Psych: Foundations of Modes and Care

The client gives a long, drawn-out explanation with excessive and irrelevant detail before answering the nurse's question. Which mental process is the client displaying? 1 Flight of ideas 2 Circumstantiality 3 Thought blocking 4 Tangential thinking

In a circumstantial thought process, excessive and unnecessary detail is included before getting to the answer. Flight of ideas is rapid shifting from one topic to another and fragmentation of ideas. Thought blocking is a sudden stoppage of the train of thought or in the middle of the sentence. Tangential thinking is similar to circumstantial thought processes, but the person never answers the question or returns to the central point of the conversation.

Which age group of hospitalized children will have the most difficulty with separation anxiety? 1 6 to 30 months 2 36 to 59 months 3 5 to 11 years 4 12 to 18 years

Infants and toddlers ages 6 to 30 months experience separation anxiety. Separation anxiety occurs in preschool and young school-aged children, but it is less obvious and less serious than it is in the toddler. The school-aged child is more accustomed to periods of separation from parents. Adolescents when hospitalized are often ambivalent about whether they want their parents with them. Peer group separation may pose more anxiety for the adolescent.

Which intervention is most important to assist a couple to cope with their feelings about the husband's terminal illness? 1 Referring the husband to a psychotherapist for help in dealing with his anger 2 Placing the couple in a couples' therapy group that addresses terminal illness 3 Helping the couple express to each other their feelings about his terminal illness 4 Encouraging the wife to verbalize her feelings to a therapist in individual therapy

It is important for the couple to discuss their feelings to maintain open communication and support each other. Referring the husband to the psychotherapist for help in dealing with his anger will not meet the needs of this couple. A couples' therapy group that addresses terminal illness may be useful in the future, but this couple need to work through their own feelings first. Encouraging the wife to verbalize her feelings during individual sessions will not directly improve communication between the husband and wife; this is the primary goal.

Which level of anxiety enhances the client's learning abilities? 1 Mild 2 Panic 3 Severe 4 Moderate

Mild anxiety motivates one to action, such as learning or making changes. Higher levels of anxiety tend to blur the individual's perceptions and interfere with functioning. Attention is severely reduced by panic. The perceptual field is greatly reduced with severe anxiety and narrowed with moderate anxiety.

A client in the mental health unit is walking swiftly around the room and rubbing his hands together. Which term describes the behavior? 1 Tardive dyskinesia 2 Withdrawal syndrome 3 Psychomotor agitation 4 Psychophysiological insomnia

Psychomotor agitation is constant motion such as pacing, hand wringing, nail biting, and other types of energetic body movements. Tardive dyskinesia is a syndrome of involuntary movements (e.g., oral, buccal, lingual, masticatory) that occur as a result of prolonged treatment with neuroleptic medications that block dopamine type 2 receptors. Withdrawal syndrome includes the signs and symptoms caused by the abrupt cessation of a substance that the client has become dependent on as a result of prolonged use. Psychophysiological insomnia refers to difficulty attaining or maintaining sleep; it is not related to agitated behavior.

The objective of a therapy group is to assist the members to change behavior so they are able to participate in life in a more satisfying manner. Which leadership style is best to achieve this objective? 1 Democratic, guiding 2 Hierarchical, directing 3 Autocratic, controlling 4 Laissez-faire, observing

A democratic, guiding leader assists the group to develop its maximum potential by facilitating and balancing group forces. Under this style, group members are encouraged to take responsibility for personal and group outcomes. A hierarchical, directing leader or an autocratic, controlling leader makes most of the decisions and controls the group. Under these styles, the members have less responsibility for making behavioral changes. A laissez-faire, observing leader allows group members to take over the group. Under this style, the group members might learn how to make behavioral changes, but the outcome is less predictable, because the leader has no input.

Which information would the nurse include when teaching a client about drugs associated with date rape? Select all that apply. One, some, or all responses may be correct. 1 Ketamine is mainly used in animals. 2 Flunitrazepam is a pill that dissolves in liquids. 3 Gamma-hydroxybutyric acid is legal for narcolepsy. 4 When taken orally, onset of ketamine is within 20 minutes. 5 Flunitrazepam is more potent when combined with alcohol. 6 Gamma-hydroxybutyric acid can cause respiratory depression.

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According to Erikson's psychosocial stages of development, which outcome will occur if an individual fails to master the maturational crisis of adolescence? 1 Role confusion 2 Feelings of inferiority 3 Interpersonal isolation 4 Difficulties with intimacy

According to Erikson, adolescents are struggling to find out who they are; this is identity versus role confusion. If an adolescent is unsuccessful in this task, role confusion may result. Industry versus inferiority is the developmental struggle of the school-aged child. This reflects part of the struggle for autonomy. Adolescents tend to be group oriented, not isolated. Developing intimacy is the developmental task for the young adult.

Which term would be used to document the client's affect, which was observed during the mental status assessment? 1 Depressed 2 Flat 3 Cooperative 4 Resistive

Affect is the observable outward manifestation of a person's mood, feelings, or tone. Common terms to describe affect include inappropriate, flat, or blunted. Mood is a feeling state reported by the client (e.g., sad, depressed, angry, anxious, happy). Attitude relates to the approach or manner of the client during the interaction with the interviewer (e.g., cooperative, resistive, friendly, ingratiating).

Aging has little effect on which process? 1 Sense of taste or smell 2 Muscle or motor strength 3 Capacity to handle life's stresses 4 Ability to remember recent events

An individual's ability to handle stress develops through experience with life; aging does not reduce this ability, but rather often strengthens it. The senses of taste and smell, muscle or motor strength, and short-term memory are often diminished in older adults, whereas long-term memory remains strong.

A client verbalizes anger toward the staff after being denied an unaccompanied day pass to leave the psychiatric facility. Which feeling is most likely to be the source of the client's anger? 1 Hopelessness 2 Indecisiveness 3 Powerlessness 4 Worthlessness

Anger is a common feeling when people do not have control over decisions that affect them. Anger could accompany hopelessness, indecisiveness, or worthlessness, but this client is clearly angry because she or he perceives that the staff is controlling her or his freedom.

Which culturally based behavior would the nurse expect to observe in an Asian client who has symptoms of anxiety and panic? 1 Reluctance to take medication 2 Minimal eye contact 3 Desire to have an Asian nurse 4 Offense at being touched

As a show of respect, people in Asian cultures tend to make little eye contact, particularly with people perceived as authority figures. People from Asian cultures are accustomed to taking medication, herbs, and other complementary therapies, so the nurse would assess before administering medication. Health care professionals with the same cultural background may be preferred, but the nurse would assess if language barriers are the chief concern. If a client is highly anxious or having symptoms of a panic attack, the nurse would not use touch, regardless of the cultural background or ethnicity.

A coworker's mother died 16 months ago, and she now cries whenever someone uses "mother" in casual conversation. Which conclusion would the nurse make about this behavior? 1 Crying is an expected response to death. 2 Excessive crying is an attention-seeking behavior. 3 The coworker may need help with grieving. 4 The coworker was extremely attached to her mother.

Crying is a release, but effective coping mechanisms should have developed. The coworker may need help with the grieving process. At 16 months after the death of a loved one, excessive crying is not an expected response. The nurse would not conclude that the coworker is seeking attention without conducting additional assessment. Concluding that the coworker was extremely attached to the mother is an unvalidated assumption.

Which speech pattern is a disturbed client displaying when she or he starts to repeat phrases that others have just said? 1 Alogia 2 Echolalia 3 Neologism 4 Symbolic speech

Echolalia is repetition of another person's remarks, words, or statements. It occurs when individuals are fearful of saying their own words and echo the words of others. Alogia is limited speech. Neologism is when new words are coined or old words take on private symbolic meanings. Symbolic speech is use of symbols to replace direct communication.

Which term describes the expected outcomes for a client who is admitted for a recurrent mental health problem? 1 Long-term goals 2 Variances of care 3 Clinical pathways 4 Measurable objectives

Expected outcomes are measurable and realistic and reflect desirable projected responses to therapeutic interventions that consider the client's present and potential capabilities. Generally, both short-term and long-term goals are included in the care plan. A variance occurs when a client's response to interventions is different from what usually is expected. A clinical pathway is a written standardized process that details essentials steps for care and describes the expected clinical course. Expected client outcomes are a component of a clinical pathway.

Which term describes a display of anger that is socially unacceptable? 1 Abuse 2 Battery 3 Aggression 4 Defensiveness

Experiencing and demonstrating anger is a normal human reaction; however, aggression is manifest when behaviors are socially and emotionally unacceptable. Abuse is a general term that infers physical, sexual, emotional, or verbal mistreatment of another individual. Battery involves harmful or offensive touching or physical contact. Defensiveness is protection of oneself against a real or perceived threat.

According to Erikson's developmental psychosocial theory, which is expected by 20 years of age? 1 Having the capacity for love and a commitment to work 2 Being creative and productive and having concern for others 3 Having a coherent sense of self and planning to accomplish future goals 4 Accepting the worth, integrity, and uniqueness of one's past and present life

Having a coherent sense of self is a task of adolescence. By age 20 years this goal should be achieved. Young adults, ages 18 to 35 years, should still be developing meaningful relationships and establishing themselves in careers. The stage of adulthood (generativity versus stagnation) is concerned with productivity, nurture, and support of the next generation. From age 65 years to death, an individual should experience a feeling of the worth of his or her life.

For a newly admitted client, which aspect of the therapeutic contract is the most important? 1 Determining the time and place for meetings with the client 2 Helping the client define treatment goals and expectations 3 Helping the client determine the frequency and duration of meetings 4 Explaining the professional responsibilities of the nurse to the client

Helping the client define treatment goals and expectations gives direction to the relationship and provides a blueprint for future evaluation of progress. The time, place, frequency, and duration of meetings and explaining the professional responsibilities of the nurse provide structure to help the client meet goals.

Which action is the priority when the nurse is establishing a therapeutic environment for a client? 1 Ensuring the client's safety 2 Accepting the client's individuality 3 Promoting the client's independence 4 Explaining to the client what is being done

Safety is the priority before any other intervention is provided. Accepting the client's individuality, promoting the client's independence, and explaining to the client what is being done are all important, but less of a priority.

According to Erikson's psychosocial stages of development, which developmental conflict is a college student attempting to resolve as he struggles with indecision about an academic major? 1 Initiative versus guilt 2 Integrity versus despair 3 Industry versus inferiority 4 Identity versus role confusion

The client is demonstrating a search for self and has not resolved the developmental conflict of adolescence, identity versus role confusion. Initiative versus guilt is the developmental conflict of early childhood. Integrity versus despair is the developmental conflict of old age. Industry versus inferiority is the developmental conflict of middle childhood.

When discussing standards for involuntary admission to a mental health facility, which factor is related to safety? 1 Mental illness 2 Severe disability 3 Currently cutting 4 Needs treatment

The client who is a danger to others or to himself or herself is a safety factor that would necessitate involuntary admission to a mental health facility. This would include the client who is cutting. Having a mental illness, a severe disability, and an inability to know that treatment is required are reasons for involuntary admission but are not safety factors.

Based on Erikson's psychosocial stages of development, which task must a 30-year-old client work through? 1 Integrity versus despair 2 Intimacy versus isolation 3 Industry versus inferiority 4 Identity versus role confusion

The major task of the young adult is to develop close, sharing relationships that may include a sexual partnership; the person develops a sense of belonging and avoids isolation ( intimacy versus isolation). During the integrity-versus-despair stage, the adjusted older adult can look back with satisfaction and acceptance of life and resolve the inevitability of death; failure at these tasks results in despair. The middle school-aged child gains a sense of competence and self-assurance as social interactions and academic pursuits are mastered; failure in these tasks leads to feelings of inferiority. During adolescence the individual develops a sense of self, self-esteem, and emotional stability; failure to establish self-identity results in a lack of self-confidence and difficulty with occupational choices.

Which quality is the most important tool the nurse brings to the therapeutic nurse-client relationship? 1 The self and a desire to help 2 Knowledge of psychopathology 3 Advanced communication skills 4 Years of experience in psychiatric nursing

The nurse brings an understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship. Knowledge of psychopathology, advanced communication skills, and years of experience in the field all support the psychotherapeutic management model and contribute to quality of care, but these are secondary to the offering of self and the fundamentals of good communication.

Which question is the most therapeutic to ask the parents of a 3-year-old child who has just died? 1 "Do you feel ready to allow us to move your child to the morgue?" 2 "Would you like to discuss your decision about organ donation?" 3 "Would you like to talk about how you'll tell your other children?" 4 "Can I be of any help with traditional practices that are important to you?"

The nurse should be sensitive to any cultural or religious beliefs that may help the parents cope with their grief. Immediately discussing the morgue or organ donation is insensitive to the parents' grief. The parents are too involved with their own grief at this time to consider their other children's grief.

Which psychotherapeutic theory uses hypnosis, dream interpretation, and free association as methods to release repressed feelings? 1 Behaviorist model 2 Psychoanalytic model 3 Psychobiological model 4 Social-interpersonal model

The psychoanalytic model studies the unconscious and uses the strategies of hypnosis, dream interpretation, and free association to encourage the release of repressed feelings. The behaviorist model holds that the self and mental symptoms are learned behaviors that persist because they are consciously rewarding to the individual; this model deals with behaviors on a conscious level of awareness. The psychobiological model views emotional and behavioral disturbances as stemming from a physical disease; abnormal behavior is directly attributed to a disease process. This model deals with behaviors on a conscious level of awareness. The social-interpersonal model affirms that crucial social processes are involved in the development and resolution of disturbed behavior; this model deals with behavior on a conscious level of awareness.

Which statements meet the criteria for involuntary hospitalization? Select all that apply. One, some, or all responses may be correct. 1 "I cry all the time; I'm just so sad." 2 "Since I retired I've been so depressed." 3 "I'd like to end it all with sleeping pills." 4 "The voices say I should kill all prostitutes."

The suicide threat "end it all" is a direct expression of intent without action. Likewise, the potential threat to harm others indicates the need for admission. Confiding feelings of sadness, depression, or anger without intent for self-harm or harm others does not meet the criteria.

A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe? 1 Making huge efforts to avoid "any kind of bug or spider" 2 Experiencing flashbacks to an event that involved a sexual attack 3 Spending hours each day worrying about something "bad happening" 4 Becoming suddenly tachycardic and diaphoretic for no apparent reason

Using worrying as a coping mechanism is a behavior characteristic of GAD. Avoiding bugs and spiders would indicate a phobia. Flashbacks to traumatic events are characteristic of post-traumatic stress disorder (PTSD). Experiencing an accelerated heart rate and perfuse sweating for no apparent reason is consistent with a panic attack.

Which initial purpose would value clarification serve? 1 Client becomes aware of personal values 2 Client values information related to needs 3 Client clarifies decisions related to health 4 Client alters value system to meet social norms

Value clarification is a technique that reveals an individual's values; this process increases awareness and effect of personal values on others. Valuing information, clarifying health decisions, and altering value systems may eventually occur through value clarification but are not expected to occur in the initial phase.

During group therapy, which behavior indicates that the working phase has begun? 1 Cohesiveness 2 Confrontation 3 Imitative behavior 4 Corrective recapitulation

When the group becomes united (cohesive), the clients can feel accepted, valued, and part of the group; this is the optimal time for the working phase to begin. Confrontation, imitative behavior, and corrective recapitulation all occur later in the working phase of group process, not in the beginning.

According to Erikson's psychosocial stages of development, mastery of which task increases a child's ability to cope with separation or pending separation from significant others? 1 Trust 2 Identity 3 Initiative 4 Autonomy

Without the development of trust, the child has little confidence that the significant other will return; separation is considered abandonment by the child. Without identity, the individual will have a problem forming a social role and a sense of self; this results in identity diffusion and confusion. Without initiative, the individual will experience the development of guilt and feelings of inadequacy. Without autonomy, the individual has little self-confidence, develops a deep sense of shame and doubt, and learns to expect defeat.