Ch.5 Cultural Issues, Ch.6 Spiritual Issues, Ch. 11 Working with the Family, Ch.19 OTC Drugs

A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down the hallway B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia C. A client in a day treatment program who says he is becoming more anxious during group therapy D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months

A. A client in acute care who has been running and falling should be helped by the treatment team on her unit. B. CORRECT: An ACT group works with clients who are nonadherent with traditional therapy, such as the client in a home setting who keeps "forgetting" his injection. C. A client who has anxiety might be referred to his counselor or mental health provider. D. A client who is grieving for her husband who died 3 months ago is currently involved in an appropriate intervention.

A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (Select all that apply.) A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Family therapy

A. CORRECT: Educational groups are services provided in a community mental health facility. B. CORRECT: Medication dispensing programs are services provided in a community mental health facility. C. CORRECT: Individual counseling programs are services provided in a community mental health facility. D. Detoxification programs are services provided in a partial hospitalization program. E. CORRECT: Family therapy is a service provided in a community mental health facility

A nurse in an acute mental health facility is assisting with discharge planning for a client who has a severe mental illness and requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following strategies should the nurse suggest as appropriate follow‑up care? A. Receiving daily care from a home health aide B. Having a weekly visit from a nurse case worker C. Attending a partial hospitalization program D. Visiting a community mental health center on a daily basis

A. Daily care provided by a home health aide will not provide adequate supervision for this client. B. Weekly visits from a case worker will not provide adequate care and supervision for this client. C. CORRECT: A partial hospitalization program can provide treatment during the day while allowing the client to spend nights at home, as long as a responsible family member is present. D. Daily visits to a community mental health center will not provide consistent supervision for this client.

A nurse is caring for several clients who are attending community‑based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home B. A client who requests that her antipsychotic medication be changed due to some new adverse effects C. A client who says he is hearing a voice that tells him he is not worthy of living anymore D. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview

A. T his client has needs that should be met, but there is another client whom the nurse should see first. B. T his client has needs that should be met, but there is another client whom the nurse should see first. C. CORRECT: A client who hears a voice telling him he is not worthy is at greatest risk for self‑harm, and the nurse should visit this client first. D. T his client has needs that should be met, but there is another client whom the nurse should see first.

A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse plan as a method of tertiary prevention? A. Educating clients on health promotion techniques to reduce the risk of depression B. Performing screenings for depression at community health programs C. Establishing rehabilitation programs to decrease the effects of depression D. Providing support groups for clients at risk for depression

A. T his intervention is an example of primary prevention. B. T his intervention is an example of secondary prevention. C. CORRECT: Rehabilitation programs are an example of tertiary prevention. Tertiary prevention deals with prevention of further problems in clients already diagnosed with mental illness. D. T his intervention is an example of primary prevention.

Which intervention is an example of a complementary and alternative medicine therapy? a. Acupuncture b. Bright-light therapy c. Electroconvulsive therapy d. Repetitive transcranial magnetic stimulation

ANS: A Acupuncture is considered a complementary and alternative therapy. The other therapies are accepted by Western medicine.

A nurse provides spiritual care for a patient awaiting a liver transplant. The nurse should anticipate that the patient's most likely response will be: a. consideration of issues related to own mortality. b. devaluation of prayer and organized religion. c. misinterpretation of medical information. d. clinical depression.

ANS: A Although each of the options is possible, the most likely response is thinking about what the illness means in terms of lifespan, quality of life, and other mortality issues.

A depressed patient expresses feelings of hopelessness, helplessness, and powerlessness. The patient's spiritual distress is related to an inability to: a. find meaning and hope through choices. b. develop wisdom in the face of adversity. c. draw strength from a higher power. d. live by higher principles.

ANS: A Although individuals cannot always choose their circumstances, they always have a choice of attitudes toward their experiences. Without finding meaning, individuals develop hopelessness.

What is the predominant religious tradition in the United States? a. Christian b. Buddhist c. Muslim d. Jewish

ANS: A Christians compose 78% of Americans.

A clinic patient comes to an appointment carrying a baby. The nurse notes abrasions on the baby's thighs and determines that skin scraping has been used. In an effort to use cultural negotiation, the nurse should: a. encourage using less pressure during scraping to prevent abrasions and infections. b. show the parent how to use moxibustion rather than skin scraping. c. explain that skin scraping does not effectively treat illness. d. caution that the scraped skin can become infected.

ANS: A Cultural negotiation is the nurse's ability to work within a patient's cultural belief system to develop culturally appropriate interventions.

The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics? a. Patients of different cultural groups may metabolize medications at different rates. b. Metabolism of psychotropic medication is consistent among various cultural groups. c. Differences in hepatic enzymes will influence the rate of elimination of psychotropic medications. d. It is important to provide patients with oral and written literature about their psychotropic medications.

ANS: A Cytochrome P-450 enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates

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

ANS: A Desired outcomes might be set for the family as a whole or for individuals within the family. The outcome most closely associated with the anxiety that each is experiencing is to focus on identifying and describing ways of coping with the anxiety.

A patient diagnosed with a history of depression disorder tells the nurse, "My primary-care provider told me to start taking fish oil capsules to prevent heart disease. Will it cause problems with my mental illness?" Select the nurse's best response. a. "It will not cause problems. It may actually help with your depressed feelings." b. "I cannot discuss recommendations you received from another health care provider." c. "It would be better for you to take vitamins C and E. I will notify your primary-care provider." d. "Please have your primary-care provider call me so we can discuss issues related to this preparation."

ANS: A Fish oil capsules supplement omega-3 and omega-6 fatty acids. These substances not only provide cardiovascular benefits; studies have demonstrated positive results in ameliorating depression after 2 or more weeks of omega-3.

A patient tells the nurse, "I make decisions each day that have a positive effect on my life." This statement is most closely related to the spiritual construct of: a. making meaning through choices. b. a presence that orders the world. c. higher purpose and principles. d. higher power and achievement.

ANS: A Frankl advocated that humans find meaning when they commit themselves to something beyond themselves. Making meaningful choices improves an individual's mental health.

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

ANS: A Healthy families nurture and support their members, buffer against stress, and provide stability and cohesion.

A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools. Group sessions are short and concise. After the group session, the patients are most likely to believe that: a. the nurse was uncaring. b. the session was effective. c. the teaching was efficient. d. they were treated respectfully.

ANS: A Hispanic individuals usually have a relational worldview. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task.

For which patient co-morbid diagnosis would it be most important for the nurse to urge the patient to immediately discontinue using kava-kava? a. Cirrhosis b. Osteoarthritis c. Multiple sclerosis d. Chronic back pain

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

A Hispanic patient says, "I have no energy and cannot eat. I want to sleep but can't, because pain moves around different parts of my body." A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing: a. lost soul (susto). b. spiritual distress. c. a broken heart. d. amok.

ANS: A Loss of one's soul, a culture-bound illness occasionally seen among Hispanic individuals, produces vague symptoms such as those described. Western medicine regards these as depressive symptoms, but individuals with lost soul speak only of physical symptoms, rather than psychological or emotional disequilibrium.

A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which action should occur next? a. Verify understanding by asking the patient to restate the information. b. Ask if the patient is willing to follow directions for medications. c. Reinforce cultural norms about eating hot and cold foods. d. Provide the information in written form to the patient.

ANS: A Many Asians and Asian-Americans believe that questioning an authority figure (nurse) would be disrespectful, so they do not ask for clarification when they do not understand directions for their treatment. Individuals of this culture are usually willing to comply once they understand. Written information may be provided later.

A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse's most appropriate initial intervention? a. Ask if the parent has used coining. b. Report the parent for suspected child abuse. c. Assess whether or not the parent desires to harm the child. d. Ask if the parent has taken the child to an acupuncturist.

ANS: A Recognition of the characteristic marks of coining or skin scraping can keep the nurse from making a culturally insensitive judgment that child abuse is occurring. Coining is used by Asian families to restore equilibrium for babies and small children.

Which statement by a mentally ill patient best exemplifies sick religiosity? a. "Suicide will result in eternal damnation for your soul." b. "Your illness has nothing to do with insufficient faith." c. "Questioning God is a common reaction to illness." d. "Your illness is not related to sin."

ANS: A Sick religiosity is marked by a lack of openness to other possibilities, a sense of exclusiveness, and absolutism. The correct option best exemplifies this thinking.

A neighbor asks a nurse, "Are there any resources that would help me get reliable information about alternative and complementary therapies?" Which resource should the nurse recommend? a. National Center for Complementary and Alternative Medicine b. American Psychiatric Association c. American Medical Association d. Centers for Disease Control and Prevention

ANS: A The National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health, has responsibility for providing information to the public regarding the safety and efficacy of alternative therapies and for funding research for these therapies.

Parents of a mentally ill teenager say, "We've never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems." The nurse's most helpful intervention would be to: a. refer the parents to a support group. b. build their self-esteem as coping parents. c. teach techniques of therapeutic communication. d. facilitate achievement of normal developmental tasks.

ANS: A The need for support can be clearly identified. Referrals are made when working with families whose needs are unmet. A support group such as the National Alliance for the Mentally Ill (NAMI) will provide these parents with the support of others who have had similar experiences and with whom they can share feelings and experiences

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

ANS: A The newly formed family will be coping with tasks associated with the stages of rearing preschool children and dealing with teenagers. These stages require different knowledge and skills.

A Hispanic patient reports symptoms consistent with the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with: a. care from a traditional healer. b. acupuncture. c. skin scraping. d. moxibustion.

ANS: A The patient is probably experiencing lost soul, a culture-bound illness. Its symptoms are depressive in nature and might well respond to treatment with an antidepressant. However, because the individual sees the cause as loss of the soul, she will not have faith in medication as a cure.

The patient says, "I know I'm very sick right now, but I trust that God will make me better." Based on this statement, the nurse can assess the patient's spirituality as being based in: a. theism. b. humanism. c. behaviorism. d. existentialism.

ANS: A Theism is the only model that suggests that people are inextricably tied to a transcendent being. This view provides hope for a better future.

A patient who takes phenytoin (Dilantin) regularly has begun taking valerian. Patient teaching should focus on which possible consequence of the patient's action? a. Breakthrough seizures b. Spontaneous bleeding c. Impaired dentition d. Gum disease

ANS: A Valerian is thought to negate the effects of several drugs, including phenytoin, making an increase in seizures probable.

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

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

A new nurse asks the mentor, "How can I help meet patients' spiritual needs?" Select the mentor's best responses. "Patients have reported that what they want most is for a spiritual care provider to (select all that apply): a. be authentic." b. be respectful." c. demonstrate caring." d. speak slowly and concretely." e. provide answers to theological questions."

ANS: A, B, C, D The needs elicited from patients (authenticity, caring, respect) can be seen as caregiver behaviors that enhance trust formation. The need to speak slowly and in concrete terms is important for patients with thought disorders who have cognitive problems that make comprehension slower and abstraction difficult to understand.

Which questions should the nurse ask to determine an individual's worldview? Select all that apply. a. "What is more important: the needs of an individual or the needs of a community?" b. "How would you describe an ideal relationship between individuals?" c. "How long have you lived at your present residence?" d. "Of what importance are possessions in your life?" e. "Do you speak any foreign languages?"

ANS: A, B, D The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine whether the worldview of the individual is analytic, relational, community, or ecologic. Other follow-up questions would be needed to validate findings.

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

ANS: A, B, D, E All of the instructions are correct except the one regarding purchase of herbals. Internet purchasing of herbals might not be the best plan unless the reputation of the firm can be confirmed.

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

ANS: A, C, D Major illnesses place severe, potentially disabling stress on families.

A parent said, "My child had mal ojo, so I did not give her the medicine for an ear infection." The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse would analyze that the situation occurred because of: a. lack of knowledge of therapeutic regimen. b. differences in perceptions of how illness occurs. c. evidence of unconscious hostility toward the child. d. a misunderstanding about the communicability of microbes.

ANS: B A parent who believes that his or her child's illness is the result of a spell cast on him or her will not understand the need for giving the child medication on a regular basis for several days. Diagnosing noncompliance will not help resolve the problem.

A patient diagnosed with schizophrenia says, "I am a reincarnation of Jesus. I can raise the dead." The most qualified person for the nurse to refer the patient would be a: a. psychiatric nurse clinician. b. professional chaplain. c. clinical psychologist. d. community minister.

ANS: B A professional chaplain holds a ministerial degree and has had a year of special study in ministering to individuals with spiritual concerns related to health problems.

An anxious patient diagnosed with diabetes says, "I'm considering taking angelica to help me relax." Select the best outcome for the plan of care. The patient will: a. report subjective feelings of improved sleep. b. identify other options to manage anxiety. c. monitor fingerstick blood glucose daily. d. rate anxiety as 5 or less on a scale of 10.

ANS: B Angelica is contraindicated in diabetes. The patient should identify other strategies to manage anxiety.

A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence? a. Serve the patient a cold beverage at the beginning of the interview. b. Review Middle Eastern cultural values before the interview. c. Avoid offering to shake hands with the patient. d. Determine if a translator is available.

ANS: B Brushing up on Middle Eastern culture would be a sensitive action that might result in a lowering of barriers between the nurse and patient. It would not be necessary to serve beverages during the interview. A translator would probably not be needed if the patient is a college professor. Shaking hands with Middle Easterners is acceptable.

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

ANS: B Caregiver role strain refers to a caregiver's felt or exhibited difficulty in performing a family caregiver role. In this case one parent exhibits stress-related illness, and the other exhibits increased anxiety.

Select the example of complementary therapy. a. St. John's wort used with valerian b. Acupuncture used with disulfiram (Antabuse) c. Fluoxetine (Prozac) used with lorazepam (Ativan) d. Propranolol (Inderal) used with systematic desensitization

ANS: B Complementary therapy is an alternative therapy used in conjunction with conventional Western medicine. Acupuncture is an alternative therapy, and disulfiram is a Western medical therapy for alcohol abuse.

Culture is defined as a group's shared: a. race and ethnicity. b. values, beliefs, and norms. c. biologic variations and psychological characteristics. d. patterned behavioral responses that developed over time.

ANS: B Culture is the internal and external manifestation of a person's, group's, or community's learned and shared values, beliefs, and norms that are used to help individuals function in life and understand and interpret life occurrences.

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

ANS: B Grief is a common reaction to having a family member diagnosed with mental illness. The grief stems from actual or potential losses such as ability to function, altered family functioning, income, and altered future prospects

An African-American patient tells a nurse with a European-American worldview, "There's no sense talking. You wouldn't understand because you live in a white world." Select the nurse's best response. a. "Nurses are educated to care for people from all cultures. It is a required component of nursing education." b. "It would be helpful if you described an example of something you think I would not understand." c. "Your mental illness is causing you to view me with prejudice. We are all here to help you." d. "Yes, I do understand. Everyone goes through the same experiences."

ANS: B Having the patient speak in specifics rather than globally will help the nurse understand the patient's perspective. This approach will help the nurse establish rapport with the patient.

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

ANS: B Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits.

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

ANS: B It is important to understand family characteristics in both the family of origin and the present family.

During an admission interview, a patient who reports high levels of anxiety says, "I've been using kava-kava for about a week to relieve anxiety." When the nurse assesses mental status, expected findings would be: a. reduced coordination and slurred speech. b. intact cognitive functioning. c. slow response times. d. paranoid thinking.

ANS: B Kava-kava relieves anxiety without producing cognitive impairment, reducing mental acuity, or affecting coordination. Kava-kava is known to have an affinity for benzodiazepine receptors.

A patient of Cuban descent is hospitalized with depression. Which factor is most applicable to care planning? a. The nurse should confer with the family's oldest woman, who will serve as the primary decision maker. b. With the patient's permission, the nurse should consult with family and religious advisors to plan care. c. The plan of care should incorporate use of meditation and contemplation techniques. d. Western medical treatment will be readily accepted by the patient.

ANS: B Patients of Hispanic cultures often have relational worldviews. Individuals who have a relational worldview usually desire the involvement of family, religious advisors, and even friends during health care visits and the planning of interventions. The patient's consent is required for this involvement.

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

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

A patient tells the nurse, "I've been having problems with my memory. I read some information on the Internet and started taking gingko." Select the nurse's best response. a. "The Internet does not have reliable health information." b. "More recent studies indicate that gingko does not help memory problems." c. "SAM-e has been shown to have better effects for treating memory problems." d. "Your memory problems are related to your mental illness. Herbs will not help."

ANS: B Recent studies indicate that gingko does not help with cognition or memory problems. SAM-e is useful for treating mild depression.

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

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

An African-American caregiver says, "Both of my parents have dementia. I find it so difficult to care for them because of their disabilities. I get depressed and hopeless thinking about it. Can you give me any suggestions for coping?" Before making suggestions, the nurse should assess: a. the parents' stage of dementia. b. the caregiver's religious ideology. c. whether or not the parents' medications are helping. d. if financial resources are sufficient to provide a health care aide.

ANS: B Serious illness of loved ones often presents difficult dilemmas and problems in adjustment for caregivers. It is known that religious activities are important coping mechanisms for many African-American caregivers of older adults.

A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge? a. Knowledge is acquired through use of affective or feeling senses. b. Knowledge is acquired according to proof of existence. c. Knowledge develops by striving for transcendence of the mind and body. d. Knowledge evolves from an individual's relationship with a supreme being.

ANS: B The European-American perspective of acquiring knowledge evolves through acquiring proof that something exists using the personal senses.

A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient's self-esteem, but after 3 weeks the patient's eye contact was unchanged. Select the accurate analysis of this scenario. a. The patient's poor eye contact indicated anger and hostility that did not resolve. b. The nurse should have assessed the patient's culture before formulating this diagnosis and plan. c. Resolution of shame and guilt cannot be expected to occur in 3 weeks. The nurse should allow more time. d. The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact.

ANS: B The amount of eye contact a person engages in is often culturally determined. In some cultures eye contact is considered insolent, whereas in others eye contact is expected and valued.

On the admission papers, a patient checked the box labeled "No religious affiliation." What meaning can the nurse draw from this information? The patient: a. is not religious. b. is probably monotheistic. c. has conventional religious values. d. is probably experiencing spiritual distress.

ANS: B The correct answer is consistent with the beliefs of 80% of Americans: there is one Supreme Being.

A patient diagnosed with schizophrenia complains of demon voices coming through the television. Which statement by the nurse providing spiritual care would be most comforting to the patient? a. "Rest assured that God will fill your heart with peace." b. "I am concerned about your spiritual distress." c. "God will hold you in the palm of His hand." d. "God knows your every thought."

ANS: B The correct answer shows compassion and caring on the part of the nurse and contributes to trust building. The nurse has offered concerns, which reassures the individual that he or she will not be abandoned. The other options each include abstract concepts that are difficult for someone who thinks concretely to interpret correctly.

A patient with major depression shows the nurse a passage in the Bible and says, "How do you think this verse relates to me?" The nurse is unfamiliar with the verse and unsure how to respond. Select the nurse's best action. a. Ask the patient, "What do you think the verse means?" b. Invite professional clergy to join the dialogue with the patient. c. Explain to the patient, "I'm not familiar with that passage. It would be better for me not to comment." d. Say to the patient, "Would you bring that up in the group session? You can get input from several people about what the verse means."

ANS: B The correct answer shows that the nurse recognizes personal limits but remains engaged in the interaction with the patient.

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

ANS: B The correct option asks about resource use in an open, direct fashion. It will give information about choices that the family has made to use other family members or resources in the community.

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

ANS: B The names and relationships of the patient's family members constitute the most fundamental information and should be obtained first.

A group of nurses disagrees about whether or not to make spirituality a part of the assessment. Which statement provides a compelling argument in favor of including spiritual assessment? a. Research clearly demonstrates that spiritual interventions by nurses are a cost-effective practice. b. Accrediting organizations regard spiritual care as a patient right. c. Spirituality is better addressed by nurses than by clergy. d. Prayer consistently improves mental health outcomes.

ANS: B There is a lack of agreement as to whether or not spiritual care should be a legitimate concern of nurses, despite a large body of research evidence citing its advantages to patients. Among the major deterrents to including spiritual care is the concern that already overburdened nurses will not find time to perform the assessment. It should be noted, however, that when an accrediting body considers a facet of care to be a right of patients, it will look for evidence of attention to that right. A spiritual assessment documented in the medical record provides such evidence.

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

ANS: B Valerian decreases sleep latency and nocturnal awakening, and it leads to a subjective sense of good sleep. Sleeping through the night is the best indicator that the herb was effective.

A patient takes valerian. Which instruction should the nurse provide? a. Store the herb in a cool place. b. Store the herb in a dry, dark place. c. This herb loses potency after 30 days. d. Avoid crushing the herb before taking it.

ANS: B Valerian must be protected from light and moisture.

A nurse cares for patients who recently immigrated to the United States. The nurse would expect patients from which countries to hold relational worldviews? Select all that apply. a. Germany b. Panama c. Mexico d. Ghana e. France

ANS: B, C, D Persons of Hispanic and African-American cultures often hold relational worldviews. Mexico and Panama are predominantly Hispanic cultures. Ghana is African. Immigrants from Germany and France (European countries) would more likely have analytic worldviews.

What information about a patient's perceptions and values would the nurse obtain by using questions from the HOPE tool? Select all that apply. a. Healthy spirituality versus sick religiosity b. That which gives the patient hope and meaning in life c. Important personal spiritual practices d. Role of religion in the patient's life e. Sources of strength and comfort

ANS: B, C, D, E The HOPE questions gather information about sources of hope, strength, comfort, meaning, peace, love, and connection; the role of organized religion for the patient; personal spirituality and practices; and effects on medical care and end-of-life decisions.

A patient says, "I am a Christian." The nurse understands that Christianity includes which groups? Select all that apply. a. Judaism b. Mormonism c. Buddhism d. Catholicism e. Greek Orthodox

ANS: B, D, E Christianity accounts for 78% of the U.S. population and includes Protestant, Mormon, Catholic, and some orthodox groups. Judaism and Buddhism are not Christian religions.

A patient moans, "God wants me to suffer, but I don't know why. I feel like an outcast. I should have never been born." Which nursing diagnosis applies? a. Potential for enhanced spiritual well-being b. Disturbed personal identity c. Spiritual distress d. Powerlessness

ANS: C Defining characteristics for the nursing diagnosis of spiritual distress are present. They include concern with the meaning of life, anger toward God, questioning the meaning of suffering, conflict about beliefs, and questions about the morality of the therapeutic regimen.

A patient diagnosed with schizophrenia, paranoid type, has been suspicious of staff since admission. The patient visits with a chaplain but then tells the nurse, "Don't send any more preachers." What is the most likely reason for the patient's reaction? a. Hostility b. Distractibility c. Inability to trust d. Inability to find meaning in suffering

ANS: C Individuals with paranoid schizophrenia often have an inability to trust. Inability to trust may be related to inadequate nurturing in infancy and to later difficulty recognizing a connection with God.

A patient says, "I know I need religion in my life, but I don't know how to find God. I feel I have been abandoned." The nurse should assess for a childhood history of: a. recurrent losses. b. overindulgence. c. lack of nurturing. d. poor school performance.

ANS: C Loder has hypothesized that early developmental experiences set the stage for later spiritual dynamics. Inadequate nurturing may result in lack of establishment of trust. Later, spiritual issues of abandonment and shame might surface.

A patient reports taking melatonin daily. Which aspect of the patient's health and function would be most important for the nurse to assess? a. Urinary and bowel elimination b. Energy and activity tolerance c. Sleep hygiene and patterns d. Memory and cognition

ANS: C Melatonin is used to reduce sleep-onset latency and decrease the number of nocturnal awakenings. The nurse should assess the patient's sleep patterns and hygiene

At the time of discharge, a patient with a European-American worldview demands copies of all medical records. Which analysis most accurately explains the patient's behavior? The patient: a. continues to experience mistrust of the team's truthfulness. b. is probably planning to see an attorney about poor care. c. values the written evidence of illness and treatment. d. probably wants to edit the records for accuracy.

ANS: C Members of European-American cultures have analytic worldviews and value information that is written because it lends proof.

A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore: a. chi. b. meridians. c. equilibrium. d. divine relationships.

ANS: C Patients who view illness as disequilibrium or lack of balance may seek alternative therapies to restore balance. Chi is an energy force. Meridians are lines in the body representing body functions.

A patient with which disorder would most likely benefit from taking St. John's wort? a. Suicidal depression b. Hypomanic symptoms c. Mild depressive symptoms d. Panic disorder with agoraphobia

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

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

ANS: C Research has suggested that St. John's wort inhibits serotonin reuptake by elevating extracellular sodium; thus it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome.

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

ANS: C The correct option is the only statement addressing coping strategies used by the family. The other options seek opinions or are closed-ended.

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

ANS: C, D Melatonin and valerian have relaxant effects that help sleep. Yohimbine can actually cause insomnia. SAM-e may help with mild depression. Vitamin C has no effect on sleep.

Alternative therapy refers to: a. any natural therapy without a research basis. b. evidence-based pharmacologic use of plant products. c. therapies used in conjunction with Western medicine. d. therapies not generally accepted by Western medicine.

ANS: D Alternative therapies are therapies that are not generally accepted by mainstream Western medicine—for example, herbaceuticals. Some alternative therapies have been researched.

A Hispanic parent says, "An old woman gave my baby the evil eye." The health care provider determines that the infant is physically healthy. The most culturally competent intervention would be to: a. tell the parent that the baby is healthy and needs no treatment. b. explain that the evil eye is a superstition and not a cause of illness. c. encourage the parent to immerse the baby in cool water baths daily. d. bring a root doctor into the consultation to restore the baby's lost soul.

ANS: D An individual who believes in mal ojo will also believe that Western medicine is ineffective to treat it. This person will believe that because the illness has an unnatural cause, treatment is best conducted by a native healer who can remove the spell.

A nurse begins work at an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after: a. identifying culture-bound issues. b. implementing scientifically proven interventions. c. correcting inferior health practices of the population. d. exploring commonly held beliefs and values of the population.

ANS: D Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture.

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

ANS: D Disabled family coping refers to the behavior of a significant family member that disables his or her own capacity as well as another's capacity to perform tasks essential to adaptation.

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

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

A family expresses helplessness related to dealing with a mentally ill member's odd behaviors, mood swings, and argumentativeness. An appropriate nursing intervention for the family would be to: a. express sympathy. b. involve local social services. c. explain symptoms of relapse. d. role-play problem situations.

ANS: D Helping a family learn to set limits and deal with difficult behaviors can often be accomplished by using role-playing situations, which give family members the opportunity to try new, more effective approaches

A nurse assesses four new patients. Which statement causes the nurse to suspect the patient may be self-medicating with an alternative therapy? a. "I frequently have skin rashes that itch." b. "Constipation is an everyday problem for me." c. "My computed tomography scan shows that I have uterine fibroid tumors." d. "I've been very depressed and anxious since I lost my job."

ANS: D Herbals are among the most frequently used alternative therapies for depression. Four of the 12 most common herbs are used to treat or prevent psychiatric symptoms.

The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after: a. ignoring the child. b. feeding the child warm foods. c. looking deeply into the child's eyes. d. a root doctor or native healer intervenes.

ANS: D Individuals who believe in culture-bound illnesses usually also believe that the cure for the illness is found in treatment by a native healer or roots doctor.

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

ANS: D Interrupted family processes are evident in the face of disruptions in family functioning as a result of having a mentally ill member.

A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with these consumers? a. Silence is considered a social error. b. Touching is an accepted part of conversation. c. Important topics are always preceded by polite social conversation. d. Rules regarding roles and status are important and must be observed.

ANS: D Relationships are based on the idea that the Supreme Being is present in each person and that all persons must be valued and treated with dignity.

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

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

The spouse of a psychiatric patient says, "This mental illness should not have happened. I tried to teach the importance of professing faith in God and getting converts, but my partner rejected them. Those practices keep me well. It's the only way to live." The nurse can assess that the spouse is demonstrating: a. atheism. b. humanism. c. agnosticism. d. sick religiosity.

ANS: D Sick religiosity is marked by a lack of openness to other possibilities, a sense of exclusiveness, and absolutism.

A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine: a. if the patient's immunizations are current. b. the patient's religious preferences. c. the patient's specific ethnic group. d. whether or not an interpreter is needed.

ANS: D The assessment depends on communication. The nurse should first determine whether or not an interpreter is needed. The other information can be subsequently assessed when communication is effective.

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

ANS: D The information almost universally obtained is that the family is under stress associated with having a mentally ill member. This stress lowers the family's level of functioning in at least one significant way.

When a Mexican-American woman and nurse interact, the patient often holds the nurse's hand or links arms with the nurse. The nurse is uncomfortable with this behavior. Which analysis is most accurate? a. The patient is using touch to make the nurse uncomfortable and manipulate the relationship based on that factor. b. An energy field disturbance has occurred. Touch rebalances the energy between the patient and nurse. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The patient is accustomed to and comfortable with touch, as are members of many Hispanic cultures.

ANS: D The most likely answer is that the patient's behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends

A patient asks, "I want to consult an herbalist. What should I do to make sure I don't get some impostor?" The nurse should advise the patient to first ask the provider: a. "How much will treatments cost?" b. "Have you treated this condition before?" c. "Do the treatments pose any dangers to me?" d. "What group has certified you in this practice?"

ANS: D The priority question is whether the individual is credentialed to practice via license or certification. Either credential suggests, but does not guarantee, some degree of knowledge and competence.

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

ANS: D This response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems.