PSYCH Mental Health Ch. 5, PSYCH Chapter 6, PSYCH Ch 8 Therapeutic Relationships, PSYCH CHAPTER 9

A client is released from involuntary commitment by the judge, who orders that a caseworker supervise him for the next 6 months. This is an example of 1 conditional discharge. 2 outpatient commitment. 3 voluntary follow-up. 4 discretionary treatment. An unconditional discharge gives the client complete freedom to choose or reject follow-up care. A conditional discharge imposes a legal requirement for the client to submit to follow-up supervision.

1

A nurse is adequately representing the stated bioethical principle when valuing 1 autonomy by respecting a client's right to decide to refuse cancer treatment. 2 justice by staying with a client who is suicidal. 3 fidelity by informing the client about the negative side effects of a proposed treatment. 4 beneficence when advocating for a client's right to enter into a clinical trial for a new medication. Autonomy refers to self-determination. Self-determination can be exercised when one makes his or her own decisions without interference from others.

1

According to the Western scientific view of health, illness is the result of 1 pathogens. 2 energy blockage. 3 spirit invasion. 4 soul loss

1

In the Eastern tradition, disease is believed to be caused by 1 fluctuations in opposing forces. 2 outside influences. 3 members' disobedience. 4 adoption of Western beliefs.

1

In the course of providing best psychiatric care for a client, the nurse must place greatest reliance on 1 legal principles. 2 ethical principles. 3 independent judgment. 4 institutional standards. Legal principles are fundamental to nursing practice. They supersede all other principles, standards, and judgments. All students are encouraged to become familiar with the important provisions of the laws in their own states regarding admissions, discharges, clients' rights, and informed consent.

1

Jonas is a 29-year-old patient with anxiety and a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry and aggressive, strikes another patient, and then attacks a staff member. He is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered: 1 a restraint. 2 a medication time-out. 3 false imprisonment. 4 malpractice. Chemical restraints are defined by those medications or doses of medication that are not being used for the patient's condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.

1

The charge nurse shares with the psychiatric technician that negligence of a patient 1 is an act or failure to act in a way that a responsible employee would act. 2 applies only when the client is abandoned or mistreated. 3 is an action that puts the client in fear of being harmed by the employee. 4 means the employee has given malicious false information about the client. Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated. Employers typically hope that staff will prevent clients from striking each other.

1

The civil rights of persons with mental illness who are hospitalized for treatment are 1 the same as those for any other citizen. 2 altered to prevent use of poor judgment. 3 always ensured by appointment of a guardian. 4 limited to provision of humane treatment. Civil rights are not lost because of hospitalization for mental illness.

1

The nurse assesses the wellness beliefs and values of a client from another culture best when asking 1 "What do you think is making you ill?" 2 "When did you first feel ill?" 3 "How can I help you get better?" 4 "Did you do something to cause the illness?"

1

The psychiatric nurse planning and implementing care for culturally diverse clients should understand 1 holistic theory. 2 systems theory. 3 adaptation theory. 4 political power theory.

1

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of 1 autonomy and beneficence. 2 advocacy and confidentiality. 3 veracity and fidelity. 4 justice and humanism. Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy.

1

Which idea held by the nurse would best promote the provision of culturally competent care? 1 Western biomedicine is one of several established healing systems. 2 Some individuals will profit from use of both Western and folk healing practices. 3 Use of cultural translators will provide valuable information into health-seeking behaviors. 4 Need for spiritual healing is a concept that crosses cultural boundaries. A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

1

Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)? 1 37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn't agree and wishes to be discharged 2 75-year-old patient with dementia who demands to be allowed to go back to his own home 3 21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home and do outpatient counseling 4 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care Against medical advice discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.

1

Which statement best explains the term "worldview"? 1 Beliefs and values held by people of a given culture about what is good, right, and normal. 2 Ideas derived from the major health care system of the culture about what causes illness. 3 Cultural norms about how, when, and to whom illness symptoms may be displayed. 4 Valuing one's beliefs and customs over those of another group. A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

1

Which statement concerning the right to treatment in public psychiatric hospitals is accurate? 1 Hospitalization without treatment violates the client's rights. 2 Right to treatment extends only to provision of food, shelter, and safety. 3 All clients have the right to choose a primary therapist and case manager. 4 The right to treatment for hallucinations has priority over treatment for anxiety. Many years ago psychiatric clients were warehoused in large mental institutions, given custodial care, and rarely released into the community. As enlightenment occurred, it was determined that each client who is hospitalized has the right to receive treatment.

1

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior? 1 You have violated Louisa's personal space by physically being too close. 2 Louisa has issues with sharing personal information. 3 You have not made the patient feel comfortable by explaining the purpose of the admission interview. 4 Louisa is responding to the voices in her head telling her to leave. By sitting and leaning in so closely, you have entered into intimate space (0 to 18 inches), rather than social distance and the patient may feel uncomfortable with being so close to someone she does not know. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

1

Which of the following statements indicate a nontherapeutic communication technique? (select all that apply): 1 "Why didn't you attend group this morning?" 2 "From what you have said, you have great difficulty sleeping at night." 3 "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" 4 "If I were you, I would quit the stressful job and find something else." 5 "I'm really proud of you for the way you stood up to your brother when he visited today." 6 "You mentioned that you have never had friends. Tell me more about that." 7 "It sounds like you have been having a very hard time at home lately." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

1,3,4,5

A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client 1 has a major mental illness. 2 is expressing a culture-bound illness. 3 requires hospitalization to protect the neighbor. 4 will probably not respond to Western medical treatment.

2

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents 1 assault. 2 battery. 3 defamation. 4 invasion of privacy. Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.

2

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to 1 health practices. 2 power and control. 3 psychological stability. 4 assimilation and conformity.

2

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting: 1 regression. 2 somatization. 3 enculturation. 4 assimilation. is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.

2

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure? 1 Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace. 2 Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. 3 Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance. 4 Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate. Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

2

Sophie, aged 27 years, has a diagnosis of paranoid schizophrenia. She stopped taking her medications and believes that she is to be taken by the aliens to live with them on another planet. She was observed walking through traffic on a busy road, and then was found climbing the railing on a bridge, to "be ready for them to take me in their ship." Sophie is hospitalized. During your shift she begins running up and down the halls, banging her head on the walls, and yelling, "Get them out of my head!" On what basis can Sophie be medicated against her will? 1 If Sophie has taken the medication in the past and has had no adverse effects 2 If Sophie may cause imminent harm to herself or others 3 If Sophie still has the capacity to make an informed decision regarding medication 4 If Sophie is provided education regarding the medication before administration of the medication A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.

2

The Eastern world view can be identified by the belief that 1 one's identity is found in individuality. 2 holds responsibility to family as central. 3 time waits for no one. 4 disease is a lack of harmony with the environment. The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

2

What ethical principle is supported when a nurse witnesses the informed consent for electroconvulsive therapy from a depressed client? 1 Beneficence 2 Autonomy 3 Justice 4 Fidelity Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care.

2

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? 1 "Don't let them beat you! Fight back!" 2 "School is stressful. What do you find most stressful?" 3 "I know just what you are going through. The stress is terrible." 4 "You have only two more semesters. You will be glad if you stick it out." This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

2

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? 1 "Is there someone in your community who usually cures your illness?" 2 "What usually helps people who have the same type of illness you have?" 3 "What questions would you like to ask about your condition?" 4 "What sorts of stress are you presently experiencing?" Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.

2

Which ethical principle refers to the individual's right to make his or her own decisions? 1 Beneficence 2 Autonomy 3 Veracity 4 Fidelity Autonomy refers to self-determination, or the right to make one's own decisions.

2

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible? 1 William did not love his wife. 2 William's response may reflect cultural norms. 3 William's response may reflect guilt. 4 William may have an antisocial personality, which would explain his lack of feeling. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient did not love his wife, and this would be jumping to conclusions. There is also nothing in the scenario to suggest guilt and there is no evidence in the scenario to suggest antisocial personality disorder.

2

You are working on an inpatient psychiatric unit and caring for Elizabeth, who is becoming agitated. You speak with Elizabeth one to one in a private setting, find out the reason for the agitation, and then assist Elizabeth with ways to calm down, possibly including prn medication to prevent further escalation of Elizabeth's agitation, which could lead to seclusion and/or restraints. You are making care decisions based on: 1 writ of habeas corpus. 2 least restrictive alternative doctrine. 3 veracity. 4 bioethics. Least restrictive alternative doctrine is described as using the least drastic means of achieving a specific goal. By doing the actions described you are possibly preventing the more restrictive setting of seclusion and/or restraints. Writ of habeas corpus is a legal term meaning a written order "to free the person." Veracity is one of the five ethical principles or guidelines. Bioethics refers to ethics in a health care setting.

2

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms? 1 "So, ethnicity refers to having the same life goals whereas culture refers to race." 2 "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." 3 "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." 4 "So, ethnicity refers to race, and culture refers to having the same worldview." Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

3

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? 1 Confidentiality is now reserved to the immediate family. 2 Only HIV status continues to be protected and privileged. 3 Nothing may be disclosed that would have been kept confidential before death. 4 The nurse must confer with the next of kin before divulging confidential, sensitive information. Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

3

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of 1 biased assessment tools. 2 insensitive practitioners. 3 insensitive interviewing techniques. 4 lack of the availability of cultural translators. Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

3

Exclusive use of Western psychological theories by nurses making client assessments will result in 1 a high level of care for all clients. 2 standardization of nomenclature for psychiatric disorders. 3 inadequate assessment of clients of diverse cultures. 4 greater ease in selecting appropriate treatment interventions.

3

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced 1 battery. 2 defamation of character. 3 false imprisonment. 4 assault. False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons.

3

If a client with psychiatric illness is determined to be incompetent to make decisions affecting his care 1 Staff members are required to use their best judgment when defining care. 2 No treatment other than custodial care can be provided. 3 The court appoints a guardian to make decisions on his behalf. 4 The doctrine of least restrictive alternative is null and void. An incompetent client is unable to make legal decisions that would affect his care, such as consenting to surgery. A court-appointed guardian functions on behalf of the client.

3

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated the ethical principle of 1 autonomy. 2 veracity. 3 fidelity. 4 justice. Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity.

3

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports 1 increased somatic expressions of distress. 2 disruption of energy balance. 3 appeasement of the spirits. 4 increased anxiety.

3

What assumption can be made about the client who has been admitted on an involuntary basis? The client can be discharged from the unit on demand. For the first 48 hours, the client can be given medication over objection. The client has agreed to fully participate in treatment and care planning. The client is a danger to self or others or unable to meet basic needs. Involuntary admission implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently.

3

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called 1 acculturation. 2 ethnocentrism. 3 enculturation. 4 cultural encounters. Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.

3

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a 1 safe person to interact with. 2 new friend. 3 stranger. 4 peer. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building.

3

When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rules, the correct assumption is that the client was admitted 1 per legal requirements. 2 for a non-emergency. 3 voluntarily. 4 involuntarily. Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.

3

Which of the following best explains the concept of cultural competence? 1 Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care. 2 Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States. 3 Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. 4 Nurses must take continuing education classes on culture in the process of becoming culturally competent. Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

3

Which of the following scenarios describe a HIPAA violation? 1 Janie, the ED nurse, gives report to Amanda, a nurse on the intensive care unit, regarding Joel, who is being admitted. 2 Mark, a nurse on the medical-surgical floor, calls his patient's primary care provider to obtain a list of current medications. 3 Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway. 4 Tony, a nurse on the psychiatric unit, gives discharge information to the counseling office where his patient will be going to outpatient treatment after discharge. Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.

3

Which right of the client has been violated if he is medicated without being asked for his permission? 1 Right to dignity and respect 2 Right to treatment 3 Right to informed consent 4 Right to refuse treatment Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.

3

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? 1 Acupuncture 2 Dietary change 3 Cleansings 4 Herbal medicine

3

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? 1 A recent immigrant from Russia 2 A deeply depressed client 3 A Chinese American client 4 A tearful client reporting pain Chinese Americans may not like to be touched by strangers.

3

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication? 1 Verbal communication is always more accurate than nonverbal communication. 2 Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. 3 Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. 4 Nonverbal communication is about 10% of all communication, and verbal communication is about 90%. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

3

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (select all that apply): 1 "You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply." 2 "I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English." 3 "Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English." 4 "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." 5 "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known." Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

3,4

A client reports to the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? 1 None, because no explicit threat has been made. 2 Ask the client if he is threathening his wife. 3 Call the client's wife and report the threat. 4 Report the incident to the client's therapist and document. The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.

4

After a client discusses her relationship with her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" The nurse's purpose is to 1 elicit more information. 2 encourage evaluation. 3 verbalize the implied. 4 clarify message. Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions.

4

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of 1 hostility. 2 lack of self-will. 3 variation from tradition. 4 illness.

4

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should 1 quickly break the silence and encourage the client to continue. 2 reassure the client that the abuse was not her fault. 3 reach out and gently touch the client's arm. 4 allow the client to break the silence Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts.

4

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? 1 Giving information and encouraging evaluation 2 Presenting reality and encouraging planning 3 Clarifying and suggesting collaboration 4 Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

4

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? 1 The mental image of a word may not be the same for both nurse and client. 2 One statement may simultaneously convey conflicting messages. 3 Many of the client's remarks are no more than social phrases. 4 Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message.

4

People who have an indigenous worldview 1 see themselves as spiritual and believe that they are linked with all other living things. 2 focus on the articulation of individual needs and ideas. 3 view the self as an extension of cosmic energy that is repeatedly reborn. 4 are concerned with being part of a harmonious community. Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

4

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique? 1 Korea 2 Mexico 3 Japan 4 Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

4

The intervention that will be most effective in preventing a nurse from making decisions that will lead to legal difficulties is 1 asking a peer to review nursing intervention related decisions. 2 balancing the rights of the client and the rights of society. maintaining currency in state laws affecting nursing practice. 3 seeking value clarification about fundamental ethical principles. 4 maintaining currency in state laws affecting nursing practice. Each nurse's practice is governed by the Nurse Practice Act of the state in which the nurse practices. The nurse should always be aware of its provisions.

4

The question that would give data of least value to the assessment of family dynamics is 1 "What changes have occurred recently at work?" 2 "Are your wife and children conforming to your expectations?" 3 "Are you experiencing stress associated with conforming to family expectations?" 4 "Do you expect others to shun or avoid you because you are seeing a therapist?" The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics.

4

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects 1 supernatural causes. 2 negative forces. 3 inheritance. 4 imbalance.

4

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" 1 Focusing 2 Restating 3 Reflection 4 Clarification Clarification verifies the nurse's interpretation of the client's message.

4

Which healing practice is least used in the Western health system of healing practices? 1 Antibiotic medication 2 Surgery 3 Targeted cellular destruction 4 Restoring lost balance or harmony

4

Which statement by the nurse reflects the process occurring in the clinical interview? 1 "Give me an example of something your wife does that 'drives you nuts.'" 2 "What makes you think your doctor will give you a pass?" 3 "When is your child custody hearing going to be held?" 4 "You are frowning. What are you feeling?" Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of client feelings than what is being verbalized.

4

Which statement is true regarding mail sent to an involuntarily admitted client residing on a psychiatric inpatient unit? 1 The client can receive mail from only family and legal sources. 2 Mail must first be opened and inspected by staff. 3 Receipt of mail is considered a privilege accorded the client for compliance. 4 Mail is a form of social interaction and so receiving mail is a client's civil right. The client's civil rights are intact, despite hospitalization. The right to communicate with those outside the hospital is ensured.

4

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic? 1 "Okay, but we are all here to help you, so come get one of the staff if you need to talk." 2 "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." 3 "I don't believe you. You are not being truthful with me." 4 "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental.

4

A client states "That nurse nevers seems comfortable being with me." The nurse can be described as A. not seeming genuine to the client. B. transmitting fear of clients. C. unfriendly and aloof. D. controlling. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion.

A

An action that is acceptable in a social relationship but not in a therapeutic relationship is A. giving advice. B. listening actively. C. clarifying feelings. D. giving positive regard. Giving and receiving advice is acceptable in a social relationship. In a therapeutic relationship, it is appropriate for the nurse to assist the client in exploring alternative solutions to problems and in making his or her own decisions.

A

One of the possible sources of boundary violations is placing the focus on A. meeting the nurse's needs. B. identifying client disturbances. C. assessing the client's ego strength. D. assessing the client's weaknesses. Boundary violations have two sources: (1) allowing the therapeutic relationship to slip into a social relationship, and (2) meeting the nurse's personal needs at the expense of the client's needs.

A

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for A. boundary blurring. B. value dissonance. C. covert anger. D. empathy. Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough.

A

The pre-orientation phase of the nurse-client relationship is characterized by the nurse's focus on A. self-analysis of strengths, limitations, and feelings. B. clarification of the nursing role. C. changing the client's dysfunctional behavior. D. incorporating coping skills into client's routine. During the preorientation phase the nurse prepares for a relationship with a client by engaging in self-examination.

A

The use of empathy and support begins in the stage of the nurse-client relationship termed the A. orientation stage. B. working stage. C. identification stage. D. resolution stage. The use of empathy and support should begin in the orientation stage. These tools are helpful in building trust and furthering the relationship.

A

To help a client develop his or her resources, the nurse must first be aware of A. the client's strengths. B. negative transferences. C. countertransferences. D. resistances. Nurses work to bolster a client's strengths, to identify areas of dysfunction, and to assist in the development of new coping strategies.

A

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply): A. In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship communication remains on a more superficial level, allowing patients to feel comfortable. The other options describe the opposite meanings of social and therapeutic relationships.

A,C,D

Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference? A. "My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge." D. "My patient, Gayle, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter." This statement indicates countertransference; Bethany may be overidentifying with the patient because of her own past history of alcoholism. She is providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to her own past than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

B

Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of A. resistance. B. transference. C. countertransference. D. emotional abreaction. The stirring up of feelings in the client by the nurse is referred to as transference.

B

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? A. Preorientation B. Orientation C. Working D. Termination Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship.

B

The orientation phase of the nurse-client relationship focuses on A. the nurse identifying personal biases. B. the nurse and client identifying client needs. C. overcoming resistance to changing behavior. D. reviewing situations that occurred in previous meetings. The orientation phase is the first stage of the nurse-client relationship and focuses on, among other things, the identification of client needs.

B

When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n) A. crisis intervention. B. therapeutic encounter. C. autonomous interaction. D. preorientation phenomenon. A therapeutic encounter is a short but helpful interaction between the nurse and client.

B

A client reports that her mother-in-law is very intrusive. The nurse responds, "I know how you feel. My mother-in-law is nosy, too." The nurse is demonstrating A. self-disclosure in an appropriate way. B. to the client permission to continue. C. countertransference. D. empathy to establish trust. Countertransference refers to the stirring up of feelings in the nurse by the client.

C

According to Rogers, a synonym for genuineness is A. respect. B. empathy. C. congruence. D. positive regard. Genuineness refers to self-awareness of one's feelings as they arise within the relationship and the ability to communicate them when appropriate. It is the ability to meet others person-to-person without hiding behind roles. Rogers uses the word congruence to signify genuineness.

C

The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship? A. Assisting the client with self-care needs when appropriate. B. Helping the client identify self-defeating behaviors. C. Providing the client with opportunities to socialize. D. Facilitating the client's communication of disturbing feelings or thoughts. E. Encouraging the client to make decisions when appropriate. Addressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.

C

The primary difference between a social and a therapeutic relationship is the A. type of information exchanged. B. amount of satisfaction felt. C. type of responsibility involved. D. amount of emotion invested. In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem- solving, and helping the client identify and test alternative coping strategies.

C

When a nurse is biased against a client, those feelings will likely make it difficult to A. assess the client's symptoms. B. assess boundary issues with the client. C. view the client with positive regard. D. engage in values clarification with the client. Whenever a nurse harbors negative feelings about a client, these feelings stand in the way of objectivity and reduce his or her ability to give the client positive regard.

C

Your patient, Emma, is crying in your one-to-one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy? A. "Emma, I'm so sorry. My father died two years ago, so I know how you are feeling." B. "Emma, you need to focus on yourself right now. You deserve to take time just for you." C. "Emma, that must have been such a hard situation to deal with." D. "Emma, I know that you will get over this. It just takes time." This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient she will get over it does not reflect empathy and is closed-ended.

C

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing A. congruence. B. empathetic feelings. C. countertransference. D. positive transference. Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past.

D

In the process of trying new values, which step shows the highest commitment to the value? A. Cherishing the value B. Publicly stating affirmation of the value C. Choosing a stand consistent with the value from among several alternatives D. Consistently acting in ways that repeatedly affirm the value Values clarification theory puts acting consistently on one's belief as the highest level of the process, following prizing and choosing.

D

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to A. enhanced client coping. B. lessening of client emotional pain. C. increased hope for client improvement. D. decreased client communication. Sympathy and the resulting projection of the nurse's feelings limits the client's opportunity to further discuss the problem.

D

The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the A. preorientation phase. B. orientation phase. C. working phase. D. termination phase. Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses.

D

Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even be out of prison." C. "The biggest question is, will you do it again? You will end up right back in prison, and have even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living." This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

D

You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed? A. "Allison, you are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. (to fellow nurse): "I haven't met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Allison, now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge." The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

D