Evolve Tests Chapter 1-6
Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic?
"Losing my job was hard but my skills will help me get another one." Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.DIF: Cognitive Level: Analyze (Analysis)REF: page 3TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
What assumption can be made about the client who has been admitted on an involuntary basis?
The client has failed to agree to fully participate in treatment and care planning. The client is a danger to self or others or unable to meet basic needs. The commitment was court ordered. Involuntary admission which is court ordered 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. Neither of the remaining options is accurate assumption regarding an involuntary admission.REF: 93-94
A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit?
"You will attend a psychotherapy group that I lead that will help you care for yourself." Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.DIF: Cognitive Level: Analyze (Analysis)REF: pages 14, 15TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment
Which criterion must be met to refer a client to a partial hospitalization program?
The client is able to return home each day. Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.REF: 67
A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment?
"By educating the public on the effects that stigmatizing has on mental health clients." Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.DIF: Cognitive Level: Analyze (Analysis)REF: page 16TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy?
"Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy since they do not represent actions by the nurse that the patient is incapable of on their own.DIF: Cognitive Level: Analyze (Analysis)REF: page 16TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement?
"I am going to help you shower, so you will not smell so bad." Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.REF: 68-69
Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met?
"I'm experiencing much less anxiety about school now." Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.DIF: Cognitive Level: Apply (Application)REF: page 24TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
A 38-year-old patient diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the patient's question?
"Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture?
"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." 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 either ethnicity and/or culture.DIF: Cognitive Level: Analyze (Analysis)REF: page 3TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity
When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members?
"That judge is going to really regret putting me in here." The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.DIF: Cognitive Level: Apply (Application)REF: pages 22, 23TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question?
"We have the specialized skills needed to care for those with mental illnesses." A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.REF: 6-7
A cognitive therapist would help a client restructure the thought "I am stupid!" to which statement?
"What I did was stupid." Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.REF: 25-26
Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture?
"What can I do to provide ethnic foods that are still low in fat?" Cultural desire is a genuine interest in the patient's unique perspective; it enables nurses to provide considerate, flexible, and respectful care to patients of all cultures. Attempting to incorporate ethnic foods into the client's prescribed diet demonstrates all these characteristics. None of the other options are focused on providing such care.REF: 87-88
The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question?
"What do you think is making you ill?" Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. While appropriate assessment questions, none of the remaining options are as well suited to gather culturally influenced information.REF: 86-87
Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture?
"What usually helps people who have the same type of illness you have?" Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client. No other option focuses on this information.REF: 87
Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit?
A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.DIF: Cognitive Level: Analyze (Analysis)REF: page 74TOP: Nursing Process: AssessmentMSC: NCLEX: Safe and Effective Care Environment
Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)?
A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately AMS 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.DIF: Cognitive Level: Analyze (Analysis)REF: page 11TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation?
A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.DIF: Cognitive Level: Analyze (Analysis)REF: pages 12, 13TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Safe and Effective Care Environment
What client assessment data demonstrates parity related to mental health care?
A client's mental health coverage is equal to his/her medical/surgical coverage. Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. None of the other options are associated with mental health insurance coverage.REF: 6-7
Which scenarios describe a HIPAA violation associated with a nurse's behavior?
A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. 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.DIF: Cognitive Level: Apply (Application)REF: pages 21, 22, 105TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
How does Harry Stack Sullivan's Interpersonal Theory view anxiety?
A painful emotion arising from social insecurity. According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.REF: 21-22
Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority?
Assessing the client for strengths upon which a nurse-client relationship can be based The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.REF: 27-28
Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)?
A patient being discharged from an inpatient alcohol rehabilitation unit PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.DIF: Cognitive Level: Analyze (Analysis)REF: page 14TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment
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 which ethical principles?
Autonomy and beneficence 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.REF: 92
Which nursing behavior best demonstrates the concept of cultural competence?
Adjusting personal practice to meet the patients' cultural preferences, beliefs, and practices 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.DIF: Cognitive Level: Apply (Application)REF: page 15TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity
Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true?
All rights remain intact. The hospitalized client is not a convicted criminal thus all civil rights remain intact.REF: 70
When treating mental illnesses with psychotropic drugs what is the focus of the treatment?
Altering brain neurochemistry. Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.REF: 56-57
Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide?
Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.DIF: Cognitive Level: Apply (Application)REF: page 26TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity
What is the premise underlying behavioral therapy?
Behavior is learned and can be modified. The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. None of the remaining options are true statements when considering behavioral therapy.REF: 22-23
Which statement best explains the term "worldview"?
Beliefs and values held by people of a given culture about what is good, right, and normal. 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. None of the other statements accurately describe the term worldview.REF: 78
According to current information what factor is associated with the most disabling mental disorders?
Biological influences Biological and genetic factors influence mental health. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.REF: 2
What term is used to identify the structures that respond to stimuli, conduct electrical impulses, and release neurotransmitters?
Neurons Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.REF: 40
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)?
Clinical Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms. None of the other options accurately identify the field that is associated with clinical practice.REF: 6-7
When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided?
Care is provided to clients in unconventional settings. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.REF: 67-68
In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic?
Creative problem-solving and intervention skills Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.REF: 67
A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization?
Denial of anxiety or depression Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. The client's behavior associated with the denial of any mental illness or understanding of the possible connection between the symptom/signs and a mental illness presents a need to explore the possibility of somatization. None of the other options support this possibility as directly.DIF: Cognitive Level: Apply (Application)REF: page 10TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression?
Dopamine Serotonin Norepinephrine Antidepressant medication targets serotonin and norepinephrine. While dopamine is implicated in schizophrenia (increase) and Parkinson's disease (decrease), it is also believed to be a factor in depression. GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer's disease as well as Huntington's disease and Parkinson's disease.DIF: Cognitive Level: Apply (Application)REF: page 16TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity
The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience?
Encouraging them to talk about their school plans to help achieve identity According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. While appropriate activities none of the options are specifically identified with the developmental task for a 14-year-old.REF: 23; Table 2-2
What term is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices?
Enculturation. 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.REF: 87-88
What is the primary advantage of using a case manager when considering the planning and implementation of client care?
Enhances resource management. Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.REF: 66-67
A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care?
Establishing a framework for selecting appropriate interventions. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. While the nursing diagnosis may contribute to the other options, none describe the purpose of the nursing diagnosis. REF: 8-9
The nurse planning care for a mentally ill client bases interventions on which concept?
Every client has a certain degree of resilience. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged. Resilience is the ability and capacity for people to secure the resources they need to support their well-being. None of the remaining options describe concepts that are the foundation for the actual creation of individualized care plans.REF: 4-5
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 which illegal act?
False imprisonment 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. None of the other options relate directly to such seclusion.REF: 101; Table 6-3
If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle?
Fidelity Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment.REF: 92
Which organ secretes hormones that are a normal component of the body's general response to stress?
Hypothalamus Pituitary gland Adrenal glands
According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder?
I've been really anxious for at least 2 years now. My marriage is in trouble because I'm always so irritable. I've had a good physical and my health care provider says I'm in good health. Its hard falling asleep and even harder staying asleep; I'm restless all night. The DSM-V criteria for generalized anxiety disorder include excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months; sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) and irritability; the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; the disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Family history is not a recognized criterion for generalized anxiety disorder.DIF: Cognitive Level: Analyze (Analysis)REF: page 11TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity
How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide?
Identify the client's culture's view regarding suicide. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor Contrast that viewpoint with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill. While the remaining options are appropriate interventions, they fail to address the possible cultural component of the client's behavior.REF: 3-4
Considering mental health, what term is used to define a deviation from expectations by members of the cultural group??
Illness Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness." None of the other terms are used to describe this concept.REF: 90
A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement?
In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.DIF: Cognitive Level: Analyze (Analysis)REF: page 26TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5?
It is a medical psychiatric assessment system. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses. None of the other options are accurate descriptions.REF: 6, 7-8
A therapeutic inpatient milieu will include which characteristic?
It provides for the client's safety and comfort. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.REF: 71
A nurse is providing care to a 28-year-old patient diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which patient symptom as having priority?
Lack of sleep Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.DIF: Cognitive Level: AnalyzingREF: page 23TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Physiological Integrity
A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism?
Lithium Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.DIF: Cognitive Level: Analyze (Analysis)REF: page 33TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity
When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority?
Maintaining a therapeutic milieu Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.REF: 71
The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority?
Making the client feel physically and emotionally safe Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher level needs.REF: 27
What function is shared by advanced practice and general practice psychiatric nurses?
Membership on a multidisciplinary team Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.REF: 65-66
Which situation demonstrates the nurse functioning in the role of advocate?
Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.REF: 64 Question 4 of 7
After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual?
Nothing may be disclosed that would have been kept confidential before death. 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. None of the other statements are accurate.REF: 98
In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care?
Nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.REF: 65-66
The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need?
Providing a safe place to practice coping skills A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.REF: 71
A client tells the mental health nurse "I am terribly frightened! I hear whispering in my head that someone is going to kill me." Which criteria of mental health can the nurse assess as lacking?
Rational thinking The ability to think rationally is lacking for this client. The client does not have an accurate picture of what is happening that is based on reliable cognitive thinking. The statement fails to meet the criteria for any of the other options.REF: 2-3
The incoherent thought and speech patterns of the client diagnosed with schizophrenia are related to the brain's inability to perform which function?
Regulate conscious mental activity. When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.REF: 39-40
A client reports to the nurse that once he is 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?
Report the incident to the client's therapist. 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.REF: 98-99
The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu?
Request that the client accompany the nurse to the client's room Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
Which right of the client has been violated if he is medicated without being asked for his permission?
Right to informed consent 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.REF: 96
Which severe mental illness is recognized across cultures?
Schizophrenia, Bipolar disorder
A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure?
Shaming the family by being responsible for the error Eastern tradition, such as in China, 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.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity
Which theorist is associated with behavioral therapy?
Skinner B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.REF: 29
Which function is classified as a circadian rhythm?
Sleep cycle Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.REF: 39-40
The mental health status of a particular client can best be assessed by considering which factor?
Status placement on a continuum from health to illness Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.REF: 2-3
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports what conclusion about this client?
The client is not conforming with social norms. Behavior that deviates from socially accepted norms does not indicate a mental illness unless there is significant disturbance in mental functioning.REF: 2-3
When considering client rights, which client can be legally medicated against his or her wishes?
The client may cause imminent harm to himself or others. 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.DIF: Cognitive Level: Apply (Application)REF: page 13TOP: Nursing Process: ImplementationMSC: NCLEX: Safe and Effective Care Environment
When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true?
They are assured the same as those for any other citizen. Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client.REF: 95
It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege?
To access all personal possessions. A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.REF: 69-70
The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The nurse may correctly assume that the client has met the criteria for which type of admission?
Voluntarily Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria.REF: Page 93-94
Which idea held by the nurse would best promote the provision of culturally competent care?
Western biomedicine is one of several established healing systems. 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.REF: 85-86
What nursing action supports a client's right to autonomy?
Witnessing the informed consent for electroconvulsive therapy from a client Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care. Witnessing the client's informed consent demonstrates attention to the client's right to autonomy. None of the other options are associated with autonomy.REF: 92
When considering mental illness, recovery is best described to a client by which statement?
Working, living, and participating in the community Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.DIF: Cognitive Level: Apply (Application)REF: pages 17, 18TOP: Nursing Process: InterventionMSC: NCLEX: Psychosocial Integrity
A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents
battery. Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.REF: 101; Table 6-3
What term is used to identify the quantitative study of the distribution of mental disorders in human populations?
epidemiology Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.REF: 6
