Exam One: Psych: HC

Reaction formation:

control behaviors or feelings that are offensive by displaying ones that are opposite. o

Identification:

take on the characteristics of someone else or group of people.

Repression:

unacceptable thoughts kept from awareness. o

Rationalization:

validate irrational and/or absurd thoughts, feeling, and/or actions by using explanations that are sensible to the person talking and all that are listening. o

A female client who physically abused her 9-year-old son is undergoing treatment to help her control her behavior. Which statement indicates that the client has developed a safe coping method to help her deescalate? 1 "I promise that I won't get so angry when my son causes trouble again." 2 "If my son gets straightened out, we shouldn't have these kinds of problems." 3 "I think the root of the problem is when my husband comes home after drinking." 4 "If I get angry at my son again, I'm going to need a pillow in the bedroom to punch."

Correct 4 "If I get angry at my son again, I'm going to need a pillow in the bedroom to punch." Verbalization of the need to take out her anger on an inanimate object indicates the potential for increased impulse control; this is important in the prevention of further abuse. Promising not to get angry is unrealistic because all parents become angry with their children at some time or another. Placing the blame on the child or the spouse, rather than on the mother's own behavior, indicates a lack of progress toward controlling anger. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.

Undoing:

an attempt to erase an act, thought, feeling, or desire.

Regression:

return to earlier, more immature, childlike behaviors. o

Sublimation:

unconscious, replacing improper, immature, and damaging behaviors and impulses with socially appropriate, productive, and responsible behaviors. o

An older client is treated in the emergency department for soft-tissue injuries that the medical team suspects might be caused by physical abuse. An adult child states that the client is forgetful and confused and falls all the time. A mini-mental examination indicates that the client is oriented to person, place, and time, and the client does not comment when asked directly how the bruises and abrasions occurred. What is the next appropriate nursing action? 1 Interview the client without the presence of family members. 2 Report the abuse to the appropriate state agency for investigation. 3 Accept the adult child's explanation until more data can be collected. 4 Refer the client's clinical record to the hospital ethics committee for review.

1 Privacy may provide an environment that is conducive to the client sharing information about the situation. The client needs to be kept safe; this action ensures additional time for assessment to rule out the possibility of abuse. Reporting the abuse to the appropriate state agency for investigation is premature; further assessment is needed to determine if it is necessary to notify the appropriate agency. Accepting the adult child's explanation until more data can be collected will form a separate relationship with the adult child, which is not in the client's best interest. Referring the client's clinical record to the hospital ethics committee for review is inappropriate; this situation presents a legal, not ethical, issue. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

A nurse works in a crisis intervention center. A woman who has experienced sexual abuse comes in and says, "I've got to talk to someone or I'll go crazy. I shouldn't have dated him." What is most important for the nurse to identify after initially assessing the client's physical condition? 1 Support system 2 Sexual background 3 Ability to relay the facts 4 Knowledge of sexual assault terminology

1 Identification of a client's support system and relationships is a priority if the victim is to be helped after the immediate crisis is over. Sexual background and ability to relay the facts may eventually be of value, but at this time they are irrelevant in the assessment of the client's current condition and needs. Knowledge of sexual assault terminology is not necessary for care to be provided.

A nurse enters a depressed client's room on the evening of admission and observes the client sitting in a chair crying. What is the most therapeutic response by the nurse? "You're crying. Let's talk about it." 2 "Let me get a cup of coffee; then we can talk." 3 "Visitors will be here soon; you'd better get ready." 4 "You'll feel better soon. Come to the sitting room with me."

1 Noting that the client is crying and suggesting that the nurse and client talk about it addresses the behavior observed, and the offer by the nurse to spend time to help the client implies that the client is worthy. With "Let me get a cup of coffee; then we can talk" the nurse offers to help but places the client second by stating the desire to get coffee first. The nurse denies the client's feelings by focusing on getting ready for visitors. Assuring the client that the client will feel better soon and asking the client to come to the sitting room constitutes false reassurance. The nurse first recognizes the client's feelings and then moves away from discussing them.

When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? Select all that apply. 1 Planning for future safety 2 Normalizing victimization 3 Validating the experiences 4 Promoting access to community services 5 Providing housing for the victim

1 3 4 Planning for the client's future safety needs, validating the client's experiences by letting the victim know that he or she is not alone, and promoting access to community services are all important roles of the nurse advocate. An advocate would not normalize the victimization by seeing the abuse as normal in the victim's relationship and failing to respond to the disclosure of the abuse. The advocate role would include information and resources for housing if needed, but not necessarily provide it. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

Which warning signals should the nurse observe in a child suspected to be a victim of abuse? Select all that apply. 1 The child doesn't want to be touched by anyone. 2 The child sleeps for an average of 15 hours a day. 3 The child frequently visits the emergency department. 4 The child suffers from fever and tenderness in the abdomen. 5 The child looks at the caregiver before answering any question.

1 3 5 The child may become scared if touched. The physical abuse may cause injuries and the child may visit the emergency department frequently. An abused child may look at the caregiver before answering any question due to fear. The child sleeping for an average of 15 hours a day does not indicate abuse. Fever and tenderness in the abdomen are not signs of abuse; it could indicate an organic cause.

Denial:

failure to acknowledge intolerable thoughts, feelings, experience, or reality. o Displacement: redirection of emotions or feelings to a subject that is more acceptable or less threatening.

When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response? Stating, "You must take your medicine now." 2 Saying, "I'll be back in a few minutes so we can talk." 3 Explaining why it is necessary to take the medication 4 Withholding the medication before notifying the primary healthcare provider

2. Saying, "I'll be back in a few minutes so we can talk" allows the angry client time to regain self-control; announcing a plan to return will ease fears of abandonment or retribution. Staying and insisting that the client take the medication may provoke increased anger and further loss of control. Clients will not accept logical explanations when angry. Alternative nursing interventions should be attempted before withholding the medication and notifying the primary healthcare provider, although these may become necessary. Test-Taking Tip: Survey the test before you start answering the questions. Plan how to complete the exam in the time allowed. Read the directions carefully and answer the questions you know for sure first.

The registered nurse is teaching a nursing student about bulimia nervosa in adolescents. Which statement made by the nursing student indicates effective learning? "The client claims to feel fat despite being underweight." 2 "The client experiences recurrent episodes of binge eating." 3 "The client exhibits intense fear of gaining weight although underweight." 4 "The client refuses to maintain body weight over a minimal ideal body weight."

2 Bulimia nervosa is an eating disorder in which the client has an obsessive desire to lose weight. In this condition, bouts of extreme overeating are followed by fasting or self-induced vomiting. A recurrent episode of binge eating is an indicator of bulimia nervosa. A client claims to feel fat despite being underweight may have anorexia nervosa. Other assessment findings of anorexia nervosa include an intense fear of gaining weight despite being underweight and a refusal to maintain a body weight over a minimal ideal body weight.

The nurse is using non-verbal active listening skills during a clinical therapeutic encounter with a client. Which non-verbal action best conveys engagement in this client interaction? Sitting with a relaxed posture 2 Leaning toward the client 3 Making eye contact 4 Facing the client

2 Leaning toward the client during a therapeutic communication encounter is the best way to convey engagement in a client interaction. Sitting with a relaxed posture conveys that the nurse may be comfortable but not necessarily engaged in the encounter. Facing the client can convey that the nurse is interested in what the client is saying, but the nurse may not yet be engaged in this encounter. Making eye contact can convey the nurse's willingness to listen to the client, but it does not demonstrate engagement in this interaction as well as leaning toward the client does.

Identify factors associated with an increased incidence of abuse within a family. Select all that apply. 1 Acute illness 2 Pregnancy 3 Drug abuse 4 Chronic illness 5 Sexual orientation

2 3 5 Pregnancy, drug abuse, and sexual orientation are associated with an increased incidence of abuse within a family. Acute and chronic illness may place stress on the family, but these factors are not specifically linked to a higher incidence of violence.

In order to provide ideal therapeutic communication to clients, a health care facility provides interpreter services. Which statement regarding an interpreter is correct? 1Interpreters can be relatives or friends of the client as well. 2 The interpreter should be able to make literal, word-for-word translations. 3 The interpreter should be able to interpret not only the language but also the culture. 4 The interpreter should be available as long as the health care provider is caring for the client.

3 The health care facility should be able to provide interpreters to the clients who cannot speak English or do not speak English well enough to meet their communication needs. The interpreter should be able to interpret not only the language but also the culture. Health care facilities should not rely on relatives or friends of the client for interpreting, because they may not be open as needed during the encounter. Literal translations are not necessary; words in one language can carry many different connotations in another language. The interpreter should be available at all points of contact but not when communication between the client and the health care provider is not occurring.

Splitting:

incapable of recognizing positive and negative characteristics of self or others as total entity. o

While assessing an older adult during a regular health checkup, a nurse finds signs of elder abuse. Which physical findings would further confirm the nurse's suspicion? Select all that apply. Incorrect 1 Presence of hyoid bone damage 2 Presence of cognitive impairment 3 Presence of burns from cigarettes 4 Presence of bed sores. 5 Presence of unexplained bruises on the wrist(s)

3 4 5 A physical finding of abuse in older adults can be the presence of burns from cigarettes. The physical presence of bed sores also indicates client abuse. Unexplained bruises on the wrist(s) may also be an indication of abuse in older adults. The presence of hyoid bone damage is an indication of intimate partner violence. The presence of cognitive impairment is a behavioral finding in older adult abuse.

What are the treatment goals in anorexia nervosa? Select all that apply. The development of a calorie-restricted diet plan 2 The development of a regular exercise schedule 3 The repairing of family interactions 4 The re-institution of normal nutrition to counteract a state of malnutrition 5 The correction of deficits and distortions in psychological functioning via psychotherapy

3 4 5 Clients with anorexia nervosa have a strong fear of becoming overweight. This is characterized by reduced nutritional food intake causing progressive weight loss and malnutrition. These clients usually have impaired family interactions due to low self-esteem. Therefore, the treatment goals should consist of repairing family interactions, reinstituting normal nutritional meals, and correcting deficits and distortions in psychological functioning. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

A nurse provides crisis intervention for a client who recently left her husband because of physical abuse. Which client behaviors indicate to the nurse that the therapy has been successful? Select all that apply. 1 Cries frequently throughout the day 2 Sleeps more than half the day 3 Utilizes healthier coping skills 4 Refuses a referral to support services 5 Describes the current situation realistically

3 5 Healthier coping provides a repertoire of skills from which to draw in future crisis situations. Being able to be objective and review the situation realistically demonstrates progress as the client moves toward resolution of the crisis. Although crying reflects that the client is expressing her feelings, usually it indicates the presence of anxiety and nonresolution of the crisis, especially if it occurs frequently throughout the day. Sleeping excessively is a maladaptive strategy. Refusing referrals to support services may indicate denial. One of the goals of crisis intervention is to develop a stronger support system.

Introjection:

incorporation of outside world into perception of self. o

A client with bulimia nervosa eats two sandwiches, two salads, and four desserts for lunch. What client behavior should the nurse anticipate after the meal is consumed? Excessive exercise 2 Hoarding of more food for a later binge 3 Active socializing with small groups of clients 4 Withdrawing from the group to go to the bathroom

4 Correct 4 Withdrawing from the group to go to the bathroom Bulimia is characterized by the binge-purge cycle; most clients withdraw from others and vomit after an eating binge. Although some individuals with bulimia may exercise to excess, this is a more common finding with the diagnosis of anorexia nervosa. Although individuals with bulimia may hoard food, this behavior commonly occurs later, when limits are put on their intake. Most individuals with bulimia do not seek support or socialization after a binge, although they may socialize at other times. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

An adolescent is admitted to the psychiatric service in stable physical condition with the diagnosis of anorexia nervosa. The adolescent has lost 20 lb (9.1 kg) in 6 weeks and is very thin but is excessively concerned about being overweight. What is the most important initial nursing intervention? Complimenting the physical appearance of the adolescent 2 Explaining the value of adequate nutrition to the adolescent 3 Exploring the reasons that the adolescent does not want to eat 4 Attempting to establish a trusting relationship with the adolescent

4 The problem is psychological. Therefore the nurse's initial approach should be directed toward establishing trust. The client is convinced about being overweight; complimenting the client will not change self-perception. The client is not ready for nutrition information. Exploring the reasons that the adolescent does not want to eat may be appropriate after trust has been established. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.

A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1 "Maybe it was your husband's fault, too." 2 "I can't agree with that—no one should be beaten." 3 "Tell me why you believe that you deserve to be beaten." 4 "You say that it was your fault—help me understand that."

4 Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. "Maybe it was your husband's fault, too" is a declarative statement that is closed, will limit dialog, and is not therapeutic. When the nurse voices her opinion saying, "I can't agree with that—no one should be beaten", the nurse is shutting off communication with the client. Nurses are to be nonjudgmental and not offer an opinion, and should ask open-ended questions to facilitate communication with the client. Asking a "why" question is generally not therapeutic because most clients cannot respond to these questions with logical explanations.

A nurse is caring for an adolescent with the diagnosis of anorexia nervosa. The plan of care should include helping the client do what? Plan nutritious meals. 2 Change attitudes about nutrition. 3 Understand that more food must be eaten. 4 Recognize how the need to control influences behavior.

4 The client's focus on controlling eating redirects attention away from those areas that are felt to be out of the client's control. This is how life's more difficult problems and challenges are avoided. Planning nutritious meals may not be productive, because these clients believe that they are eating nutritious meals. It is not the client's attitudes or beliefs about food but instead the distorted self-image that is the problem. Understanding that more food must be eaten may not be productive, because these clients believe that they are eating enough food.

A nurse, providing care in a hospital skilled nursing unit, witnesses a client's spouse shaking the elderly client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with managers and report the abuse to which party? 1 The client 2 The client's spouse 3 The client's primary healthcare provider 4 Adult Protective Services

4 The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified. The term Adult Protective Services refers to the range of laws and regulations enacted to deal with abusive situations. The laws and regulations are typically administered by an agency within the state, for example, the Department of Social Services, which receives and investigates complaints. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

Intellectualization:

scrutinize events using only facts and no feelings. o

Which therapeutic communication technique is most useful for the nurse to use when the client begins to repeat previously mentioned issues in the same therapeutic conversation? Focusing 2 Clarifying 3 Paraphrasing 4 Summarizing

Focusing is a therapeutic communication technique that is useful when clients begin to repeat themselves. Clarification helps to check whether the client's understanding is accurate by restating an unclear or ambiguous message. Paraphrasing involves restating a message more briefly using one's own words. Summarizing is a concise review of key aspects of an interaction.

Dissociation:

Separation of memory, identity, consciousness, and/or perception of the environment., Compartmentalization of difficult or disagreeable characteristics of self.

Suppression:

consciously putting a disturbing thought or incident out of awareness. o

Conversion:

Unconscious., Change anxiety into physical symptoms with no physiological cause.

Compensation:

attempt to overcome a real or imagined shortcoming.

Projection:

attributing one's feelings, impulses, thoughts, or wishes to others. o