a. Why do you continue to alienate your peers by your angry outbursts? b. You accomplish nothing when you lose your temper like that. c. Showing your anger in that manner is very childish and insensitive. d. During the group, you raised your voice, yelled at a peer, and slammed the door.

d. During the group, you raised your voice, yelled at a peer, and slammed the door.

A decrease in norepinephrine levels plays a significant role in which disorder? a. Mania b. Schizophrenia c. Anxiety d. Major depressive disorder

d. Major depressive disorder

A client's spouse of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist stresses the importance of proper sleep, nutrition, and exercise. Which statement is true regarding the rationale for the therapist's advice? a. An interpersonal approach is indicated for depressed clients. b. Sleep, nutrition, and exercise affect imbalances in neurotransmitters. c. Sleep, nutrition, and exercise will alleviate symptoms of depression. d. The client is susceptible to illness due to effects of stress on the immune system.

d. The client is susceptible to illness due to effects of stress on the immune system.