MH Exam 2

Match the group member's comment to the role it most closely represents. a. Playboy b. Energizer c. Organizer d. Follower 1. "We aren't getting much done; let's speed things up and make a decision." 2. "Last week we finished our first goal and today we are starting on our second." 3. "Everyone has had good ideas so far; so, whatever you say is fine with me." 4. "It doesn't really matter what we do. I'm just here because they make me attend."

1. ANS: B 2. ANS: C 3. ANS: D 4. ANS: A

20. A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I will be glad when I can help someone else." This statement reflects a. altruism. b. universality. c. cohesiveness. d. corrective recapitulation.

ANS: A Altruism refers to the experience of being helpful or useful to others, a condition that the patient anticipates will happen. The other options are also therapeutic factors identified by Yalom.

14. A therapy group adds new members as others leave. What type of group is evident? a. Open b. Closed c. Homogeneous d. Heterogeneous

ANS: A An open group is a group that adds members throughout the life of the group as other members leave and as more persons who would benefit from the group become available. A closed group does not add new members; the membership is established at the beginning and, except for the occasional losses as some members leave, does not change thereafter. A homogeneous group includes members who are similar, and a heterogeneous group includes dissimilar members; not enough data are provided here to determine which applies in this case.

16. Which statement provides the best rationale for closely monitoring a severely depressed patient during antidepressant medication therapy? a. As depression lifts, physical energy becomes available to carry out suicide. b. Patients who previously had suicidal thoughts need to discuss their feelings. c. For most patients, antidepressant medication results in increased suicidal thinking. d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

ANS: A Antidepressant medication has the objective of relieving depression. Risk for suicide is greater as the depression lifts, primarily because the patient has more physical energy at a time when he or she may still have suicidal ideation. The other options have little to do with nursing interventions relating to antidepressant medication therapy.

4. Which documentation of family assessment indicates a healthy and functional family? a. Members provide mutual support. b. Power is distributed equally among all members. c. Members believe there are specific causes for events. d. Under stress, members turn inward and become enmeshed.

ANS: A Healthy families nurture and support their members, buffer against stress, and provide stability and cohesion. The distracters are unrelated or incorrect.

2. A leader plans to start a new self-esteem building group. Which intervention would be most helpful for assuring mutual respect within the group? a. Describe the importance of mutual respect in the first session and establish it as a group norm. b. Exclude potential members whose behavior suggests they are likely to be disrespectful of others. c. Give members a brochure describing the purpose, norms, and expectations of the group. d. Explain that mutual respect is expected and confront those who are not respectful.

ANS: A It is helpful to motivate members to behave respectfully by describing how mutual respect benefits all members and is necessary for the group to be fully therapeutic. Setting a tone and expectation of mutual respect from the outset is the most helpful intervention listed. Excluding members because of how they might behave could exclude members who would have been appropriate, depriving them of the potential benefits of the group. Conveying expectations by brochure is less effective than doing so orally, because it lacks the connection to each member a skilled leader can create to motivate members and impart the expectation of respect. Confronting inappropriate behavior is therapeutic but only addresses existing behavior rather than preventing all such undesired behavior.

22. A nurse leads a psychoeducational group for patients in the community diagnosed with schizophrenia. A realistic outcome for group members is that they will a. discuss ways to manage their illness. b. develop a high level of trust and cohesiveness. c. understand unconscious motivation for behavior. d. demonstrate insight about development of their illness.

ANS: A Patients with schizophrenia almost universally have problems associated with everyday living in the community, so discussing ways to manage the illness would be an important aspect of psychoeducation. Discussing concerns about daily life would be a goal to which each could relate. Developing trust and cohesion is desirable but is not the priority outcome of a psychoeducational group. Understanding unconscious motivation would not be addressed. Insight would be difficult for a patient with residual schizophrenia because of the tendency toward concrete thinking.

26. A 16-year-old wants to drive, but the parents will not allow it. A 14-year-old sibling was invited to several sleepovers, but the parents found reasons to deny permission. Both teens are annoyed because the parents buy clothes for them that are more suitable for younger children. The parents say, "We don't want our kids to grow up too fast." Which term best describes this family's boundaries? a. Rigid b. Clear c. Enmeshed d. Differentiated

ANS: A Rigid boundaries are those that do not change or flex with changing circumstances, as indicated here by parents who are reluctant to revise their roles and expectations about their children as the children mature. Enmeshed boundaries are those that have failed to differentiate or develop individually; the family shares roles and thoughts to an excessive degree, without a healthy degree of individuality. Clear boundaries are not enmeshed; they are appropriate and well maintained.

23. Which comment by a mother during a family therapy session shows evidence of scapegoating? a. "Our youngest child always starts arguments and upsets everyone else." b. "We all express our feelings openly except when we think it might upset my husband." c. "Our oldest child knows that my husband and I are doing all we can for the others." d. "After my husband has been drinking, I have to get everyone up and ready for school."

ANS: A Scapegoating is blaming family problems on a member of the family who is not very powerful. The purpose of the blaming is to keep the focus off painful issues and off the blamers themselves. A double-bind message, such as "We all express our feelings openly except when," involves giving instructions that are inherently contradictory or that place the person in a no-win situation. "Our oldest child knows that ..." is an example of triangulation, wherein a third party is engaged to help stabilize an unstable pair within the family. A child assuming parental responsibilities (e.g., caring for siblings) because a parent fails to do so is an example of enabling.

13. Three members of a therapy group share covert glances as other members of the group describe problems. When one makes a statement that subtly criticizes another speaker, the others nod in agreement. Which group dynamic should the leader suspect? a. Some members are acting as a subgroup instead of as members of the main group. b. Some of the members have become bored and are disregarding others. c. Three members are showing their frustration with slower members. d. The leadership of the group has been ineffective.

ANS: A Subgroups, small groups isolated within a larger group and functioning separately from it, sometimes form within therapy groups. When this occurs, subgroup members are cohesive with other subgroup members but not with the members of the larger group. Members of the subgroup may be bored or frustrated or expressing passive aggression, but the primary dynamic is the splitting off from the main group.

11. It has been 5 days since a suicidal patient was hospitalized and prescribed an antidepressant medication. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a. Supervise the patient 24 hours a day. b. Begin discharge planning for the patient. c. Refer the patient to art and music therapists. d. Consider discontinuation of suicide precautions.

ANS: A The patient now has more energy and may have decided on suicide, especially given the prior suicide attempt history. The patient must be supervised 24 hours per day. The patient is still a suicide risk.

9. A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse leader would be most effective? a. Say to everyone, "Most of you have become quiet. I wonder if it might be related to concerns you may have about how the group is progressing today." b. Say to everyone, "One person has done most of the talking. I think it would be helpful for everyone to say how that has affected your experience of the group." c. Say to everyone, "I noticed that as our group progressed, most members became quiet, then disinterested, and now seem almost angry. What is going on?" d. Say to the talkative patient, "You have been doing most of the talking, and others have not had a chance to speak as a result. Could you please yield to others now?"

ANS: A The most effective action the nurse leader can take will be the one that encourages the group to solve its own problem. Pointing out changes in the group and asking members to respond to them lays the foundation for a discussion of group dynamics. Asking members to respond to the talkative patient puts that patient in an awkward position, likely increasing her anxiety. As anxiety increases, monopolizing behavior tends to increase as well, so this response would be self-defeating. Asking members what is going on is a broader opening and might lead to responses unrelated to the issue that bears addressing; narrowing the focus to the group process more directly addresses what is occurring in the group. Focusing on the talkative patient would be less effective and involves the leader addressing the issue instead of members first attempting to do so themselves (giving them a chance to practice skills such as assertive communication).

17. Parents of a mentally ill teenager say, "We have never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems we are facing." Select the nurse's most helpful intervention. a. Refer the parents to a support group. b. Build the parents' self-concept as coping parents. c. Teach the parents techniques of therapeutic communication. d. Facilitate achievement of normal developmental tasks of the family.

ANS: A The need for support is evident. Referrals are made when working with families whose needs are unmet. A support group will provide the parents with support of others with similar experiences and with whom they can share feelings and experiences. The distracters are less relevant to providing a network of support.

9. A college student who attempted suicide by overdose was hospitalized. When the parents were contacted, they responded, "We should have seen this coming. We did not do enough." The parents' reaction reflects a. guilt. b. denial. c. shame. d. rescue feelings.

ANS: A The parents' statements indicate guilt. Guilt is evident from the parents' self-chastisement. The feelings suggested in the distracters are not clearly described in the scenario.

4. During group therapy, one patient says to another, "When I first started in this group, you were unable to make a decision, but now you can. You've made so much progress that I am beginning to think maybe I can conquer my fears too." Which therapeutic factor is evident by this statement? a. Hope b. Altruism c. Catharsis d. Cohesiveness

ANS: A The patient's profession that he may be able to learn to cope more effectively reflects hope. Groups can instill hope in individuals who are demoralized or pessimistic. Altruism refers to doing good for others, which can result in positive feelings about oneself. Catharsis refers to venting of strong emotions. Cohesion refers to coming together and developing a connection with other group members.

10. A patient asks, "What is the major difference between conventional health care and complementary and alternative medicine (CAM)?" The nurse's best reply is that conventional health care a. focuses on what is done to the patient, whereas CAM focuses on body-mind interaction with an actively involved patient. b. has been tested by research so less regulation is needed, but CAM is religiously based and highly regulated. c. is controlled by the health care industry, but CAM is the people's medicine and not motivated by profit. d. is holistic and focused on health promotion, whereas CAM treats illnesses and is symptom-specific.

ANS: A Conventional health care focuses primarily on curative actions implemented on a mostly passive patient, whereas CAM focuses more on the mind-body aspects of health, along with the active involvement of the patient. Conventional health care is largely grounded in scientific research, and its various components are heavily regulated; the opposite tends to be true of CAM. Some forms of CAM have their roots in religious or cultural practices, but this is not characteristic of CAM as a whole. Both conventional health care and CAM can focus on health promotion and treatment of illness. Although critics express concern about the role of profit in conventional health care, the profit motive can also apply in CAM.

17. A nurse plans health education for a patient who will be receiving warfarin for several weeks after knee-replacement surgery. Which substance should the nurse caution the patient to avoid? a. Fish oil b. Black cohosh c. Lavender d. Mandarin

ANS: A Fish oil may increase bleeding time and therefore has a potentially hazardous interaction with the anticoagulant warfarin. Black cohosh is an herbal treatment for hot flashes. Mandarin and lavender may have calming effects, which may be helpful, but would not cause increased risk of bleeding.

13. For which patient would it be most important for the nurse to urge immediate discontinuation of kava? A patient with a comorbid diagnosis of a. cirrhosis. b. osteoarthritis. c. multiple sclerosis. d. chronic back pain.

ANS: A Kava should be used with caution in patients with liver disease because of its potentially hepatotoxic effects. The other health problems do not pose immediate dangers.

22. During an assessment interview, a patient diagnosed with inflammatory bowel disease accompanied by frequent episodes of diarrhea says, "I've been using probiotics in small doses for about a week." When the nurse assesses mental status, expected findings would be a. intact cognitive function. b. slow verbal responses. c. paranoid thinking. d. slurred speech.

ANS: A Probiotics may reduce inflammation and heal the gut. No effect on cognitive function would be associated with use of microbiomes, including probiotics. The patient has taken small doses, so response times would be normal. It does not usually produce the effects cited in the distracters.

8. A patient diagnosed with major depressive disorder tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John's wort." Which action should the nurse take first? a. Advise the patient of the danger of serotonin syndrome. b. Suggest that aromatherapy may produce better results. c. Assess the patient for depression and risk for suicide. d. Suggest the patient decrease the antidepressant dose.

ANS: A Research has suggested that St. John's wort is a mild inhibitor of serotonin reuptake and could lead to serotonin syndrome; this risk is increased if the patient is taking other medications that increase serotonin activity. Assessing the depression would be a secondary intervention. Aromatherapy has not been shown to be an effective adjunct or treatment for depression. Although a dosage reduction in her SSRI medication might reduce the risk of serotonin syndrome, this intervention is not in the nurse's scope of practice.

7. A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient's current prescription drugs. Select the nurse's best comment to the patient. a. "Thanks for telling me. I'll make a note in your medical record that you take it." b. "You are experiencing a placebo effect. When we believe something will help, it usually does." c. "Self-management of health problems can be dangerous. You should have notified me sooner." d. "Research studies show that herbals actually increase migraine pain by inflaming nerve cells in the brain."

ANS: A The nurse should reinforce the patient for reporting use of the herb. Many patients keep secrets about use of alternative therapies. If it poses no danger, the nurse can document the use. The patient may also get placebo effect from the herb, but it is not necessary for the nurse to point out that information. The distracters are judgmental and may discourage the patient from openly sharing in the future.

2. A parent was recently hospitalized with severe depression. Family members say, "We're falling apart. Nobody knows what to expect, who should make decisions, or how to keep the family together." Which interventions should the nurse use when working with this family? (Select all that apply.) a. Help the family set realistic expectations. b. Provide empathy, acceptance, and support. c. Empower the family by teaching problem solving. d. Negotiate role flexibility among family members. e. Focus planning on the family rather than on the patient.

ANS: A, B, C, D The correct answers address expressed needs of the family. The distracter is inappropriate.

1. A patient in good health and without any major health needs says, "I want to try some techniques to improve my mental and physical well-being but I'm overwhelmed by all the suggestions on the Internet." Which techniques would be appropriate for the nurse to suggest? (Select all that apply.) a. Yoga b. Exercise c. Meditation d. Aromatherapy e. Acupuncture f. Spinal manipulation

ANS: A, B, C, D Yoga, exercise, meditation, and aromatherapy are self-help techniques that may have a positive effect on the patient's physical and mental well-being. These techniques are unlikely to cause harm. The patient is in good health; therefore, acupuncture and spinal manipulation are not indicated.

3. Which important points should the nurse teach a patient about using herbal preparations? (Select all that apply.) a. Check active and inactive ingredients. b. Discontinue use if side or adverse effects occur. c. Avoid herbals during pregnancy and breast-feeding. d. Buying from online sources is preferable and cheaper. e. Inform your health care provider about the use of herbals.

ANS: A, B, C, E All of the instruction is correct except regarding purchase of herbals. Herbals should be purchased from a reputable firm. Internet purchasing might not be the best plan, unless the reputation of the firm can be confirmed.

4. A patient reports frequent sleep disturbances. Which interventions could be considered to help improve the patient's sleep pattern? (Select all that apply.) a. Melatonin b. Chamomile c. Vitamin C d. Valerian e. SAM-e

ANS: A, B, D Melatonin, chamomile, and valerian have relaxant effects that help sleep. SAM-e may help with mild depression. Vitamin C has no effect on sleep.

2. A patient who emigrated from India is hospitalized. The patient and family use ayurvedic medicine. The nurse wants to adjust this patient's care so that it is more comfortable and familiar. What changes from usual Western practice should be considered? (Select all that apply.) a. In preparation for discharge, include a significant focus on preventive practices. b. Spend time exploring the patient's life overall, focusing on broader issues than health. c. Involve the patient's entire family and treatment team in decisions about treatment options. d. Anticipate that the patient will prefer and value interventions with high technology features. e. Provide relevant health-related information and then encourage the patient to determine which course of action to pursue.

ANS: A, B, E Ayurvedic medicine, an ancient practice that originated in India, stresses individual responsibility for health, is holistic, promotes prevention, recognizes the uniqueness of the individual, and offers natural methods of treatment. Ayurvedic medicine does not require spiritual cleansing or the involvement of family and the treatment team in all decisions.

3. Which situations are most likely to place severe, disabling stress on a family? (Select all that apply.) a. A parent needs long-term care after sustaining a severe brain injury. b. The youngest child in a family leaves for college in another state. c. A spouse is diagnosed with liver failure and needs a transplant. d. Parents of three children, aged 9, 7, and 2 years, get a divorce. e. A parent retires after working at the same job for 28 years.

ANS: A, C, D Major illnesses and divorce place severe, potentially disabling stress on families. The distracters identify normal milestones in a family's development.

1. A wife believes her husband is having an affair. Lately, he has been disinterested in romance and working late. The husband has an important, demanding project at work. The mother asks her teen, "What have you noticed about your father?" The teen later mentions this to the father, who says, "Tell your mother that I can't deal with her insecurities right now." Family therapy should focus on (Select all that apply.) a. identifying and reducing the cognitive distortion in each parent's perceptions. b. confronting the family with the need for honest, direct, assertive communication. c. helping the parents find ways to cope more effectively with their stress and fears. d. supporting the teen to redirect the parents when they try to communicate through her. e. convincing the mother that her fear of an affair is due to her own insecurities and unfounded. f. helping the husband understand how others might misinterpret the changes in his behavior.

ANS: A, C, D, F Each parent is seeing the other's behavior in a possibly distorted manner, which the nurse would explore and help the parents correct. The nurse would guide the parents to communicate more effectively, but confrontation would likely be non-therapeutic because it would increase the tension and triangulation. Since fear and anxiety contribute to triangulation, increasing the parent's coping abilities as well as reducing anxiety and fear would be areas for intervention. Teaching the adolescent how to protect herself from triangulation, when done in conjunction with interventions to help the parents reduce this behavior, would be protective of the adolescent and would assist the parents in their efforts to change this pattern of communication. The nurse has no facts about whether or not the husband is having an affair; therefore, the nurse should not convince the wife that her fear is only due to her insecurities. Her fears may be well-founded. Helping the husband understand how his wife might see the changes in behavior differently can help him to respond helpfully instead of accusing her of being insecure.

19. A group has two more sessions before it ends. One member was previously vocal and has shown much progress but has now grown silent. What explanation most likely underlies this behavior? The silent member a. has participated in the group and now has nothing more to offer. b. is having trouble dealing with feelings about termination of this group. c. wants to give quieter members a chance to talk in the remaining sessions. d. is engaging in attention-seeking behavior aimed at continuation of the group.

ANS: B A chief task during the termination phase of a group is to take what has been learned in group and transition to life without the group. The end of a group can be a significant loss for members, who may experience loss and grief and respond with sadness or anger. It is unlikely he would have nothing to say; at the very least, he could be responding to the comments of others even if not focusing on his own issues. He may wish to give quieter members a chance to talk, but again, this would not require or explain his complete silence. Some members, faced with only two remaining sessions, may be becoming more dominant under this pressure of time, but here too this is unlikely to lead a previously active participant to fall completely silent. The member is not attention-seeking.

24. Which type of group is a staff nurse with 2 months' psychiatric experience best qualified to conduct? a. Psychodynamic/psychoanalytic group b. Medication education group c. Existential/Gestalt group d. Family therapy group

ANS: B All nurses receive information about patient teaching strategies and basic information about psychotropic medications, making a medication education group a logical group for a beginner to conduct. The other groups would need a leader with more education and experience.

21. During a support group, a patient diagnosed with schizophrenia says, "Sometimes I feel sad that I will never have a good job like my brother. Then I dwell on it and maybe I should not." Select the nurse leader's best comment to facilitate discussion of this issue. a. "It is often better to focus on our successes rather than our failures." b. "How have others in the group handled painful feelings like these?" c. "Grieving for what is lost is a normal part of having a mental disorder." d. "I wonder if you might also experience feelings of anger and helplessness."

ANS: B Asking others to share their experiences will facilitate discussion of an issue. Giving information may serve to close discussion of the issue because it sounds final. Suggesting a focus on the positives implies a discussion of the issue is not appropriate. Suggesting other possible feelings is inappropriate at this point, considering the patient has identified feelings of sadness and seems to have a desire to explore this feeling. Focusing on other feelings will derail discussion of the patient's grief for his perceived lost potential.

8. An adult diagnosed with schizophrenia lives with elderly parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill because of the stress. Which nursing diagnosis is most applicable to this scenario? a. Ineffective family coping related to parental role conflict b. Caregiver role strain related to the stress of chronic illness c. Impaired parenting related to patient's repeated hospitalizations d. Interrupted family processes related to relapse of acute psychosis

ANS: B Caregiver role strain refers to a caregiver's felt or exhibited difficulty in performing a family caregiver role. In this case, one parent exhibits stress-related illness and the other exhibits increased anxiety. The other nursing diagnoses are not substantiated by the information given and are incorrectly formatted (one nursing diagnosis should not be the etiology for another).

9. An adult, recently diagnosed with AIDS, is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family. a. Describe the stages of the anticipatory grieving process. b. Identify and describe effective methods for coping with anxiety. c. Recognize ways dysfunctional communication is expressed in the family. d. Examine previously unexpressed feelings related to the patient's sexuality.

ANS: B Desired outcomes might be set for the family as a whole or for individuals within the family. The outcome most closely associated with the anxiety that each member is experiencing is to focus on identifying and describing ways of coping with the anxiety. The other options are not appropriate at this time.

10. A parent is admitted to a unit for treatment of addictions. The patient's spouse and adolescent children participate in a family session. What is the most important aspect of this family's assessment? a. Spouse's codependent behaviors b. Interactions among family members c. Patient's reaction to the family's anger d. Children's responses to the family sessions

ANS: B Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits. The other options are narrower in scope when compared with the correct option.

11. A parent is admitted to a unit for treatment of addictions. The patient's spouse and adolescent children attend a family session. Which initial assessment question should the nurse ask of family members? a. "What changes are most important to you?" b. "How are feelings expressed in your family?" c. "What types of family education would benefit your family?" d. "Can you identify a long-term goal for improved functioning?"

ANS: B It is important to understand family characteristics, particularly in a family under stress. Expression of feelings is an important aspect of assessment of the family's function (or dysfunction). The distracters relate more to outcome identification and planning interventions, both of which should be delayed until the assessment is complete.

3. When a nurse assesses a family, which family task has the highest priority for healthy family functioning? a. Allocation of family resources b. Physical maintenance and safety c. Maintenance of order and authority d. Reproduction of new family members

ANS: B Physical and safety needs have greater importance in Maslow's hierarchy than other needs.

4. Which change in the brain's biochemical function is most associated with suicidal behavior? a. Dopamine excess b. Serotonin deficiency c. Acetylcholine excess d. aminobutyric acid deficiency

ANS: B Research suggests that low levels of serotonin may play a role in the decision to commit suicide. The other neurotransmitter alterations have not been implicated in suicidality.

19. Which scenario best illustrates scapegoating within a family? a. The identified patient sends messages of aggression to selected family members. b. Family members project problems of the family onto one particular family member. c. The identified patient threatens separation from the family to induce feelings of isolation and despair. d. Family members give the identified patient nonverbal messages that conflict with verbal messages.

ANS: B Scapegoating projects blame for family problems onto a member who is less powerful. The purpose of this projection is to distract from issues or dysfunctional behaviors in the members of the family.

1. An adult outpatient diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this patient's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed? a. Amitriptyline b. Fluoxetine c. Desipramine d. Tranylcypromine sulfate

ANS: B Selective serotonin reuptake inhibitor antidepressants are very safe in overdosage situations, which is not true of the other medications listed. Given this patient's history of overdosing, it is important that the medication be as safe as possible in the event of another overdose of prescribed medication.

10. Select the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills. a. "Why do you want to kill yourself?" b. "Do you have access to medications?" c. "Have you been taking drugs and alcohol?" d. "Did something happen with your parents?"

ANS: B The nurse must assess the patient's access to means to carry out the plan and, if there is access, alert the parents to remove from the home and take additional actions to assure the patient's safety. The information in the other questions may be important to ask but are not the most critical.

11. The nurse is planning a new sexuality group for patients. Which location would best enhance the effectiveness of this group? a. The hospital auditorium b. A small conference room c. A common area, such as a day room d. The corner of the music therapy room

ANS: B The conference room would provide a quiet, private area with few distractions, separate from other patient areas and effective for teaching and learning about a private topic. The auditorium is too large, and members' anxiety or lack of trust might lead them to spread out too far from each other, interfering with group process. The day room and the music therapy room are too busy and exposed, reducing privacy and increasing distractions.

12. A nurse interviews a homeless parent with two teenage children. To best assess the family's use of resources, the nurse should ask a. "Can you describe a problem your family has successfully resolved?" b. "What community agencies have you found helpful in the past?" c. "What aspect of being homeless is most frightening for you?" d. "Do you feel you have adequate resources to survive?"

ANS: B The correct option asks about use of resources in an open, direct fashion. It will give information about choices the family has made regarding use of resources in the community. The other questions do not address prior use of resources or focus on other aspects of coping.

5. A 15-year-old is hospitalized after a suicide attempt. This adolescent lives with the mother, stepfather, and several siblings. When performing a family assessment, the nurse must first determine a. how the family expresses and manages emotion. b. names and relationships of the family's members. c. the communication patterns between the patient and parents. d. the meaning that the patient's suicide attempt has for family members.

ANS: B The identity of the members of the family is the most fundamental information and should be obtained first. Without this, the nurse cannot fully process the other responses.

15. During a therapy group that uses existential/Gestalt theory, patients shared feelings that occurred at the time of their admission. After a brief silence, one member says, "Several people have described feeling angry. I would like to hear from members who had other feelings." Which group role is evident by this comment? a. Energizer b. Encourager c. Compromiser d. Self-confessor

ANS: B The member is filling the role of encourager by acknowledging those who have contributed and encouraging input from others. An energizer encourages the group to make decisions or take an action. The compromiser focuses on reducing or resolving conflict to preserve harmony. A self-confessor verbalizes feelings or observations unrelated to the group.

13. Two divorced people plan to marry. The man has a teenager, and the woman has a toddler. This family will benefit most from a. role-playing opportunities for conflict resolution regarding discipline. b. guidance about parenting children at two developmental levels. c. formal teaching about problem-solving skills. d. referral to a family therapist.

ANS: B The newly formed family will be coping with tasks associated with the stage of rearing preschool children and teenagers. These stages require different knowledge and skills. There is no evidence of a problem, so the distracters are not indicated.

14. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, "Our hopes for our child's future are ruined. We probably won't ever have grandchildren." The nurse will use interventions to assist with a. denial. b. acceptance. c. acting out. d. manipulation.

ANS: B The parents comment suggests they are experiencing grief, a common reaction to having a family member diagnosed with mental illness. The grief stems from actual or potential losses, such as the family's ability to function, financial well-being, and altered future. Supporting the parents' acceptance of the patient's illness will enhance coping. Data do not support choosing any of the other options.

23. A patient in a detoxification unit asks, "What good it will do to go to Alcoholics Anonymous and talk to other people with the same problem?" The nurse's best response would be to explain that self-help groups such as AA provide opportunities for a. newly discharged alcoholics to learn about the disease of alcoholism. b. people with common problems to share their experiences with alcoholism and recovery. c. patients with alcoholism to receive insight-oriented treatment about the etiology of their disease. d. professional counselors to provide guidance to individuals recovering from alcoholism.

ANS: B The patient needs basic information about the purpose of a self-help group. The basis of self-help groups is sharing by individuals with similar problems. Self-help is based on the belief that an individual with a problem can be truly understood and helped only by others who have the same problem. The other options fail to address this or provide incorrect information.

25. A wife believes her husband is having an affair. Lately, he has been disinterested in romance and working late. The husband has an important, demanding project at work. The mother asks her teen, "What have you noticed about your father?" The teen later mentions this to the father, who says, "Tell your mother that I can't deal with her insecurities right now." Which family dynamic is evident? a. Multigenerational dysfunction b. Triangulation c. Enmeshment d. Blaming

ANS: B Triangulation is a family dynamic wherein a pair relationship (usually the parents) is under stress and copes by drawing in a third person (usually a child) to align with one or the other members of the pair relationship. Multigenerational dysfunction is any dysfunction that exists within or across multiple generations of a family, such as child abuse or alcoholism. Blaming is distracting attention from one's own dysfunction or reducing one's own anxiety by blaming another person. Enmeshment refers to blurred family boundaries or blending together of the thoughts, feelings, or family roles of the individuals so that clear distinctions among members fail to emerge.

11. A patient has tried a variety of CAM approaches to manage health concerns. The nurse asks, "How is going to CAM practitioners different from seeing your medical doctors?" The patient is most likely to respond, "The CAM practitioners a. usually prescribe a course of invasive and sometimes painful treatments." b. spend more time talking with me and not just about my symptoms." c. say I need to become much more spiritual to be well." d. order many tests to determine my diagnoses."

ANS: B CAM practitioners often spend considerable time assessing the person in a holistic way. Visits typically involve lengthy discussions, in contrast to traditional physician visits, where contact is often brief. CAM remedies can sometimes be invasive or slightly painful, but usually they are noninvasive and well-tolerated. Some CAM practices are very spiritually focused, but most do not have overt religious elements. Conventional health care involves more diagnostic testing than CAM.

21. Which patient would most likely benefit from taking St. John's wort? A patient with a. mood swings. b. hypomanic symptoms. c. mild depressive symptoms. d. panic disorder with agoraphobia.

ANS: C St. John's wort may be effective in treating mild to moderate depression. St John's wort has not been found to be effective in treatment of cyclothymic, bipolar, or anxiety disorders.

9. A patient tells the nurse, "I get sick so much, so I started taking ginseng to boost my immune system." The patient's only other medication is warfarin daily. Which potential complication should be included in the nursing assessment? a. Gastrointestinal distress b. Spontaneous bleeding c. Thromboembolism d. Drowsiness

ANS: B Ginseng may interact with anticoagulants and cause spontaneous bleeding. Warfarin is such an agent and can predispose the patient to spontaneous bleeding. It would not increase the risk of thromboembolism. Drowsiness and gastrointestinal complaints are common side effects.

19. A patient had a venous thrombosis 3 weeks ago and is now taking warfarin. When visiting the laboratory to have a prothrombin time drawn, the patient reports drinking ginseng tea to stimulate the immune system. Which nursing diagnosis applies? a. Impaired memory related to neurological changes b. Deficient knowledge related to potentially harmful drug interactions c. Ineffective denial related to consequences of mismanagement of therapeutic regime d. Effective management of the therapeutic regime related to augmentation of anti-coagulant therapy

ANS: B Ginseng tea is amongst the top 10 herbal products used in the United States and believed to have multiple beneficial properties. Because it antagonizes platelet-activating factor, it should not be taken by patients who are receiving anticoagulants or who have other potential bleeding problems. Thus, deficient knowledge is an appropriate nursing diagnosis.

16. Which CAM method is associated with using allergy injections of small amounts of an allergen in solution? a. Naturopathy b. Homeopathy c. Chiropractic d. Shiatsu

ANS: B Homeopathy uses small doses of a substance to stimulate the body's defenses and healing mechanisms to treat illness. Naturopathy emphasizes health restoration rather than disease. Chiropractic uses manipulation of the body to restore health. Shiatsu is a type of massage.

18. A patient report, "Last night I had several mixed drinks at a party. When I got home, I had difficulty falling sleep. I made two cups of herbal tea with lavender. This morning, I feel very groggy and have a headache." The nurse should explain that a. lavender should be delayed at least 1 hour after using alcohol to avoid side effects. b. lavender may increase sedation from other central nervous system depressants. c. herbal teas often cause nervous system side effects such as headaches. d. these feelings are actually a hangover from excessive alcohol intake.

ANS: B Lavender has sedative properties that are potentiated when used in combination with other central nervous system depressants. Headaches are another possible side effect of this herbal medicine. The nurse should advise caution in ingesting alcohol and lavender for these reasons. Taking lavender an hour after alcohol will not prevent these interactions, and it is likely that the lavender played a role in her feeling perhaps worse than usual after this episode of drinking. Herbal teas cause headaches in some cases, but it is not characteristic of this group of herbal remedies.

5. A patient says, "I have taken mega doses of vitamins for 3 months to improve my circulation, but I think I feel worse." Which action should the nurse take first? a. Explain to the patient that vitamin mega doses may be harmful and advise caution. b. Assess the patient for symptoms and signs of toxicity from excess vitamin exposure. c. Assess for signs of circulatory integrity to determine whether improvement has occurred. d. Educate the patient that research has not shown that megadoses of vitamins produce benefits.

ANS: B Mega doses of many vitamins, especially when taken over long periods, may produce dangerous side effects or toxicity. The priority for the nurse is to assess for signs of any dangerous consequences of the patient's use of such a regimen. Secondary interventions would include patient education about research findings related to the practice, along with any benefits and undesired effects associated with the practice. A health care provider should also assess the patient for cardiovascular concerns.

1. A patient tells the nurse, "I've been having problems getting a good night's sleep. I read some information on the Internet and started taking kava kava." Select the nurse's priority response. a. "The Internet does not have reliable health information for consumers." b. "The Food and Drug Administration warned against using it due to the link to severe liver damage." c. "Melatonin has been shown to have better effects for treating sleep disturbances." d. "Your sleep disturbances are related to your problems with anxiety. Herbs will not help."

ANS: B The Food and Drug Administration (FDA) warned against using kava kava due to the link to severe liver damage. The nurse has responsibilities to educate patients regarding safe use of complementary therapies. Melatonin may be useful for sleep disturbances, but the patient's safety is a higher priority. The other distracters are misleading.

12. An older male patient has suffered with episodic pruritus and skin eruptions for over 2 years. This patient tells the nurse, "When my skin gets better for a few days, I start worrying that it's going to start itching again soon. I think my worry may actually trigger the problems to start all over again." Which self-help technique should the nurse consider suggesting for this patient? a. Melatonin b. Meditation c. Purification d. Acupuncture

ANS: B The patient's comment suggests an element of anxiety accompanies the skin problem. Meditation is a popular self-help method recommended to reduce physical and emotional stress and to promote wellness. Purification, associated with ayurvedic practices, may or may not appeal to this patient. Acupuncture is performed by a professional practitioner, so it is not a self-help technique. The scenario does not indicate the patient is experiencing insomnia, so melatonin is not indicated.

20. Select the best desired outcome for a patient who uses valerian. The patient will report a. stress level is lower. b. undisturbed sleep throughout the night. c. increased interest in recreational activities. d. early morning waking without an alarm clock.

ANS: B Valerian decreases sleep latency, nocturnal waking, and leads to a subjective sense of good sleep. Sleeping through the night is the best indicator the herb was effective. Although the patient's stress level may be lowered by use of valerian, the problem is insomnia; outcomes should relate to the problem. Early morning waking is indicative of depression or anxiety.

1. The next-to-last meeting of an interpersonal therapy group is taking place. The leader should take which actions? (Select all that apply.) a. Support appropriate expressions of disagreement by the group's members. b. Facilitate discussion and resolution of feelings about the end of the group. c. Encourage members to reflect on their progress and that of the group itself. d. Remind members of the group's norms and rules, emphasizing confidentiality. e. Help members identify goals they would like to accomplish after the group ends. f. Promote the identification and development of new options for solving problems.

ANS: B, C, E The goals for the termination phase of groups are to prepare the group for separation, resolve related feelings, and prepare each member for the future. Contributions and accomplishments of members are elicited, post-group goals are identified, and feelings about the group's ending are discussed. Group norms are the focus of the orientation phase, and conflict and problem solving are emphasized in the working phase.

2. A leader begins the discussion at the first meeting of a new group. Which comments should be included? (Select all that apply.) a. "We use groups to provide treatment because it's a more cost-effective use of staff in this time of budget constraints." b. "When someone shares a personal experience, it's important to keep the information confidential." c. "Talking to family members about our group discussions will help us achieve our goals." d. "Everyone is expected to share a personal experience at each group meeting." e. "It is important for everyone to arrive on time for our group."

ANS: B, E The leader must set ground rules for the group before members can effectively participate. Confidentiality of personal experiences should be maintained. Arriving on time is important to the group process. Talking to family members would jeopardize confidentiality. While groups are cost-effective, blaming the budget would not help members feel valued. Setting an expectation to share may be intimidating for a withdrawn patient.

1. A married couple has two biologic children who live with them as well as a child from the wife's first marriage. What type of family is evident? a. Homogeneous b. Extended c. Blended d. Nuclear

ANS: C A blended family is made up of members from two or more unrelated families. It is not a nuclear family because a stepchild is present. It is not an extended family, because there are only two generations present. Homogeneous is not a family type.

2. A married couple has two children living in the home. Recently, the wife's mother moved in. This family should be assessed as a. nuclear. b. blended. c. extended. d. alternative.

ANS: C An extended family has members from three or more generations living together. Nuclear family refers to a couple and their children. A blended family is one made up of members from two or more unrelated families. An alternative family can consist of a same-sex couple or an unmarried couple and children.

5. A college student who failed two tests cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate and asked to be left alone for a few hours. Which behavior provides the strongest clue of an impending suicide attempt? a. Calling parents b. Excessive crying c. Giving away sweaters d. Staying alone in dorm room

ANS: C Giving away prized possessions may signal that the individual thinks he or she will have no further need for the item, such as when a suicide plan has been formulated. Calling parents, remaining in a dorm, and crying do not provide direct clues to suicide.

23. Which complementary and alternative therapy may be safely combined with traditional Western medicine in the treatment of anxiety disorder? a. Electroconvulsive therapy b. Mega doses of vitamins c. Meditative practices d. Herbal therapy

ANS: C Yoga, meditation, and prayer are considered to be beneficial adjuncts to treatment for anxiety disorder. Research supports this with findings of lower catecholamine levels following meditation. Patient self-reports suggest patient satisfaction, with increased ability to relax. Meditation and spiritual practices have no associated untoward side effects. Herbal therapy and megadoses of vitamins have potential associated side effects and interactions. Electroconvulsive therapy is not CAM.

18. A group is in the working phase. One member states, "That is the stupidest thing I've ever heard. Everyone whines and tells everyone else what to do. This group is a waste of my time." Which initial action by the group leader would be most therapeutic? a. Advise the member that hostility is inappropriate. Remove the member if it continues. b. Keep the group's focus on this member so the person can express the anger. c. Meet privately with the member outside of group to discuss the anger. d. Change to a more positive topic of discussion in this group session.

ANS: C Meeting privately with the member can convey interest and help defuse the anger so that it is less disruptive to the group. Removing the member would be a last resort and used only when the behavior is intolerably disruptive to the group process and all other interventions have failed. Decreasing the focus on the hostile member and focusing more on positive members can help soften the anger. Angry members often hide considerable vulnerability by using anger to keep others at a distance and intimidated. Changing the subject fails to respond to the behavior.

6. A patient in a group therapy session listens to others and then remarks, "I used to think I was the only one who felt afraid. I guess I'm not as alone as I thought." This comment is an example of a. altruism. b. ventilation. c. universality. d. group cohesiveness.

ANS: C Realizing that one is not alone and that others share the same problems and feelings is called universality. Ventilation refers to expressing emotions. Altruism refers to benefitting by being of help to others. Group cohesiveness refers to the degree of bonding among members of the group.

15. Which intervention will the nurse recommend for the distressed family and friends of someone who has committed suicide? a. Participating in reminiscence therapy b. Psychological postmortem assessment c. Attending a self-help group for survivors d. Contracting for at least two sessions of group therapy

ANS: C Survivors need outlets for their feelings about the loss and the deceased person. Self-help groups provide peer support while survivors work through feelings of loss, anger, and guilt. Psychological postmortem assessment would not provide the support necessary to work through feelings of loss associated with the suicide. Reminiscence therapy is not geared to loss resolution. Contracting for two sessions of group therapy would not provide sufficient time to work through the issues associated with a death by suicide.

6. A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to a. current stress level. b. mood disturbance. c. suicide potential. d. level of anxiety.

ANS: C The SAD PERSONS tool evaluates 10 major risk factors in suicide potential: sex, age, depression, previous attempt, ethanol use, rational thinking loss, social supports lacking, organized plan, no spouse, and sickness. The tool does not have categories to provide information on the other options listed.

12. A nurse and patient construct a no-suicide contract. Select the preferable wording. a. "I will not try to harm myself during the next 24 hours." b. "I will not make a suicide attempt while I am hospitalized." c. "For the next 24 hours, I will not in any way attempt to harm or kill myself." d. "I will not kill myself until I call my primary nurse or a member of the staff."

ANS: C The correct answer leaves no loopholes. The wording about not harming oneself and not making an attempt leaves loopholes or can be ignored by the patient who thinks "I am not going to harm myself, I am going to kill myself" or "I am not going to attempt suicide, I am going to commit suicide." A patient may call a therapist and leave the telephone to carry out the suicidal plan.

18. Select the best question for the nurse to ask to assess a family's ability to cope. a. "What strengths does your family have?" b. "Do you think your family copes effectively?" c. "Describe how you successfully handled one family problem." d. "How do you think the current family problem should be resolved?"

ANS: C The correct option is the only statement addressing coping strategies used by the family. The distracters seek opinions or use closed-ended communication techniques.

14. A nurse interacts with an outpatient who has a history of multiple suicide attempts. Select the most helpful response for a nurse to make when the patient states, "I am considering committing suicide." a. "I'm glad you shared this. Please do not worry. We will handle it together." b. "I think you should admit yourself to the hospital to keep you safe." c. "Bringing up these feelings is a very positive action on your part." d. "We need to talk about the good things you have to live for."

ANS: C The correct response gives the patient reinforcement, recognition, and validation for making a positive response rather than acting out the suicidal impulse. It gives neither advice nor false reassurance, and it does not imply stereotypes such as "You have a lot to live for." It uses the patient's ambivalence and sets the stage for more realistic problem solving.

17. A group is in the working phase. One member says, "That is the stupidest thing I've ever heard. Everyone whines and tells everyone else what to do. This group is a total waste of my time." Which comment by the group leader would be most therapeutic? a. "You seem to think you know a lot already. Since you know so much, perhaps you can tell everyone why you are back in the hospital?" b. "I think you have made your views clear, but I wonder if others feel the same way. How does everyone else feel about our group?" c. "It must be hard to be so angry." Direct this comment to another group member, "You were also angry at first but not now. What has helped you?" d. "I would like to remind you that one of our group rules is that everyone is to offer only positive responses to the comments of others."

ANS: C The member's comments demean the group and its members and suggest that the member is very angry. Labeling the emotion and conveying empathy would be therapeutic. Focusing on members who are likely to be more positive can balance the influence of demoralizing members. "You seem to know a lot ..." conveys hostility from the leader, who confronts and challenges the member to explain how he came to be readmitted if he was so knowledgeable, implying that he is less knowledgeable than he claims. This comment suggests countertransference and is non-therapeutic. Shifting away from the complaining member to see if others agree seeks to have others express disagreement with this member, but that might not happen. In the face of his anger, they might be quiet or afraid to oppose him, or they could respond in kind by expressing hostility themselves. A rule that only positive exchanges are permitted would suppress conflict, reducing the effectiveness of the therapy group.

7. A nurse at the well child clinic realizes that many parents have misconceptions about effective ways of disciplining their children. The nurse decides to form a group to address this problem. What should be the focus of the group? a. Support b. Socialization c. Health education d. Symptom management

ANS: C The nurse has diagnosed a knowledge deficit. The focus of the group should be education. Support and socialization are beneficial but should not be the primary focus of the group, and symptoms are not identified for intervention here.

7. A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority? a. Powerlessness b. Social isolation c. Risk for suicide d. Compromised family coping

ANS: C This diagnosis is the only one with life-or-death ramifications and is therefore of higher priority than the other options.

13. A tearful, anxious patient at the outpatient clinic reports, "I should be dead." The initial task of the nurse conducting the assessment interview is to a. assess lethality of suicide plan. b. encourage expression of anger. c. establish trust with the patient. d. determine risk factors for suicide.

ANS: C This scenario presents a potential crisis. Establishing trust facilitates a therapeutic alliance that will allow the nurse to obtain relevant assessment data such as the presence of a suicide plan, lethality of plan, and presence of risk factors for suicide.

6. Acupuncture is a traditional Chinese medical treatment based on the belief that a. insertion of needles in key locations will drain toxic energies. b. pressure on meridian points will correct problems in energy flow. c. insertion of needles modulates the flow of energy along body meridians. d. taking small doses of noxious substances will alleviate specific symptoms.

ANS: C Acupuncture involves the insertion of needles to modulate the flow of body energy (qi) along specific body pathways called meridians. Acupressure uses pressure to affect energy flow. Homeopathy involves the use of microdosages of specific substances to effect health improvement. Traditional Chinese medicine (TCM) is more concerned with energy and life force balance, and acupuncture is not predicated on the removal of toxic energies.

14. A patient tells the nurse, "I prefer to treat my physical problems with herbs and vitamins. They are natural substances, and natural products are safe." Which response by the nurse would be most appropriate? a. "Natural substances tend to be safer than conventional medical remedies." b. "Natural remedies give you the idea that you are controlling your treatment." c. "The word natural can be a marketing term used to imply a product is healthy, but that's not always true." d. "You should not treat your own physical problems. You should see your health care provider for these problems."

ANS: C CAM remedies are usually natural substances, but it is a fallacy that products labeled natural are safer than conventional medicines. Some natural products contain powerful ingredients that can cause illness and damage to the body if taken inappropriately and, for some persons, can be dangerous even when used as directed. This is the most important message for the nurse to convey to the patient. So-called natural substances can have a number of significant side effects. Natural substances may give one the belief that he is controlling his own treatment, but that is not the message that most needs to be communicated here. Many patients can safely self-manage minor physical problems.

2. A patient shows a nurse this advertisement: "Our product is a scientific breakthrough helpful for depression, anxiety, and sleeplessness. Made from an ancient formula, it stimulates circulation and excretes toxins. Satisfaction guaranteed or your money back." Select the nurse's best response. a. "Over-the-counter products for sleep problems are ineffective." b. "Do not take anything unless it's prescribed by your doctor." c. "Let's do some additional investigation of that product." d. "It sounds like you are trying to self-medicate."

ANS: C Helping consumers actively evaluate the quality of information available to them is important. It is important for the nurse to work with the patient and include the patient's preferences regarding management of health. Advertisements indicating scientific breakthroughs or promising miracles for multiple ailments are usually for products that are useless and being fraudulently marketed. Some may even be harmful. Some over-the-counter products can be useful, and patients do not need a prescription for these products. The broader issue is safety and efficacy, rather than whether the patient is trying to self-medicate.

24. A patient diagnosed with depression confidently tells the nurse, "I've been supplementing my paroxetine with St. John's wort. It has helped a great deal." What is the nurse's priority action? a. Assess changes in the patient's level of depression. b. Remind the patient to use a secondary form of birth control. c. Educate the patient about the risks of selective serotonin syndrome. d. Suggest adding valerian to the treatment regimen to further improve results.

ANS: C St. John's wort inhibits serotonin reuptake by elevating extracellular sodium; thus, it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome. Discussing the patient's birth control method is a secondary priority.

24. Which example of behavior in a family system demonstrates double bind communication? a. A mother tells her daughter, "You make me so mad that sometimes I wish I had never had you." b. A teenager tells her father, "You are treating me like a baby when you tell me I must be home by 10 PM on a school night." c. A son tells his mother, "You worry too much about what might happen. Nothing has happened yet, so why worry?" d. A wife tells her husband, "You go ahead with your bowling trip. Try not to worry about me falling on my crutches while I'm alone at home."

ANS: D A double bind communication is one that is inherently contradictory, that is, a comment that gives conflicting directions. In this case, the wife on crutches suggests that her husband should go bowling but then indicates that she will be at greater risk if he does, which in effect tells him "go ahead" and "don't do it" at the same time. This remark places the husband in a double bind, a situation in which no acceptable response exists. The distracters are clear, direct communications.

5. During a group therapy session, a newly admitted patient suddenly says to the nurse, "How old are you? You seem too young to be leading a group." Select the nurse's most appropriate response. a. "I am wondering what leads you to ask. Please tell me more." b. "I am old enough to be a nurse, which qualifies me to lead this group." c. "My age is not pertinent to why we are here and should not concern you." d. "You are wondering whether I have enough experience to lead this group?"

ANS: D A question such as this is common in the initial phase of group development when members are getting to know one another, dealing with trust issues, and testing the leader. Making explicit the implied serves to role model more effective communication and prompts further discussion of the patient's concern. Asking the patient to tell the leader more about the question focuses on the reason for the member's concern rather than on the issue raised (the experience and ability of the leader) and is a less helpful response. "I am old enough to be a nurse" and "age is not pertinent" are defensive responses and fail to address the patient's valid concern.

8. Which outcome would be most appropriate for a symptom-management group for persons diagnosed with schizophrenia? Group members will a. state the names of their medications. b. resolve conflicts within their families. c. rate anxiety at least two points lower. d. describe ways to cope with their illness.

ANS: D An appropriate psychoeducational focus for patients with schizophrenia is managing their symptoms; coping with symptoms such as impaired memory or impaired reality testing can improve functioning and enhance their quality of life. Names of medications might be appropriate for a medication education group but would be a low priority for symptom management. Addressing intra-family issues would be more appropriate within a family therapy group or possibly a support group. Rating anxiety lower would be an expected outcome for a stress-management group.

16. A nurse assesses a patient for inclusion in group therapy. This patient has a childhood history of neglect and ridicule by parents. The patient says to the nurse, "My boss always expects more of me than the others, but talking to him would only make it worse." Which type of group would best address the patient's needs? a. Support b. Self-Help c. Psychoeducational d. Cognitive-behavioral

ANS: D Cognitive-behavioral group therapy focuses on specific maladaptive behaviors and thought patterns. Patients often repeat patterns of behavior in a group that they learned in their families. This type of group will afford the patient an opportunity for a corrective recapitulation of the primary family group. The incorrect answers identify groups appropriate for other types of problems.

20. A parent became unemployed 6 months ago. The parent has subsequently been verbally abusive toward the spouse and oldest child. The child ran away twice, and the spouse has become depressed. What is the most appropriate nursing diagnosis for this family? a. Impaired parenting related to verbal abuse of oldest child b. Impaired social interaction related to disruption of family bonds c. Ineffective community coping related to fears about economic stability d. Disabled family coping related to insecurity secondary to loss of family income

ANS: D Disabled family coping refers to the behavior of a significant family member that disables his or her own capacity as well as another's capacity to perform tasks essential to adaptation. The distracters are inaccurate because the stressors influence more than one individual.

21. A parent says, "My son and I argue constantly since he started using drugs. When I talk to him about not using drugs, he tells me to stay out of his business." What is the nurse's first most appropriate action? a. Educate the parent about stages of family development. b. Report the son to law enforcement authorities. c. Refer the son for substance abuse treatment. d. Make a referral for family therapy.

ANS: D Family therapy is indicated, and the nurse should provide a referral. Reporting the child to law enforcement would undermine trust and violate confidentiality. The other distracters may occur later.

16. A family expresses helplessness related to dealing with a mentally ill member's odd behaviors, mood swings, and argumentativeness. An effective nursing intervention for this family would be to a. express sympathy for their situation. b. involve local social service agencies. c. explain symptoms of relapse. d. role-play difficult situations.

ANS: D Helping a family learn to set limits and deal with difficult behaviors can often be accomplished by using role-playing situations, which give family members the opportunity to try new, more effective approaches. The other options would not provide learning opportunities.

1. A patient tells members of a therapy group, "I hear voices saying my doctor is poisoning me." Another patient replies, "I once heard voices too. They sounded real, but I found out later they were not. The voices you hear are not real either." Which therapeutic factor is exemplified in this interchange? a. Catharsis b. Universality c. Imitative behavior d. Interpersonal learning

ANS: D Here a member gains insight into his own experiences from hearing about the experiences of others through interpersonal learning. Catharsis refers to a therapeutic discharge of emotions. Universality refers to members realizing their feelings are common to most people and not abnormal. Imitative behavior involves copying or borrowing the adaptive behavior of others.

12. Which remark by a group participant would the nurse expect during the working stage of group therapy? a. "My problems are very personal and private. How do I know people in this group will not tell others what you hear?" b. "I have enjoyed this group. It's hard to believe that a few weeks ago I couldn't even bring myself to talk here." c. "One thing everyone seems to have in common is that sometimes it's hard to be honest with those you love most." d. "I don't think I agree with your action. It might help you, but it seems like it would upset your family."

ANS: D In the working stage, members actively interact to help each other accomplish goals, and because trust has developed, conflict and disagreement can be expressed. Focusing on trust and confidentiality typically occur in the orientation phase as part of establishing group norms. Commonality and universality are also themes typically expressed in the orientation phase, whereas reflecting on progress is a task addressed in the termination phase.

15. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, "Our child acts so strangely that we don't invite friends to our home. We quit taking vacations. Sometimes we don't get any sleep." Which nursing diagnosis best applies? a. Impaired parenting b. Parental role conflict c. Impaired social interaction d. Interrupted family processes

ANS: D Interrupted family processes are evident in the face of disruptions in family functioning as a result of having a mentally ill member. Assessment data best support this diagnosis. Data are insufficient to support the other diagnoses.

22. Which scenario best demonstrates a healthy family? a. One parent takes care of children. The other parent earns income and maintains the home. b. A family has strict boundaries that require members to address problems within the family. c. A couple requires their adolescent children to attend church services three times a week. d. A couple renews their marital relationship after their children become adults.

ANS: D Revamping the marital relationship after children move out of the family of origin indicates the family is moving through its stages of development. Strict family boundaries or roles interfere with flexibility and use of outside resources. Adolescents should have some input into deciding their activities.

8. A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. The initial outcome is that the patient will a. verbalize a will to live by the end of the second hospital day. b. describe two new coping mechanisms by the end of the third hospital day. c. accurately delineate personal strengths by the end of first week of hospitalization. d. exercise suicide self-restraint by refraining from attempts to harm self for 24 hours.

ANS: D Suicide self-restraint relates most directly to the priority problem of risk for self-directed violence. The other outcomes are related to hope, coping, and self-esteem.

10. Guidelines followed by the leader of a therapeutic group include focusing on recognizing dysfunctional behavior and thinking patterns, followed by identifying and practicing more adaptive alternate behaviors and thinking. Which theory is evident by this approach? a. Behavioral b. Interpersonal c. Psychodynamic d. Cognitive-behavioral

ANS: D The characteristics described are those of cognitive-behavioral therapy, in which patients learn to reframe dysfunctional thoughts and extinguish maladaptive behaviors. Behavioral therapy focuses solely on changing behavior rather than thoughts, feelings, and behaviors together. Interpersonal theory focuses on interactions and relationships. Psychodynamic groups focus on developing insight to resolve unconscious conflicts.

7. The parent of an adolescent diagnosed with mental illness asks the nurse, "Why do you want to do a family assessment? My teenager is the patient, not the rest of us." Select the nurse's best response. a. "Family dysfunction might have caused the mental illness." b. "Family members provide more accurate information than the patient." c. "Family assessment is part of the protocol for care of all patients with mental illness." d. "Every family member's perception of events is different and adds to the total picture."

ANS: D The identified patient usually bears most of the family system's anxiety and may have come to the attention of parents, teachers, or law enforcement because of poor coping skills. The correct response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems. The other responses are either incorrect or evasive.

6. Which information is the nurse most likely to find when assessing the family of a patient with a serious mental illness? a. The family exhibits many characteristics of dysfunctional families. b. Several family members have serious problems with their physical health. c. Power in the family is maintained in the parental dyad and rarely delegated. d. Stress from living with a mentally ill member has challenged the family's function.

ANS: D The information almost universally obtained is that the family is under stress associated with having a mentally ill member. This stress lowers the family's level of functioning in at least one significant way. Stress does not necessarily mean the family has become dysfunctional.

3. A young female member in a therapy group says to an older female member, "You are just like my mother, always trying to control me with your observations and suggestions." Which therapeutic factor of a group is evident by this behavior? a. Instillation of hope b. Existential resolution c. Development of socializing techniques d. Corrective recapitulation of the primary family group

ANS: D The younger patient is demonstrating an emotional attachment to the older patient that mirrors patterns within her own family of origin, a phenomenon called corrective recapitulation of the primary family group. Feedback from the group then helps the member gain insight about this behavior and leads to more effective ways of relating to her family members. Instillation of hope involves conveying optimism and sharing progress. Existential resolution refers to the realization that certain existential experiences such as death are part of life, aiding the adjustment to such realities. Development of socializing techniques involves gaining social skills through the group's feedback and practice within the group.

2. Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk? a. Turning on the oven and letting gas escape into the apartment during the night b. Cutting the wrists in the bathroom while the spouse reads in the next room c. Overdosing on aspirin with codeine while the spouse is out with friends d. Jumping from a railroad bridge located in a deserted area late at night

ANS: D This is a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential. See relationship to audience response question.

3. Which measure would be considered a form of primary prevention for suicide? a. Psychiatric hospitalization of a suicidal patient b. Referral of a formerly suicidal patient to a support group c. Suicide precautions for 24 hours for newly admitted patients d. Helping school children learn to manage stress and be resilient

ANS: D This measure promotes effective coping and reduces the likelihood that such children will become suicidal later in life. Admissions and suicide precautions are secondary prevention measures. Support group referral is a tertiary prevention measure.

15. An immigrant from China needs a colonic resection but is anxious and reluctant about surgery. This patient usually follows traditional Chinese health practices. Which comment by the nurse would most likely reduce the patient's anxiety and reluctance? a. "Surgery will help rebalance the yin and yang forces and return you to harmony." b. "The surgery we are recommending will help you achieve final transformation." c. "I know this is new to you, but you can trust us to take very good care of you." d. "If you would like, we could investigate using acupuncture to help control pain."

ANS: D It would be helpful to incorporate elements of TCM as appropriate; such as acupuncture for pain control. TCM has the goal of healing in harmony with one's environment and all of creation in mind, body, and spirit, as well as balance of yin and yang energies and a state of transition. However, it would not be helpful to suggest that surgery will balance the yin and the yang, since this is not how balance is achieved in TCM. Transformation is recognized as a stage of healing occurring when mutual, creative, active participation occurs between healers and the patient toward changes in the mind, body, and spirit; but "final transformation" could imply the end of corporeal life and might be perceived as hastening his demise. Appealing to him to trust persons whose practices are foreign to him conflicts with the patient's values and would not likely be effective.

4. A patient with a history of asthma says, "I've been very nervous lately. I think aromatherapy will help. I am ordering $250 worth of oils from an Internet site that promised swift results." Select the nurse's best action. a. Support the patient's efforts to become informed and to find health solutions. b. Suggest the patient check with friends who have tried aromatherapy for treatment of anxiety. c. Remind the patient, "If you spend that much on oils, you may not be able to buy your prescribed medication." d. Tell the patient, "Aromatherapy can complicateNURSINGTB.COM respiratory problems such as asthma. Let's consider some other options."

ANS: D Safety is paramount, and aromatherapy may cause complications for a patient with asthma. The nurse should view alternative treatments with an open mind and try to recognize the importance of the treatment to the patient while trying to give the patient accurate, reliable information about the treatment. Although efforts to become health literate should be supported, educating the patient about the pitfalls of relying on the Internet is essential. The opinions of others, whether they are positive or negative, lack a scientific basis and are subject to confounding variables such as the placebo effect and individual factors such as age and health history. Admonishing the patient may jeopardize the relationship.

3. A patient wants to learn more about integrative therapies. Which resource should the nurse suggest for the most reliable information? a. Internet b. American Nurses Association (ANA) c. Food and Drug Administration (FDA) d. National Center for Complementary and Integrative Health (NCCIH)

ANS: D The NCCIH provides reliable, objective, and scientific information to help in making decisions about use of these practices. NCCIH supports not only research, but also the development and sharing of this kind of information. The FDA has information, but it is not as extensive as NCCIH. The Internet has many resources but some are unreliable. The ANA does not provide extensive information about this topic.