New Mental Health Study Set

Because of cultural inhibitions, a client is reluctant to verbalize spiritual concerns. Understanding this, the nurse implements which nursing intervention? 1) Reassure the client that it is acceptable to talk about spiritual concerns. 2) Question the client about why religious orientation is important. 3) Refer the client to a nondenominational group. 4) Discuss the nurse's personal spiritual beliefs.

1: A holistic approach to nursing care is provided when the framework of the nurse-client relationship includes spiritual health. Reassuring the client that it is acceptable to verbalize spiritual concerns communicates that the nurse values the client's spirituality and opens, rather than blocks, the lines of communication.

A nurse encourages a client to tell his or her story, actively listens to the account of the resulting distress, and assists the client to record the story in his or her own words. This nurse is employing which commitment in the "Tidal Model of Recovery?" 1) Value the Voice. 2) Respect the Language. 3) Develop Genuine Curiosity. 4) Become the Apprentice. Test-Taking Tip: Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change is Constant, and Be Transparent.

1: During the Value the Voice commitment, the person is encouraged to tell his or her story. The person's story represents the beginning and endpoint of the helping encounter, embracing not only an account of the person's distress, but also the hope for its resolution. The nurse in the question is employing this commitment.

An inpatient client diagnosed with antisocial personality disorder states, "When I am discharged, I am going to cut my mother-in-law's throat." Which legal principle applies to this situation? 1) Duty to warn 2) Maintenance of confidentiality 3) False imprisonment 4) Least restrictive interventions

1: Duty to warn is the responsibility of a treating mental health professional to notify an intended, identifiable victim. This client has made a verbal threat toward the identifiable mother-in-law and therefore the legal principle of "duty to warn" would apply.

A client diagnosed with a thought disorder lists previously successful strategies and skills used when disturbing auditory hallucinations have occurred. What step of the Wellness Recovery Action Plan (WRAP) recovery model is this client employing? 1) Developing a Wellness Toolbox 2) Daily Maintenance List 3) Triggers 4) Early Warning Signs

1: In the first step (Developing a Wellness Toolbox) a client creates a list of tools, strategies, and skills that he or she has used in the past to assist in relieving disturbing symptoms. The client in the question is employing this step.

A neighbor asks a psychiatric nurse, "How can you work with the mentally ill day in and day out?" The nurse replies, "It's just the right thing to do." The nurse is operating from which ethical framework? 1) Kantianism 2) Christian ethics 3) Ethical egoism 4) Utilitarianism

1: Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse's response indicates a Kantian perspective.

Which of the following procedures would be used to detect altered brain function? Select all that apply. 1) Magnetic resonance imaging (MRI) 2) Electroencephalography (EEG) 3) Positron emission tomography (PET) 4) Endoscopy 5) Gastroscopy

1: Magnetic resonance imaging is a type of diagnostic radiography that is valuable in providing soft-tissue images of the brain and can be used to detect altered brain function. 2: Electroencephalography is a diagnostic technique used to diagnose epilepsy, brain lesions, and convulsive disorders, and it can be used to detect altered brain function. 3: Positron emission tomography imaging is used to determine blood flow and metabolic activity of the brain and can be used to detect altered brain function.

In studying for the National Council of State Boards (NCLEX) exam, the student concludes that psychiatric nursing is accountable to which of the following ethical codes or guidelines? Select all that apply. 1) American Nurses Association Code of Ethics for Nurses 2) American Hospital Association Patients' Bill of Rights 3) Bill of Rights for Psychiatric Patients 4) American Nurses Association Nurses' Bill of Rights 5) American Medical Association Code of Medical Ethics

1: Psychiatric nursing is accountable to the American Nurses Association Code of Ethics for Nurses. 2: Psychiatric nursing is accountable to the American Hospital Association Patients' Bill of Rights. 3: Psychiatric nursing is accountable to the Bill of Rights for Psychiatric Patients. Feedback 4: Psychiatric nursing is accountable to the American Nurses' Association Nurses' Bill of Rights.

The nurse is teaching a student about the human limbic system. Which student response demonstrates that teaching about the function of the limbic system has been effective? 1) "It helps stabilize emotional behavior." 2) "It helps maintain balance and muscle tone." 3) "It helps with visual perception and spatial relationships." 4) "It helps with muscular coordination."

1: The limbic system is the "emotional brain." It is associated with fear, anxiety, anger, aggression, love, joy, hope, sexuality, and social behavior.

A client has been suffering from sweaty palms, palpitations, shortness of breath, and dizziness for the past year. After the client has been medically cleared, which would potentially cause these symptoms? 1) Pathophysiological changes of the temporal cortex 2) Decreased levels of gamma-aminobutyric acid (GABA) 3) Decreased levels of prolactin 4) Decreased levels of norepinephrine

1: The symptoms presented in the question are indicative of an anxiety disorder. Pathophysiological changes of the temporal cortex have been implicated in anxiety disorders.

Compared with the general population, which psychopathology is more common among Native Americans? 1) Schizophrenia 2) Alcohol use disorder 3) Post-traumatic stress disorder 4) Impulse control disorder

2: Alcohol abuse and dependence are more common among Native Americans than the general population. This may be due to a variety of physical, sociocultural, and environmental causes.

A nursing instructor is teaching about the guiding principles of the recovery model as described by the Substance Abuse and Mental Health Services Administration (SAMHSA). Which student statement indicates that further teaching is needed? 1) "Recovery emerges from hope." 2) "Recovery is specifically focused on symptom reduction." 3) "Recovery is person-driven." 4) "Recovery is supported by addressing trauma."

2: Because recovery is holistic, it is not specifically focused on symptom reduction. This student statement indicates that further teaching is needed.

A Spanish client is uncooperative and confused because of difficulty responding to the nursing staff. What would initially help the nurse facilitate this client's care? 1) Leading a reminiscence group 2) Understanding the norms of the client's culture 3) Leading a re-socialization group 4) Encouraging open expression of feelings

2: Caregivers must have an understanding of the norms of other cultures in order to accept the client and provide professional care. With this knowledge, the nursing staff can better relate to this client.

A 30-year-old continually changes jobs and has difficulty establishing long-term relationships. According to Erikson's psychosocial theory, this client is having difficulty successfully completing which development task conflict? 1) Industry versus inferiority 2) Intimacy versus isolation 3) Generativity versus stagnation 4) Ego integrity versus despair

2: Intimacy versus isolation takes place in early adulthood (ages 18 to 40). The goal of successful completion for this conflict is finding oneself, and cultivating/maintaining an effective loving relationship. This young man has moved from job to job, seeking his own identification, and has not yet been able to establish a meaningful long-term relationship. Therefore, he has not successfully completed this stage and is in the negative stage of Erikson's intimacy versus isolation psychosocial stage of personality development.

Which of the following accurately describes components of William A. Anthony's definition of Recovery? Select all that apply. 1) Recovery follows a predictable pattern of behavioral change. 2) Recovery is a way of living a satisfying, hopeful, and contributing life. 3) Recovery involves the development of meaning and purpose in one's life. 4) Recovery is growth beyond the effects of mental illness. 5) Recovery is a change in one's attitudes, values, feelings, goals, skills, and/or roles. Test-Taking Tip: William A. Anthony, Executive Director of the Center for Psychiatric Rehabilitation at Boston University, offers this definition of recovery.

2: Recovery is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. 3: Recovery involves the development of meaning and purpose in one's life. 4: Recovery involves growing beyond the catastrophic effects of mental illness. 5: Recovery involves changing one's attitudes, values, feelings, goals, skills, and/or roles.

A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. Which would describe this nurse's actions? 1) Intentional tort 2) Negligence 3) Battery 4) Assault

2: The nursing action was an unreasonable or careless act. In this case, the nurse is negligent and could be held liable for the client's death.

The nursing staff of an inpatient psychiatric unit failed to run the regularly scheduled groups because of staffing problems. The unit manager determines that this action impacts which client right? 1) Right to respectful care 2) Right to receive treatment 3) Right to reasonable continuity of care 4) Right to review the treatment plan

2: The principle of beneficence states there is a duty to promote the good of clients. By not providing scheduled therapy groups, the staff did not respect the client's right to treatment.

A client's husband died 23 years ago. She has not changed a thing in their house since that time. His slippers are still beside the bed. The nurse identifies that the client is exhibiting which pathological grief response? 1) Inhibited grief response 2) Prolonged grief response 3) Delayed grief response 4) Distorted grief response

2: The prolonged grief response is characterized by intense preoccupation with memories of the lost person years after the loss has occurred. This is how the client in the question has responded to her husband's death.

30. Which concepts should a nurse identify as being included in the DSM-IV-TR definition of personality? (Select all that apply.) A. Personality is an enduring pattern of perceiving. B. Personality is influenced by relationships between the environment and self. C. Personality is developed in sporadic stages that vary from person to person. D. Personality is influenced by a wide range of social and personal contexts. E. Personality is inborn and cannot be influenced by developmental progression.

30. ANS: A, B, D The nurse should identify that the following concepts are included in the DSM-IV-TR definition of personality: Personality is an enduring pattern of perceiving, a wide range of social and personal contexts influences it, and it is inborn. Personality disorders are coded on Axis II of the DSM-IV-TR multiaxial diagnosis and include disorders organized into three clusters: odd and eccentric disorders (cluster A); dramatic, emotional, or erratic disorders (cluster B); and anxious or fearful disorders (cluster C). PTS: 1 REF: 32 KEY: Cognitive Level: Application | Integrated Process: Assessment

Which statement best explains the etiology of anxiety from a biological perspective? 1) Dysregulation of the limbic system 2) Decreased levels of neurotransmitters, such as serotonin, dopamine, and norepinephrine 3) Decreased amounts of inhibitory amino acids, such as gamma-aminobutyric acid (GABA) 4) Hypothyroidism

3: Decreased levels of GABA contribute to anxiety, movement, and seizure disorders. This explains the etiology of anxiety from a biological perspective.

A suicidal college student is admitted to a psychiatric unit. Family members describe a punitive mother who expected perfection. The student states, "Wow, that's right! I never thought about that connection." Where would Freud postulate that these client memories were stored? 1) In the conscience 2) In the conscious 3) In the preconscious 4) In the unconscious

3: Freud believed that the preconscious included all memories that may have been forgotten or were not in present awareness but, if prompted, could be readily recalled. The situation presented in the question indicates that memories of the student's childhood, of which the student was not currently aware, were prompted into awareness. These memories were stored in the preconscious.

A client states, "I am really focused on learning about my illness and want to be able to recognize, monitor, and manage my symptoms." The nurse recognizes that this client is in which stage of the Psychological Recovery Model? 1) Moratorium 2) Awareness 3) Preparation 4) Rebuilding Test-Taking Tip: Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1: Moratorium, Stage 2: Awareness, Stage 3: Preparation, Stage 4: Rebuilding, and Stage 5: Growth.

3: In the Preparation stage the client resolves to begin the work of recovery. The client takes responsibility for learning about the effects of the illness and how to recognize, monitor, and manage symptoms. The client in the question is in the Preparation stage.

A homeless client, diagnosed with schizophrenia, has been admitted to an inpatient unit. The client refuses to go to group therapy and hordes multiple pantry items. According to Maslow's theory, how would the nurse interpret this client's needs? 1) Group therapy sessions will help with self-esteem and should be prioritized. 2) This client's need for self-actualization is much stronger than basic needs for rest and safety. 3) Self-actualization can be addressed only after physiological needs have been met. 4) Psychological health should be prioritized over physical health.

3: Maslow's theory creates a hierarchy of needs. Primary needs for food and safety must be met in order to achieve secondary needs such as self-actualization.

A client diagnosed with a thought disorder volunteers at a homeless shelter's soup kitchen. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in which dimension of recovery is this client participating? 1) Health 2) Home 3) Purpose 4) Community Test-Taking Tip: SAMHSA suggests that a life in recovery is supported by four major dimensions.

3: Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. This client is participating in the purpose dimension of recovery.

A client hates her mother because her mother paid little attention to her when she was growing up. Which client statement represents the defense mechanism of reaction formation? 1) "I don't like to talk about my relationship with my mother." 2) "It's my mother's fault that I feel this way." 3) "I have a wonderful mother whom I love very much." 4) "My mom always loved my sister more than she loved me."

3: The client hides her negative unacceptable feelings by an exaggerated expression of positive feelings. This is an example of reaction formation.

A client is admitted to the emergency department with a diagnosis of panic-level anxiety. The nurse charts which symptoms that describe the characteristics of panic-level anxiety? 1) "Experiencing decreased attention span and diminished perceptual fields." 2) "Experiencing increased motivation and enhanced awareness of surroundings." 3) "Experiencing greatly narrowed perceptual field, headaches, insomnia, and confusion." 4) "Has decreased reality orientation and refuses to leave bedroom."

4: At a panic level of anxiety, clients can experience decreased reality orientation, which may include hallucinations or delusions. These individuals can also experience either extreme withdrawal behaviors or wild and desperate actions.

A 68-year-old woman with a history of multiple divorces is admitted after phoning her daughter stating, "I have nothing to live for and am going to swallow a bottle of sleeping pills." This woman is struggling with which of Erikson's developmental task conflicts? 1) Trust versus mistrust 2) Industry versus inferiority 3) Generativity versus stagnation 4) Ego integrity versus despair

4: Ego integrity versus despair occurs in the last years of life (ages 65 and older). The older adult reflects back on life and either derives pleasure and meaning from past events or feels self-contempt, anger, and depression when focusing on past failures. When the mother states, "I have nothing left to live for," she is demonstrating despair in the self-assessment of her life.

A single man lives with his mother. His father died when he was 6 years old. Using psychoanalytic theory, the nurse determines that the timing of this man's father's death may have caused problems with which developmental response? 1) Resolution of an Electra complex 2) Resolution of the oral stage 3) Resolution associated with latency 4) Resolution of an Oedipus complex

4: Freud describes the Oedipus complex, which occurs during the phallic stage of development. The male child experiences an unconscious desire to eliminate the parent of the same gender and to possess the parent of the opposite gender for himself. Resolution of this internal conflict occurs when the child develops a strong identification with the parent of the same gender. At the age of 6 years, the death of this man's father could have negatively affected his identification with the same-sex parent.

A client admitted to the emergency department after being mugged while crossing the street cannot remember anything about the incident. The nurse recognizes the use of which defense mechanism? 1) Isolation 2) Displacement 3) Compensation 4) Repression

4: The client in the question is using the defense mechanism of repression. Repression is the unconscious, involuntary blocking of unpleasant feelings and experiences from one's own awareness. The client remembers nothing about the mugging and is therefore unconsciously repressing these memories.

The emergency department physician tells a mother that her child has died as the result of drowning. She shows no emotional reaction to this message. The mother is demonstrating the use of which defense mechanism? 1) Undoing 2) Rationalization 3) Suppression 4) Isolation

4: The mother in the question is using the defense mechanism of isolation. Isolation is the separation of thought or memory from the feeling, tone, or emotion associated with the memory or event. The mother shows no emotion because she has isolated her unbearable feelings and reaction to her child's death.

When planning client care, what is the best reason for including favorite ethnic foods in the diets of clients from other cultures? 1) It prevents malnutrition. 2) It prevents clients from becoming agitated. 3) It ensures the client's cooperation with scientifically based treatment. 4) It conveys acceptance of the client's beliefs and identity.

4: When the nurse includes favorite ethnic foods in the diets of clients from other cultures, the nurse shows respect for a client's cultural differences and accepts the client's beliefs and identity. This will promote dietary intake and enhance therapeutic relationship rapport.

What is the most important reason for nurses to explore their own culture, as well as the cultures of their clients? 1) To recognize that cultural customs and beliefs are resistant to change 2) To anticipate the client's dietary preferences and other personal care practices 3) To understand that cultures have little diversity within and among themselves 4) To understand and respond appropriately to diverse human behaviors

4: Within our American "melting pot," any or all characteristics could apply to individuals within any or all of the cultural groups represented. To work effectively with diverse populations, nurses must understand their own culture as well as the cultures of their clients.

A nursing school graduate failing the NCLEX exam and a 15-year-old high school girl not being selected for the cheer leading squad are examples of which of the following? A. Focal stimuli B. Contextual stimuli C. Residual stimuli D. Spatial stimuli

A. Focal stimuli is the correct answer because not being selected for the cheer leading squad is the immediate concern. Contextual stimuli are present in the environment and contribute to the behavior being caused by the focal stimuli. Residual stimuli are factors that may influence maladaptive behavior in response to focal and contextual stimuli. Spatial stimuli isn't even in the book.

Which of the following outcome criteria would be most appropriate for the client described in question 1? A. Karen is able to express positive aspects about herself and her life situation. B. Karen is able to accept constructive criticism without becoming defensive. C. Karen is able to develop positive interpersonal relationships. D. Karen is able to accept positive feedback from others.

A. Karen is able to express positive aspects about herself and her life situation is the correct answer from the back of the book and the first listed in the criteria. However, it is just one of the outcome criteria for situational low self-esteem. Other outcomes are ability to accept positive feedback from others, able to attempt new experiences, able to accept personal responsibility for own problems, able to accept constructive criticism withoth becoming defensive. uses good eye contact, is able to make independent decisions about life situations, is able to develop positive interpersonal relationships and able to communicate needs and wants to others assertively.

Tommy says to his friend, "I can't even talk to my Daddy until after he has read his newspaper." This is an example of which of the following? A. Rigid boundary B. A boundary violation C. Enmeshed boundary. D. Too flexible boundary

A. Rigid boundary is the correct answer. The father has set rigid boundaries to keep others out of his personal space.

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? 1."Medications only address biological factors. Environmental and interpersonal factors must also be considered." 2."Because biological factors are the sole cause of depression, medications will improve your mood." 3."Environmental factors have been shown to exert the most influence in the development of depression." 4."Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

ANS: 1 Rationale: The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.

Which client should the nurse anticipate to be most receptive to psychiatric treatment? 1. A Jewish, female social worker. 2. A Baptist, homeless male. 3. A Catholic, black male. 4. A Protestant, Swedish business executive.

ANS: 1 Rationale: The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important as physical health. Women are also more likely to seek treatment for mental health problems than men.

A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

ANS: 1 Rationale: The nurse should determine that defense mechanisms can be appropriate during times of stress. The client with no defense mechanisms may have a lower tolerance for stress, thus leading to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

ANS: 1 Rationale: The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.

A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress are relative rather than absolute; individual responses to stress vary. 2. It is abnormal for identical twins to react differently to similar stressors. 3. Identical twins should share the same temperament and respond similarly to stress. 4. Environmental influences to stress weigh more heavily than genetic influences.

ANS: 1 Rationale: The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress. Mental health is a state of being that is relative to the individual client. Environmental influences and temperament can affect stress reactions.

Which of the following symptoms should a nurse associate with the development of increased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

ANS: 1, 2 Rationale: The nurse should associate depression and fatigue with increased levels of TSH. TSH is only increased when thyroid levels are low, as in the diagnosis of hypothyroidism. In addition to depression and fatigue, other symptoms, such as decreased libido, memory impairment, and suicidal ideation are associated with chronic hypothyroidism.

A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span

ANS: 1, 2, 4 Rationale: The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is significant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, difficulty concentrating, muscle tension, and sleep disturbance.

Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) 1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. 2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. 3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is a possible correlation between increased levels of prolactin and anorexia nervosa. 5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

ANS: 1, 3 Rationale: The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones and gonadotropin. Anorexia nervosa has also been correlated with increased cortisol levels.

Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? 1. Major depressive episode 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 2 Rationale: Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and schizophrenia.

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoimmunology 3. Diagnostic technology 4. Neurophysiology

ANS: 2 Rationale: Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli.

Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

ANS: 2 Rationale: The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior.

Which nursing statement about the concept of neurosis is most accurate? 1. An individual experiencing neurosis is unaware that he or she is experiencing distress. 2. An individual experiencing neurosis feels helpless to change his or her situation. 3. An individual experiencing neurosis is aware of psychological causes of his or her behavior. 4. An individual experiencing neurosis has a loss of contact with reality.

ANS: 2 Rationale: The nurse should define the concept of neurosis with the following characteristics: The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of the psychological causes of the distress, and the client experiences no loss of contact with reality.

At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection.

ANS: 2 Rationale: The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired. The client's ability to communicate distress would be considered a positive attribute.

A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

ANS: 2 Rationale: The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.

According to Maslow's hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours. 2. A client exhibiting aggressive behavior toward another client. 3. A client stating that no one cares. 4. A client verbalizing feelings of failure.

ANS: 2 Rationale: The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow's hierarchy of needs and must be fulfilled before other higher-level needs can be met. Clients who complain, have feelings of failure, or state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem.

Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality.

ANS: 2 Rationale: The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. The client with psychosis is unaware that his or her behavior is maladaptive or that he or she has a psychological problem.

An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

ANS: 2 Rationale: The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.

How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflects a disturbance in the 1. psychosocial, biological, or developmental process underlying mental functioning." 2. psychological, cognitive, or developmental process underlying mental functioning." 3. psychological, biological, or developmental process underlying mental functioning." 4. psychological, biological, or psychosocial process underlying mental functioning."

ANS: 3 Rationale: "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflects a disturbance in the psychological, biological, or developmental process underlying mental functioning", is the new DSM 5 definition of a mental disorder.

Which client statement reflects an understanding of circadian rhythms in psychopathology? 1."When I dream about my mother's horrible train accident, I become hysterical." 2."I get really irritable during my menstrual cycle." 3."I'm a morning person. I get my best work done before noon." 4."Every February, I tend to experience periods of sadness."

ANS: 3 Rationale: By stating, "I am a morning person," the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness.

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It's just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

ANS: 3 Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip physiological and psychosocial questions, as this would lead to an inaccurate assessment.

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I still don't have any appetite and continue to lose weight."

ANS: 3 Rationale: The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life.

An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? 1. The employee assertively confronts the boss. 2. The employee leaves the staff meeting to work out in the gym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch.

ANS: 3 Rationale: The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less-threatening target.

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

ANS: 3 Rationale: The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities.

A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship. 2. Achieving a sense of self-confidence. 3. Possessing a feeling of self-fulfillment and realizing full potential. 4. Developing a sense of purpose and the ability to direct activities.

ANS: 3 Rationale: The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow's hierarchy of needs.

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

ANS: 3 Rationale: The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

ANS: 3 Rationale: The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.

A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 3 Rationale: The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.

When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

ANS: 4 Rationale: The client's statement "I don't drink too much!" alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.

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. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

ANS: 4 Rationale: The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the client's distress does not indicate a mental illness.

A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

ANS: 4 Rationale: The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

ANS: 4 Rationale: The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1."The occipital lobe governs perceptions, judging them as positive or negative." 2."The parietal lobe has been linked to depression." 3."The medulla regulates key biological and psychological activities." 4."The limbic system is largely responsible for one's emotional state."

ANS: 4 Rationale: The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system if often called the "emotional brain" and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that regulate heart rate and reflexes.

A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

ANS: 4 Rationale: The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

ANS: 4 Rationale: The therapist's recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology.

Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? 1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy. 2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill. 3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents. 4. Studies in which monozygotic twins were raised together by mentally ill biological parents. 5. All of the above.

ANS: 5 Rationale: The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.

28. Which is a nursing intervention to assist a client to achieve Erikson's developmental task of ego integrity? A. Encourage a life review of triumphs and disappointments B. Provide opportunities for success experiences C. Focus on embracing the future D. Foster the development of creativity

ANS: A Erikson believed that between the age of 65 years and death, the goal is to review one's life and derive meaning from both positive and negative events, while achieving a positive sense of self. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Implementation

27. An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. "What do you think needs to change about how you express anger?" B. "How did you feel after attending the anger management session?" C. "On a scale of 1 to 10, please rate your current level of anger." D. "What bothers you about the actions of others when you get angry?"

ANS: A In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

20. A client is recovering from abdominal surgery. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the client's level of pain B. Assessing and documenting the client's vital signs C. Assessing skin turgor and hydration status D. Assessing incisional site for serosanguineous drainage

ANS: A Pain will distract the client and interfere with the learning process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

26. According to Peplau, treatment of client symptoms should involve which nursing action? A. Establishing a therapeutic nurse-client relationship B. Using the technique of desensitization C. Challenging clients' negative thoughts D. Uncovering clients' past experiences

ANS: A Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

6. A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions

ANS: A Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the client's laundry and managing finances, the mother is fostering the client's dependence. PTS: 1 REF: 207 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. The nurse should recognize which acronym as representing problem-oriented charting? A. SOAPIE B. APIE C. DAR D. PQRST

ANS: A The acronym SOAPIE represents problem-oriented charting which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. This type of charting identifies nursing diagnoses (client problems) on a written plan of care with appropriate nursing interventions described for each. PTS: 1 REF: 181 KEY: Cognitive Level: Comprehension | Integrated Process: Implementation

3. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans

ANS: A The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group's educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices. PTS: 1 REF: 106 KEY: Cognitive Level: Comprehension | Integrated Process: Assessment

10. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement? A. An adult child considers, but is not governed by, the advice of his or her parents. B. An adult child appears to listen, but ignores, the advice of his or her parents. C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents.

ANS: A The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. 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? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

ANS: A 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. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Evaluation

23. Which statement describes achievement of Erikson's generativity versus stagnation developmental stage? A. "I've been a girl scout leader for troop 259 for 7 years." B. "I feel great that I could pay for my bike with my paper route money." C. "My parents are so pleased that John and I are going to be married." D. "I've had a very full life. I'm not afraid to leave this world."

ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? A. Try to locate a shaman that will agree to come to the ED. B. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. C. Ask the client to explain what the shaman can do that the physician cannot. D. Inform the client that refusing treatment is a client's right.

ANS: A The most appropriate nursing intervention would be to try to locate a shaman who will agree to come to the ED. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients. PTS: 1 REF: 108 KEY: Cognitive Level: Analysis | Integrated Process: Implementation

7. 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."

ANS: A 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. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. 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." A. Restatement B. Offering general leads C. Focusing D. Accepting

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement 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. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences

ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Assessment

6. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? A. Families are male dominated with clear male-female role distinctions. B. Religious tenets support the use of violence in a marital context. C. The nuclear family is female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in the family.

ANS: A The nurse should associate the cultural belief that families are male dominated with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually possesses the ultimate authority. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

13. The following outcome was developed for a client: "Client will list five personal strengths by the end of day 1." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

ANS: A The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day 1. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals. The self-care deficit and risk for disturbed self-concept nursing diagnoses are incorrectly written. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

11. In what probable way should a nurse expect an Asian American client to view mental illness? A. Mental illness relates to uncontrolled behaviors that bring shame to the family. B. Mental illness is a curse from God related to immoral behaviors. C. Mental illness is cured by home remedies based on superstitions. D. Mental illness is cured by "hot and cold" herbal remedies.

ANS: A The nurse should expect that many Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

3. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing reply? A. "Group therapy provides the opportunity to learn and practice new coping skills." B. "Group therapy is mandatory. All clients must attend." C. "Group therapy is optional. You can go if you find the topic helpful and interesting." D. "Group therapy is an economical way of providing therapy to many clients concurrently."

ANS: A The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. "Are you currently thinking about harming yourself?" B. "Why do you want to harm yourself?" C. "Have you thought about the consequences of your actions?" D. "Who is your emergency contact person?"

ANS: A The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm. PTS: 1 REF: 242 KEY: Cognitive Level: Analysis | Integrated Process: Assessment

16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking.

ANS: A The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury due to confusion and potential for falls. History of suicide and hopelessness would lead to the development of a risk for suicide nursing diagnosis. Disorganized thoughts and delusional thinking would lead to the development of an altered thought process nursing diagnosis. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

12. Which cultural considerations should a nurse identify with Western European Americans? A. They are present-time oriented and perceive the future as God's will. B. They value youth, and older adults are commonly placed in nursing homes. C. They are at high risk for alcoholism due to a genetic predisposition. D. They are future oriented and practice preventive health care.

ANS: A The nurse should identify that most Western European Americans are present oriented and perceive the future as God's will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes. PTS: 1 REF: 111 KEY: Cognitive Level: Application | Integrated Process: Assessment

17. A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions? A. The id B. The superid C. The ego D. The superego

ANS: A The nurse should identify that the husband's actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives. PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Evaluation

14. A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Erikson's psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 to 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others. PTS: 1 REF: 39 KEY: Cognitive Level: Application | Integrated Process: Assessment

14. During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the man's loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurse's action? A. The nurse's action should be evaluated as unacceptable due to breech of cultural norms. B. The nurse's action should be evaluated as empathetic; encouraging expressions of feelings. C. The nurse's action should be evaluated as the technique of offering self. D. The nurse's action should be evaluated as inappropriate due to poor timing.

ANS: A The nurse's action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the other's hand or shoulder but only between members of the same sex. PTS: 1 REF: 111 KEY: Cognitive Level: Application | Integrated Process: Evaluation

5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients' bedside at the appropriate times.

ANS: A The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem. PTS: 1 REF: 232 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Evaluation

17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

21. A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

27. During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. PTS: 1 REF: 151 KEY: Cognitive Level: Application | Integrated Process: Implementation

15. A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? A. Triangulation B. Pseudohostility C. Double-bind communication D. Pseudomutuality

ANS: A Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Evaluation

11. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) A. "Tell me what happened." B. "What coping methods have you used, and did they work?" C. "Describe to me what your life was like before this happened." D. "Let's focus on the current problem." E. "I'll assist you in selecting functional coping strategies."

ANS: A, B, C In the assessment phase, the nurse should gather information regarding the precipitating stressor and the resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing interventions rather than assessments. PTS: 1 REF: 243 KEY: Cognitive Level: Application | Integrated Process: Assessment

34. Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal. PTS: 1 REF: 151 KEY: Cognitive Level: Application | Integrated Process: Assessment

12. Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid "I" statements related to expression of feelings.

ANS: A, B, D The nurse should determine that when working with an inpatient client who expresses anger inappropriately, it is important to maintain a calm demeanor, clearly define the consequences, and set limits on the behavior. The use of therapeutic touch may not be appropriate and could escalate the client's anger. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

19. A female nurse is caring for an Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? (Select all that apply.) A. Limited touch is acceptable only between members of the same sex. B. Conversing individuals of this culture stand far apart and do not make eye contact. C. Devout Muslim men may not shake hands with women. D. The man is the head of the household and women take on a subordinate role. E. Men of this culture are responsible for the education of their children.

ANS: A, C, D When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of the children. PTS: 1 REF: 111-112 KEY: Cognitive Level: Application | Integrated Process: Assessment

31. Which of the following nursing interventions fall within the standards of psychiatric-mental health clinical nursing practice for a nurse generalist? (Select all that apply.) A. Assist clients to perform activities of daily living. B. Consult with other clinicians to provide services for clients and effect system change. C. Encourage clients to discuss triggers for relapse. D. Use prescriptive authority in accordance with state and federal laws. E. Educate families about signs and symptoms of alcohol dependence and withdrawal.

ANS: A, C, E Assisting clients to perform daily living activities, encouraging clients to discuss triggers, and educating families are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatric-mental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

19. A nurse is evaluating the effectiveness of teaching after instructing a group of clients on joint replacement. In the evaluation step of the nursing process, which learning domain is the most difficult to measure? A. Normative domain B. Affective domain C. Cognitive domain D. Psychomotor domain

ANS: B Affective knowledge is the most difficult to evaluate because of differences in values, cultures, and attitudes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

15. A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction? A. "All cultures communicate freely within their group." B. "All cultures embrace light therapeutic touch." C. "All cultures view the importance of timeliness differently." D. "All cultures display biological variations."

ANS: B All cultures do not embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considered unacceptable. This student statement indicates the need for further instruction. PTS: 1 REF: 104 KEY: Cognitive Level: Application | Integrated Process: Evaluation

17. A nursing instructor is teaching about the importance of healthy family member expectations for newly blended families. Which student statement indicates a need for further instruction? A. "Healthy family member expectations should be flexible." B. "Healthy family member expectations should be conforming." C. "Healthy family member expectations should be individual." D. "Healthy family member expectations should be realistic."

ANS: B Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family member expectations. PTS: 1 REF: 207 KEY: Cognitive Level: Application | Integrated Process: Evaluation

13. During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? A. The husband is expressing an emotional cutoff. B. The husband is expressing double-bind communication. C. The husband is expressing indirect messages. D. The husband is expressing avoidance behaviors.

ANS: B Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong. PTS: 1 REF: 214 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing reply is most appropriate? A. "I'm confident you know what's best for you." B. "This may not be the best time for you to make such an important decision." C. "Your children will be terribly disappointed." D. "Tell me why you want to make this change."

ANS: B During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

23. A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. A client is assigned the nursing diagnosis of impaired social interaction R/T socio-cultural differences AEB client stating, "Although I'd like to, I don't join in because I don't speak the language so good." Which correctly written outcome addresses this client's problem? A. The client will collaborate with nursing staff to set specific goals by day 3. B. The client will participate in one group activity of choice by day 2. C. The client will express a desire to interact with others. D. The client will become increasingly independent by discharge.

ANS: B In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client need or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

21. A 29-year-old client living with parents has few interpersonal relationships. The client states, "I have trouble trusting people." Based on Erikson's developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental deficits in earlier life stages have impaired the client's adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The client's developmental problems began in the intimacy versus isolation stage.

ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

21. During the implementation phase of the nursing process, a nurse is teaching an adult with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client? A. Using repetition B. Speaking directly face-to-face C. Employing the use of sign language D. Providing large-print materials

ANS: B Speaking face-to-face is an appropriate way to teach individuals with alterations in hearing. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

24. A psychiatric nurse uses Sullivan's theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed? A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal conflicts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences.

ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulty in living. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Evaluation

22. Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist? A. "Let's discuss your use of defense mechanisms." B. "We need to examine how your relationships affect your ability to cope." C. "It is important that you take the medications that I have prescribed for you." D. "Your genetic background is a factor in your predisposition to mental illness."

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Intervention

29. From an interpersonal theory perspective, which intervention would a nurse use to assist a client diagnosed with major depressive disorder? A. Encourage discussion of feelings B. Offer family therapy sessions C. Discuss childhood events D. Teach alternate coping skills

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. Family therapy would assist the client to deal with relationships within the family system. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Implementation

6. Within the nurse's scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services

ANS: B The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. It is within the scope of practice of a registered psychiatric mental health nurse generalist to provide education, case management, and milieu therapy. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

ANS: B The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

15. A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities

ANS: B The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups. PTS: 1 REF: 229 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

ANS: B The nurse should assess that tense facial expressions and body language may indicate that a client's anger is escalating. The nurse should conduct a thorough assessment of the client's past and current violent behaviors, and develop interventions for deescalation. PTS: 1 REF: 243 KEY: Cognitive Level: Application | Integrated Process: Assessment

19. A nurse is caring for a hospitalized client who is quarrelsome, opinionated, and has little regard for others. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development? A. Infancy B. Childhood C. Early adolescence D. Late adolescence

ANS: B The nurse should associate the client's behavior with a deficit in the childhood stage of Sullivan's interpersonal theory. The childhood stage in Sullivan's interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Evaluation

16. According to Freud, which statement should a nurse associate with predominance of the superego? A. "No one is looking, so I will take three cigarettes from Mom's pack." B. "I don't ever cheat on tests. It is wrong." C. "If I skip school I will get in trouble and fail my test." D. "Dad won't miss this little bit of vodka."

ANS: B The nurse should associate the statement "I don't ever cheat on tests. It is wrong." as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the "perfection principle." PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Evaluation

7. When working with clients of a particular culture, which action should a nurse avoid? A. Maintaining eye contact based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication

ANS: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals. PTS: 1 REF: 104 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis

ANS: B The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility. PTS: 1 REF: 242 KEY: Cognitive Level: Application | Integrated Process: Assessment

3. Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations

ANS: B The nurse should determine that the correctly written diagnosis would be Self-care deficit: hygiene R/T altered thought AEB disheveled appearance. The nursing diagnosis should describe the client's condition, facilitating the choice of interventions. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

3. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: B The nurse should determine that this client has completed the "Learning to delay satisfaction" stage of development according to Peplau's interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others. PTS: 1 REF: 47 KEY: Cognitive Level: Application | Integrated Process: Assessment

11. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's history, in which phase of development according to Mahler's theory, should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase

ANS: B The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infant's focus is on basic needs and comfort. PTS: 1 REF: 41 KEY: Cognitive Level: Application | Integrated Process: Assessment

1. An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth's choices? A. Most African American homes are headed by strong, dominant father figures. B. Most African Americans choose to remain within their own social organization. C. Most African Americans are uncomfortable expressing emotions and need group affiliations. D. Most African Americans have limited religious beliefs which contribute to criminal activity.

ANS: B The nurse should identify that a tendency to remain within one's own social organization may have played a role in this youth's choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educated and future focused. Those who have not assimilated may be unemployed or have low-paying jobs, and view the future as hopeless given their previous encounters with racism and discrimination. PTS: 1 REF: 106 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

ANS: B The nurse should identify that maintaining an 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). PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Evaluation

7. What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

ANS: B The nurse should include the client's family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment. PTS: 1 REF: 229 KEY: Cognitive Level: Application | Integrated Process: Implementation

14. How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physician's priority of care D. By the client's preference

ANS: B The nurse should prioritize nursing diagnoses related to life-threatening potential. Safety is always the nurse's first priority. PTS: 1 REF: 178 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions

ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego. PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Assessment

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

ANS: B The nurse's statement, "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. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client's problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion

ANS: B The nursing diagnosis altered sensory perception accurately reflects the client's symptoms of hearing things that others do not. A nursing diagnosis describes a client's condition and facilitates the prescription of interventions. Delusional thinking, confusion, and disorientation are problems associated with the nursing diagnosis of altered thought processes. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

11. What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis.

ANS: B The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client including information collected from the client, significant others, and health-care providers. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self. PTS: 1 REF: 153 KEY: Cognitive Level: Application | Integrated Process: Implementation

31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

33. A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

8. To effectively care for Asian American clients, a nurse should be aware of which cultural norm? A. Obesity and alcoholism are common problems. B. Older people maintain positions of authority within the culture. C. "Tai" and "chi" are the fundamental concepts of Asian health practices. D. Asian Americans are likely to seek psychiatric help.

ANS: B To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of "yin" and "yang," not "tai" and "chi," is the fundamental concept of Asian health practices. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept? A. Differentiation of self B. Triangulation C. Fusion D. Emotional cutoff

ANS: B Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couple's marital problems. PTS: 1 REF: 210-211 KEY: Cognitive Level: Application | Integrated Process: Evaluation

18. When interviewing a client of a different culture, which of the following questions should a nurse consider asking? (Select all that apply.) A. Would using perfume products be acceptable? B. Who may be expected to be present during the client interview? C. Should communication patterns be modified to accommodate this client? D. How much eye contact should be made with the client? E. Would hand shaking be acceptable?

ANS: B, C, D, E When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability. Given that cultural influences affect human behavior, its interpretation, and another person's response, it is important for nurses to understand the effects of these cultural influences to work effectively with diverse populations. PTS: 1 REF: 119 KEY: Cognitive Level: Application | Integrated Process: Implementation

33. After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? (Select all that apply.) A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature

ANS: B, C, E A nursing diagnosis is a statement of a client's functional problem. An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it does not as yet exist. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) A. Respiratory therapist and psychiatrist B. Occupational therapist and psychologist C. Recreational therapist and art therapist D. Social worker and hospital volunteer E. Mental health technician and chaplain

ANS: B, C, E The interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. In addition, a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, psychodramatist, and dietician participate in the interdisciplinary treatment team. PTS: 1 REF: 230-231 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. Which of the following are accurate descriptors of a therapeutic community? (Select all that apply.) A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

ANS: B, E In a therapeutic community, the unit responsibilities are assigned according to client capability and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills. PTS: 1 REF: 228-229 KEY: Cognitive Level: Application | Integrated Process: Implementation

20. Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? (Select all that apply.) A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans

ANS: B, E The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested. PTS: 1 REF: 108-109 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions

ANS: C A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input. PTS: 1 REF: 228 KEY: Cognitive Level: Application | Integrated Process: Planning

17. Which cultural group is correctly matched with the disease process for which this group is most susceptible? A. African Americans are susceptible to lactose intolerance. B. Western European Americans are susceptible to malaria. C. Arab Americans are susceptible to sickle cell disease. D. Jewish Americans are susceptible to thalassemia.

ANS: C A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disease. PTS: 1 REF: 112 KEY: Cognitive Level: Application | Integrated Process: Assessment

25. 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 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

ANS: C An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it doesn't as of yet exist. The client's statement indicates that role performance is altered due to the fact that fear of failure prevents seeking employment. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

28. The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview? A. "Appears uncooperative. Exhibits characteristics of depression." B. "Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression." C. "States, 'I don't need to be here.' when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission." D. "Unwilling to respond openly during interview."

ANS: C Documentation occurs in the implementation phase of the nursing process. All charting entries to the client's legal record should be objective and based on assessed data. Implications and generalizations should be avoided. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

16. A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate? A. Touch each member lightly as this enhances the communication process. B. Direct questions to the young males of the family as they maintain positions of authority. C. Avoid direct eye contact as it implies rudeness. D. Remain objective and empathetic as Asians express feelings freely.

ANS: C In the Asian culture, eye contact is often avoided as it connotes rudeness and lack of respect. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Implementation

30. The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client 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 son" D. The client who argued with her boyfriend and inflicted a superficial cut on her arm

ANS: C In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. These data are prioritized to meet client needs with an emphasis on safety. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

12. During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? A. Multigenerational transmission B. Disengagement C. Mother-child subsystem D. Emotional cutoff

ANS: C In this situation, the mother and child have formed a subsystem in which they have aligned themselves against the father. PTS: 1 REF: 210 | 213 KEY: Cognitive Level: Application | Integrated Process: Assessment

17. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which reply by the instructor most accurately answers the student's question? A. "Use the Nursing Interventions Classification (NIC) as a reference for nursing outcomes." B. "Look at your client's problems and set a realistic, achievable goal." C. "Use the Nursing Outcomes Classification (NOC) as a reference for nursing outcomes." D. "Copy your standard outcomes from a nursing care plan textbook."

ANS: C NOC is a comprehensive, standardized classification of client outcomes developed to evaluate the effects of nursing interventions. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

16. An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? A. "Your son should be consistently disciplined by only one parent." B. "You should not have any more children because your son will need your full attention." C. "You need to keep the lines of communication open between all of you." D. "Allow your son to make his own choices because this new situation will be stressful."

ANS: C Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure. PTS: 1 REF: 204 KEY: Cognitive Level: Application | Integrated Process: Implementation

5. Which task should the nurse recognize as appropriate to stage IV of the family life cycle? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship

ANS: C Stage IV of the family life cycle is described as the "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs. PTS: 1 REF: 203 KEY: Cognitive Level: Application | Integrated Process: Assessment

3. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture. PTS: 1 REF: 205 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale

ANS: C The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is used to assess gamma-glutamyl transferase levels which may be an indication of alcoholism. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

ANS: C The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? A. Health teacher B. Case manager C. Milieu manager D. Psychotherapist

ANS: C The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. Health teaching involves promoting health and a safe environment. Case management is utilized to organize client care so that outcomes are achieved. Psychotherapy involves conducting individual, couples, group, and family counseling. PTS: 1 REF: 173 KEY: Cognitive Level: Comprehension | Integrated Process: Implementation

13. A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order 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."

ANS: C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

3. 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?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

ANS: C 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. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Evaluation

1. Which data gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful

ANS: C The nurse should ask the client to describe any thoughts of self-harm during the assessment phase of the nursing process. Assessment involves collecting and analyzing data about the client that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. The other three options are employed during the evaluation phase of the nursing process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect

ANS: C The nurse should ask the client to identify name, date, residential address, and situation to assess the client's orientation. Assessment of the client's orientation to reality is part of a mental status evaluation. PTS: 1 REF: 172 KEY: Cognitive Level: Comprehension | Integrated Process: Assessment

1. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures.

ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal. PTS: 1 REF: 204 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist

ANS: C The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process. PTS: 1 REF: 230 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology? A. Dissociative disorders B. Alzheimer's dementia C. Stress-related disorders D. Schizophrenia-spectrum disorders

ANS: C The nurse should correlate Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology may occur when individuals fail to meet the expectations of the culture. PTS: 1 REF: 106 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken-down" after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger

ANS: C The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken-down" after a violent outburst is to process feelings and concerns related to the witnessed intervention. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

15. A client has flashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system? A. The "good me" B. The "bad me" C. The "not me" D. The "bad you"

ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the "not me" part of the personality. According to Sullivan, the "not me" part of the personality develops in response to situations that produced intense anxiety in childhood. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Assessment

5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision? A. Future orientation causes the client to devalue assertiveness skills. B. Decreased emotional expression makes it difficult to be assertive. C. Assertiveness techniques may not be aligned with the client's definition of the female role. D. Religious prohibitions prevent the client's participation in assertiveness training.

ANS: C The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the family which is male dominated. The father usually possesses the ultimate authority. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Evaluation

18. A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the "Identifying oneself" stage according to Peplau's interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her. PTS: 1 REF: 47 KEY: Cognitive Level: Application | Integrated Process: Assessment

12. A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency

ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freud's stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Assessment

13. A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group? A. African Americans B. Asian Americans C. Native Americans D. Jewish Americans

ANS: C The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present. PTS: 1 REF: 108 KEY: Cognitive Level: Application | Integrated Process: Assessment

13. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Erikson's developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this tasks results in the capacity for mutual love and respect. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

2. A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize a deficit in which developmental stage? A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

ANS: C The nurse should recognize that the client who states, "No one will ever love a loser like me." has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

5. Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment team's goals. B. Nursing interventions are solely directed by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures.

ANS: C The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client's care. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should determine that according to Mahler's developmental theory, this child's development is at which phase? A. The autistic phase B. The symbiotic phase C. The differentiation subphase of the separation-individuation phase D. The rapprochement subphase of the separation-individuation phase

ANS: C The nurse should understand that this client is in the differentiation subphase of the separation-individuation phase. This subphase begins with the child's initial physical movements away from the mothering figure. A primary recognition of separateness commences. PTS: 1 REF: 42 KEY: Cognitive Level: Application | Integrated Process: Assessment

6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader

ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person—in this case, the child's parent. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

1. An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? A. Conflict should be avoided at all costs on inpatient psychiatric units. B. Conflict should be resolved by the nursing staff. C. Every interaction is an opportunity for therapeutic intervention. D. Conflict resolution should only be addressed during group therapy.

ANS: C The nurse's response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

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

ANS: C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this client's problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The client's sleep habits will improve during hospitalization.

ANS: C The outcome "The client will sleep 7 uninterrupted hours by day four of hospitalization." is accurately written and an appropriate outcome to address the client problem of insomnia. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Analysis | Integrated Process: Planning

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations

ANS: C The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential. PTS: 1 REF: 244 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

19. A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

22. The nurse asks a newly admitted client, "What can we do to help you?" 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

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

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

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment. PTS: 1 REF: 153 KEY: Cognitive Level: Application | Integrated Process: Implementation

28. A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

18. A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? A. Coping by attacking B. Coping by surrendering C. Coping by avoiding D. Coping by belittling

ANS: C When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper. PTS: 1 REF: 208 KEY: Cognitive Level: Application | Integrated Process: Evaluation

14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

7. A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged.

ANS: C With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt. PTS: 1 REF: 213 KEY: Cognitive Level: Application | Integrated Process: Assessment

32. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) A. Client outcomes are specifically formulated by nurses. 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.

ANS: C, D The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

7. A nurse charts "Verbalizes understanding of the side effects of Prozac." This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response

ANS: D "Verbalizes understanding of the side effects of Prozac." is an example of the response category of focused charting. The response is a description of the client's reaction to any part of medical or nursing care. PTS: 1 REF: 182 KEY: Cognitive Level: Application | Integrated Process: Implementation

14. A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents "Marital schism." What does the nurse mean by this documentation? A. The couple has a compatible marriage relationship. B. The husband has a dominant relationship over the wife. C. The couple has an enmeshed relationship. D. The couple has an incompatible marriage relationship.

ANS: D A marital schism is a state of chronic disequilibrium and discord. This describes this couple's marriage. PTS: 1 REF: 215 KEY: Cognitive Level: Application | Integrated Process: Assessment

27. The nurse practitioner plans to use a psychoanalytical framework when treating a client diagnosed with an anxiety disorder. Which would be the focus of this nursing intervention? A. Correcting inappropriate learning patterns B. Changing a dysfunctional social environment C. Exploring the "here-and-now" with the client and family D. Dealing with issues of physical abuse at an early age

ANS: D Freud, a psychoanalytic theorist, considered the first 5 years of a child's life to be the most important, because he believed that an individual's basic character had been formed by the age of five. PTS: 1 REF: 35 KEY: Cognitive Level: Application | Integrated Process: Implementation

20. According to psychoanalytic theory, treatment of symptoms should involve which nursing action? A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and effects of actions D. Recognizing and discussing the client's use of ego defense mechanisms

ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Intervention

8. A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? A. All family members should use past incidents to make their point. B. One family member should act as a gatekeeper in order to avoid family confrontation. C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation.

ANS: D Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise. PTS: 1 REF: 208 KEY: Cognitive Level: Application | Integrated Process: Implementation

11. During family counseling a husband states, "Every time my wife and I discuss child discipline, we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using? A. Reframing B. Restructuring the family C. Expressive psychotherapy D. Paradoxical intervention

ANS: D In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change. PTS: 1 REF: 215 KEY: Cognitive Level: Application | Integrated Process: Implementation

23. An instructor overhears a student say, "That family seems to disagree more than agree. The family seems to be dysfunctional." To further assess the family's situation, which would be an appropriate instructor reply? A. "Families who disagree can be a challenge to the treatment team." B. "You seem very critical of the family. Do you believe that you are unable to help them?" C. "Let's bring the family in for an educational session to improve their communication." D. "What appears to trigger family disagreements?"

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, prior to intervening with this family, the nurse needs further information about the cause of family conflicts. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

22. A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation? A. Provide warm milk and a backrub. B. Give a sleep medication. C. Hold a relaxation group before bedtime. D. Review the client's normal sleep pattern.

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, the nurse must initially determine the client's normal sleep patterns in order to evaluate if a true problem exists. PTS: 1 REF: 165 KEY: Cognitive Level: Analysis | Integrated Process: Assessment

26. During an intake interview, which question would assist the nurse in gathering data about the client's judgment? A. "What brought you to the hospital? Do you know what day and season it is now?" B. "On a scale of 1 to 10, how would you rate your stress level?" C. "What does the phrase 'a rolling stone gathers no moss' mean to you?" D. "If you found a stamped, addressed envelope in the street, what would you do?"

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. The nurse presents a situation that requires the client to make a judgment call and can assess appropriate judgment based on the client's action choice. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

24. Which nursing response would be appropriately used in the evaluation phase of the nursing process? A. "If I were in your situation, I would not repeat a behavior that has caused problems." B. "What do you think needs changing, and what do you want to do differently?" C. "What exactly will it take to carry out your plan, and what else do you need to do?" D. "This new approach seems to work for you."

ANS: D In the evaluation phase of the nursing process, the nurse evaluates progress toward attainment of the expected outcomes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

25. A nursing instructor is teaching about the application of Peplau's theory to nursing care. Which student statement indicates that learning has occurred? A. "The nurse assumes the role of a parenting figure instructing the client in good health practices." B. "The nurse is concerned more about psychosocial functioning than physiological functioning." C. "The nurse bases the client care plan on standardized nursing approaches and physician orders." D. "The nurse applies principles of human relations to the problems that arise at all levels of experience."

ANS: D Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Evaluation

4. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication. PTS: 1 REF: 206 KEY: Cognitive Level: Application | Integrated Process: Evaluation

10. In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects

ANS: D The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the client's safety and physiological needs are met within the milieu. PTS: 1 REF: 228 KEY: Cognitive Level: Analysis | Integrated Process: Planning

6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior.

ANS: D The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior. PTS: 1 REF: 244 KEY: Cognitive Level: Analysis | Integrated Process: Planning

2. A client on an inpatient unit angrily states to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? A. "I'll talk to Peter and present your concerns." B. "Why are you overreacting to this issue?" C. "You should bring this to the attention of your treatment team." D. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

ANS: D The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

ANS: D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? 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 group, you raised your voice, yelled at a peer, left, and slammed the door."

ANS: D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

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

ANS: D The nurse is using the therapeutic communication technique of making observations when 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. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Evaluation

10. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections

ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, non-achievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. "You've really been helpful. Can I count on you for continued support?" B. "I work out in the college gym rather than jogging outdoors." C. "I'm really glad I didn't go home. It would have been hard to come back." D. "I carry mace when I jog. It makes me feel safe and secure."

ANS: D The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. PTS: 1 REF: 244-245 KEY: Cognitive Level: Analysis | Integrated Process: Evaluation

3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this client's crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6.

ANS: D The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame. PTS: 1 REF: 242 KEY: Cognitive Level: Application | Integrated Process: Planning

1. According to Erikson's developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations

ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve established life goals and consider the welfare of future generations. According to Erikson, the client would be in the generativity versus stagnation stage of development. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Planning

6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

ANS: D The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a client's learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance. PTS: 1 REF: 232 KEY: Cognitive Level: Application | Integrated Process: Planning

5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, in which stage of development should the nurse identify a need for improvement? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: D The nurse should identify that this client needs to improve in the "Developing skills in participation" stage of Peplau's interpersonal theory. Older children in this phase learn the skills of compromise, competition, and cooperation with others. PTS: 1 REF: 48 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. When planning client care for a Latino American, the nurse should be aware of which cultural influence that may impact access to health care? A. The root doctor may be the first contact made when illness is encountered. B. The "yin" and "yang" practitioner may be the first contact made when illness is encountered. C. The shaman may be the first contact made when illness is encountered. D. The curandero may be the first contact made when illness is encountered.

ANS: D The nurse should understand that some Latin Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

ANS: D The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance. PTS: 1 REF: 240 KEY: Cognitive Level: Application | Integrated Process: Planning

7. A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau's framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader

ANS: D The nurse who directs client interaction and plans for interventions is assuming the role of leader. According to Peplau, a leader directs the nurse-client interaction and ensures that actions are taken to achieve goals. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

5. 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? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

ANS: D The nurse's statement, "Things will look better tomorrow after a good night's sleep." 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. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? A. Extremes of emotional expression prevent accurate assessment of this culture. B. Suspicion of Western civilization has resulted in minimal cultural research. C. The small size of this subpopulation makes research virtually impossible. D. The Asian American culture includes individuals from many different countries.

ANS: D The nursing instructor's best explanation is that the Asian American culture is difficult to classify globally due to the number of countries that identify with this culture. The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Evaluation

11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information

ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Evaluation

4. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days.

ANS: D The statement "Client will initiate interaction with one peer during free time within 2 days." is an example of a correctly formulated expected outcome. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

30. 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."

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

18. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

Velma told Betty a secret that Mary told her. This is an example of which of the following? A. Too flexible boundary. B. A boundary violation. C. Rigid boundary. D. Enmeshed boundary

B. A boundary violation is the correct answer because Velma told Betty something that Mary shared with her in confidence. Other examples of boundary violations are invading someone's personal space, opening their mail, reading their diary, unwanted touching, even smoking in non-smoking public areas. Telling someone they "should" believe, feel, decide, choose or think in a certain way is another example of a boundary violation.

Twins Jan and Jean still dress alike even though they are grown and married. This is an example of which of the following? A. Rigid boundary B. Enmeshed boundary C. A boundary violation D. Boundary pliancy

B. Enmeshed boundary is the correct answer because when two people's boundaries are so blended together that neither can be sure where one stops and the other begins. They may be unable to differentiate his or her feelings, wants, and needs from the other person's. This does not only apply to twins. Boundary pliancy refers to a boundary being either rigid, flexible or enmeshed. A boundary violation would be an unwanted intrusion of anothers personal or psychological space.

Karen, age 23 graduated from nursing school with a 3.2/4.0 gpa. She recently took the NCLEX exam and did not pass. Because of this, she had to give up her graduate nursing job until she can pass the exam. She has become very depressed and has sought counseling at the mental health clinic. Karen says to the psychiatric nurse, "I am a complete failure. I'm so dumb, I can't do anything right." What is the most appropriate nursing dx. for Karen? A. Chronic low self-esteem. B. Situational low self-esteem C. Defensive coping D. Risk for situational low self esteem.

B. Situational low self-esteem is correct because it relates to Karen's feeling of failure in a situation of importance. The dx is evidenced by Karen's statement that she is a complete failure, she is dumb and can't do anything right based on this one experience. Karen is not a risk because she has had the failure and her dx is not chronic because it is not the result of repeated failures. Defensive coping is not applicable because Karen is asking for help.

A mother berates her child for breaking a cup and says, "Your are BAD and SO DESTRUCTIVE." This statement discourages the development of positive self-esteem by not meeting which parenting focus as described by Warren? A. A sense of competence B. Unconditional love C. A sense of survival D. Realistic goals

B. Unconditional love. According to warren, Parents promote self-esteem when they provide unconditional love for their children. CHILDREN NEED TO KNOW THAT THEY ARE LOVED AND ACCEPTED REGARDLESS OF SUCCESSES OR FAILURES. Criticism of behavior should not be linked with criticism of the child. In the situation presented the mother discourages the development of positive self-esteem by not meeting the child's need for unconditional love.

The psychiatric nurse encourages Nancy (the client in question 3) to express her anger. Why is this an appropriate nursing intervention? A. Anger is the basis for self-esteem problems. B. The nurse suspects that Nancy was abused as a child. C. The nurse is attempting to guide Nancy through the grief process. D. The nurse recognizes that Nancy has long-standing repressed anger.

C. The nurse is attempting to guide Nancy through the grief process is part of the evaluation process when reassessing to determine if the client has been successful.

The husband says to the wife, "What do you want to do tonight?" and the wife responds, "Whatever you want to do." This is an example of which of the following? A. Rigid boundary. B. A boundary violation C. Too flexible boundary. D. Showing respect for the boundary of another.

C. Too flexible boundary is the correct answer because the wife is too flexible, she is allowing her husband to make her choices and direct her behavior. People with rigid boundaries often have a hard time trusting others, keep others at a distance and are difficult to communicate with. They are often withdrawn emotionally and physically. Telling his wife what they would do without asking would be a boundary violation.

Nancy tried out for the cheer leading squad in junior high, but was rejected. At age 15, she had looked forward to trying out for the cheer leading squad in high school. She took cheer leading classes and practiced for many hours every day. However, when tryouts were held, she was not selected. She has become despondent, and her mother takes her to the mental health clinic for counseling. She tells the nurse, "What's the use of trying? I'm not good at anything!" Which of the following nursing interventions is best for Nancy's specific problem? A. Encourage Nancy to talk about her feeling of shame over the second failure. B. Assist Nancy to problem-solve her reasons for not making the team. C. Help Nancy understand the importance of good self-care and personal hygiene in the maintenance of self-esteem. D. Explore with Nancy her past successes and accomplishments.

D. Explore with Nancy her past successes and accomplishments.

Karen's counselor asked her if she would like a hug. This is an example of which of the following? A. Rigid boundary B. A boundary violation C. Enmeshed boundary D. Showing respect for the boundary of another

D. Showing respect for the boundary of another is the correct answer because the counselor respected Karen's personal and psychological space by asking if she would like a hug, not just hugging her.

"Promiscuity can be very dangerous." According to Sigmund Freud, this client statement reflects the predominance of the __________ structure of the personality.

Ego

A branch of philosophy that addresses methods for determining the rightness or wrongness of one's actions is defined as __________.

Ethics

The term __________ relates to people who identify with each other because of a shared heritage.

Ethnicity

A client is diagnosed with major depressive episode. Which of the following laboratory results would the nurse expect if an alteration in the endocrine system was associated with this condition? Select all that apply. 1) Elevated serum cortisol 2) Decreased thyroid-stimulating hormone 3) Elevated melatonin levels 4) Decreased serum cortisol 5) Increased thyroid-stimulating hormone

Feedback 1: Clients experiencing depression have hormonal inhibition failure resulting in hypersecretion of cortisol. Feedback 3: Elevated melatonin levels are associated with depression in some individuals during the fall and winter months when the amount of daylight decreases. Feedback 5: Increased levels of thyroid-stimulating hormone are associated with hypothyroidism and often result in symptoms of depression.

A client diagnosed with Schizophrenia was hospitalized due to physical aggression. The staff applied four-point restraints. The client yells that the nurses will be sued for assault and battery. The nurses are protected under which of the following conditions? Select all that apply. 1) The client is voluntarily committed and poses no danger to self or others. 2) The client is voluntarily committed and poses a danger to self or others. 3) The client is involuntarily committed but poses no danger to self or others. 4) The client is involuntarily committed and poses a danger to self or others. 5) The Good Samaritan Law applies.

Feedback 2: As a threat to self or others, the client can be restrained despite objections even if voluntarily committed. Nurses would be protected from liability in this situation. Feedback 4: As a threat to self or others, the client can be restrained despite commitment status. Nurses would be protected from liability in this situation.

In the Psychological Recovery Model in relation to the concept of Hope, mobilization of resources is to the Preparation stage as hopelessness and despair is to the __________ stage.

Moratorium

A set of beliefs, values, rites, and rituals adopted by a group of people can be defined as __________.

Religion

Already in Order: Order the stages of the general adaptation syndrome according to Hans Selye. Alarm Reaction Stage Stage of Resistance Stage of Exhaustion

Selye called the general reaction of the body to stress the general adaptation syndrome. He described the reaction in three distinct stages: 1. Alarm Reaction Stage: During this stage, the physiological responses of the fight-or-flight syndrome are initiated. 2. Stage of Resistance: The individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear. 3. Stage of Exhaustion: This stage occurs when there is prolonged exposure to the stressor to which the body has become adjusted. The adaptive energy is depleted, and the individual can no longer draw from the resources for adaptation described in the first two stages.

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? a. Blue cheese, red wine, raisins b. Black beans, garlic, pears c. Pork, shellfish, egg yolks d. Milk, peanuts, tomatoes

a

What is the goal of cognitive therapy with depressed clients? a. identify and change dysfunctional pattern of thinking b. resolve the symptoms and initiate or restore adaptive family functioning c. alter the neurotransmitters that are creating the depressed mood d. provide feedback from peers who are having similar experiences

a

A client has just been admitted to the psychiatric unit with a diagnosis of MDD. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply a. slumped posture b. delusional thinking c. feelings of despair d. feels best early in the morning e. anorexia

a b c e

Sally is admitted to the hospital with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? Select all that apply. a. Teach assertive communication skills. b. Make observations to Sally when she completes a goal or task. c. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with Sally using a nonjudgmental, accepting approach.

a b d

Elisa says to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse?" a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will better in time."

a. "You are very angry now. This is a normal response to your loss."

Which of the following behaviors are associated with the phenomenon of transference? (Select all that apply.) a. The client attributes toward the nurse feelings associated with a person from the client's past. b. The nurse attributes toward the client feelings associated with a person for the nurse's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

a. The client attributes toward the nurse feelings associated with a person from the client's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.

a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment.

An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?"

b

The physician orders sertraline 50 mg PO bid for Margaret, a68-year-old women with MDD. After 3 days of taking the medication, Margaret says to the nurse "I don't think this medicine is doing any good. I don't feel a bit better". What is the most appropriate response by the nurse? a. Cheer up, Margaret. You have so much to be happy about b. Sometimes it takes a few weeks for the medication to bring an improvement in symptoms c. I'll report that to the physician. Maybe he will order you something different d. Try not to dwell on you symptoms. Why don't you join the others down in the dayroom

b

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? Select all that apply a. dont eat chocolate b. it sometimes take a while for the medication to be effective c. dont take this medication with your migraine drugs "triptans" d. go to the lab each each to check therapeutic level e. this drug causes a high degree of sedation, take at bedtime

b c

Nurse Rosetta, who is the adult child of an alcoholic, is working with John, a client who abuses alcohol. John has experience a successful detoxification process and is beginning a rehabilitation program. He says to Rosetta, "I'm not going to go to those stupid AA meetings. They don't help anything." Rosetta, who's father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" Rosetta's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries

b. Countertransference

Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the client's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the client from various sources e. Formulating nursing diagnoses and setting goals

b. Creating an environment for the establishment of trust and rapport e. Formulating nursing diagnoses and setting goals

When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

b. Respect

A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had while he was alive."

c

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. imbalanced nutrition; less than body requirements b. complicated grieving c. risk for suicide d. social isolation

c

When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

c. Genuineness

Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and a box of chocolates to his room. He presents these gifts to Nurse Mary, saying, "Thank you for taking care of me." What is a correct response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."

c. Thank you. I will share these with the rest of the staff."

Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment. d. Tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

d

Nurse Jones is working with Kim, a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. Kim tells Nurse Jones she wants to learn more adaptive ways to handle her anger. Together they set some goals. b. The goals of therapy have been met, but Kim cries and says she has to keep coming to therapy in order to be able to handle her anger appropriately. c. Nurse Jones reads Kim's previous medical records. She explores her feelings about working with a woman who has abused her child. d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

Hildegard Peplau identified seven subroles within the role of the nurse. She believed the emphasis in psychiatric nursing was on which of the subroles? a. The resource person b. The teacher c. The surrogate d. The counselor

d. The counselor

In the _______________________ stress response, the individual becomes fixed in the denial stage of the grieving process.

delayed or inhibited